345: How to Effectively Use Intermittent Fasting with Cynthia Thurlow

There are some people that do extended fasting, shorter fasting. I'm a fan of women having at least two meals within a feeding window. So that's why I'm a fan of a wider feeding window. Six to eight hours to allow themselves to eat enough protein to preserve and protect lean muscle so that they remain insulin sensitive.

Hi, I'm Natalie Jill and I help women in their 40s, 50s and beyond redefine, rebrand and laugh with aging. Welcome to midlife Conversations. On this podcast, I do what I do best. Taking complicated information that is relevant in this point of our lives now and break it down simply with actionable steps you can implement to level up your life. I also regularly interview some of the most inspiring people living their best midlife years. Now on this show I cover topics about our shifting hormones, weight struggles, our mood and focus changes, raising teenagers, our relationships, career changes, beauty and more. If you are new here, I encourage you go back and listen from episode one when this podcast was previously called Listen up for the full transformative experience.

For this deep dive conversation, I've got Cynthia Thurlow and she's a nurse. She is a nurse practitioner, but she's also an author of the bestselling book Intermittent Fasting transformation. She's a two time TEDx speaker. Her second talk had over 13 million views. Yep, 13 million views. She stands for intermittent fasting. She has changed her own life through this. She's changed countless other people's lives through this. So I want to dive into why this is an important topic for midlife women. Thanks for being here Cynthia.

Yeah, thank you so much for having me. I think that intermittent fasting is not new. It's not unique, it's not new or novel. But in our kind of harried modern day lifestyles, the concept of eating less frequently really puts a spin on all the recommendations I was making for years to patients about snacks and mini meals and stoke your metabolism and all this nonsense that we doubt is really not the case.

So let's I want to dive into first of all why this became so relevant to you. I know you had your own personal journey. If we can, if we can start a little bit with that. Just because intermittent fasting is very misunderstood, it's also become trendy in some, some ways. But why was this answer for you first and then why is it so important for people to understand?

Yeah, I mean even though I am a traditional allopathic trained provider, nothing prepared me for perimenopause. Not my mom, not my gyn, not my girlfriends Nothing. And so I was doing everything wrong. In my early 40s, I was probably over exercising, too low carb, I had too much stress. I had a very stressful job in the hospital. I worked for a big cardiology group. And all of a sudden it was like I became weight loss resistant and I was exhausted and I just didn't feel good. And so in the span of one week's time, I had three different people friends just say to me, why don't you think about fasting? And I was like, no, no, no, that's restrictive, that's bad. And so I bought a book that changed my life. And so I always like to give Dr. Jason Fung credit for writing a complete guide to fasting, which is what I read. And then I thought to myself, I'm going to try this and I'll be darned. I didn't lose weight right away, but I did feel 100% better. I had so much mental clarity. I eventually did lose the 5 to 10 pounds of fluff that no middle aged woman wants to deal with. And it really gave me a profound appreciation for looking at lifestyle as really the cornerstone of health and helping my patients and my clients understand that intermittent fasting is really accessible for most, if not all women. But we don't need to fear monger ourselves. We just need to embrace our physiology and understand there's a way to fast for our health and what life stage we're in.

So let's define intermittent fasting first. I've heard different things like, oh, it's all your foods in four hours or six hours or eight hours, or if you just do a 12 hour window or if you skip a day. So how do you define intermittent fasting?

It's eating less often. And all of those, those different types of fasting are all still applicable. There are some people that do extended fasting, shorter fasting. I'm a fan of women having at least two meals within a feeding window. So that's why I'm a fan of a wider feeding window. Six to eight hours to allow themselves to eat enough protein to preserve and protect lean muscle so that they remain insulin sensitive. So from my perspective, all of those things apply, but I really do like women in particular to make sure they're getting at least two good sized meals most days of the week.

Okay, I have a couple of questions in what you just said. One, what is insulin? You said, so they remain insulin sensitive. What does that mean?

