Understanding Metabolic Health with Cynthia Thurlow

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I have one of my favorite guests back again, it's Cynthia Thurlow. She is best known for her book Intermittent Fasting Transformation and she's known as a fasting expert because of her multiple TEDx talks with over 14 million views.

However, we are going to shift gears.

Now and talk about metabolic health kind of step up from intermittent fasting because that can totally help restore metabolic health. But we'll dig into a little bit about who should fast and who shouldn't fast and all of that as well. But we're going to really dig into metabolic health, what it is, what's causing the big challenges we have with it, most importantly, what we can do to start to shift it around. Now, if you missed the other interviews I've done with Cynthia, we will link to them in the show notes and we'll also link to all of her information. I'm going to put that at jjvirgin.com forward/everyday wellness because that is the name of her awesome podcast, Everyday Wellness. You've probably seen Cynthia Gosh where abc, fox, ktla, cw, Medium, Entrepreneur, even the Megyn Kelly Show. She's been all over the place focusing on her mission to educate women on the benefits of both intermittent fasting, but bigger than that, on having optimal metabolic health so that they can live their most optimal lives. So I will be right back with Cynthia Thurlow. Stay with me.

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All right, Cynthia Thurlow, welcome back.

Thank you, jj. I've been so looking forward to reconnecting with you and recording podcasts together.

Well, you've been very busy since you launched the intermittent fasting transformation. And what I really want to dig into today is, like, to go beyond that, because that was like, the start, but now you're really getting into metabolic health, which, I mean, I can't imagine anything more important with the current status of our metabolic health. So let's dive into that. Like, where are we now? And what does this even mean?

Yeah, so prior to the pandemic, there was a UNC School of Chapel Hill study that came out and it talked about at that time, 88.2% of Americans were not metabolically healthy.

But what does that even mean, that not metabolically healthy?

Yeah, so it's really speaking to people that are insulin sensitive individuals that are able to have a healthy blood sugar response, that are not prescribed medications to treat blood pressure, are not prescribed medications to address diabetes, have a healthy waist circumference, have a healthy lipid panel. It's that basic that we are now in a position as a country where you are an outlier if you are not insulin resistant. And so I look at this as a crisis that not enough individuals are talking about. And so when we think about that was 2018, when that study came out, we go through the pandemic, we come out of the pandemic, we are less healthy. Now it's 92 to 93% of Americans are not metabolically healthy. And what that really speaks to is we have a crisis of not just adults with high blood pressure, diabetes, metabolic syndrome, cardiovascular disease, neurocognitive disorders, polycystic ovarian syndrome, which is the number one cause of infertility. We're looking at a generation of children that are also not as metabolically healthy and very likely will not be as healthy as their parents. And so I look at this as a clinician, I look at this as a crisis to speak of. And so when I'm speaking to women, especially in perimenopause and menopause, it's helping them understand that hypertension or high blood pressure is not a normal function of aging. That is what I used to tell patients. And I always say, know better, do better. But I think people understand this piece of insulin resistance is at the basis of every chronic health issue that we're seeing. It is inflammation, oxidative stress, and insulin resistance that is really creating a lot of these chronic health problems.

And let's break it down for every listening as to what is insulin resistance.

Yeah, so we have many hormones in our bodies, but it's helping us understand that when we eat food, we have a corresponding reaction. Our body will appropriately try to maintain homeostasis, which means our body wants to keep our blood glucose within a very narrow parameter. And so when we eat protein versus carbohydrate versus fat, our bodies have a corresponding reaction to each. So if you eat a steak with some broccoli and a baked potato, you're going to have a different blood sugar response than if you sit down and eat a Big Gulp and a package of cookies. Not surprisingly, having processed carbohydrates are going to have a more impactful effect on our blood glucose. So we have our glucose, which when we eat meals, that can be impacted whether it's higher or lower. And we have insulin, that is a hormone that is designed to help move glucose from our bloodstream into cells. And over time, if we're dealing with chronically high blood glucose, which is what most Americans are dealing with in response to chronic stress, poor quality sleep, crappy processed diets, lack of physical activity, and understanding that insulin resistance actually starts in our muscles. That's why the value of physical activity is so important, helping people understand over time, if our blood glucose or blood sugar is too high, over time, those cells become less sensitive, like a lock and key mechanism telling our body to take that glucose and shuttle it into the cells. So over time, our cells become less sensitive to insulin's effects. We can develop things like non alcoholic fatty liver disease, which is the number one liver problem here in the United States right now. It's not cirrhosis like it used to be 15, 20, 30 years ago. We can develop elevated triglycerides, which again is a response. Our body is looking for a way to, to correspondingly address chronically high glucose levels. And so at a very basic level, when we talk about insulin resistance, what we are really speaking to is this loss of insulin sensitivity. Imagine your cell is a front door and you're banging on the front door. No one can hear the message because it has been desensitized over time. So it starts off as insulin resistance and then progresses to diabetes. And that's what we're trying to, you know, help people understand what are the things we can do proactively that can lessen our likelihood of going on to developing disease. We want to people to understand that you can reverse these things. This is not once you get a diagnosis, this means this is forever. I love sharing with people the message of hope that understand there's a lot that we can do at our disposal to help reverse the effects of insulin resistance.

