Episode 267: Melatonin, The New Controversial IF Study, Fasting Insulin, Visceral & Subcutaneous Fat, Creatine Use For Men & Women, Sarcopenia, And More!

Intermittent Fasting


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May 29

Welcome to Episode 267 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Cynthia Thurlow, author of Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging.

Today's episode of The Intermittent Fasting Podcast is brought to you by:

BUTCHERBOX: Grass-Fed Beef, Organic Chicken, Heritage Pork, Wild-Caught Seafood: Nutrient-Rich, Raised Sustainably The Way Nature Intended, And Shipped Straight To Your Door! For A Limited Time Go To butcherbox.com/ifpodcast And Get 2 10 Oz. Ribeyes, 5 Lbs Of Chicken Drumsticks, And A Pack Of Burgers For FREE!!

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AVALONX SERRAPEPTASE: A proteolytic enzyme which may help clear sinuses and brain fog, reduce allergies, support a healthy inflammatory state, enhance wound healing, break down fatty deposits and amyloid plaque, supercharge your fast, and more! Avalonx supplements are free of toxic fillers, common allergens, heavy metals,  mold, and triple tested for purity and potency. Get on the email list to stay up to date with all the special offers and news about Melanie's new supplements at Avalonx.Us/emaillist, and use the code melanieavalon for 10% on any order at Avalonx.Us and MDlogichealth.com

To submit your own questions, email questions@IFpodcast.com, or submit your questions here!! 


BUTCHERBOX: For A Limited Time Go To butcherbox.com/ifpodcast And Get 2 10 Oz. Ribeyes, 5 Lbs Of Chicken Drumsticks, And A Pack Of Burgers For FREE!!

BEAUTYCOUNTER: Keep Your Fast Clean Inside And Out With Safe Skincare! Shop With Us At melanieavalon.com/beautycounter or beautycounter.com/cynthiathurlow And Use The Code CLEANFORALL20 For 20% Off PLUS Something Magical Might Happen After Your First Order! Find Your Perfect Beautycounter Products With Melanie's Quiz: Melanieavalon.Com/Beautycounterquiz
Join Melanie's Facebook Group Clean Beauty And Safe Skincare With Melanie Avalon To Discuss And Learn About All The Things Clean Beauty, Beautycounter And Safe Skincare!

BLUBLOX: Go To BluBlox.com And Use The Code ifpodcast For 15% Off!

Leave A New Review (Or Update An Old One) On iTunes To Get Exclusive Access To The Lost Epsiode: Epiosde 1!

Discussing The New Calorie Restriction/IF Study

Calorie Restriction with or without Time-Restricted Eating in Weight Loss

Fasting Has NO Benefits?! (Jason Fung)

Studying Studies: Part V – power and significance  (Peter Attia)

Order At Avalonx.Us, And Get On The Email List To Stay Up To Date With All The Special Offers And News About Melanie's New Supplements At melanieavalon.com/avalonx!

Listener Q&A: Zack - Creatine

Listener Q&A: Loredana - Creatine For Women


#205 – Energy balance, nutrition, & building muscle | Layne Norton, Ph.D. (Pt.2)

The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores

Use The Code MELANIEAVALON For 10% Any Order At avalonx.us And mdlogichealth.com, And Get On The Email List To Stay Up To Date With All The Special Offers And News About Melanie's New Supplements At avalonx.us/emaillist

Our content does not constitute an attempt to practice medicine, and does not establish a doctor-patient relationship. Please consult a qualified health care provider for medical advice and answers to personal health questions.


Melanie Avalon: Welcome to Episode 267 of The Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat, not what you eat with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker and author of What When Wine: Lose Weight and Feel Great with Paleo-Style Meals, Intermittent Fasting, and Wine. And I'm here with my cohost, Cynthia Thurlow, Nurse Practitioner and author of Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging. For more on us, check out ifpodcast.com, melanieavalon.com, and cynthiathurlow.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment and no doctor-patient relationship is formed. So, pour yourself a mug of black coffee, a cup of tea, or even a glass of wine, if it's that time, and get ready for The Intermittent Fasting Podcast.

Hi, friends. I'm about to tell you how you can get a free grilling bundle with over seven pounds of delicious meat all for free. Yes, for free. We are so honored to be sponsored by ButcherBox. They make it so, so easy to get high-quality humanely raised meat that you can trust. They deliver 100% grass-fed grass-finished beef, free range organic chicken, heritage breed pork, that's really hard to find, by the way, and wild caught sustainable and responsible seafood shipped directly to your door. When you become a member, you're joining a community focused on doing what's better for everyone. That includes caring about the lives of animals, the livelihoods of farmers, treating our planet with respect, and enjoying deliciously better meals together. There is a lot of confusion out there when it comes to transparency regarding grazing practices, what is actually in our food, how animals are being treated. I did so much research on ButcherBox. You can actually check out my blog post all about it at melanieavalon.com/butcherbox, but I am so grateful for all of the information that I learned about their company. All of their beef is 100% grass fed and grass finished that's really hard to find. And they work personally with all the farmers to truly support the regenerative agriculture system. I also did an interview with Robb Wolf on my show, The Melanie Avalon Biohacking Podcast, all about the massive importance of supporting regenerative agriculture for the sustainability of not only ourselves with the planet. This is so important to me. I'll put a link to that in the show notes. 

If you recently saw a documentary on Netflix called Seaspiracy, you might be a little bit nervous about eating seafood. Now, I understand why ButcherBox makes it so, so clear and important about how they work with the seafood industry. Everything is checked for transparency, for quality, and for sustainable raising practices. You want their seafood. The value is incredible. The average cost is actually less than $6 per meal and it's so easy. Everything ships directly to your door. I am a huge steak lover. Every time I go to a restaurant, I usually order the steak. Oh, my goodness, the ButcherBox steaks are amazing. I remember the first time I had one and I just thought, "This is honestly one of the best steaks I've ever had in my entire life." On top of that did you know that the fatty acid profile of grass-fed, grass-finished steaks is much healthier for you than conventional steaks. And their bacon, for example, is from pastured pork and sugar and nitrate free. How hard is that to find? 

And for a limited time, ButcherBox is offering our new members a free grilling bundle in their first order. Friends, this is a deal you do not want to miss, especially with the warm weather upon us. Just go to butcherbox.com/ifpodcast and you will get two 10-ounce grass-fed ribeyes, five pounds of organic free range chicken drumsticks, and a pack of grass-fed burgers all for free. Yes, for free. That's butcherbox.com/ifpodcast to claim this deal. And we'll put all this information in the show notes. 

And one more thing before we jump in. Are you fasting clean inside and out? So, when it comes to weight loss, we focus a lot on what and when we eat. It makes sense, because these foods affect our hormones and how our bodies store and burn fat. But do what is possibly one of the most influential factors in weight gain? It's not your food and it's not fasting, it's actually our skincare and makeup. As it turns out, Europe has banned over a thousand compounds found in conventional skincare and makeup in the US due to their toxicity. These include endocrine disrupters, which mess with your hormones, carcinogens linked to cancer, and obesogens, which literally can cause your body to store and gain weight. Basically, when we're using conventional skincare and makeup, we are giving these obesogenic compounds direct access to our bloodstream and then in our bodies. Studies have shown they do things like reduce our satiety hormones, increase our hunger hormones, make fat cells more likely to store fat, and more resistant to burning fat, and so much more. If you have stubborn fat, friends, your skincare and makeup maybe playing a role in that. Beyond weight gain and weight loss, these compounds have very detrimental effects on our health and they affect the health of our future generations. That's because ladies when we have babies, a huge percent of those toxic compounds go through the placenta into the newborn. It is so, so shocking. And the effects last for years. 

