Welcome to Episode 272 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.
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21:35 - Listener Feedback: Sarah - CGM
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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 272 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 podcast 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.
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Melanie Avalon: Hi, everybody and welcome. This is Episode number 272 of The Intermittent Fasting Podcast. I'm Melanie Avalon and I'm here with, Cynthia Thurlow.
Cynthia Thurlow: Hey, Melanie. How are you today?
Melanie Avalon: I'm good. How about you?
Cynthia Thurlow: I'm great. In three days, I will be on vacation with my family.
Melanie Avalon: This is very exciting.
Cynthia Thurlow: It is really exciting. The most exciting part that I've realized is that now, my children are old enough that they have to get all their clothing and all of their things together without my help.
Melanie Avalon: Oh, that's nice.
Cynthia Thurlow: It’s a huge milestone. For 17 years, I've been packing four people for trips and now, technically, I'm guiding two, and I'm only packing one, and that's very exciting.
Melanie Avalon: I should after this call my mother and thank her for all the time she did that. [chuckles] I think my favorite part of traveling when we were little was everything, she would pack us for the plane ride.
Cynthia Thurlow: I used to do all that. Now, I've got two surly, yet wonderful teenage boys. Other than making sure, I've got one EpiPen packed and a couple sundry things. They're very fairly independent. Let me make-- I provide that qualifier. But I'm Marvel now when we get on planes that I don't have to-- Let me just backtrack. When you have younger children, it's like, “I don't want them to have a poopy diaper, I don't want them to make a lot of noise, I don't want them to scream.” Now, they are quiet, and they either eat or they're attached to their iPads, and it's very pleasant. Very, very pleasant.
Melanie Avalon: Does one of them have a life-threatening allergy?
Cynthia Thurlow: Yes. My 16-year-old has peanut and tree nut allergies. If I had to pick a child to have a food allergy and I would not, of course want either of my children to have a food allergy, but he is by far the most conscientious of the two. And so, he navigates pretty well. Very responsible. Now, he's at the age where he can carry his own EpiPen, but I always have a backup. He navigates his carnivorish world really nicely. And so, when we travel, it's always the-- Let's hope it's the airline that doesn't serve peanuts as a snack.
Melanie Avalon: Are there airlines that still serve peanuts?
Cynthia Thurlow: Occasionally, I see that and I generally, when I get on the plane, I just politely ask. [chuckles] There is a person on the airplane that an aerosolized peanut could be a problem if you're on a long flight. I have never had a problem. People have always been super respectful of that, thankfully.
Melanie Avalon: What will set it off?
Cynthia Thurlow: Well, it's interesting. Every couple of years, they do RAS Testing, which is really looking at provoking the inflammatory response in the blood. And so, what's been interesting is that his results have never gotten better over the years. It's like in the hierarchy of nuts, it's like walnut, and hazelnut, and then peanut, and then almonds don't even register, but I just don't ever want to take the chance. And so, from our perspective, he's only had one confirmed contact with a tree nut, which was probably, I don't know, eight years ago, and he vomited violently, and had some wheezing, and it was all incredibly scary, and then, actually had a second exposure, even though we were really diligent when we went to a restaurant explaining what his allergies were. He had the whole like his lips started to tingle, and his tongue started to tingle, and then of course, we go down the rabbit hole of, “How far away from a hospital? Making sure we have the Epi Pen and trying to get things on board to help quiet the inflammatory response, the histamine response,” and it's scary.
It's interesting because teenage boys are the most likely to trigger an anaphylactic episode because they think they're completely impervious to anything. Their frontal lobe isn't fully developed and I worry more about him when he starts navigating life outside of our house, and dating, and the exposures he can get there, and his allergies have never gotten better. When we looked into peanut desensitization, he would have to do it for the rest of his life like you do a series of these immunological therapies and then it resolves itself, it's like forever, and he said, “I don't want to do that.” He's like, “I'd rather just avoid.”
Melanie Avalon: One of the last serving jobs that I had and this was in LA. It was at a really nice steak house and one of the managers had a peppermint allergy. They said, “You can't have peppermint.” My thing, as listeners know and I might have told this story on the show before. I'm obsessed with my peppermint breath spray. I make it out of peppermint essential oil and water and it's like a thing on this podcast, by the way, people make it. We have links to the way I make it in ifpodcast.com/stuffwelike. I have this spray with me all day, every day. I use it all day, every day. I have an oral breath, fresh breath fixation. They said, “You can’t have peppermint” and I was like, “Okay, but I can have peppermints?” I was like, “It can't be that big of a deal.” All he did was use the peppermint spray while working and he had to go to the hospital. I was like, “Oh.” Then it was a running joke and they're like, “It's fine. It's not a big deal. This happens with new servers.” [laughs] I felt so bad. I felt terrible. I brought him the next day, massive gift of like, “Wine?” He's like, “I can't accept this.” I was like, “You have to. [chuckles] I'm so sorry.” So, yeah, that stuff can be serious.
Cynthia Thurlow: It really can be. Had I not seen the impact as a nurse in the ER many years ago, I would never have understood how significant it can be. I just saw too many anaphylactic episodes. For anyone that's listening, this isn't familiar with that term. It's the most life-threatening response to an allergen and unfortunately, we're seeing more and more of this. Only 30% of kids outgrow their food allergies. It's a really small percentage. There're so many people navigating, young adulthood, and adulthood with food allergies. And so, yeah, it's surprising how the body can manifest exposure to specific allergens. It's really humbling quite honestly. Like, “Had I not had a child with a life-threatening food allergy?” I think my life would have been very different because it changed everything for me. I just didn't view the world as a safe place anymore. When I kept thinking like, “We could go anywhere, and he could get an exposure, and what's going to happen?” I don't want to be jabbing my two-year-old with an EpiPen. Obviously, I would have done it if I needed to. It definitely can be frightening as a parent and I think it's one of those things unless you've experienced it like you did with your boss, you probably can't even appreciate how significant it can be.