I know we're going to get into that, but before we do, I. There's a couple things I want to unpack because when I hear all of this and really look at insulin resistance at really the core of all of these challenges, it feels like we're looking at the wrong thing, the focus. Now we're starting to look a lot more at blood sugar, but blood sugar to me feels like a lagging indicator. And I'm just wondering why we're not focusing more on things like fasting insulin Triglycerides, Like, I look at the metabolic health numbers and they say, okay, you're, you're metabolically healthy if your triglycerides are 150 or less. But I would argue you've got an indicator right there of a problem. So what are you looking at to really identify if someone is insulin resistant? And you know what's happening first? Because isn't it by the time we start to see some blood sugar abnormalities, a whole lot of stuff's gone down the pike, Right?

Absolutely. And I think that there's nothing more frustrating because my whole background was in critical care cardiology. And towards the end of 2016, when I left clinical cardiology, I kept saying to my colleagues, I think we're missing something. If it's taking 10 years for a patient to get a diagnosis, that's the average 10 years to get a proper diabetes diagnosis. What is going on behind the scenes that we are not addressing? So to your point, fasting insulin is way more sensitive for looking at insulin resistance way before a fasting glucose. An oral glucose tolerance test, a hemoglobin A1C, which I don't even draw anymore, looking at that, fasting insulin is one of the most important markers. And I like to see that between 2 to 5 milligrams per deciliter. So when a woman comes to me as an example and says, I'm weight loss resistant, my fasting glucose is fine, my A1C is fine. And then we draw a fasting insulin and it's 15. I'm like, okay, this is the canary in the coal mine. To your point, the triglyceride piece, I like it below 75 because that is oftentimes a reflection of how much carbohydrate, usually the processed carbohydrates. What's your hdl? You know, we talk about it being this heart, healthy cholesterol, there's so much more to lipids than that. That's kind of this old school thought process. But we know that if your HDL is less than 55, that in and of itself is a poor prognostic indicator of metabolic health. And so helping people understand, we like to look at that fasting glucose. And this is not your grandmother's fasting glucose. When I was in a nurse practitioner school 25 years ago, we used to tell patients, oh, 120 was fine, 130. Oh, yeah, you would talk about 140. You know, it's much higher than it is now. And I say, when you put your feet on the floor in the Morning. I want to see your fasting glucose between 70, 75 and 85. That's where I wanted to see. We know if you have a fasting glucose between 90 and 99, you are at 30% greater risk of developing diabetes. That is from Dr. Robert Leste, who's one of these preeminent endocrinologists and metabolic health experts. And so I really start to dial back the layers to see what else could be going. What are your inflammatory markers doing? What's your high sensitivity crp? What's your homocysteine? What's your leptin? Now, you can have a normal insulin and have an elevated leptin, and that can be from a variety of different things. But if someone says to me, I eat a good dinner and then I'm still hungry, I start to think, what else could be going on? And leptin resistance can be problematic because that's speaking to communication between the brain and the gut and helping with satiety. There's other, you know, adiponectin, there's other markers you can look at. I don't per se, use that as a frontline, but I think that fasting insulin can be very, very insightful. And here's the thing. I've had physicians refuse to draw these for patients because they don't know how to interpret it. And I lovingly say, then you need to figure that out, because when you understand how valuable it is, it's covered by insurance. And there's a company I'm not affiliated with, but I usually will refer people. I'm like, if your physician or healthcare provider won't draw it for you, you can go to own your labs. I have no affiliation with them. And for like $12, you can get a fasting insulin drawn. And I think it's very much a proactive situation where you can yourselves, even if your healthcare practitioner is not willing to draw for you, you can monitor some of your labs on your own. And it's all about empowerment. We want to be able to look and see, is your fasting insulin normal six months ago? And then maybe you were impacted by the virus. Maybe you, your thyroid was underactive. Maybe you, you had a diagnosis and you weren't able to be as physically active and you suspect that there might be some degree of latent insulin resistance going on. You can look at those numbers and you can use them for comparative reasons. I was able to discern that my thyroid wasn't fully optimized because my fasting insulin, although still within that normal range, was starting to creep. And, and I was like, I could tell that there was some degree of beginning latent insulin resistance, especially as we were adjusting my hormone replacement therapy. So I think for everyone listening, it takes about 20 years for conventional research to actually come into clinical practice. And so I always say, if your healthcare practitioner is still using what they learned 20 years ago and they, they're not willing to unlearn or they're not willing to reconsider other options, I would say we are designed to be lifelong learners as clinicians. If they're not willing to relearn, then you need a new clinician, as I heard you say.