Conventional lipstick, for example, often tests high in lead and the half-life of lead is up to 30 years. That means when you put on some conventional lipstick, 30 years later, maybe half of that lead has left your bones. On top of that, there is essentially no regulation of these products on the shelves. That's why it's up to us to choose brands that are changing this. The brand that is working the hardest to do this is Beautycounter. They were founded on a mission to change this. Every single ingredient is extensively tested to be safe for your skin, so, you can truly feel good about what you put on. And friends, these products really, really work. They are incredible. They have counter time for anti-ageing, counter match for normal skin, counter control for acne and oily prone, and counter start for sensitive. I use their Overnight Resurfacing Peel and vitamin C serum every single night of my life and their makeup is amazing. Check on my Instagram to see what it looks like. Tina Fey, even wore all Beautycounter makeup when she hosted The Golden Globes. So, yes, it is high-definition camera ready. They have so many other products, deodorant, shampoo and conditioner that I love, products for babies, and so much more. You can shop with us at beautycounter.com/melanieavalon or beautycounter.com/cynthiathurlow and use the coupon code, CLEANFORALL20 to get 20% off your first order. Also, make sure to get on my clean beauty email list, that's at melanieavalon.com/cleanbeauty. I give away a lot of free things on that list. So, definitely check it out. And you can join me in my Facebook group, Clean Beauty and Safe Skincare with Melanie Avalon. People share their experiences, ask questions, give product reviews, and I do a giveaway every single week in that group as well. 

And lastly, if you're thinking of making Clean Beauty and Safe Skincare, a part of your future like we have, we definitely recommend becoming a band of Beauty member. It's sort of like the Amazon Prime for clean beauty. You get 10% back in product credit, free shipping on qualifying orders, and a welcome gift that is worth way more than the price of the yearlong membership. It is totally completely worth it. So, again, to shop with us, go to beautycounter.com/melanieavalon or beautycounter.com/cynthiathurlow and use the coupon code, CLEANFORALL20 to get 20% off your first order. And we'll put all this information in the show notes. All right, now, back to the show.

Melanie Avalon: Hi, everybody, and welcome. This is Episode number 267 of The Intermittent Fasting Podcast. I'm Melanie Avalon and I am here with, Cynthia Thurlow. How are you today, Cynthia?

Cynthia Thurlow: I'm doing well, my friend. How are you?

Melanie Avalon: What's crazy and new in your life? I know you're all over the place with shows, and book madness, and everything.

Cynthia Thurlow: Yeah. No, I think our mindset were four weeks away from a vacation. It's getting two teenage boys, and my husband, and myself mentally prepared. If anyone's listening has teenagers, that they grow so fast at this point that they have to try on a bunch of clothes, because where we're going to we're going to need some nicer things for dinner. And so, nothing that they had from last summer fits them. Absolutely nothing. There's been a lot of growing pains in this past weekend. Lots of boy hormones and nonsense, but I think we finally got it organized and under control. We live in a part of the country where we have four seasons. I was transitioning closets, and sheets, and all of these things, lots of motherly things, and then gearing up for a busy week of Everyday Wellness podcasting myself.

Melanie Avalon: I don't think I know, how old are they? 

Cynthia Thurlow: My oldest is 16 and my youngest is 14. One is six feet tall and the other one is 5'5". They're wonderful, but we have moments. Hormonal moments with boys, even though, they keep to themselves. I would say, it's almost living with a college student, because they stay up really late, they sleep in and I let them sleep in, because we're coming off of spring sports, we haven't yet started summer sports. And from my perspective, as long as they get good grades and they've got a nice group of friends. I'm pretty tolerant. But yeah, it's like they come out of their rooms to eat, and shower, and then they go back. They are like moles. I just think it's very different than when I grew up. My mother would not have been tolerant of that, but I just think it's coming off the past two years of a pandemic. The fact that they had an entire school year, where they were physically in school, and got to participate in sports, and got to spend time with friends that I'm like, "Them sleeping in on the weekend is really not a big deal," although, they do stay up later than my husband and I. It's a known fact. They're probably up till two on the weekend and then they sleep until noon. 

Melanie Avalon: I'm researching sleep a lot, and adolescence, and even like in your teens and stuff you really do need more sleep. Whenever I read that, I get jealous of my former self because I still sleep in and so back then it was scientifically normal. And my mom as well always let me sleep in which I'm very grateful for.

Cynthia Thurlow: They really do need to sleep. If you understand physiologically what's happening with their bodies that to me, there's no value in waking them up at 7 AM and having them be really grumpy and disagreeable. I'm like, "I'd rather they sleep." Much to the same point, one of the blessings of the past few years is that I was much less regimented about getting up really early to go to the gym. And now, most days, I wake up without an alarm clock and my body naturally on its own will wake up somewhere between six and seven, and I'll go to bed between 9:30 and 10. But I think it's important for all of us to lean into our biologic needs as it pertains to honoring our own unique chronobiology. I know that I tend to get up early, and you tend to stay up late, and even as adults, I think each one of us has our own innate, I don't want to say peculiarities, but things that make us unique. I think I would never have survived working in medicine, if I was not someone that could get up early, because we had to be rounding really early in the morning like obscenely early.

Melanie Avalon: That's something that we'll carry on. Gin, as well was or is [chuckles] a lion, an early bird as well. We balance that dynamic. It's funny. I sleep in, I stay up really late, I work late, I sleep in, I still feel guilty about it every single morning. I should probably work on that. Because I don't think I need to be feeling guilty, but I do. 

Cynthia Thurlow: Yeah. No, you shouldn't. Well, because I think as a culture, we praise people.

Melanie Avalon: it's out of line with society. 

Cynthia Thurlow: Yeah. It's like we praise people. But now, if the past two years have taught us nothing, we have way more flexibility than we ever thought were possible. If you have the ability to work from home, find the schedule that works for you. I can tell you quite honestly, I would much rather work really hard while my kids are generally in school, and then late afternoon when carpool starts, I can jump into that, and then I can relax into my evening as opposed to-- Years ago, I would fight myself to stay up really late and work, and there's this law of diminishing returns that I fervently believe in. And for me, especially, when I was writing my book, I was like, "I'm much better in the morning. Much better in the early afternoon." And then as the day goes on, I get a little less patient and a little-- It's not that I can't do podcasts recordings, because I'm sure both of us have had to be flexible with people that live overseas or have varying types of different work schedules. But as a rule, I've just come to find out like I'm at my best earlier in the day.

Melanie Avalon: Yep. And I'm at my best at night.

Cynthia Thurlow: [laughs] And so, we record in the afternoon when we're bridging both.

Melanie Avalon: Yeah. [chuckles] Works well. My mom, though, she's been very supportive of my sleep schedule like you, she let me sleep in. Every time I come to her, and lament my staying up late, and sleeping in late, she's like, "Melanie, that's just the way you are. Don't try to change it," because she's a night owl, too, and her mom and her dad are. 

Cynthia Thurlow: That's really interesting. My mom was one of those people, who worked. She's always had a very demanding job. Before she retired as a CIO of a huge medical system, I think she was probably getting by on three or four hours of sleep a night. And now, that she's retired, it is so nice to see her actually sleeping in. There was a Sunday morning, I think I called her at nine and she was like, "Oh, we hadn't gotten up yet." I was like, "I'm glad to know you're becoming a normal human and listening to what your body needs." She even acknowledges now that all those years where she didn't get enough sleep and it impacted so many things including her metabolic health that she wishes she had listened more to what her body was trying to tell her.

Melanie Avalon: Have you interviewed Matthew Walker? 

Cynthia Thurlow: I have not.

Melanie Avalon: I really want to interview him. He's the sleep guy. What's his book called?