That means. Well, let's back up. And we understand that most, if not all the Most of the population here in the United states, at least 93% of us, are no longer insulin sensitive, which means that we are insulin resistant as a byproduct of our modern day lifestyles. It means that our muscles are no longer in a position where they're able to soak up extra carbohydrate that we've consumed, which is stored as glycogen. We talk about insulin sensitivity, it's really referring to do you have a healthy blood pressure, what's your waist circumference, are your lipids, are they normal? Is your fasting blood sugar within a healthy limit? And so when I talk about insulin sensitivity, it is the cornerstone of most chronic diseases. And it's why intermittent fasting, I think is such an important strategy to help us maintain that blood sugar regulation and level so that we remain healthy. Because I think for a lot of women, they don't understand that some of our hormones, our sex hormones in particular, like estrogen, help protect us until we go into menopause. And as we're losing estrogen, it can actually exacerbate this. So helping women understand that we want to have our hormones work with us and not against us.

Can I dive a little bit more into the blood sugar conversation with you or is that. Because I've got a bunch of questions around that. So traditional medicine, if you would look at Western MD will go textbook on what's right or wrong with insulin and blood sugars. So they'll basically say if you're fasting, blood sugar call it is over 120, if your A1C is this high or if after 2 hours of eating it doesn't go back to normal, it's these. That's when they say that there is an actual problem. Right. But to me, that's not looking at any of the warning signs that happen when earlier on. So like to me, and I'm not a doctor or an nd, so I'm just asking the question for a lot of people. I think there's a lot of people that when they are grazing all day or eating food all day, they are on a constant state of higher blood sugar, which even though that may not reflect on their A1C for months, or that might not reflect on their fasting for months, that could be creating a problem right there. Could you talk a little bit about that? Because I, I have a feeling, and you're the expert here, but that has something to do with why intermittent fasting is critical.

Absolutely. And I think it's important for people to Understand that when we eat food, our blood sugar, depending if we're having carbohydrates or fat or protein, will be, you know, will be, will increase appropriately. If you have just carbohydrates, you're going to have a greater blood sugar rise. If you have fats, you're going to have a lower blood sugar rise. But in response to your blood sugar going up, there's another hormone called insulin, which unfortunately gets a bad rap and that is secreted to help bring your blood sugar back down. What I think is important for people to understand is that when we are not eating every two to three hours, we're not eating all these carbohydrates. And I'm not anti carb, let me be very clear. But when we're balancing our meals properly, insulin is secreted less often because our blood sugar is going up less often. And I think it's an important understanding for people to, to recognize that when we are eating two meals a day versus six, when we are consuming the right macronutrients, right types of carbohydrates, fats and protein together, we're going to have a more negligible blood sugar. And I would even back up when you mentioned earlier about some of those labs. A fasting insulin is one of the best ways. It's usually one of the first biomarkers that will, will dysregulate, meaning it'll become abnormal way before blood sugar, way before an A1C. And so I encourage all of my female patients, and it's anywhere from a 12 to a $20 test, it is very inexpensive, covered by insurance, to ask for a fasting insulin because that sometimes is the canary in the coal mine. That is oftentimes the very first lab test that will start to become abnormal way before you'll see a fasting blood sugar A1C. And it's not to suggest that those lab, other labs are not helpful. But I think when we're really advocating for ourselves and we're really wanting to be able to be consumers of our own medical care, it's important to be able to say, hey, I'm aware that a fasting insulin is a really biomarker because how many women come to me and their fasting blood sugars aren't bad, their A1Cs aren't bad, but their fasting insulin is 10 or 20 and they're, they're weight loss resistant. I'll say, okay, the first thing we need to do is help lower that insulin. And one of the ways that we can do that is eating less often. We're not provoking this insulin response all day long. We're provoking it twice a day, maybe three times a day. And we're managing our macros in a way that we maximize protein, add in those healthy fats and those healthy carbohydrates, which means the less processed variety, and those things are a great first step.