Melanie Avalon: Yeah. In a way, I'm glad that I had that experience, because I will really, really respect that going forward. Now, I'm just thinking, I bet in the future of healthcare way down the road. I feel they'll probably come up with something where they literally-- I understand that the allergy desensitization is this technique, but I wonder if in the future, there'll be a process where it literally just tells the immune system, “Hey, this isn't a big deal” like an instant shift.
Cynthia Thurlow: I hope so. I just think there are a lot of families that are navigating. I know I felt fear and overwhelm even as a healthcare professional because my son’s allergist resounding words were, “Carrying EpiPen and pray.” I was like, “Who wants to hear that when they find out their two-year-old has life-threatening food allergies?” It's the last thing you want to hear. There're plenty of people that are hearing the same information from their allergist. Hopefully, there's something coming, there's some amazing, amazing immunologist, allergist out there that's going to revolutionize the way that we look at food allergies.
Melanie Avalon: I bet there is. Did you read Dr. Jason Fung’s, The Cancer Code?
Cynthia Thurlow: I did.
Melanie Avalon: This was not allergies. But I feel the last part of his book had a really interesting information about immunotherapy for cancer, and just modulation of the immune system, and such.
Cynthia Thurlow: Yeah. It's interesting because it's such a departure from the conventional allopathic model that has been the norm over the last 50 years. I think Jason's brilliant and I'm so glad that he got people interested in having different types of conversations around cancer therapies because-- Did you interview? Why am I drawing a total blank, Sam Apple?
Melanie Avalon: No.
Cynthia Thurlow: He brought back Warburg's research on the cancer model that is more aligned with Jason Fung’s book and was moving away from DNA-based or genetic-mediated types of cancers. He was a Jewish scientist in the midst of World War II and for some reason, Hitler took a liking to him and allowed him to continue his research. The book is really interesting. I'd love to share it with you.
Melanie Avalon: Wait, how old is he now? Because you asked me if I interviewed him?
Cynthia Thurlow: He's dead. Yeah, and then at Warburg-- Sam Apple is the author.
Melanie Avalon: I'm so confused about this timeline. [laughs]
Cynthia Thurlow: Sorry. No, Sam Apple is the author and he's a research scientist. Yes, Warburg is the-- [crosstalk]
Melanie Avalon: Oh, what is his book called? Does it the word Warburg in the title?
Cynthia Thurlow: I'm terrible with names. Melanie knows this about me. It's a struggle. I've been this way my whole life. Sometimes, I have these moments where I'm like, “I can't remember.” I can see the cover I’ll have to share it with you separately.
Melanie Avalon: Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection.
Cynthia Thurlow: It was very interesting.
Melanie Avalon: That sounds like a health page turner.
Cynthia Thurlow: Sometimes, a lot of times, Melanie and I, our podcasts overlap with guests and sometimes it doesn't. But I kept thinking, I was like, “I don't know if you've interviewed him.”
Melanie Avalon: I have not. There were some moments in Jason's book, where I was like, “Dah, dah, dah.” I was so invested. He does really nice reveals. The nuance that I didn't realize until reading his book was that the big paradigm shift that happened with Warburg was re-understanding because basically, the Warburg effect is the idea that cancer cells use-- They use glycolysis. They're running on glucose rather than fat. Jason talks about how they're actually-- it's not because they can't burn fat, it's because they're choosing to burn sugar, which is very interesting to me.
Cynthia Thurlow: Well, and you think about in the 1950s as Crick and Watson discovered the DNA Helix. That really shifted research in a totally different direction. And so, yeah, we're coming back to a principle that has been around for 80 years that largely had been left unrevealed, undiscovered, rediscovered, I had to think about.
Melanie Avalon: Hiding, I don't know.
Cynthia Thurlow: Hiding. Hiding probably because of the context in which that research was ongoing.
Melanie Avalon: Oh, yeah, literally hiding.
Cynthia Thurlow: Yeah. [laughs]
Melanie Avalon: Well, for listeners, we'll put links to all of this in the show notes. And again, the show notes will be at ifpodcast.com/episode272.
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Melanie Avalon: Shall we jump into everything for today?
Cynthia Thurlow: Absolutely.
Melanie Avalon: All right. To start things off, we actually have some listener feedback and this comes from Sarah. Sarah says, “I want to thank you. Several months ago, I got a CGM from NutriSense and I realized my fasting blood sugar was higher than it should be. The NutriSense dietician was encouraging me to eat breakfast earlier to help with high blood sugar in the morning. I just knew that couldn't be the answer. For months, I reached out to you, Benjamin Bikman, Cynthia Thurlow, and another doctor. I just couldn't figure it out. I heard your interview with Dr. Rick Johnson and that was so amazing. Then you guys talked about an interview with Peter Attia and David Perlmutter, and that was also amazing. I bought Nature Wants Us to Be Fat.” And for listeners, that is Rick Johnson's book. “Guess what changed. I started drinking more water and stopped eating dark chocolate with sugar at night. Well, I cut out all sugar, I also started taking vitamin C. That's it. I have lowered my blood sugars to the mid-90s. I couldn't be happier. This could have potentially been so bad down the road and so much harder to deal with.” So, that's some pretty cool feedback from Sarah. For listeners, I had Rick Johnson on the Melanie Avalon Biohacking Podcast. Cynthia had Rick Johnson on Everyday Wellness.