Cynthia Thurlow: I'm not familiar with his work. But yeah, I think all the chronobiology and all the research that's emerging about circadian biology to me is really fascinating. The more I understand and the more I can share with people. It just explains so much about melatonin clocks, and digestion, and why we shouldn't eat two to three hours before bedtime, and how that impacts insulin sensitivity. All of a sudden, all these things make sense. I don't know about you, but if I eat too late into the evening, my Oura Ring's just squawking at me the next day. Your heart rate was up, it was elevated overnight. I'm like, "How does it know I didn't even eat that much?"

Melanie Avalon: It's funny. I eat very late, and right up until bed, [chuckles] and my Oura Ring, so, It's interesting. I've hit a glass ceiling I think in that-- It'll say that I slept really great and it will give me a good readiness score. Actually, when I interviewed Harpreet, who was the CEO at the time of Oura, he's not anymore. I don't know-- [crosstalk] 

Cynthia Thurlow: I know. I know, because I was trying to get him on the podcast and then they politely told me he was gone.

Melanie Avalon: Yeah. I saw that on Instagram. It says former CEO. I was like, "Oh." Basically, I could have a perfect sleep, but because I go to bed so late, even though, the Oura Ring knows I go to bed late, and it recommends that I go to bed at 2 AM, it's not going to give me over a certain score. Because one of the factors is, if you went to bed early, so, I think that hinders my score. But it's interesting. It will say, "Did you eat too close to bed?" But I still get a really good score.

Cynthia Thurlow: But I also think there's an age-related variable. I think Peter Attia was talking about as an example like HRV, if you plot it someone at 30 is going to get a different HRV than someone say, my age. I'm 50. If listeners don't know that, I'm 50. He was talking about like an HRV predicted average for a 30-year-old might be very different than someone at 50. I have patients that are always fixated on their HRV information or a variability, and I have to point them to his article and I'm like, "Maybe you need to take a look at this," because there is some age-related variance. Just like my bone mass and my muscle mass isn't going to be the same as it was in my 30s and that's okay. I think HRV is another one of those metrics that can be impacted by age. Just based on chronologic age, not that I'm not a good example of a healthy 50-year-old, there're some variances that you got that are unique to the aging process.

Melanie Avalon: Actually, I finally bit the bullet and subscribed to his subscriber feed. I'm working my way backwards through all of his Q&A episodes.

Cynthia Thurlow: Oh.

Melanie Avalon: They are so good. I just listened to the HRV one. It took me a while to bite the bullet, but totally worth it.

Cynthia Thurlow: It was totally worth it. I was actually telling my husband is obsessed with Peter Attia and now, listens to his podcasts and Huberman. He's an engineer. To him, the level of detail he really appreciates, even though he's not someone that's an academic and he's works for a German-based company. I was trying to convince him to get the insider with Peter Attia and he was like, "Well, you can just tell me what I need to know." I was like, "Buddy, I take notes." When I listen to Peter, I have a notepad out, same thing with Huberman. I just take notes, because I'm learning so much. I think that's one of the really amazing attributes of podcasting is you have the ability to impact so many people unknowingly. It's a wonderful resource and it's a wonderful way to learn.

Melanie Avalon: If I get to interview him, I told you how I finally connected with his people, right? So, if I get to, I will be so nervous. I don't even know. Oh, my goodness.

Cynthia Thurlow: I think that'd be a really cool thing. 

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Friends, you know I'm a night owl. I like working late. With BLUblox, I can totally do that and still get an amazing night's rest. The thing is there are a lot of blue-light blocking glasses on the market. As you guys know, I only want the best of the best, that is BLUblox. Andy Mant founded the company, because he realized just how profound of an effect blue-light blocking glasses were having on his own health. But he realized most of the ones on the market weren't actually blocking all of the blue light. That's why he made BLUblox. They have an array of glasses to fit different needs. They're clear computer glasses. Those are actually great to wear during the day, especially if you're staring at computers all day. They also have their light sensitivity glasses. You can also wear those during the day with screens. They're tinted with a special yellow color that actually has been shown to boost mood. And then lastly, they have their blue-light blocking glasses for sleep. Those are the ones that you put on two to three hours before bedtime to help get the best night of sleep possible. If you had all struggled with sleep issues, when you start using these, you're going to wonder how you ever slept without them. Same with computer issues. If you get headaches, dry eyes, tension, anxiety from our modern environment, definitely check out their computer glasses and summer glow glasses.

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Melanie Avalon: For listeners, we have gathered some feedback, which I was posting in my Facebook group, IF Biohackers about Cynthia being on board, which is just so exciting. I'm already just so enjoying this. But it was interesting because people were putting comments of what they were looking forward to-- Oh, which if you haven't heard the announcement. If you would like to get the missing secret Episode Number One of this show, which was lost for a long time, and I did get a question about this. Somebody emailed and said, "I thought you said this was lost. How do you now have it?" It was lost. When Gin was working on making the transition, she was cleaning up her emails and everything, and she found it in our old emails to each other. That's how it randomly popped out of the universe. If you would like to hear the missing Episode number 1, we will send it to you. Just write a new or update your old iTunes review for this show and include in the review what you are excited to experience or learn about with Cynthia specifically, and email that to questions@ifpodcast.com, and we will send you that first episode. 

All of that to say, one of the feedbacks that we have been getting is that people are really excited, especially, so, Cynthia is a Nurse Practitioner, and has a clinical background, and so, people I think are really excited for us to dive a little bit more into more clinical stuff, and studies, and things like that. We thought for today's episode, which is still listener Q&A, but we would start things off by, it was actually perfect timing. A study came out which a lot of you might be familiar with because it hit all of the headlines. The study itself is called "calorie restriction with or without time-restricted eating and weight loss." It was published on April 21st, 2022 in the New England Journal of Medicine. We'll put a link to it in the show notes. And again, the show notes will be at ifpodcast.com/episode267. But in any case, what is so special about this study is that it took over the news. The headlines were things like, "time-restricted eating, no better than counting calories study finds," that was on CNN. New York Times said, "Scientists find no benefits to time-restricted eating." It definitely created a lot of controversy. We thought we would actually take a moment, and look at this study, what is it showing, what is it finding, are these headlines correct, and what they are portraying? You want to start Cynthia, anything to say about the study?

Cynthia Thurlow: Yeah, it's interesting. The media likes to just be sensational and sensationalize information. As soon as it came out, I went and pulled the study, and looked at it, read through it, and most of my clinical peers felt very similarly that when you're looking at research, and I'm not sure. If you've talked about this on the podcast before when you're looking at research, you want to look at how many people were enrolled, were they healthy, was there a breakdown? One of the things that stood out almost automatically was that I think the BMI range like as an example. Body mass index, which isn't per se necessarily, particularly accurate, especially if you're muscular. But the body mass index was between 28 and 40. And for context purposes, a BMI of 30 and above is obese and then 40 and above is considered to be morbidly obese for most metrics that are used. It stood out to me initially, they're saying that no one is diabetic. But yet, clearly, this is not the healthiest population of people to start with. That was the first thing that stood out. 

Another thing that stood out for me was that in terms of looking at the population, there was no accountability for physical activity. They weren't observing people eating and they had some degree. I forget how the terminology they use, but there was some type of processed food products that they were expected to consume. We don't really know, per se, and this is why nutritional science is so confounding is that it's actually very hard to track with every single thing people put into their mouths, unless they're in a controlled environment. So, those were the first two things that stood out to me. How about you, Melanie? When you were looking at the research what stood out for you?