Okay, so now another train of thought would be to, instead of intermittent fasting, would be to just take out sugar or take out carbs and go like extreme keto, but still eat. What are your thoughts there? Is that. Do you. Do you still. Do you suggest that, like for people to lower that, or is it more just. No, it's okay to spike your blood sugar and your insulin as long as we're just doing it in a window a couple times a day.

Such a good question. So first and foremost, if you have a glucometer or continuous glucose monitor and you can monitor your blood sugar response to meals, that is not. That is that knowledge is power. So if you eat a meal, let's say, Natalie, you have a steak, you have sweet potato, you have some, like, some healthy fat, like maybe some avocado, your blood Sugar goes up 20 points after your meal. That's excellent. Versus if you sit down and have a plate of pasta with very little protein and your blood sugar goes up 50 points, you know that you've consumed too much carbohydrate and probably not enough protein. So when I'm talking to women about maximizing their results that they're going to get with whether it's fasting or ketogenic diet with a net carbohydrate of under 50 grams, that's kind of what. What the kind of conventional wisdom is. I do think lower carbohydrate diets are beneficial, especially for those that are insulin resistant. And the average American right now is consuming 200 to 300 grams of carbohydrate a day. Wow. So even getting your carbohydrates under 50, under 75, under 100 for a lot of people, can be very beneficial. My concern about really restrictive ketogenic diets, meaning you're having 20, 30. Yeah. The carbohydrates, that's tough to maintain. So I actually teach people how to carbohydrate cycle, meaning on, on more active days, maybe when they're lifting, they'll have a little bit more discretionary carbohydrate, and maybe on a less active day, they're going to pull those. The carbohydrate Threshold down. And I think that can be very helpful. Okay. For many people they just have been told heart healthy grains have all the carbs you want.

Sure.

And it's a lot of it's retraining to understand that the most exaggerated blood sugar response we will get is from carbs, then protein, then fat. That doesn't mean that you don't eat fat or protein or carbs. It's maximizing what is going to be of greatest benefit. So if you're insulin resistant, you definitely want to lower that carbohydrate threshold and lean into protein and healthy fats. Okay, that's a good start.

One more question before I ask you more about carb cycling and then more about. I want to go deeper onto intermittent fasting. One more question about blood sugar. You, you mentioned if you have a steak and some healthy fats and some a sweet potato and it only goes up 20 points. What if though? Because continual glucose monitors are a thing. I'm a huge fan of them. By the way. You're somebody is like, well I'm eating and it's going up a hundred points. Is that worrisome? Is that a concern? Have we already gotten too late and is that important to put a stop on that then?

Yeah. I mean if you're going up 100 points, then you definitely, then definitely the macros in your meal need to be recalibrated. It doesn't mean that that's going to be the case all the time. But this is absolutely why I'm such a huge fan of glucometers and CGMs, because you can get a personalized sense of how sleep and stress and nutrition and exercise impact your blood sugar. A hundred. If you have a hundred point jump with a meal, it is absolutely positively not the right meal for you. I like to see 20 to 25 points. That's a sweet spot. So because you really should get like a very negligible bump, you shouldn't see this exaggerated response. If I sit down and have a piece of cake, you better believe I'm going to get an exaggerated response. And I want that. And actually it's interesting, Dr. Ken Berry actually talks about when your blood Sugar goes above 140 that you are actually creating microvascular damage to the inside of your blood vessels. So it's just something to think about. Like it's not benign to have your blood sugar be elevated and high over a protracted amount of time.

Yeah.

Because when we have that much circulating blood glucose, it is creating to inflammation, oxidative Stress and it makes our platelets sticky. Yes, it's just important to think about just like sugar. If we wet sugar and we touch it on our hands, it's sticky. The same thing kind of applies within the inside of our blood vessels. And so helping people understand that we want to have, you know, a 20 to 25 point increase is fine, but anything much more than you really have to dial back usually on carbohydrate portions.