I said last week that it was going to be this week, but I was incorrect in the lineup. Next week, Rick Johnson is actually going to be on this podcast. This is a really great teaser question for next week's episode. You definitely want to check it out, but Rick has some very, very interesting information surrounding the role of sugar, and fructose, and metabolic health, and in particular, Sarah was talking about some things that he talks about to help with all of that, particularly, the role of vitamin C. But super happy for you, Sarah that you're able to solve the issue. And also, I like the feedback about how-- because if you haven't a CGM from NutriSense, you do get to work with a dietician who can help you with your results, and what they mean and make suggestions. It's nice that Sarah was able to work with them, but also knew that for her personally, those suggestions weren't probably going to-- they weren't what resonated with her. So, I'm glad that she was able to find something that did work. Do you have thoughts, Cynthia?
Cynthia Thurlow: No, I think it really goes back to bio individuality the N of 1. The recognition that it may take multiple changes to your lifestyle to see some significant improvements. I'm sure the hydration and the reduction in processed sugars really made a big difference. One thing I want to point out that Sarah mentioned was that she stopped eating chocolate at night. And so, it's probably a good reminder, just to remind people that we have more insulin sensitivity during the day. If you're already leaning in the direction of insulin resistance or you're noticing your blood sugars are higher, you really want to be examining, like, how close to bedtime you're eating, what you're eating for your last meal, and sometimes, if you're deciding to have more discretionary carbohydrates, maybe easier and better to do that earlier in the day.
Melanie Avalon: Awesome, awesome, awesome. I think the vitamin C piece was because it lowers uric acid, I believe, I think that's the connection with that. So, again, listeners, tune in next week to learn more.
Cynthia Thurlow: I love Rick Johnson. I think resounding. I say to everyone, he's one of the most delightful interviews I've had easily in my podcasting career. He's just infectious everyone. That's my number two downloaded episode of the year. I'm not exaggerating.
Melanie Avalon: I should go and look at my stats.
Cynthia Thurlow: I'm very OCD about that. That's why some people come back multiple times. I'm like, “Your content really resonated and I need to bring you back.”
Melanie Avalon: I should probably do that. Yeah. I rarely look at the numbers. I probably should.
Cynthia Thurlow: I don't know. I'm very competitive with myself. It's like, I want to know each month that there are more people curious and interested and it allows me to see what content really resonates. Obviously, I think you're the same way. You wouldn't bring someone on The Biohacking Podcast unless you were super interested in them as an individual in their work, in their research. But it's always amazing to me, there are sometimes surprises, sometimes, I'm surprised by something will really resonate or other times, I'm like, “Oh, my gosh, this is the best interview” and then it doesn't get as much downloads. And so, I just find it all fascinating.
Melanie Avalon: I was just thinking about that because I was thinking about how people I bring back, it's honestly, it's based on who I really like. I know I've brought back some people that-- Again, I'd have to go look at the numbers, but my gut tells me they probably weren't necessarily the highest in the numbers, but I just really wanted to talk to them again. Yeah, it's an interesting balance. It's really fun. I think it's really fun like how we get to choose the lineup, really creating shows.
Cynthia Thurlow: Absolutely, absolutely. Speaking of amazing people that I know you've had on twice, I've had on twice. Robb Wolf, I could talk to. He's another person I could just talk to you for hours.
Melanie Avalon: Between the two shows, I think it's been, is it four? It's definitely three. He can come on anytime. I'll just have The Melanie Avalon Biohacking Robb Wolf Podcast.
Cynthia Thurlow: That's awesome. He's such a cool guy. He’s just so humble, down to earth, and just a great human.
Melanie Avalon: I know. Oh, and that was super fun. Cynthia and I both got to interview Mark Sisson last week and it was back-to-back.
Cynthia Thurlow: Yeah, we had an embarrassing kerfuffle on my end, which I'm grateful that I have a friend who intervened immediately, but there was a miscommunication between my podcast team member and what time Mark said he was available. And so, I was on the fly. [laughs] I think it turned out fine, but it was one of those things where you can't apologize enough when you're leaving someone at that level in their business wondering what you're doing. So, anyway, I think it'll all be fine. But still, it was a little embarrassing.
Melanie Avalon: Yeah, you and I talked about it right after it happened. I just would have been so flustered in my head, but I'm sure he probably didn't think about it nearly as much as you did.
Cynthia Thurlow: No, he's probably like amateur. I think it was fine. I agree with him.
Melanie Avalon: What's really interesting about him is, I was thinking beforehand, because I've been a follower of him for so long. I know Elle really well, I know his coauthor Brad really well, but I've never met him. I had an idea of what I thought he was going to be like and he was exactly what I thought he was going to be like, which was I thought he was going to be just really nice and just really, really energetic. Because I feel with people and interviews, everybody who I've had on has been so gracious and lovely. But sometimes, you get the sense that I thought with Mark, I didn't feel I was going to get any sense that this was out of his way or anything like that. This is what he does. I just thought he'd be all energy, and all in, and that's that was really the vibe I got, which was very inspiring, because I think he's 76? Oh, 67, 67.
Cynthia Thurlow: 69.
Melanie Avalon: 69. Well, not 76. Sorry.
Cynthia Thurlow: Yeah, no. I was going to say, if he's 76, it looks pretty dang good. He was delightful and humble. I loved that. He is very committed to his family and the tail end of our discussion was about, how did you find balance with your family? Then he gave some really great insights and certainly, things I got off and I was just like, “Wow, the greatest gift you can give your loved ones is time.”