Melanie Avalon: Yeah. I actually have it pulled up right here, so they can comment on what they were eating. They were following, for men, it was a 1,500 to 1,800 calorie per day diet and women, it was a 1,200 to 1,500 calorie per day. And then that processed food you were talking about was they were provided one protein shake per day for the first six months to help improve adherence, which speaks to what you just said that it's difficult when it's an outpatient study, where it's not controlled, [chuckles] where they're not in a metabolic ward receiving all of their food, it's difficult to actually have people to know exactly what they're eating and if they're adhering. 

That was one of the big things that stood out. Because the study is talking about the benefits of intermittent fasting versus calorie restriction. It's actually shocking to me that they did not pull the participants on their ease of use. They didn't ask them at all about their psychological experience of it, because oftentimes, they'll ask that in studies. I forget the terminology they use, but it'll be like, "Was it difficult or not?" And they didn’t ask them that at all. We have no idea if the people who were doing the calorie restriction versus the fasting and calorie restriction, if one of those was an easier protocol to follow or not, which would have major implications for how this actually would apply to real life.

Cynthia Thurlow: It's interesting not to interrupt you, but one of the other things that something you said reminded me of this one issue. When you were looking at the macro breakdown to the breakdown of protein, fat, and carbs. I was like, you already have a potentially, metabolically unhealthy group and it was very heavy on carbohydrates. I'm not anti-carb. Let me be really clear. I don't think that everyone has to be low carb or ketogenic. But if you already have a population of people that are being enrolled in a study that we know are probably insulin resistant or at least are diabetic, even though they screen for diabetes, but there's no way someone with a BMI of 40 is not insulin resistant. It's really interesting to me that instead of pushing the protein lever, it was still a very carbohydrate focused diet. With a macro breakdown to me was not the macro breakdown I suggest for people when they're trying to lose weight.

Melanie Avalon: Yeah. No, that's an excellent point. I wonder the screening, because they did screen for diabetes. I wonder if they were screening for type 1 and type-- They're probably screening for both, but they didn't screen at all for prediabetes. 

Cynthia Thurlow: Yeah. The conventional Western medicine or allopathic model is still really looking at fasting glucose and A1c, which is a 90-day snapshot of blood sugar control. The thing that I like to always introduce, well, your fasting blood sugar can be okay and your A1c can still be okay. But if your fasting insulin is dysregulated, that's oftentimes the very first biomarker that will dysregulate, they're very likely not even looking at that. I can't tell you how many people, like, I talked to them and they'll share their labs and I'm like, "Where's the fasting insulin?" Then they get a fasting insulin back. And instead of being between two and five, which is where ideally it should be, it's 20. I'm like, "Okay, well, this explains why your weight loss resistant." 

I don't think that they provided information about how they were screening. I agree with you that that could have also very likely been a way that they may have missed people, who would not have been metabolically flexible enough to be able to participate in a meaningful way. Not to mention the fact that oftentimes, insulin resistance can also be connected with leptin resistance. I'm sure our listeners are really savvy about leptin being this other hormone. I just start to think about all of the little nuances like as a clinician that I didn't see were even addressed or mentioned in that study. I think the other piece is like, New England Journal of Medicine is a preeminent Journal. Even really good journals can have research in them that cause us all to scratch our heads and say, "Okay, well, it was helpful. We have to do more research to look at these variables, and we have to be even more conscientious about who we're enrolling in these studies, and what's really going on for them outside of this laboratory environment."

Melanie Avalon: So, something you said sparked a very tiny little baby rabbit hole for me tangent. Actually, the episode I was listening to last night that Peter Attia, Q&A episode, I was listening to the one on continuous glucose monitors and he was talking about, "Would we ever have a continuous insulin monitor?" The potential with that or the issues with that he answered the question of what did he think was the first biomarker that would be off that would indicate prediabetes or headed that route? Do you want to guess what it was?

Cynthia Thurlow: Probably, not going to be like uric acid or something like that.

Melanie Avalon: It's in the realm of what you were talking about. 

Cynthia Thurlow: So, did he think it was insulin? 

Melanie Avalon: Yes, but what type. when? 

Cynthia Thurlow: Probably, postprandial?

Melanie Avalon: Yeah. Basically, after eating, the insulin that would be the first thing. But that's something that we're not really ever testing. So, that's why he was saying, one of the benefits of having a continuous insulin monitor would pick up on that. In any case, back to the study. I guess, we can talk about what it actually found. This is probably the first thing that stood out to me the biggest thing, which was, if you had come to me and said, "We're going to do a study, where we will compare people on calorie restriction and then people on calorie restriction with fasting," what do you think we'll find? Honestly, I think I would say, "What this study found is pretty much exactly what I would have anticipated finding," which is I would anticipate that they both lose weight or I would guess that the fasting people would lose a little bit more weight. But I wouldn't think that it would be a massive amount more, because both are calorie restricted. I would expect that all other biomarkers would probably improve a little bit more in the fasting group, which is exactly what this study found, despite the lack of "statistical significance," which is something I can comment on in a little bit of detail. We'll put a link in the show notes. 

Jason Fung did a nice write up on this in his Substack. We can put a link to that. He talks about this in that right up. But basically, for people who aren't familiar, when you have a study, significance means statistical significance. It doesn't mean because if people hear significance, they might think it means like, "Oh, that was like a really good effect." But it just means that it's showing statistically that this is happening. But I think a lot of people don't realize is, it's not you do the study, and then you look at the data, and then you determine if what you found was statistically significant. It's set up from the beginning to only be statistically significant if a certain outcome happens. That's a subtle nuance, but it's really important and it has to do with something called powering a study. 

This study was powered to find a weight loss difference of 2.5 kilograms, which is five and a half pounds. What that means is that if the fasted group did not lose five and a half pounds more than the other group, then the conclusion is it's not statistically significant. What ended up happening was, the fasting group lost about four pounds more, not 5.5. Because of that, they can conclude, "Nope, there's no statistical significance," which I think is doing a bit of disservice to the whole concept. What Jason talks about in his write up is he says that if you look at the numbers, so, basically, the calorie restriction group, they lost 6.3 kilograms after 12 months, which means that the fasting group in order to be statistically significant would have had to have a 40% increase in weight loss, numbers wise. 

As Jason points out in his overview, that's a really high bar, [chuckles] especially when they're already losing a significant amount of weight. But when I say significant, I don't mean statistically significant. In any case, the study was underpowered. Not that it was set up to fail, sort of was. We can put a link in the show notes. Peter Attia also has a really nice write up, where he it's a five- or six-part series, where he talks about how to interpret and read studies. He talks about this about powering studies and he talks in that about how just because something is not statistically significant, it doesn't mean that it's not showing something. And just because something shows something, they don't necessarily correlate. So, I have other thoughts, but I'll stop because that was a lot.

Cynthia Thurlow: No, I think you did an excellent job. I think on a lot of levels, right after that study came out, I jumped on and did a really short IG live saying, "This is not going to change my perspective on fasting." I think this really speaks to the fact that the media likes to jump on one little snippet and say to propagate this misinformation that, "Oh, fasting isn't valuable." I always explained that if you looked at the groups, the fasting group always did better. It just didn't reach, as you mentioned, the statistical significance that had been set up prior to the study starting. I think this is a really important reason for why even at a very basic level, each one of us need to understand how to properly interpret a study or even to be able to look at some of the big highlights that you and I have talked about, so that you can examine it and say, "Is this really valid?" Can we extrapolate from one study, that fasting is invaluable or is not valuable, rather? I think it really goes back to not throwing the baby out with the bathwater. I mean, I hate that expression, but it just seems really appropriate in the circumstance. And certainly, you and I both have seen thousands and thousands of people that have benefited from eating less often. 

The other piece is, and someone asked me this, and I never dove down the rabbit hole to figure out who had sponsored the study. I know it was done in China, but I don't know who sponsored the study. Because sometimes, when you see who's sponsoring particular research, it makes you understand why they're getting results that might be contrary to what is commonly believed to be true. 