This is so important because traditional western medicine, not knocking it, just will say they're looking at two hours post meal. But that doesn't show the whole story. That shows when it. To me that shows like more of the damage is done. So I love what you just shared because that's how I feel that it's important to look like. Right. Like we should never be eating things that are bringing us up that high because the two hour mark is not too telling until it's basically too late, in my opinion on that. Okay, so let's talk about. You mentioned carb cycling. Can you explain what is that? Is that customized for people? Can, can everybody play with that? Like can give us a general understanding of that?

Yeah, I think carb cycling is something that's really not well understood, but I think it's a way for people to be lower carbohydrate. Now note, I'm not saying keto, I'm not saying super low carb that allows people to play around their carbohydrates so they don't feel like they are having a particularly restrictive lifestyle. Because anything that I suggest, I always want it to be sustainable. And sustainability means we have to have a little bit of an exit strategy. So as an example, I lift heavy legs twice a week on the days I lift heavy legs because it's one of our biggest muscle groups. That is a higher discretionary carbohydrate day. I've been doing this a long time, so I don't have to measure everything. But it's going to be the day I'm going to have fruit. I'm probably going to have some fruit vegetables. I don't eat grains because they don't agree with me. But if someone tolerates grains, maybe that's a day you have a small portion of grains. And so it really means instead of maybe having 50 to 75 grams of carbohydrate, maybe you're having 100 or 150. Again, it really depends on the individual and it really depends on how physically active you are. Like another example is when someone is carb cycling, maybe Their total carbs over the course of seven days is in that 50 to 75 range. But they push themselves out of ketosis or they're pushing their blood sugar up just to allow their bodies to become a little bit more efficient. I think that sustainability is important. And I find for a lot of people, knowing they've got two days out of the week where they're gonna have more carbohydrates, it allows them to feel like they're not living such a restrictive life.

I love that and I love what you said about doing it around like leg day or doing around your workout, because I think then you can really use it for your benefit because clearly your workout needs that fuel too. So you're gonna feel muscle growth, you're gonna feel that workout. So I like that plan and I would even take it further that when you want that treat or that cake or whatever, maybe you even time that with that.

Yeah, absolutely. And I'm a huge fan of also recommending that women are active. So it's not just, you know, lifting the gym or doing pilates or whatever things that you. But being physically active, understanding how important, like taking a 10 or 15 minute walk after a meal, really thinking of your muscles as a glucose disposal unit, really understand they're just stopping up the blood sugar. So it's important just to understand there are storage site for glycogen or stored sugar. Also a very effective way to help lower your blood sugar on days maybe where you've had a little bit more discretionary carbohydrate, maybe you had some alcohol, maybe you had a dessert, go take a 10 or 15 minute walk. It's a really good way to lower that blood sugar.

Okay, you mentioned earlier cortisol, stress, you mentioned some of that affecting it as well. Can you elaborate on that a little?

Yeah. So I remind people that, you know, our bodies are kind of on alert mode. You know, we're, we have the autonomic nervous system, so we've got the parasympathetic and the sympathetic. And most of us live in the sympathetic dominant state where our bodies perceive that we're dealing with danger or trying to flee from danger. So when we're stressed, you're running through an airport, you, you know, get into a car accident, you have an argument with a loved one, It's a normal physiologic response that your cortisol will go up and your body is thinking that you're fleeing from danger, there's something going on. So it's also going to liberalize Some glucose. So your blood sugar is going to go up to actually fuel your muscles, fuel your brain, kind of move things along. But it's not the acute stress that is problematic with high cortisol, it's chronic stress. So the people that are chronically not sleeping while they're over exercising, maybe they're over fasting, maybe they are going through a divorce or they've lost their job, or they're, you know, we just went through a pandemic. A lot of people were doing a lot of chronic stress. And so understanding that we want to do the things that are going to quiet that inflammation and that chronic stress. And so this is where lifestyle becomes really important. I always remind people that as I've gotten older, I've had to do more things in my day to day to quiet my autonomic nervous system, quiet things down, whether it's connection with nature, walking your dog, hugging your pet, hugging your loved ones, you know, releasing oxytocin, which will help reduce cortisol. So all these different ways that understanding we don't cortisol is not all bad, but we want to mitigate and manage our stress response as much as we can by chronic issues that we're dealing with in our day to day.