Melanie Avalon: Yeah, I love that. All right, shall we go on to our next question?
Cynthia Thurlow: Absolutely. This is from Sia. Subject is: “Help me please.” My name is Sia. I'm 41 and pretty sure I'm pre-menopausal. My thyroid is a tad off and I'm trying to correct that. I started fasting November 15th, and I started at 167 pounds, and here it is April 23th, and I weigh 162 pounds. I've always been a healthy eater, I switch it up with OMAD and ADF, and feel tired all the time. It's been hard to workout, I'm sure because of thyroid. I listen to your podcasts, and I've read your books and others from Dr. Fung. I know we're not supposed to compare ourselves to others, but I feel I'm seeing super slow results. Can you give me some tips or what your thoughts are? Sincerely, Sia.
Melanie Avalon: All right, Sia, thank you so much for your question. First of all, with the thyroid stuff, I'm super curious. This is a good thing to talk about just for listeners in general. The hypothyroidism issue can be a really tricky one to tackle and I think it's really, really important to work with a practitioner who's really knowledgeable in making sure they are addressing it correctly. By that, testing all the levels they need to be testing. The free T3, the total and free T4, the TSH, the reverse T3, Elle Russ has a really great book called The Paleo Thyroid Solution. For anybody who wants to get, I believe the most comprehensive overview of hypothyroidism, and what you need to be testing, and how diet affects it. I've been texting her this week about my own panel, because the doctor and I was telling Cynthia about this as well. I've been working with a conventional doctor on my-- because I have hypothyroidism and I'm on thyroid medication. This has been a whole experience just hitting home again, how important it is to take agency in your own health and your relationship with your doctor, and the labs that are being drawn, and stuff like that, because I've been working with conventional doctor for a while on my thyroid and I was working with her, because I found her within my insurance plan, and she actually was open to testing everything, and what she was prescribing me was what I also thought I should be on, and I was feeling good.
But actually, the most recent time around, she changed my dosage. I was telling Cynthia about it. But basically, it was incorrect. The way she changed, it didn't make sense math wise for what she was trying to do. All of that to say, I'm all over the place right here. But I think it's really, really important to work with a practitioner who really can help you. I'd be curious, Sia, when you say, it's off. I'm wondering in what regards it's off. Is it what are you low in, how are you addressing it, is it with the medication and how is that being adjusted? And then all of that to say, but I'm super curious to hear Cynthia's thoughts on this. But if you're struggling with hypothyroidism and this issue, it sounds you're doing a lot of fasting and I probably would not be doing all of that fasting, especially like the ADF. What are your thoughts?
Cynthia Thurlow: Oh, I have so much. For full disclosure, Sia, I also have hypothyroidism, probably have Hashimoto’s, but I've never had positive antibodies, probably, because we're gluten free. There's a lot that I think about. When someone's in perimenopause and we're talking about hormesis, which is this hormetic stress in the right amount at the right time, there are a couple things that I think about. You mentioned that your values are off and I don't have a sense of what your labs were, but we have to think comprehensively. We have to think about what's your sleep quality, are you exercising, are you eating an anti-inflammatory diet? We know with an autoimmune issue you really have to work on gut health. I don't know, if you're just on synthetic medications like Synthroid. And if you are, that's totally okay, that's synthetic T4. But if your body can't actively convert T4 to the active form of thyroid hormone, which is T3, that could explain why the way the scale isn't really budging and why you're so tired.
But the fact that you're so symptomatic, you're very tired. That should be a clue that you need to back up the bus, I would stop doing this really long fasts because in and of itself that is a stress to the body. I would absolutely positively work with a thyroid specialist, whether that's an endocrinologist, an integrative medicine, or an open-minded primary care provider, and make sure that they're looking at cofactors. I would ensure they're looking at iodine, and magnesium, and zinc, and your B vitamins, and looking at inflammatory markers. I see a lot of women that in early perimenopause are becoming insulin resistant and it could very well be. It's a combination of multiple factors that are contributing to why you feel so poorly. Weight loss resistance is more often than not, because of multiple factors. It's not just one factor. I think this really speaks to doing more digging. I would imagine it is not just your thyroid. It could also be adrenals, it could be low progesterone in relationship to estrogen, it could be your sleep quality. Don't give up hope, you just need more information, and I would absolutely positively back off on those long fasting windows. There's just no way you're going to be able to get in enough protein in one meal a day to be able to properly feel your body at this point. It sounds the fatigue is what you really need to use as your gauge. You can do fasting when you're not quite so tired. Then, it might just be that you start with a 12-hour window of not eating and slowly opening that up. But I really do fervently believe that you need more information.
I love Elle’s book. Elle is a fantastic resource. I also think about and I'm turning my head to look, because I have a bunch of thyroid books. I actually did a reels on this talking about my favorite thyroid resources. We'll put the list of books that I generally recommend. I've got four or five. But I think Elle Russ' book is an excellent first choice to help educate you. She's all about empowerment and she really comes at it from the perspective of she suffered for years because she was navigating a world in which they weren't looking at the full picture. I think it's important to really understand, like, a full thyroid panel is a TSH, it's a free and total T3 and T4, it's a reverse T3, its antibodies. You can split hairs beyond that, but it really is important to have all those factors. If you're on medication that is not supporting your body adequately and you're not getting the right labs, not the errors on your part, but the practitioners are not ordering the right labs, it may not illuminate what is going on and giving you the full picture. So, good luck and definitely keep us posted.