Melanie Avalon: Yeah. It says that it was supported by some Grants National Key Research and Development Project, Outstanding Youth Development Scheme of Nanfang Hospital, a lot of other research programs. It's just so interesting. In a way, it's arbitrary. If the researchers had decided beforehand, let's set it up to look for a four-pound difference, then it would have been a completely different interpretation. Isn't that crazy? You would have a completely different headline, same findings, probably, to that point about the benefits extending beyond just the fasting. Basically, in the fasting group, because they looked at the participants results six months out and 12 months out, and basically, everything got better in the fasting group compared to the calorie restriction groups. The HOMA-IR, which is huge comparing insulin and glucose, the insulin, glucose, HDL, triglycerides, blood pressure were all better in the fasting group. LDL was very similar in the two groups, which is interesting. I don't know why that might be. I was actually wondering if you had any theories on why the LDL is really interesting. At six months, it was down negative 5.9 in the fasting group and down negative 11.3 in the calorie restriction group. So, almost double. But then it evened out at 12 months. Negative 8.4 compared to negative 8.9.

Cynthia Thurlow: I wonder if it's really a marker in that instance of inflammation and a reduction in oxidative stress, because it's not uncommon. For listeners benefit, when we're looking at LDL, it's only one piece of a puzzle. I always like to look at advanced lipid analysis. Looking at particle size and as an example, you can have light and fluffy or you can have dense and small. The latter, it tends to be more atherogenic. If you're already looking at a population that to me sounds, they're not metabolically healthy. I think that weight loss is probably what's driving the lowered LDL numbers. Why the HDL--? Well, they didn't account for physical activity. I think that was one of the things that stood out to me, because we know that HDL is-- There are many things that impact HDL, obviously. But one of the things that's impacted by HDL is exercise. If these people were couch potatoes, I don't know what the equivalent would be. I don't know how physically active this group was. I'm assuming they weren't. That could account for why there wasn't a significant change in their HDL, my first thought.

Melanie Avalon: I think the biggest difference just looking through the charts, the area of abdominal subcutaneous fat was really different. At 12 months, the calorie-restricted group lost 37 centimeters squared and the time-restricted eating group lost 53.2. 

Cynthia Thurlow: That's significant. 

Melanie Avalon: This was subcutaneous. The visceral was still it was 21 for the calorie restriction and 26 for the fasted group.

Cynthia Thurlow: No, so that differentiators, the subcutaneous fat is an annoying fat. That's the one that most of us, when we think about fat on our bodies that we don't like, that's not as pathogenic as visceral fat. I think that with weight loss, you'll see changes in both, but one is certainly more significant than the other. And obviously, where we carry fat is significant. On our butt, in our thighs, as women is much less significant than our abdomen area like our truncal. They call it truncal obesity, but that area is much more significant, because that's closer to our major organs and generally correlates with metabolic inflexibility and insulin resistance.

Melanie Avalon: Yep. That's all in my head right now because I'm prepping to interview Sara Gottfried on Monday, who Cynthia just interviewed as well. She talks a lot about the role of different types of fat in the body and how it changes for women in menopause and good times. But yeah, so, basically, it's frustrating, honestly, because the study showed in my opinion, really great things about fasting and just the takeaways in the headlines are just so not representative of what it actually found. And then on top of that, I can see the benefit of comparing fasted calorie restriction to calorie restriction. But at the same time, I think, in general, the reason people love fasting is they get the benefits without the calorie restriction. I was reading one comment on the study and I actually laughed, because it's not funny, but it's the type of thing I would laugh at and it was like-- Somebody said, "Well, basically, all the studies showed is that calorie restriction works," which yes, [laughs] if it's actually controlled.

Cynthia Thurlow: Well, and I think it goes back to there's always this debate about calories versus the carb, insulin hypothesis, and weight loss. It's two different dogmas really fighting fervently to better understand what drives inflammation, and weight loss resistance, or weight gain, and so. The debate is still out there. There's no question that fasting is a valuable resource. For a lot of people, who don't want to calorie count and I'm definitely one of them, I just enjoy knowing that I can eat within a particular window and I can modulate a lot of different factors that helped me maintain a healthy weight.

Melanie Avalon: Exactly. I think what's interesting and this is a question that has stuck with me in my show, The Melanie Avalon Biohacking Podcast. I've interviewed so many people, but every now and then I ask a guest a question, and it just sticks with me asking them, and it sticks with me their answer. And one of those questions was, when I had James Clement on the show. He wrote a book called The Switch and we've become really good friends. But I asked him all of these different things like fasting, calorie restriction, protein restriction, are they additive, or are they all activating similar pathways? So, they're not additive. He said, "They're not." They basically cancel each other out. If you're doing calorie restriction and calorie restriction in fasting, you're not necessarily going to see a huge additive benefit, because they both work by similar mechanisms even though fasting doesn't necessarily require calorie restriction. They activate similar pathways. So, yeah.

Cynthia Thurlow: I haven't interviewed him, yet. 

Melanie Avalon: He's lovely. Although, I was just talking to him, because [chuckles] I was giving him my monologue of what I thought about the study and to see what his thoughts were and he said he basically agreed. So, I felt good. [laughs] 

Cynthia Thurlow: Good to have that validation.

Melanie Avalon: I know. I was like, "Okay, from the scientist." He runs a lab that studies the blood work of super centenarians. He did this huge super centenarian study, and then he wrote The Switch, and right now he's actually working with Steve Horvath, who I would die to interview. [laughs] George Church wrote the foreword to his book, it's all the big wigs in the genetics world. He did say, last night, he's not really doing podcast interviews anymore. I don't think they're his thing. 

Cynthia Thurlow: A lot of those researchers-- I always think like Rick Johnson, for anyone that's listening, he's this amazing fructose researcher. But he is probably one of the most gregarious, happy, extroverted researchers I've ever met in my entire life. I thought when I recorded with him that it was so dense in terms of content that I was like, "Well, I'm going to be curious to see how this resonates with my listeners" and they loved it. They're like, "Oh, my gosh, he makes it so clear." I agree with you that sometimes these research folk tend to be a little more cerebral, they're a little more introverted, they might be less comfortable doing podcast interviews, which is a shame because I think podcasting is such an amazing way to really get a sense for what people are doing and to share ideas in a way that can inspire others to take better care. My feeling is, I listen to podcasts, because I'm always looking for another angle to look at to help patients take better care of themselves. But not all of us are extroverts and introverts. Some people are just true introverts. The thought of being on a podcast probably gives them hives.

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Melanie Avalon: I'm glad you brought Rick up. When Gin and I were discussing, transitioning her out of the show, and I wasn't sure yet about Cynthia, I was like, "Oh no, I need to bank up some interviews." I actually reached out to Rick to see if you'd like to come on this show, because I just think his content is so valuable and listeners of this show would really love his work, because I had him on the other show. So, I'm actually interviewing him for this show. I don't know when we'll air it, but just to have it. I'm interviewing him this week.

Cynthia Thurlow: I think he's amazing. He's probably easily one of my favorite interviews I've done this year.

Melanie Avalon: He's just fabulous. [laughs] So, listeners get excited. I'm not sure when we'll air that, but we will have an episode on this show with him upcoming. Okay, I think we tore that study apart. Again-- [chuckles] For listeners, again, the show notes will be at ifpodcast.com/episode267. We'll put a link to that study there. If you want to read the whole study, it is in the New England Journal of Medicine. Right now, only the abstract is available, but you can sign up for a New England of Journal Medicine account and you get I think at the beginning three free studies. Use them wisely. [laughs] So, you can grab this one if you like. Okay, shall we jump into some listener questions? 