So one thing I had somebody on that I interviewed recently about cortisol specifically, and one analogy she gave which was so fascinating to me was that she said that it used to be we're biologically wired that way for like running from a bear or you know, when you really had to escape something. But what happens now is we get an email that disturbs us and then we're all cortisol spiking. And then to calm us down, we grab the M&MS. Or whatever. So now we've spiked our blood sugar like double. But we're not actually running from a bear, so it's just all sitting there. So she just was, it was such a good analogy to me that you think, we think when we're like that we just need more sugar and more carbs to calm us, but it's actually the opposite because that's just fueling, making it worse.

Exactly. And that's when I say like, go, go hug someone you like or you love. Because the oxytocin release you get from connection is one of the things that will help lower cortisol. So that's a great, it's a great analogy that they used.

Okay, let's dive a little bit deeper into intermittent fasting because this is the, your jam, your genius. How is that what do you suggest? Somebody get started with it, go over like some of the benefits of it. Like, what can they expect and how do they ease into something like this?

Yeah, I would say, number one, when it comes to fasting, I always think about the cognitive benefits. So mental clarity. Because your blood sugar is low, your insulin levels are low, you're going to have more energy. If you're doing it well, you are going to have improvement in something called autophagy, which is this waste and recycling process. So think about it. When you are in an unfed state, your body can go in and get rid of the trash and the diseased disordered organelles, mitochondria, things that could potentially go on to create disease. Our body effectively goes in and takes out these dysfunctional cells. I also think about improved blood sugar, improve blood pressure, improve lipids, understanding that we lower our risk of neurocognitive issues. So Parkinson's, Alzheimer's, dementia, we're at reduced risk of certain types of cancers, especially breast cancer, some of the female reproductive cancers, colon cancer. And then lastly, I think a lot about gut health. I think so many people, we hear about the gut microbiome, we don't really understand what that is. But when we're in an unfed state, our body goes in and actually actively repairs. We've got the lining of our small intestine actually goes in and helps to repair these things when we're not eating as frequently. So it really allows our bodies to be fully optimized. And the other thing that I would add, Natalie, is that a lot of people find that they're, if they're, you know, in this middle age, perimenopause, menopause, all of a sudden they're sleeping better, they feel less stressed, they feel like they have more energy to contribute not only to their exercise program, but to their loved ones, maybe to their work. And it just allows them to be less food, myopic and allows them to like, fully participate in their life without so much focus on like, when's that next meal or snack?

Wow.

And in terms of, you know, like really looking at how to do it, I always say that I have a very stepwise approach. So if you're coming from a standard American diet and you're eating snacks and mini meals, you stop snacking. That's like the first band rip off. Because it's going to force you to reallocate your meals, like more protein with your meals, more healthy fats, maybe adjusting your carbohydrates. So you're really going from no snacking to adjusting your macros, and then going from not eating from dinner to breakfast. And so many people snack at night, kind of mindless snacking where they're drinking a lot. And I just remind them, like, from the time that you finish dinner until breakfast the next morning, you probably are going to spend most of that time sleeping. So it really isn't as scary as it sounds. And then really understanding that you can consume water, you can consume electrolytes, bitter teas and coffee if you need to. Like, you want to stay hydrated. So understanding, like, what are the things you can do in a fasted state? And maybe by the time you wake up the next morning, you've already fasted 14 hours.

Yeah.

People start to realize then they're like, oh, I can do this.

Yes.