Melanie Avalon: I actually emailed my doctor and I sent her, I was like, I don't know how she's going to take this, but I sent her a really long thing. I tried to approach it to her as not me saying like, “This is the way it is,” but saying like, “Oh, I'm curious about this. What do you think about this?” It was resources surrounding-- A discussion we had been having, because her concern, for example, and Elle was telling me about how this is such an issue is. Oftentimes, when people are on thyroid medications, if they're on T3 medication, it can or it should in a way suppress their TSH. And so, doctors treat to not lower the TSH, and so, then they can possibly keep patients in a hypothyroid state when arguably the TSH should be lowered when you're on T3 supplementation. So, that's a little bit of a nuance and I don't know if it's relative at all to Sia’s situation, but it could be something to consider for people.
Cynthia Thurlow: I think it's really hard. I have to be honest I have functional training and I can tell you that if I had not been seeing an integrative medicine provider at the time of my diagnosis, I probably would have been left floundering for a few years. There are still individuals that are open-minded. I know Melanie works with someone who takes insurance that's open-minded. These unicorns do exist. Another resource that I generally direct people to is www.ifm.org, where you can look for practitioners in your area that have functional medicine training and tend to be a little bit more open-minded. I certainly have done a lot of podcasts with thyroid experts, some of whom are clinicians. Recently, it was Dr. Amie Hornaman is one. I know she works throughout the United States, I think about Dr. Eric Balcavage, who's wonderful and has a new book coming out. I think about Elle and there's someone else that we have scheduled for the podcast that's coming out this fall. But there's definitely a lot of resources. Dr. Amy Myers has a lot of resources online. Like I mentioned, I will make sure that we put it in the show notes. Some of the books that I give like a stepwise progression, because I probably have every book that's out there on thyroid. The ones that I think that I reference the most for patients, the Elle’s book is a great, first step for sure.
Melanie Avalon: Awesome. Again, we'll put links to all of that in the show notes and the show notes have a full transcript as well. All right, so, the next question, actually, the good question to piggyback on that. This comes from Gab and the subject is: “Podcast question.” And Gab says, “Hi, I have PCOS, hypothyroidism, and Hashimoto’s. My Hashimoto’s antibodies have gone down. So, it feels I'm mainly dealing with hypothyroidism and PCOS now. I love eating keto because it finally makes my chronic inflammation go down, my bloating has resolved, and I don't feel as swollen. However, I feel very restricted and limited with the way I'm eating and I'm still not losing fat. I have a huge laundry list of food sensitivities and allergies due to my Hashimoto’s, and I've been feeling so much better after staying away from all the foods that came back reactive from the test. I do take HCl and digestive enzymes along with one berberine a day at my meal, which is always in the evening. Melanie and I are very alike. My eating window is later at night.
I'm in a bittersweet spot. The information of knowing my trigger foods for sensitivities is helpful, but now, I feel I have to eat this careful and clean forever just to feel okay. I'm trying to lose six to 10 pounds and the fat won't come off. I'm only 5’1”. Even two pounds is very noticeable for me and physically uncomfortable. I've heard you talk about this before on, “what exactly is the body running on if carbs are low?” I stay away from all processed foods and PUFAs, and I've been doing protein-sparing modified fast days here and there. My fat is also not high because I know eating high fat can stall fat loss. Nothing is working. The stubborn fat I'm trying to lose is on my arms and thighs. What is going on if my body is not using fat stores as fuel and energy, what am I running off of then? I'm in no way eating at a calorie surplus and I'm definitely not eating enough to maintain either, yet, here I am maintaining or gaining. Am I just doomed because of my hyperthyroidism? I'm finally on a medication that is starting to make me feel a little better each month. I take LDN, a B complex and I am constantly searching supplements and protocols. I take magnesium and CBD at night etc., etc. I do Pilates, lightweight training, walking, and yoga. When I used to do heavier weights training, I bulked up. This is probably due to my PCOS and the fact that I am testosterone and DHEA dominant. I know this probably means cortisol is my root issue.
Does this mean my body refuses to lose fat because I'm running off cortisol? My body feels best when I'm doing low impact workouts and walking. It still is infuriating because I'm not eating enough and I know starvation mode is half myth, half reality. But you said it best on one of your pods, “you just can't gain fat if you're not eating enough to gain.” I've heard high insulin could also cause fat retention, but my insulin isn't a problem. I got a NutriSense CGM sent to me. I'll be setting up that soon to see what's happening. Please help. I feel hopeless, and helpless, and that my metabolism is permanently shut down. I love you both and I've been binging both of your podcasts. No pun intended. I'm losing my mind. I just want to lose the last pounds of fat, but nothing I do works.”
Cynthia Thurlow: Oh, Gab, I have to tell you. When I read this before we got on today and then listened to Melanie share your podcast question, you need to give yourself some grace. I sense that you're really, really hard on yourself and I don't know how long you've been on this journey. I think that sometimes when I sense that patients are really frustrated, we have to really simplify things. There is the power of our minds and I think that we have to look at things from different angles. When we're talking about weight loss and it's something we want really badly, I always remind people that we have to get our bodies better balanced in order to lose weight. I know that that's very often. The point of frustration that people as an example will come to me and say, I want to lose weight, but really, it's all the other things going on. I don't know how long you've been fasting, I don't know if you're doing OMAD, you've mentioned several times in this question that you are concerned you're not eating enough. The concept of your body perceiving that there's not enough food coming on board can absolutely positively-- negatively impact your metabolism.