Cynthia Thurlow: Sure. 

Melanie Avalon: To start things off, this is very exciting, because Cynthia and I were brainstorming about topics to talk about and Cynthia, specifically, wanted to talk about creatine and I was like, "Well, I got you covered," because if listeners are curious, we have this massive document of all questions that have ever been submitted to the show ever and it is hundreds and hundreds of questions. If there's ever a topic we actually want to talk about, we don't have to make up a question. I just have to go in there and find it, because I'm sure somebody has submitted one before. We have two questions about creatine that I'm going to read and then I'm super curious to get Cynthia's thoughts on this. The first question is from Zach and the subject is: "Creatine." And Zach says, "Hi, thank you for all the work you do on this podcast. I'm a former American football player, who has had great success using intermittent fasting one meal a day, paleo eating, and HIIT workouts to lose weight and develop an awesome fulfilling lifestyle. When I finished playing football, I was 300 pounds with zero diet discipline. Luckily, my brother." Hi, John, "told me about your podcast and your books and in the 10 months since my football career ended, I've lost about 80 pounds. I'm still losing weight, but I am also at the point, where I would like to work on muscle mass and tone again. In pursuit of this, I've hidden my scale, opting instead to focus on being happy with my body and not relying on what the scale tells me for my happiness. I use a one-meal-a-day approach. While I have tons of energy for my workouts, I am looking for something to maximize my muscle recovery given my intense workouts. In the past, I've had success taking creatine for this purpose, but that was during my football, eat everything, and get as huge as possible regardless of impact on your body stage. That's my comment." That sounds really intense. He says, "I don't think that creatine has been discussed on the show yet and if so, I apologize for the repeated question. What are your thoughts about supplementing creatine, whether it is beneficial or harmful? If beneficial, when to take it, how much to take, etc.? Thank you so much in advance and keep up the amazing work." And then, Cynthia actually got a DM question from Laura Dana or Laura Dana. And she says, "That she would like advise/education on using creatine as a woman. When, how much, expected reaction, brand? Thanks." She says she loves Cynthia's book, which, by the way is Intermittent Fasting Transformation. So, creatine questions from a man and a woman.

Cynthia Thurlow: I love it. It's interesting. I started working with a new trainer in 2021 like out of her mouth, the first thing she said to me and she's very research based, she's a former attorney, she's just incredible. She was like, "You need to use creatine." I was like, "Wait a minute." I was like, "I've heard so many conflicting things." For benefits of the listeners, there are sex differences between the utilization of creatine. But in terms of benefits, they include things like increased muscular endurance, they increase muscular power, strength, they can improve bone health, and we know that it improves brain health, and it can improve cognitive function, and it helps recycle ATP, which I'm sure Melanie and Gin have talked about, it decreases the effects of sleep deprivation, improves mood and memory. There's lots of benefits, obviously. 

And obviously, the first question comes from someone who played what sounds to be professional football. The second question comes from a young woman, who's asking and so, what I always say is that there are sex-related differences with creatine. We know that women make 70% to 80% less amounts of endogenous creatine in their muscle tissue. But what's interesting is we have increased higher resting concentrations of creatine. It's like, what we do have is significant in terms of, it's almost like testosterone. Women make less testosterone, but what we have in our bodies is the most bioavailable hormone. So, much the point of what we're saying with creatine, there are sex-related differences. What's interesting though is when I looked at the research, we know that there are changes during our menstrual cycles with creatine. We actually get, when we have a more higher estrogen state, so in the follicular phase, we have increased creatine kinase and this can impact glucose oxidation. We know that creatine supplementation in women can be really beneficial in perimenopause and menopause, can actually improve muscle, bone strength and help ward off sarcopenia, which is a term that is essentially muscle loss with aging.

It's not a question of if but when, it starts to accelerate after 40. For those that aren't aware, we have peak bone and muscle mass in our 20s and 30s. I, of course, didn't appreciate this until I got to middle age. It's really important. I think even if you're looking at a review of randomized controlled studies, it definitely looks like supplementation with creatine has a lot of benefits. If people want us to go into a deeper dive into these things, there's a lot. It's so interesting. If you look at the research, sometimes, people will talk about needing a loading phase. I'm not sure, per se, that we all need a loading phase. But I do think it is interesting and what I generally recommend people aim for is a gram a day and the product that I use and take which was recommended to me by my trainer. I want to give her full credit is a product called Con-Cret. It's CON-CRET. And the manufacturer is Promera Sports. You can go to their website. 

What I like that is important is that a lot of times people are worried about taking creatine, because they think it's going to make them bloated, it's going to make them look bulky. As it pertains to women, we just don't have enough circulating testosterone for that to be an issue. Obviously, I use one scoop a day in a protein shake and that works really well for me. Do I feel like it has to be timed around workouts? No. That's oftentimes the question I get. But I do take it during my feeding window. I don't take it in a fasted state. I would imagine men could definitely start with a higher starting dose. This Con-Cret product, it's 750 milligrams in a scoop. Obviously, if we're aiming for a gram a day, you probably want a little more than a scoop and a half or a woman. For a man, you might want a product that has more concentration of the product per scoop. Because for men, it was looking like maintenance phase is somewhere between two to five grams a day. Now, with that being said, I think low and slow is the way to go. Try it out, see how you feel, be careful sourcing supplements on Amazon. I don't know if you've talked about this before.

Melanie Avalon: We talk about this so much. 

Cynthia Thurlow: Yeah. You may actually get something legitimate on Amazon, but the statistical likelihood is pretty low. As it pertains to creatine, you can go directly to the Con-Cret website. I have no affiliation with them whatsoever. But that's generally the recommendation, because there's a lot of junk that's out there. I'm not going to name stores that I think of when I say this, but you really want to look like-- My trainer at one point was an IFBB like bodybuilder. She now looks like a very petite normal person. But this is the product she uses and recommends for her clients, and she's very research based, and very smart. And so, I always like to give her props. But creatine, yes. Creatine supplementation, especially for women really important. We don't have as much circulating in our tissues. In our menstrual cycles, we definitely want to be supplementing it. If we are perimenopausal, menopausal, we want to be more apt to be utilizing creatine because it can help with muscle and bone strength. Like I mentioned, it's not an if but when. Sarcopenia will happen if we don't work against it. That's why Melanie and I always talk about this. You have to eat enough protein, make sure you're doing some weightbearing exercise, getting high-quality sleep, all of which can help you ward off sarcopenia.

Melanie Avalon: I love this. Did you listen to--? How many times can we say Peter Attia on today's episode? Do listen-- [laughs] We're such fan girls. Did you listen to his interview with Layne Norton, recently?

Cynthia Thurlow: I have not, because I went down a rabbit hole listening to-- So, do you know the Low Carb MD Docs?

Melanie Avalon: I do. Who are they? I think so. 

Cynthia Thurlow: It's Dr. Tro and then Brian Lenzkes. They're very good friends. But Tro and biolane as he calls himself have had some knockdown drag outs. But they did actually have a very respectful conversation. I've listened to him on a few other people's podcasts and I have to set aside the time, because as anyone who knows Peter Attia, or Huberman Lab, or any of those, it can sometimes be a two-and-a-half-hour conversation. I have to mentally be on my game to set aside that amount of time and take notes. I haven't listened yet. That was my long explanation for having listened yet, but I do intend to.

Melanie Avalon: Do you what's funny? Speaking of sleep earlier, I listen to very specific podcasts at night during my routine. The shows I listen to at night are always either Ritual, Well-Fed Women, or Peter Attia. I just wonder if I were to listen to Peter Attia during the day, if I would get sleepy, because I'm so conditioned to-- It's like my wind down. I find it very comforting to hear him talk about. [laughs] In any case, though, that recent episode, we can put a link to in the show notes, because they did a deep dive into creatine. Layne was talking about the importance of what you just talked about of finding a good version. They were talking a lot about all the claims that are often put on them are just marketing. 