Slowly kind of opening up your fasting window, depending on your own circumstances. Obviously people that are more metabolically flexible, and I can help define that people that are able to use both fats and carbohydrates for fuel are going to have an easier time slowly working into those longer fasts. And then I do have some patients, it'll take them six or eight weeks because they have so much stored carbohydrate on board that their body kind of burn through what's there before they can start, effectively utilizing insulin to free up the fat to use as a fuel source.

It's so wild because if you. If somebody's in midlife and they're. And that's like between. Call it 40 and 64. Right. We grew up, we all were in the time where we used to talk about eat every two hours so your body doesn't need its muscles. And so we. It's like we were brainwashed to believe you have to eat every two to three hours. Like, I don't. And it's funny because that actually came from the bodybuilding industry, you know, because that's how they would put on muscle. They wanted to be able to get enough protein, enough carbs in, and you couldn't, you know, use it all in one sitting. So that's where that came from. But it's really interesting that we've all been trained that fasting is bad, you know, but so how did you. How do. How long does it take for somebody to truly unwind that?

Like.

Like, how can someone expect. How long should they expect to feel hungry or be in that habit? How long did it take you when you shifted?

Yeah, well, I think the most important thing is to say, like, I'm never an advocate of People suffering, like there's no white knuckle fasting. I think that's a really, a really unhealthy way to be. Like, if that's how you feel, like you're white knuckling it, then you're doing it wrong. So I do find most people, it's two to three weeks of like slowly saying, okay, I went 14 hours yesterday, in two days I'm going to go to 14 and a half. And it's that slow incremental improvement until they get to a point where like I'm not even thinking about the fact that I'm not eating. I'm just like, okay, it's 11 o', clock, I'm hungry, I'm now going to stop. So I think a great deal of it is understanding how do you break a fast, what breaks a fast, and also what can you consume in a fasted state that is going to allow you to embrace a clean fast, meaning one that's not going to evoke an insulin response or you know, impact your blood sugar. So again, those bitter teas, bitter is good. I think we're, unfortunately, we're a society that really loves sweet. And I just remind people there's specific plant based compounds in bitter coffee and bitter teas that are designed to send very impactful messages to our bodies. So green tea, black tea, plain coffee, and if you need to add high quality salt or add cinnamon, you can do both, which will change the flavor profile but will not break a fast. And lots of water because we want to remain hydrated. But for women in particular, if you're still getting a menstrual cycle, there's a time in your, in your cycle when you can get away with fasting pretty easily. So from the day you start menstruating up until ovulation, so this is when the follicular phase and estrogen predominates, you can get away with harder workouts, more fasting, lower carbohydrate versus after ovulation when progesterone predominates. And it's going to be a little more challenging. Maybe you have to back off on the intensity of exercise. Maybe you have to, you know, adjust your carbohydrate intake. This is also the time that the week before your menstrual cycle, I would say take your gas off, take the, your foot off the gas. When it comes to fasting, this is really a time to maybe do 12 hours of digestive rest or maybe 13 hours. And I find if most women are doing that, then they do really, really well, so it's also that piece of. You're still cycling understanding when to fast and when not. And then menopausal women and men have it so much easier because not as much circulating hormones day to day, week to week. As long as they've leaned into getting enough sleep and the right macros and they're managing their stress. I find menopausal women have a much easier time.

Okay, so we, you talked about the extended period from dinner to breakfast. What about the hours that you're eating in between? So call it six hours or eight hours. Eight hours I'll start. Um, that which I think most people start with is that eight hour window when they really jump in. How many times are you eating during that? And does that matter? Like, can you, do you need to eat only two times and have that break in between? Or could you be snacking the whole time? Like, because I think some people take it as I'm gonna eat everything I can in eight hours. So what is the best practice there?