I think that we have to be very, very clear that if you're eating at a caloric deficit all the time, and you've got thyroid issues, and you've got some PCOS, and you've got food sensitivities, and you're being really strict with your nutrition, and you're doing this exercising, it tells me that there's a degree of intensity that needs to first be backed off of, but I don't know your age. So, I don't know if you're still in your peak fertile years or you're in perimenopause or menopause, but there's a lot to unpack. I think it really needs to really reflect on simplifying your program, because this degree of intensity is telling me that you're putting your body under an incredible amount of stress, whether you recognize it or not. If you're in the hierarchy of hormones, as I know, Melanie's talked about and I've talked about a lot on podcasts. If cortisol is up, glucose is going to be up and your body is really going to struggle on a lot of different levels. When I work with PCOS patients, yes, sometimes they do very well with a 12-hour, 13, 14-hour period during the day where they're not eating and maybe they do well on low carbs. So, it doesn't mean everyone does well.
I had Dr. Sara Gottfried on recently and I know Melanie also recently interviewed her. She talks a lot about that there are women, who due to their own genetic makeup do need some degree of discretionary high-quality carbs in order to get that proper T4 to T3 conversion, so, inactive to active thyroid hormone. I think there's a lot here to work with, but I think you also need to start giving yourself some grace. I don't say that to be flippant or unreceptive, because I've been that person, the scale was stuck, and I was frustrated, and I'm not a very tall person. I'm only 5’3”. So, I completely understand that. But at one point and certainly with myself personally, we had to level the playing field and start over and it may be that you need to back off on the intensity of what you're doing. The last thing that I just want to add is depending on how old you are, Melanie is a very young, metabolically flexible woman. Melanie can eat late into the evening and it works for her. But I find for women as they're getting closer to middle age, and certainly, I'm 50. I'm at a different life stage. That doesn't work as well. We know we're less insulin sensitive during the evening and that might be another reason to reflect on when you're eating, what you're eating, and being a little bit kinder to your body. Lean into the lifestyle, give yourself some grace, maybe there's value in working with a practitioner who's going to be able to look at a whole system as opposed to just one issue related to having an underactive thyroid and PCOS. But all these pieces of the puzzle will fall into place eventually.
Melanie Avalon: Yeah, I thought that was an incredible answer. I could not have said it better. I have quite a few thoughts and they all are very similar and echo what Cynthia said. It's a really good question. You keep asking, if you're literally not eating enough to maintain or gain, how are you maintaining or gaining? That's a reality where if you are maintaining or gaining, you are eating enough to maintain or gain, but it might not be because you are eating a lot. It's more likely the hormonal system that your body is in, and it's learning how to adapt, and how to deal with what you are taking in. It can feel like, no matter how much you restrict, your body's going to just maintain at that or you're saying gaining. It's really, really interesting, especially the more I learn about, the book I'm reading right now, I'm really excited. I'm going to be interviewing-- Do you know Ari-- Is it Ari Whitten?
Cynthia Thurlow: Yes, he's on my schedule.
Melanie Avalon: Okay. Are we both for his Eat for Energy? Have you read the book, yet?
Cynthia Thurlow: Mm-mm.
Melanie Avalon: I’ve just started it. A lot of it is talking about the mitochondria and it's just making me realize more and more how-- Because the thesis thus far, I just started the book. But the primary thesis is that chronic fatigue and all of these health issues really the root of them is in the mitochondria. If the mitochondria are not producing energy or shutting down their energy production, we're going to have all of these experiences. That's a very hormonal thing. The mitochondria not producing as much energy as they should be, that's what they're doing because of the environmental stressors that they are exposed to. That's a language of your body and that's why the answer, I believe is and Cynthia said this is, in a rebalancing. The answer is likely in a more broad lifestyle shift change and all this rather than-- because you say that you're looking for supplements, and trying all these different things, and the answer probably is not there. I am really curious to see what you learn with the NutriSense CGM. That might be helpful seeing how your blood sugars are reacting to things. I did want to comment on that you say you know that you don't have issues with insulin. I'm wondering how you know that, especially if you still have active PCOS that is often linked to insulin. I would find it interesting if your insulin is great and you're experiencing all these issues and have PCOS. That would seem a little bit like an anomaly to me. I do wonder if maybe insulin is still high for you.
But going back to the dietary approach, because it sounds what you're doing is, you really want to be doing keto, and you're doing a very restrictive, it sounds like a low-fat version of keto, and it doesn't seem to be working. There are two big paradigm shifts that I would suggest trying. One would be going higher fat on the keto, but adding those fats from C8 MCT oils. Basically, eating what you're eating now, but adding in a- This is just something to try. I'm not saying this is necessarily the answer, but if you add in a lot of fat from C8 MCT oil, you can stay in this keto state that you want to be in, and that's a very metabolic fat, and that it stimulates energy production. It can really stroke your metabolism and it itself is not easily stored as fat. It might be something that can give your body a signal of abundance while supporting a fat burning state. It's just something to try.
Option number two and Cynthia touched on this going on a higher carb approach. We've had a lot of people throughout the years reach out to this show, who have been doing low carb. They're just wedded to low carb and they just you know are convinced that keto is the only way that things are going to work. We've suggested or I've suggested trying actually-- I know Cynthia was talking about Sara Gottfried’s approach, which is still a ketogenic approach, but with more carbs. But I would also like to suggest that and/or an actually high-carb approach. A lot of people switch to a high carb, low fat approach still Whole Foods based, still high protein. That is like the thing, I can't tell you how many people I've suggested this to and then they reach back out and say, “Wow, I got my energy back, I started losing weight again.” That's something to try. I know it can be really scary, especially, if you are scared of carbs, but it's something to try. To clarify, I like with the high carb doing a lower fat approach, because then you're not hitting your body with fat and carbs at the same time in a high amount, which I think for a lot of people does not work that well for metabolic health. Yeah, those are just some of my thoughts. Any follow up thoughts?