Cynthia Thurlow: Yeah. Melanie will share the research study I shared with her via text message before we jumped on. My hope is that we are going to be able to offer up some research-based opinions on a lot of topics that people are interested in learning more about. And obviously, if people are interested in learning more, I actually have a lot of notes. I took a lot of notes when I was reading a lot of research articles, because there's a lot to creatine, it's really interesting. Maybe what we'll do is create a mini-creatine PDF or something in the future.

Melanie Avalon: Yeah, that'd be amazing. Questions for you. "Should everybody be taking creatine?"

Cynthia Thurlow: Well, from what it sounds like, I didn't see any major contraindications. Meaning, things that people shouldn't be doing. But I think when women are in their follicular phase, that's when actually creatine is at its lowest. It's reduced in pregnancy, it's obviously lower in postmenopausal women. Obviously, if you're pregnant, I'm not advocating you take this. Let me just put that caveat in there. You have to have a conversation with your OB or your nurse midwife. But menstruating women, yes. Postmenopausal and Perimenopausal women, yes. Because what people don't understand is that muscle loss with aging also impacts our insulin sensitivity, and impacts our metabolic health, and we want to do everything we can to maintain as much lean muscle mass as we can throughout our lifetime. What's interesting is we become insulin resistant in our muscles first. This is really important for people to understand. 

To me, I want to do everything I can to preserve my muscle mass and to continue to build it. I know you're going to interview Dr. Gabrielle Lyon. She's a good friend and I've interviewed her on my podcast. We can even include that link. But she is a muscle protein synthesis expert and she talks a lot about these kinds of topics. I always say she's rubbed off on me entirely, forced me to really understand muscle physiology to different level. For everyone that's listening, unless you're pregnant, I'm not making any blanket statements about pregnant women. But menstruating women, men, and women in middle age like perimenopause and menopause, you can benefit from this. I think it's fairly inexpensive. I want to say, when I bought Con-Crete, I think it was under $25 and it's got 64 servings. You might buy a couple of these a year trying to see how you feel it does for you. But for me, because I'm at a stage where I need to continue to preserve, and maintain, and build what I have, and I'm working at a hormonal disadvantage at this stage. If you're under the age of 40, you're at a hormonal advantage to someone who's middle age. So, it's easier to build and maintain muscle. But at my stage, I have to work harder at it and I'm okay with that. I'm not complaining.

Melanie Avalon: "Since it's an amino acid would you consider breaking the fast?" 

Cynthia Thurlow: Yeah, I would take it. I take it in a shake. To me, I can consume it in a feeding window. I think one of the things that I've seen pretty consistently in your communities and our new shared communities, but also in your own community, people are trying to figure out like, "When they can take something?" When they can't take it, take this with food, or take this with a meal, or take it in a shake. There's no taste to it. I've even put it on water. That's not my preferred way, but you don't have to take it immediately after exercise. Just like you don't have to consume 30 grams of protein immediately after exercise. Your body keeps track over a 24-hour period of time. Don't get caught up in the before and after nonsense. There's so much misinformation about that in particular that I just see across social media. People are paralyzed about when to take stuff. This is definitely something worth taking in your feeding window. 

Melanie Avalon: Yeah, that was actually something from the Layne Norton episode. He's all about eat protein constantly all day.

Cynthia Thurlow: Have you seen him? He's pretty big. He's a big guy.

Melanie Avalon: Yeah. What's interesting about the creatine, so, it recently, semi-recently came on my radar, independent of all of this conversation. I'm going to interview a guy named Simon Hill, he wrote a book called The Proof Is in the Plants. Do you know him? 

Cynthia Thurlow: Mm-mm.

Melanie Avalon: He's big in the vegan world. He was on Rich Roll and they were talking about creatine because there is this study that is, I guess, hotly debated. It's called The Influence of Creatine Supplementation on the Cognitive Functioning of Vegetarians and Omnivores. And basically, what it did was it looked at omnivores and vegetarians before with no creatine supplementation, and then gave them these different cognitive tests, and then had an arm who took creatine to see how they performed with the creatine. When they did that the vegetarian arm performed way better, way better. Whereas before, they had been pretty similar in their performance on the cognition test. It's complicated and the reason it's debated is people debate about how to interpret those findings. But the main way it's been interpreted is, since the vegetarians did way better with creatine supplementation than the omnivores indicates that maybe they were deficient in creatine. That might be something to consider, which is that if you are everything. Cynthia was just saying, if you're not getting all of your protein, or if you're on a vegetarian, or a vegan diet, this definitely might be something that you would like to supplement with.

Cynthia Thurlow: No, I'm so glad you brought that up because that was a part of my little segue. The other thing that I just want to interject that I thought was interesting is, we know that creatine has benefits on sleep, because it interacts specifically with glycine and GABA. These are these inhibitory neurotransmitters in the brain. A lot of people take GABA before bed. But I will say that since I've been taking creatine, I feel there's a whole mountain of things I take to support sleep. I'll be totally transparent. But when I've been consistently taking certain supplements, I've definitely noted an improvement in my sleep quality for sure. But there's also research to show that it can be helpful for sleep support as well.

Melanie Avalon: Out of curiosity, what have been some of the main things that you've implemented that you've noticed? Again, it's hard like you just said because there are so many factors. But what are some of the things that you've noticed the biggest effects on your sleep?

Cynthia Thurlow: In terms of supplementation or just lifestyle? 

Melanie Avalon: Yeah. I guess, anything.

Cynthia Thurlow: I would say GABA and L-theanine for me have been huge, huge. Those two in particular and then high-dose melatonin, and obviously, north of 40, we make less melatonin. Just like every other hormone, we start producing less and less of things. I started working with a new integrative medicine doc towards the tail end of 2021. When he looked in his labs, the first thing he said was, "Oh, my God, you need some melatonin." I said, "Well, my sleep isn't that bad." And then we started talking about the role of melatonin and how it's this master antioxidant. And so that's something I've been using with my own patient's, high-dose melatonin that has really been life changing. This is not medical advice. Obviously, have a conversation with your healthcare provider. But if you're north of 40, you're making less of it and melatonin is more than just helping you sleep. I think those three things for me, the GABA, the L-theanine, the high-dose melatonin has really made a tremendous net impact. I think you're going to interview Dr. John Lieurance, right on your Biohacking.

Melanie Avalon: I did interview him. 

Cynthia Thurlow: Yeah. He reschedules, I reschedule. He reschedules, but he has a product called Sandman. Have you tried it? 

Melanie Avalon: No, it's in my refrigerator.

Cynthia Thurlow: I think it freaks everyone out, because it's per rectum, which my entire family thinks it's hilarious. I only maybe use it once a week. But wow, that stuff-- it's pretty powerful. Don't be afraid of it. But I think when you're younger, there's probably less need of being on super physiologic dosing. I look forward to connecting with him because the more I learn about chronobiology, and circadian biology, and melatonin, the more I feel I'm just I'm like, "Wow, my eyes are open to a whole new world."

Melanie Avalon: I think you and I talked about this when I interviewed you on my show. But I interviewed John, I read his book, which is I think called like Melatonin Miracle or something like that. I was like, "Well, this is very convincing." I still even despite reading his whole book, which talks a ton about there not being a feedback loop system that would hinder your natural melatonin production, I was still not quite sold. He sent me that you use different words that I normally hear. What word did you use for it?