Yeah, so it's not an eight hour of grazing. It is really designed to be, you know, let's say you break your fast at 10, you have a good sized meal and maybe you eat, eat five hours later. I like women to work up to 100 grams of protein a day. That is what they are aiming for. Which means you are slowly increasing your protein intake. So maybe you're starting at 50 grams of protein a day. Well, you're going to increase it to 30 grams with each meal and then go to 35, then go to 40. Like now it's very easy for me to do that. But most women are so grossly undereating protein, they're never satiated, which is why they snack. They can't build or maintain muscle. That's number two. And you want to think about muscle as this organ of longevity, really important for us to maintain it. And then the other piece is once people are able to adjust their macros, it's easy to go four or five hours between a meal. And so it's never about having an eight hour period of grazing. That would definitely negate the benefit of having lowered insulin levels, but it's helping people understand. Like there are some women that need to have three meals in eight hours. And that's okay. I don't get hungry because I eat such a large amount of protein with that first meal, I won't be hungry for four or five hours. But new people that are newer to this, it's really, it's astonishing for them to understand that that protein piece is very important and that's why I always say like one meal a day as a sustained strategy for women I think is ultimately can be detrimental to maintaining our muscle and our insulin sensitivity.

Can you give us an example of like what you actually eat in a day? So like what, like what did you do for breakfast, what would you have for dinner and do you have a lunch or a snack?

Yeah. So typically I will break my fast around 10 or 11am and I usually will break it with 40 to 50 grams of protein. And so earlier today I had, I had a, a bison burger and a half that I'd made at home. I had two deviled eggs because I'm obsessed with eggs and I had some shishito peppers. So for me it's non starchy vegetables and protein and that works really well for me. Now I will eat again later in the day. I'm probably going to cook some shrimp. Shrimp and I would say because I want to hit that 50 gram threshold with that meal, I'll probably have half a pound of shrimp. So helping people understand that for me it's always the metric is lean protein because that's what I do best with. I try to avoid eating too much chicken. I know it's easy to eat chicken but I would like experiment like bison is just as delicious as beef and, and we eat a lot of bison in our house. But trying to change things up so that you're having different types of proteins and then non starchy vegetables. So I also have asparagus, I also have green beans I'll probably have with my dinner. And that's a pretty typical day. 110.

So no snack?

No.

You didn't come and have your apple and peanut butter. You didn't have your hummus and vegetables. You didn't, you, you, you just didn't snack. You didn't, you didn't need it or crave it. Right.

And, but, but I'm also, I've been doing this for a long time. So I always say when you're new to fasting and you haven't yet gotten those macros right for yourself, if you're hungry in between, eat. But just remember that if you're hungry in between, it's just a reminder. Next time bump up the protein, maybe add a little healthy fat, maybe have some avocado, maybe have some nuts. Be careful with the nuts though because they're very easy to overeat because they're delicious. Or if you tolerate dairy, maybe you add some dairy to your salad. I think that's important just to understand. Like, there's. What I think is important about intermittent fasting is it's flexible, so you don't have to be super rigid. But I do think it's important, like, the longer you're doing it and the sooner you figure out for yourself what foods make you feel good, what foods don't make you feel good. What are the things that give you energy? What are the things that make you forget about having to, like, think about snacking? I think that's all important. But obviously, if you're hungry in between meals and you're new to fasting, eat. I'm not discouraging anyone from eating, but.

I think, like what you said, most people are hungry because they're eating not enough protein, not enough fat. They're eating way too many starchy carbs, which is spiking your blood sugar and creating that more. You feel like you need more hunger because you're more hungry. So absolutely this vicious loop there. What about getting in all the vegetables that were taught, like, you need to eat, you know, 20 different vegetables a week or whatever? Are you getting those in? Does it not. Is not that important to you? What are your thoughts there?