Cynthia Thurlow: Yeah, I think it's really the N of 1. It's definitely on this journey and there's no one size fits all. But I think if you're too fervently trying to move too many levers all at the same time, it's going to be hard to know what's effective and what has been helpful. But I think getting things back to a really simplistic methodology is the best starting point and just giving yourself grace because I know how frustrating it can be to be weight loss resistant. I've now been there twice in my 40s and so, I think it's important to just understand that there's some imbalanced part of your system. If you look at your body as a system, there's something that's imbalanced that's creating this resistance. Once you figure out what it is, it will fall into place.
Melanie Avalon: And also, something to consider because we don't know what your weight is. It's also possible to evaluate the weight that you're looking to lose and I'm all for people wanting to lose whatever weight they want to lose, like, no judgement. People can do whatever they want. But the six to 10 pounds, are they the last six to 10 vanity pounds or are you coming from a higher weight? It might be that where your body is right now is a very healthy weight and losing those six to 10 pounds are going to be something that will be hard just because depending on what your weight is right now, they're not something that your body has any intention of losing because it doesn't perceive that as something that it needs to be if you're a completely normal weight or on the lower side of normal. So, something else to consider.
Cynthia Thurlow: Absolutely. But first and foremost, give yourself grace.
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Melanie Avalon: All right, shall we go on to our next question?
Cynthia Thurlow: Yes. This is from Christina: “Confused on eating in window.” “Hello, I'm so excited to start this journey with intermittent fasting. I am four days in and doing a 16:8. So far, it's been good. However, I feel I'm only cutting out breakfast and a snack. I'm a CrossFitter. So, I'm used to eating nonstop through the day. Sidenote, On break from CrossFit as I've been on and off since October, hello sinus season and weight gain. I've been having my normal lunch grilled chicken, broccoli, cauliflower, sweet potatoes, and red potatoes followed up with mixed nuts, snack, and then dinner which varies, but I try to stick to protein and veggies. I'm wondering if this is too much. I'm typically hungry by lunch. As for the snack I worry it's just out of habit. Any recommendations? I'm breaking the constant eating once I open my window. Also, I have now been craving pineapple listening to your podcast all day at work. So, I switched from nuts to a bowl of fresh fruit. Pineapples, strawberries, red grapes, cantaloupe, watermelon as of today. Thanks for the advice and looking forward to this journey.”
Melanie Avalon: All right, Christina, thank you for your question. I think you’ve answered your question when you asked us about-- Well, you said you're wondering if it's too much for the snack you worry, it's just out of habit. It sounds you have a pretty intuitive idea that the snack you're eating you're not actually hungry for. I don't want to put words in your mouth, Cynthia, but haven’t you talked before about how you are not a fan of snacks?
Cynthia Thurlow: I'm generally, generally not. I think sometimes, maybe we didn't have-- As an example, she's giving a good example of protein and some healthy carbs, and maybe she needed to add some fat to that meal to maybe keep her satiated, because she was going towards nuts. Whether or not, that's by habit or it's by her body just needing to feel they're fully satiated I, sometimes feel like, “If you're using those carbohydrates, it's fine to use a little bit of olive oil, or butter, or something that's going to keep that satiety.” I don't know, if she's just not getting enough nutrient density in that meal, obviously, that's a clean meal, but maybe there's not enough nutrient density there and that could be what's driving that. I know for myself personally, today, it was my first day back in the gym doing a heavy lifting day and I definitely am finding my first meal that I had was definitely there was more substance to it than on the day that I'm not exercising as fervently. CrossFit is intense.
The other thing that I think about is, I don't know how young this woman is, but are you exercising for your menstrual cycle? Your follicular phase from the day you start bleeding up until ovulation, if you have a typical 28-day cycle, you can get away with more intense types of exercise. But if you're after ovulation closer to when you're going to start bleeding, your body's going to struggle a bit more. You're going to have more cravings for some carbohydrate rich foods, you may not be able to work out as intensely, and so really examining if you're still menstruating, where you are in your cycle to lean towards what will work best for you.
The other thing is, if you look at people like Dr. Stacy Sims, who is anti-fasting, but does a lot of research in women's physiology and athletes. We're talking about a very small subsect of the population. Again, the menstrual cycle is important. Where you're training, at the level you're training is important to really be cognizant of how that's going to impact your recovery. Do you really want to be restricting food if you're training for something? Those are the things that come up in my head and definitely as listeners are leaving questions in the future, I would encourage them to at least give us some context like, “Are you 35 or are you 50? Are you 25 or are you 40?” Because that can help guide some of the suggestions that we make.
Melanie Avalon: Yeah. It sounds like if I'm reading it correctly, so, she's not doing any CrossFit right now. I think the issue is that she's used to eating a lot from doing CrossFit, but now, she's not doing CrossFit and so, she's wondering if this is all just habit from her CrossFit days.
Cynthia Thurlow: But she seems pretty intuitive. When people say, “I wonder if it's X,” they generally, probably already have a sense of what may need to be adjusted.
Melanie Avalon: Yeah, exactly. [chuckles] As far as it sounds you're eating the exact same amount of food that you're eating when you were heavily doing CrossFit, and now, you're wondering if it's too much. I know it sounds really simple, but you're asking how do you stop the habit of eating constantly the whole time. There's a magic to just creating some rules, some yes/no rules that you stick to and trying it. Rather than saying, “I'm going to eat my meal, and then I'm going to try not to have a snack, or maybe I'll have like a little bit of a snack,” and you could just say, “I'm not having snacks.” I know that sounds very simple, but it's approach that you can stick to. You can have your meal, and have it in a set place like in the kitchen, and then when you're done with the meal putting everything away, and then kitchen closed and no snacks, and even not having the snacks in the house, so that they're not accessible, and then holding yourself accountable, then having your dinner later. I think we can empower ourselves a lot more than we think we can if we just set up a rule that we say we're going to follow and then we follow it rather than trying to follow it, which is a nuance, a small nuance with language, but I think it makes a big difference. Shall we do one more question?