Cynthia Thurlow: Yeah, per rectum, it's how you take it. I was trying to explain to people like you put it up your bum, that's how you take it. It's a very vascular area. So, it's a good way to administer medications or supplements.

Melanie Avalon: Yeah, what's funny-- It's fit in my refrigerator. I feel like John will text me every month or so. I'll be like, "Have you tried it yet?" I'm like, "It's still there."

Cynthia Thurlow: No, don't freak out about it. But I do agree with you, Melanie. Even when I was talking to Michael Breus, I asked him what he thought about high-dose melatonin. He wasn't a fan. I think it always needs to be taken in the context of, for me, I'm 50 years old. My body makes less of it. I sleep better with some supplementation. I'm okay with it. But would I have taken that at 30? Probably, not. Your body's still making vibrant amounts of that hormone and so I think maybe cut it in half and use half the dose.

Melanie Avalon: Well, two things shifted my thinking on that. One was I-- Three things. One was, when I got COVID, the doctor I was working with who is more-- He's a conventional MD, but more open minded. Part of his protocol was getting on melatonin for COVID. I was taking pretty high-dose melatonin during that and not experiencing any perceived negative benefits of that. And then two other things happened. One, the melatonin I currently use is by Pure Encapsulations. It's the exact same bottle as my digestive enzymes. Same size, same color, same everything. I take an exuberant amount of digestive enzymes, like a ton, especially I eat pounds and pounds of protein. I took half a bottle, not realizing it. [chuckles] What was interesting was, I woke up the next day, because I didn't realize that I'd taken that much-- I didn't realize until the next night that I'd taken in half a bottle of melatonin. I was like, "Oh, okay, I think may be my perception--" I didn't experience any feelings of grogginess or anything. I just felt really good the next day. I was like, "I wonder how much my perception of melatonin making me feel too drowsy or an issue. How much of that is psychological?" Because when I took half a bottle not realizing it, it was fine. 

The third thing that sold me on it was interviewing Dr. Steven Gundry for his newest book. His book, Unlocking the Keto Code, he talks a lot about the mitochondria in the cell and everything that's happening with energy production. And even though, John Lieurance talked about in his book, I don't think I really grasp the fact until I read Stephen Gundry's Unlocking the Keto Code that in our cells, the two things that are really keeping those mitochondria going and serving as antioxidants are glutathione and melatonin. Then I was like, "Oh, so, melatonin, it has a lot of benefits on a cellular level beyond just sleep." Now, I do supplement with it more. I'm trying to find my right dose, but I take at least one of my pills each night. I think it's three milligram. 

Cynthia Thurlow: Well, it sounds appropriate. It's funny. MD Logic makes a product and I was transitioning from designs for health. They have a sustained release formulation. In my mind, I was like, "Okay designs for healthy dose and I'll make the equivalent with this other product." It's the first time I've taken too much melatonin. Three of the same, it was the same dose, but MD Logic's product was stronger. I woke up the next day and I could barely get my eyes open. I was like, "The thing you do if you've taken too much melatonin as you get sunlight exposure on your retinas that will help suppress melatonin, increase cortisol." I'm oversimplifying, but yeah, I got out and took a two mile walk outside in the Sun without sunglasses, and then felt better. But I was like, "Whoa, that is not the same. It's much stronger."

Melanie Avalon: Which brings us back to the importance of vetting your brands. There actually is a study, when I was researching, I think for this show, I was researching, when they test supplements, the actual-- what's included in the supplement and there's a study on testing melatonin supplements. Oh, my goodness, the range of what was in them compared to what they said is just so scary. [chuckles] You definitely want to make sure that you are taking brands that you trust, and it sounds like MD Logic's melatonin probably, actually has what it says it has. 

Cynthia Thurlow: Yeah, no, no, it was unbelievable. I was stunned. I think after many years of prescribing medications, and supplements, and things like that, I'm pretty savvy. But that was a little humbling. I was like, "Oh, thank God, I'm glad I didn't have to be talking on a stage that morning. I would have been feeling I was struggling a bit." I'm like, "I got a little too much melatonin," but you can work around that.

Melanie Avalon: If you would like to get their melatonin, we'll put a link to their website in the show notes, but the code, MELANIEAVALON will get you a discount code on their website. So, okay, well, this was so fun. I'm excited, because this was our first-- Last week, I just interviewed you. But this was our first normal episode [chuckles] and I really enjoyed it.

Cynthia Thurlow: Absolutely. No, it's nice to have a forum to be able to discuss some of these things, because it's hard on social media. I endeavor to try to respond like when that New England Journal medicine article came out, I did a very brief IG live, just so that it was available to be able to send out and share with people. But as I'm sure you're in the same boat, it's impossible to get to every question and answer every question. I look forward to seeing what the listeners want to learn more about. And obviously, we didn't get to all the questions that we've been asked. So, we'll get to those in future episodes.

Melanie Avalon: Exactly. Yeah, it's really nice to have, especially the creatine as well, to have had a foundational conversation. Then in the future, when people are like, "What about creatine?" We can be like, "We talked about it on the IF podcast. For listeners, if you go to ifpodcast.com, there is a search feature there. Because we have transcripts for all the episodes, you'll usually find the episode, where we talked about it, which is really nice. Definitely take advantage of those transcripts and the search function, which some resources for you guys. If you would like to submit your own questions for this show, you can directly email questions@ifpodcast.com or you can go to ifpodcast.com and you can submit questions there. You can get all of the stuff that we like at ifpodcast.com/stuffwelike and you can follow us on Instagram. I will say, Cynthia, you're one of my Instagram role models. [chuckles] You do it so well. You do all those IG lives and I'm like, "Ah." They drain me so much, the IG lives.

Cynthia Thurlow: You and I've learned shorter is better. Not only does it get more views, because I used to get so many questions when I would do Ask Me Anything. I was like, "Oh, I'm going to do an IG live and I'll answer all them all at once." No, no, it turns into an hour-long discussion. I told my team, "Now, I'm going to just be targeted." When I come on, I've got something to say. My team did reels yesterday that has gotten some interesting feedback. I may have to address that in an IG live this Week at some point.

Melanie Avalon: Oh, exciting. For listeners, if you'd like to see all of that content, okay, tell me your handle, again. There are underscores in it, right?

Cynthia Thurlow: Yeah. It's @cynthia_thurlow_. If anyone who's wondering, I used to have a business name. And so, after the viral TED talk, I got the bright idea that I was going to change all of my social media handles to the same thing. The unfortunate thing for me was that a lot of the handles that I wanted were already taken by other Cynthia Thurlow. So, I was left with-- It's bizarre constellation of different usernames on different platforms. But yeah, @cynthia_thurlow_, you'll see me there.

Melanie Avalon: And I am just @melanieavalon. I've actually been pretty surprised with social media that knock on wood. Melanie Avalon was pretty much always available everywhere. Even on Venmo, [chuckles] it's like a unique name that I guess nobody has.

Cynthia Thurlow: This is my married last name. And so, there are a lot of Cynthia Thurlows and that's their maiden name. So, inevitably, at least once a month, I get a message asking, if I'm someone that's from Maine, and I'm like, "No, this is my married name. I'm nor that person. Nope, nope, nope."

Melanie Avalon: So, yes. Well, I think that is all the things. This has been absolutely wonderful and I will talk to you next week. 

Cynthia Thurlow: Sounds great.

Melanie Avalon: Bye. 

Melanie Avalon: Thank you so much for listening to the Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing your review on iTunes. We couldn't do this without our amazing team. Administration by Sharon Merriman, editing by Podcast Doctors, show notes and artwork by Brianna Joyner, transcripts by SpeechDocs, and original theme composed by Leland Cox, and recomposed by Steve Saunders. See you next week.


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More on Cynthia: cynthiathurlow.com

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