Well, I think this is one of those. It's very bio individual. Four years ago, I was in the hospital, and I have to be careful. Like, I do really well with protein, and I can't. As an example, I love Brussels sprouts. I can't eat them every day. My gut just. It's just a disaster. So for me, I always aim to have some variety. I like cabbage. I like Brussels sprouts. I like asparagus. This. I'm obsessed with shishito peppers. Like, absolutely obsessed. And I'll just cook, like, a massive amount of them and have some every day. I do try to make sure that I'm eating a good amount of brightly pigmented vegetables. But if you talk to Dr. Terry Wall, she would tell you to have nine cups of veggies a day. There's no way I could have that much. My gut would not be happy with me. So I think a lot of it's individual. I do aim to have brightly pigmented fruits and vegetables. Like, I had blueberries this morning, and then I had the shishito peppers with my first meal that I had. And so I think it's important to have variety. Most of us eat the same 10 foods all the time. So when you go to the grocery store, look for what's in season. Sometimes we have near misses. I have Teenagers. And occasionally they look at me like I have two heads when I bring home weird vegetable that they're like, what do we do with this? But sometimes we have winners. Like fennel is a favorite in our house. We will have on occasion. So I think there's a degree of variety. Get out of your comfort zone, own. We're always trying to mix things up in my house. Although if you ask the teenagers, they probably have four or five things that they like to eat and that's kind of what they focus on. But as an adult, a real adult, I do encourage people to experiment. Don't be frightened. Go to the store, you know, look for a recipe. It doesn't have to be complicated. I'm a huge believer, as I know you are, to not make things super complicated. So just have like Maybe you have 10 proteins and 10 veggies and maybe have five pieces of fruit that or types of fruit that you like. Like, and you just kind of move them around depending on what day of the week it is.

I've got a few final questions for you. What do you want women especially to decide about intermittent fasting?

I want them to be open to the possibility that fasting may be a strategy that really allows you to feel good in your body. I know as we are getting older, we're taught things like weight gain is just a function of aging. This is to be expected. And I'm here to say that I can't tell you how many of my close friends and colleagues are living their best lives in middle age. So.

Don'T, per se, listen to all the hype that's out there. There's a lot of fear mongering. Be open minded to the possibility that intermittent fasting or eating less often can be a really effective way to balance your hormones, to be able to address some of the body composition changes that occur with aging, and to just be able to live a life where you're not focused on food all the time. I like food, but I don't think about food the way I did when I was eating snacks and mini meals and racing around a hospital seeing patients. I have a much healthier relationship with food. I'm like, okay, the food works for me on my timetable as opposed to the other way around.

Yeah, yeah. What is your vision? What do you want women to see for a vision for themselves when they start shifting this? Because a lot of them, most of them listening, are not intermittent fasting yet. They haven't done this. It's scary to them. I want them to hear from you like the vision of what life could look like when they start adding this in?

Yeah, I think for a lot of people, if this concept is new or you've never tried it before, imagine having more energy. Imagine having more mental clarity. And I think for many of us that are, you know, approaching menopause or in that age range, we see things that are happening to older family members that are kind of scary, you know, in terms of cognition and mental health changes. So from my perspective, when we're imagining what the possibility could be, imagine living your best life when your kids are grown. When your kids are maybe in college, out of the house, you have more ability to connect with your partner. You have more ability to be more physically active because you have less constraints on your time than you did when your children were younger or different life stages. So I think about more energy, more mental clarity, and just the freedom of not worrying about. I used to walk around with Pyrex dishes. Oh, yeah, it was like snacks and mini meals everywhere I went. And just having food freedom. I think it allows you to have less cravings because you're listening to your body, you're paying attention to the cues. You're not muting them by constantly eating. And I think for a lot of us, there's myself included, I'm not perfect. There have been times in my life where I've just realized, like, my relationship with food was not healthy because I wasn't eating for the right reasons. Like, I was eating because I was stressed or scared or any multiplicity of I was breastfeeding and wasn't eating enough food, so I was craving junk at night. Just understanding that this is an opportunity for you to try something out. Does intermittent fasting work perfectly for everyone? No, but I find most, if not all, of my female patients find tremendous amount of solace in utilizing this as a strategy that they can use for the rest of their lives, not just right now.

So good. Thank you so much, Cynthia. This was fantastic. Thank you.

Thanks for having me.

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