Well, if the doctor won't order it for you, then you can go over. Here I go. If the doctor won't order it for you, then get a new one.

Correct.

And get a new healthcare practitioner who's up on this stuff, fascinated by it, and wants to be on the cutting edge of it.

Absolutely.

Because this is not new information either.

Yeah. And I think the other thing that I find so frustrating is I am comfortable enough as an individual to say 20 years ago I didn't know better, but now I do. And now, because I know better, I want to make sure you get the best information. And for me, metabolic health is so tied up into what's going on with us in perimenopause and menopause. And if we have not become our own best advocate by that point, we must, as we're losing estrogen, I always say we lose those people pleasing skills, which is a less thing that all of a sudden we're less concerned with what people think of us. And we're like, hey, this is not okay. And you know, there are many, many providers out there that can provide the level of care that you're looking for.

So you just listed the challenge, insulin resistance and how it's expanded and dramatically increased during the pandemic. No surprise. The surprise of it even being 88% and how this isn't considered the biggest epidemic of our time is bizarro and it's just being ignored. That's even weirder. But what's behind it? Because we can't fix something if we don't know what's creating the issue.

Yeah, I mean, I think that there's multiple things that are at play here. I think that it's the food that we consume. We know that 60 to 70% of Americans consume hyper processed, hyper palatable foods. So the food that's easy and very addicting to eat, I think we eat too frequently, but we'll just put that in there. I think we don't manage our stress and certainly the last three years have shown that we're not physically active. And when I said insulin resistance starts in your muscles, that is based on research. This is not just contrived. We are designed to move. We are not designed to be sedentary. I think a great deal of it is also impacted by the endocrine mimicking chemicals we are exposed to in our environments. You know, we live in a very toxic environment. And I read recently that some of these endocrine mimicking chemicals are a thousand times more potent than the actual hormone. And I say that again, a thousand times more potent than the actual hormone. Our hormones don't stand a chance. And you think about the water supply. Like as one example, most water is, does not filter out oral contraceptives, hormones that we urinate into the system, antibiotics. We are just bathed in these hormones, these synthetic hormones all the time. And it's interesting, I was talking to a colleague and I said, well, is there any filter that filters out all these synthetic hormones? And they said, no, unfortunately. So we have this chronic overexposure. And then I also think about how many people don't value high quality sleep. I don't think I valued sleep enough until I hit perimenopause. And then when it went south, I was like, okay, this is something I clearly need to prioritize. But how many people don't appreciate or value high quality sleep? So I think that there's many things that contribute I would tag onto that is understanding. You know, 22 years ago, when the Women's Health Initiative study came out and the onslaught of that, I was a new nurse practitioner, and I recall all my patients were removed from hormone replacement therapy. And these women would cry about how they suddenly went from being able to think clearly and have a libido and just be able to function and sleep. And all of a sudden they weren't. And so we had a whole generation of clinicians that were fearful to prescribe hormones. Women were afraid to take them. And that's starting to turn, thankfully. But understanding that as women are navigating perimenopause into menopause, we're losing influence sensitivity just by virtue of losing estradiol. It's important for women to understand, like whether you choose to take hormone replacement therapy or not, you need to understand the net impact on your health. And this is something that I can speak from a personal circumstance. I was on hrt. I was on Too Much. We stopped it I went off for six months, although I was still taking progesterone. My clinician came to me when he drew my labs, and he said, I would never know that your labs came from you had they not been drawn in my office. Because the amount of inflammation and oxidative stress, just being off of estrogen for six months, it's unbelievable. And so I feel like I have to share these stories to say I've always looked healthy from the outside, but not being on estrogen for me was profoundly detrimental to my metabolic health. I'm back on it now, along with testosterone and progesterone. But I share this so that people understand, like, you can look healthy on the outside. And for many of us, not being on HRT in and of itself will really adversely impact our metabolic health. And so I think that conversation has to be had. I think that we need to not be fearful to have that conversation. And whatever decision you choose to make, you have to make it with the understanding of what that impacts, whether you're on HRT or not. How to impact bone and brain and muscle health, et cetera.

Yeah, bone, brain, heart. So I used to work out of a medical spa where they would have me do the nutrition and fitness programs for the. The patients, and they would come in and have their labs drawn, and I would look at their labs, and I could tell by their labs and their age if they were on hormone replacement therapy or not. And it was insane. The difference. The cardiovascular risk factors were cra. Just the jump right off the bat.

Do you want me to tell you what my APOB was? And I'll. I can explain, like, what that is. So you want your apob, which is a marker of inflammation and oxidative stress. You want it less than 80. When I was off of HRT with 139, you know, I went through this whole cardiac workup. I had a coronary artery scan. I had a special carotid ultrasound. I mean, I have done all these things that have happened, so it's no surprise. When you were working in that environment, you could clearly see who was on it and who was not.

And this was 15 years ago. And it was like, holy smokes, what a difference. I'm just so fortunate that I was surrounded by gynecologists when all of my hormones started to go sideways and I didn't have to go through this. I was listening to your list, so I don't think you know this. I used to teach this course for healthcare practitioners called Overcoming Weight Loss Resistance. It all happened because Dr. Phil had a book, and in the book he had a chapter called Weight Loss Resistance. It really was about insulin resistance. But I started to go through what are all the things that could get in the way of you losing weight or cause you to gain weight? And it was toxins. You know, obviously we had to fix the diet and exercise. It was stress, it was sleep, it was sex hormones, it was thyroid, it was gut health, it was insulin and leptin resistance. It was all of those things, right? And the thing is, they're not independent of each other. If you have cortisol issues, you'll probably have thyroid issues. If you've got estrogen issues, you'll probably have insulin issues. Then you'll have inflammation. Like they all would become this tangled web. But at the very basis of this, and we talked about this in your podcast, was this concept that I learned from Dr. Diana Schwarzbein of you must get healthy to lose weight. You don't lose weight to get healthy. Now, I would put in front of it, because that was 20 plus years ago and we didn't have this term yet, is that you don't lose weight to get metabolically healthy. You must get metabolically healthy to lose weight. So there are all of these issues, and I guess we could do a diagram to go, which are your issues, and address your top priorities and go down the line. But how do you take someone coming in? And the first obvious thing is we've got to measure the right things. Again, if you've got a doctor who's not looking at things like fasting insulin or an apob, the numbers we now know that are so predictive, if you were going to pick one thing to look for cardiovascular risk, you'd be smarter to look at an apob. So these numbers that are so predictive of what's happening, and because a lot of these things, you don't become diabetic overnight, you become diabetic over time. And there's signs all along the way, just like success leaves clues, you know, there are signs all along the way that this has happened to you. You do not wake up one morning diabetic. So what are the things then that we can do to start turning this around? And why do you think, especially for women, are women just not doing the right things here? Like what's happening with women where they're really struggling with this?

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Well, I think there are several things. I think in many ways until women are 40ish, that we are prioritizing everyone else in our life. Our children, our significant others, our employers, our friends. And then things start to go south. So when I think about the most important first thing to address is sleep. Because if I can get a woman to sleep through the night, I can get them to lose weight. And I explain that to them when I talk about the changes that are happening physiologically in our bodies. And early perimenopause. Late 30s, early 40s. You're going into early ovarian failure. Our ovaries are as old as we are. I know people hate hearing that, but it's the truth. Early ovarian failure. How does that show up? Because our ovaries are responsible for the hormone progesterone. So that can show up as some insomnia, it can be some anxiety, some depression. It can show up as estrogen dominance. So women start having much heavier menstrual cycles. And our adrenal glands are designed to be this emergency backup system, but the quarterback has to step in. You know, our adrenal glands get called upon to help support us hormonally as this transition is occurring. And so one of the first things I do, especially women come to me and they're like, well, I was prescribed in sleep aid and I was given Paxil or Prozac or Zoloft or whatever antidepressant or anti anxiety agent. And I always say, well, maybe the thing that we need to start with is let's get your sleep dialed in. So sleep hygiene, you know, making sure you're not sitting on your iPad or your laptop computer until midnight and getting that second win. Help people understand that we do have this whole sleep ritual. Just like when we are raising little people and we have a ritual for them so their bodies know it's time to go to bed. It's helping people understand. You know, maybe wearing blue blockers in the evening, getting off electronics, maybe you need a bath, maybe you need to soak in magnesium, maybe you need to read a book in addition to, you know, maybe as a perimenopausal woman, maybe you need progesterone the week prior to Your menstrual cycle. I mean, something so simple can be so effective. I mean, I've had women that have said that progesterone for them in early perimenopause or even middle perimenopause has been life changing. So if I can get you to sleep through the night, I can get you to manage your stress, I can get you to make better food choices, I can get you to show up better in your personal life. So sleep is number one. And there's lots of hacks around sleep. But I always say you need the basics to be able to do that, because we know based on research, if I can get you to sleep through the night, your blood sugar's gonna be better balanced, you're gonna wake up in the morning, you're going to make better choices when you do eat meals. And actually that first meal of the day is the most important meal for setting up your blood sugar response for the rest of the day. And why is this relevant? We know that if you have a protein laden breakfast, which I know is something that you are a fan of, you know, first meal of the day, whether it's 11 o' clock in the morning, 9 o' clock in the morning, a protein laden breakfast is going to keep your blood sugar stable and it's going to reduce the likelihood that you're going to have cravings. So we call it hyperphasia versus if you sit down and have a bowl of cereal, you have a pop tart, you have a croissant that's five times the size of croissant that you would ever get in France, you are going to have much better blood sugar control. And we know that it's more aligned in the circadian biology. We are designed to actually eat earlier in the day, not later. We are more insulin sensitive earlier in the day than we are later on. So it all goes back to figuring out ways that we can support our bodies to make sure we optimize our hormonal regulation, but doing it in a way that is sustainable. Because you and I both know there's always like the next get quick fix phase. You know, this one thing, this potion pillar powder is going to fix everything. And I tell everyone we really do have to make lifestyle changes that are sustainable so that we can go on and be able to sustain things. So you know that first meal of the day, having some protein, understanding protein is satiating. Understand you want at least 30 grams of protein to trigger this muscle protein synthesis. I know we talked about this on my podcast, but helping women Understand how critically important that protein piece is. And then I'm a huge fan of intermittent fasting, if that's appropriate for you, but only intermittent fasting, if you can actually get your protein in. So I'm not a fan of Omad.

But here's what I think is the biggest challenge with the fasting umbrella. There is fasting, intermittent fasting, time restricted, feeding Omad, every other, it's like, okay, so when you talk about it, because you did write the book, right? So we have to address it when you talk about it, what specifically are you talking about? When is it appropriate? When is it not appropriate? Let's break it down.

Yeah, so when I talk about intermittent fasting, it's a period in time in which you abstain from eating food or caloric beverages and a period in time which you eat. The most important thing that you can take away from this conversation about intermittent fasting is not starvation and it is not restriction. It is not designed to be restrictive in the sense that you are, you should be nourishing your body. I think that there's this common misnomer on social media that what we're suggesting is people starve themselves. That is not what we're doing. We're just saying we're going to eat two meals a day or three meals a day in this feeding window and helping people understand that the individuals that are appropriate for intermittent fasting are individuals that can manage their blood sugar. They're individuals who are sleeping well. And I go back to that sleep piece. If I can get you to sleep through the nights, I can get you to make good food choices. I can get you to get to a point where intermittent fasting is a viable option. It's not an option if you're pregnant or breastfeeding. It's not an option if you have a disordered relationship with food, anorexia, bulimia or binge eating. Have I met women that fall within those parameters and have gone through enough support and services with their psychologists, eating disorder specialists and are able to intermittent fast? Sure, but it's the minority or people that are chronically sick because when I find that someone's on 15, 20, 30 medications, they need to loop in their internist because they may need an adjustment in their blood pressure medicine, they may need an adjustment in their cholesterol medication, they may need an adjustment in their diabetes medicine. But most other individuals, my teenagers included, can eat for 12 hours of digestive rest, meaning that there's a 12 hour window in which you do not eat. Most people can do that. They just are terrified to do that. The average that I read recently was one of Sachin Panda's research was looking at meal frequency and the amount of time people drank caloric beverages and food. It was 10 to 12 times a day. It's wild. And I thought to myself that's 10 to 12 times a day that your body is trying to process a bolus of food and or a sugar sweetened beverage. And we talked about insulin resistance and how that can impact it quite significantly. So I always, from the context of helping people understand what intermittent fasting is not starvation, it is not designed to keep you protein deficient because we know as women are getting older we need more protein, not less. So when I see someone that says to me, I am Omad all the way, Team Omad seven days a week, oh boy.

I how do you get enough protein, Omad? How? If we need to get at least a hundred grams, how is this working?

You can't. I always say, I come from a place of education and I just want women to be able to make good choices, healthy choices. And if you're getting 35 grams of protein and three meals a day, great. If you can get by with 50 and two, fantastic. But you definitely want to be ensuring you're getting enough protein. That is the most important macronutrient at this stage of life in particular because we need more, not less.

Right?

So that's, that's my soapbox about Omad. And this is also why when people ask me, am I a fan of prolonged fasting, you know, 24 hours, 48 hours, 72 hours, not if you're already lean, because it's at the expense of your muscle. And so I've gotten more and more outspoken about this. I am a lean 52 year old and I do not do long fasts anymore. I don't because I want to maintain my muscle. And so I think when you find that reframe, it's not coming from a place of judgment, it's coming from a place of empowerment. And I want every listener here to understand like, yes, you can intermittent fast. If you have 30, 40, 50 pounds to lose, you can get by with a little bit of longer fasting, but making sure on those other days you're eating sufficient amount of protein. So protein is definitely what you want to be focused on if you are choosing to intermittent fast.

For sure, you know, it comes to this bigger umbrella of diets are tools, they're tools. So to me, an intermittent fast of eating for 12 hours, fasting for 12 hours is actually just the way we should eat. To me, that's like, stop eating. Shut the kitchen down after dinner, and don't go in there until after you've been up for an hour or two. Ideally two, shut the door. But what you decide to do after that really is what's the effect you're trying to achieve. And then you choose the appropriate dietary tool, not the tool that your manicurist told you was working perfectly. You know, this used to drive me crazy. I go, eating does not make you a nutritionist.

Very true.

So careful where you're reading this advice or taking this advice. And then I also find that with all of these diet books, everyone tends to write the book. I can totally say this now with the next book I'm writing. They write the book for them. They write the book that's working for them. So that doesn't mean that's the book for everybody. Diets are tools. Pull the stuff that you need for what you're attempting to achieve there. All right, sleep again. I honestly, I don't know how to help someone with insulin sensitivity, like, unless they are sleeping well.

That's the Karen. I incentivize people. I'm like, listen, this is the way I can get you to a point where your body will be in a position where it can get healthy to lose weight if I can get you to sleep. And this is also how I'm able to say to women, stop staying up until 1 o' clock in the morning to do stuff. Go to bed. Like, my whole family laughs at me. I'm the first one in bed. Obviously, I'm not irresponsible. I wait until my kids are home, but I am the first person in bed because I know that I need the sleep. I need a solid eight hours a night of sleep to function fast. There's no shame in that. Like, the years of getting by with four and five hours of sleep completely were not helpful for me in terms of, you know, navigating perimenopause. So sleep is the way for sure.

Okay, beyond sleep, what are some of the other things here? Like maybe some supplements or gut health? Like, what else is critical?

Yeah, I mean, I think that, you know, when we're talking to women about navigating perimenopause and to menopause, I mean, stress management is without question. We know that chronic stress, even high cortisol, low cortisol, I mean, it will show up as adiposity around your abdomen. So we talk about there's 40 times more cortisol receptors in our abdomen. So when someone is dealing with acute on top of chronic stress, they'll sometimes say, I have the menopause. You know, I have all this adipose tissue that I don't know what to do with. But it understanding that managing your stress is not five minutes of meditation once a week. It is a proactive way of managing your stress day to day. It could be like I had two dogs and my husband love to be hugged. So I can like get a little oxytocin boost. And understanding this hormone oxytocin gives you a little bit of a reduction in cortisol on the short term. Doesn't last forever. The connection to nature meditation, which I know you're a huge fan of, for me, it's, you know, getting outside and just putting my feet in the earth. It's starting to get colder where I am right now. But I do genuinely love that. For me, it's reading a book like reading a book for pleasure. I love doing that. But finding things that you enjoy doing, because that is going to help buffer that cortisol response. But I would also think about things like myo inositol can be very helpful for not only sleep support, but also stress management. Also insulin sensitivity. This is something that's naturally occurring in the body. We don't make enough of it. It gets depleted very easily. But helping people understand, you know, there's little hacks, whether it's myo inositol, creatine, which I know we're both fans of, helps with sleep architecture. Also there's some metabolic effects that can be very helpful when people are dealing with chronic stress and they feel like wired and tired. I start to think about adaptogenic herbs, ashwagandha, I think about L Theanine or gaba. All of these things are very nourishing to the adrenal glands, but also very helpful. L theanine is a compound that's found in things like green tea. So it's also naturally occurring. But I don't know how many people even have decaffeinated tea right before bed. So those are the things I think about along with. I gotta be honest with you, we know that trauma has a large impact on not only autoimmune conditions, but also has a huge net impact on weight loss resistance. There is that connection. I interviewed Dr. Gabor Mate and I was stunned looking at the statistics in his book that helping people understand, like unprocessed trauma. There's. You can go online and look at these scales like adverse Childhood events. If you have a high score, you're at greater risk for developing an autoimmune condition. You are at greater risk for weight loss resistance. You are at greater risk for, you know, this chronically over activated sympathetic nervous system. And I know JJ's talked a lot about the sympathetic nervous system, which is the I'm being chased by rabid animal system. But most of us are living in these chronically overactivated sympathetic nervous system. So those are the things I think about. Along with gut health does play a role. We know chronic cortisol can disrupt the gut microbiome. We know there's something called the ester ebola, which is this kind of awkward, strange word how our body's able to actually process up and package estrogen and get rid of it effectively. That's why a bowel movement every day, the bare minimum. It's not normal to poop once or twice a week. I still meet women that think that's completely normal. But cleaning up your personal care products, cleaning up your water, you know, we have a filtration system in our house. We had our water tested. There's lots of different ways to kind of look at how you can limit your exposure to toxins. But all these things definitely play a role not only in metabolic health, but also than insulin resistance and optimizing our health as we're navigating middle age and beyond.

I want to just go back to stress just for one minute. Do you have a way that you look at this? Because it would be so awesome if there was a way we could test our sympathetic nervous system and really see what the heck is going on. Right?

Yeah. I mean I think a rough estimation of looking at heart rate variability. So I wear an OURA ring and I can tell when my HRV is lower than it should be. Obviously there's age adjusted heart rate variability. I don't expect as a 52 year old that my heart rate variability is going to be what a 20 year old is. But it's good if I'm in the 50s. I'm really good if I'm at 60. But if I'm in the 20s, it usually means I didn't get enough sleep or I'm traveling. I really tank when I travel. That's a given. Like, especially if I'm jet lagged, my HRV will end up in the toilet. But based on like what I, I read in my understanding is it's really looking at this balance of the autonomic nervous system parasympathetic to sympathetic. We Want balance. But most of us tend to be revved up and we don't have enough restorative time. It could be taking a nap on the couch. It could be reading that good book. It could be sitting outside in nature. It could be taking your dogs for a walk, loving on your animals or your significant other, your spouse, your kids. You know, just getting that oxytocin release. That. That is what I think is a good, quick, safe way of observing heart rate variability, is a good way to get it. Some insights into the autonomic nervous system.

It's interesting. I was just checking, and I remember hearing Peter Attia talking about something that was like the number 13.7. I think that there wasn't, like, as long as you were not below that. And I'm just one of those people that has a sucky HRV. Like, I'm happy if it's 20.

So I just started looking. Cause I was like, 50, you're my hero. But it didn't start there. I mean, once I started tracking it. And then there was some biohacking female I had on my podcast who I'm very fond of, and she posted what her HRV was one day. And I was like, I know you're in your 30s, but dang, I mean, it was like well over a hundred. I was like, how do you know? Yeah. So I. So I think some of it's genetics. I think there's absolutely a role in there. But if I'm in the 50s, I'm doing good. But jet lag, or if I'm at elevation, I'm super sensitive to elevation. Elevation. Mine goes in the toilet. I was in Denver, and the whole time I was there, I was like, my HRV is like 15 terrible. And then it went back to baseline when I got home. So I. I think it's looking at acute stress, chronic stress, balancing that autonomic nervous system. But I. I certainly think that having. Whether it's a whoop band or an aura, I think those tracking devices can be helpful, provided that you don't allow it to ruin your day. Like, if I look at my HIV and it's terrible, I kind of go, okay, note to stop. This is not the day to do hint. Maybe this is the day to do something else.

This is really a great reminder, and I think you've just listed a lot of things. And someone might hear the song go, holy smokes. And what I'm going to just recommend, as you said, okay, if sleep's not there, fix that one first, is that this is Peeling an onion. So like the HRV thing, it was a reminder. I'm like, oh, okay, that's what I'm gonna peel next. I'll just start. Because what you measure and monitor, you can improve. So maybe it' that you're monitoring your body composition, maybe you're monitoring your sleep, maybe it's now hrv. But pick one and then once you've really gotten that into place, then you can pick the next one. Otherwise you can listen to all this and go, holy smokes, I've. I don't, ah, I'm out. You know, I don't know what to do. And I think you've made a really great case for the stress and sleep piece of this because those two factors, especially for women, are so huge. Holy smokes. And if you're not fixed, like just those two alone, you can be eating correctly, exercising, and you will still be holding onto belly fat, you know, having trouble putting on muscle, being in a bad mood. So I'm glad that you've really hit those ones. Now I want to make sure that we tell everyone where to find you and your amazing podcast and then if you have something special to give everyone today.

Yes, of course. So obviously my podcast is everyday wellness. One of my favorite things that I do in my business. I am active on YouTube. I have a newly relaunched YouTube channel. You can find me on Instagram, you can find me on Twitter. Before warned, I can sometimes be a little bit snarky. There's a free Facebook group called Intermittent Fasting Lifestyle backslash my name. It is a drama free environment. Is a very nice group of men and women that are in there. But easiest place to go is to my website, www.cynthia thurlow.com and yes, I have a little weight loss guide quickie that we are gifting to your community.

Because nice, we'll put all that like so all of these things we'll put in the show notes. I'll also put it at jjvirgin.com forward/everyday wellness. So it'll be easy. The guide will be there. And then of course, all of your information. Podcast is phenomenal. I'm excited that you're building your YouTube channel. It's humbling.

You know, I kind of feel like, you know, we're trying to stay on top of the trends and I'm, you know, doing all the things and you just hope that people are watching and they're interested, invested. Because ultimately I'm all about science based strategy and how they can allow us to navigate perimenopause. And menopause in a place of inspiration and empowerment and not in fear, which I think unfortunately as a byproduct of kind of the traditional realm. Many women feel that way and I don't want them to feel like I'm like learn from my mistakes and the things that I have learned along the way so that you can navigate those.

Years with joy, with grace and ease.

Yes.

Yes, with grace. Well, thank you for the work that you do and thank you again for another amazing podcast. You are always an incredible resource and wealth of information.

Thank you. Such a pleasure to be with you.

Be sure to join me next time for more tools, tips and techniques you can incorporate into everyday life to ensure you look and feel great and more.

Importantly, that you're built to last. And check me out on Instagram, Facebook.

YouTube and my website, jjvirgin.com and make sure to follow my podcast so you don't miss a single episode@subscribetoj.com See you next time.

Hello listeners, this is Anne Bogle, author, blogger and creator of the podcast what Should I Read next? Since 2016, I've been helping readers bring more joy and delight into their reading lives. Every week I take all things books and reading with a guest and guide them in discovering their next read. They share three books they love, one book they don't, and what they've been reading lately, and I recommend three titles they may enjoy reading next. Guests have said our conversations are like therapy, troubleshooting issues that have plagued their reading lives for years and possibly the rest of their lives as well. And of course, recommending books that meet the moment. Whether they are looking for deep introspection to spur or encourage a life change or a frothy page turner to help them escape the stresses of work, school, everything, you'll learn something about yourself as a reader and you'll definitely walk away confident to choose your next read, with a whole list of new books and authors to try. So join us each Tuesday for what Should I Read Next? Subscribe now wherever you're listening to this podcast and Visit our website whatshouldireadnextpodcast.com to find out more.