Cynthia Thurlow: Sure.
Melanie Avalon: All right. We have one more question from Michelle. The subject is: “Blood work” and I feel this is a really good question for Cynthia. Michelle says, “Good afternoon. I've been doing IF since March 28th, 2021 and I love it. I'm 39 years old and I'm having issues with bloodwork. My bloodwork is always good, but I've always had low iron. This past time, it was 8.6. My doctor encouraged me to really take my iron for three months and take ibuprofen a few days before my super heavy periods to decrease the flow. Taking the ibuprofen actually works. My last test, my iron was up to 12, but my sodium chloride and potassium were all off. Any ideas of what's going on? Could this be due to fasting? I use the sauna several times a week and I do hot yoga. I'm going to have it rechecked next week, but I wanted to see if anyone else had these issues. Thanks in advance,” Michelle. And now, Cynthia, now that I read this, I see what you're saying. So, thoughts on that?
Cynthia Thurlow: Yeah. Well, there's a lot here. I think Michelle is actually referring to her hemoglobin going from 8.6 to 12. It's definitely heading in the right direction. First of all, she's 39. This is perimenopause. When our bodies are heading towards 10 to 15 years out for menopause and our ovaries are producing less progesterone, so, we have this relative estrogen dominance, which can contribute to heavy menstrual cycles amongst other symptoms. That's number one.
Number two, if she's doing a lot of exercise and she's doing the infrared sauna, you can absolutely lose discretionary electrolytes. I actually just did a podcast with the amazing Robb Wolf on this particular topic, because we get so many questions. And so, yes, you can effectively lose sodium chloride, magnesium, potassium with sweating. You can have renal losses in your urine. If you are not replacing the electrolytes after sauna and yoga, you absolutely need to be. In fact, I generally recommend that people are using electrolytes throughout the day, especially if they're fasting, but then you add in the exercise and all the extra sweating, and you need to replace not only the water that you've lost, but also the electrolytes.
Couple of different things. This is perimenopause. Your heavy menstrual cycles will probably persist and continue. There's a lot of different ways to address that, but it sounds like relative estrogen dominance, but most importantly and the thing that I think will be most beneficial is to replace the electrolytes. I have a product called Simply Hydration that you can take in a fed or a fasted state and then, I love LMNT, Robb Wolf's product. My favorite is Orange Salt. I would say in our family, the next big flavor is Grapefruit, which unfortunately, they only have out in a limited amount. But those are definitely some options. You want to salt your food and you want to be making sure that you're staying ahead of those electrolyte losses. I don't know what your numbers were, so, they may just be suboptimal or if they were significant, I would imagine this healthcare practitioner probably would have sent you home with some recommendations. So, those are my thoughts. What do you think, Melanie?
Melanie Avalon: Yeah, I thought that was great. For listeners, LMNT is actually a sponsor on today's episode. I think it's in the pre-roll. You can listen to that to get a free offer and I think a discount on electrolytes. So, check that out. They just changed it. it’s some offer, but I think it's a discount. Yeah, regarding the iron, the hemoglobin, so, I have struggled historically with anemia and mine got very bad. Very, very bad. Mine got to four. I thought I was dying. The reason I bring that up is you're asking if it could be due to fasting. My historical struggle-- So, now, I very intensely monitor my iron panel. Its changes and its fluctuations have been pretty independent of my fasting experience. There are a lot of potential causes and your doctor, hopefully, talked to you about this. But there are a lot of causes for anemia and the inability to keep up your hemoglobin or keep up your ferritin, which is a storage form of iron. It can be internal bleeding, which is what they thought it was with me because mine was so severe. It can be absorption issues, just not being able to absorb. People with celiac often have this issue. You could have normal iron levels, but not have ferritin, because your body is not converting it to ferritin or hemoglobin is just not building up. I'm actually about to read a book. I'm really excited. Do you know Dr. Morley Robbins?
Cynthia Thurlow: I’ve heard of him.
Melanie Avalon: He wrote a book called, I think, Cu-RE. I haven't read it yet, but he's going to be coming on my show and apparently, he talks all about the copper-iron relationship and that whole role. I think at least, a reason that the body struggles so much with iron is because it's actually a very inflammatory compound. It's ironic because we need it. It's vital to our life. We would be dead without it. Like I said, I literally felt I was dying when I was that anemic. It does create oxidative stress, it's inflammatory, it can potentially feed pathogens. The body is very, very intense in regulating it sort of like a blood sugar, how blood sugar can be toxic, so the body's really intense about regulating that. There are so many places that things can go wrong. [chuckles] Like, where you're getting it from, where you're absorbing it? All of that to say, I don't believe the fasting is the cause of that. It's probably something else and it's probably something where you really need to work with a knowledgeable practitioner to find the root of it.
I will say what's worked for me for keeping up my iron, actually, I know you're really good friends with her, Dr. Cochrane? Are you friends with Teri.
Cynthia Thurlow: Yes, very good friends.
Melanie Avalon: She made the suggestion to supplement with chlorophyll to boost iron and I found that really helpful. I also supplement with grass-fed spleen that has the highest amount of heme iron of basically, any animal product that you can get. I currently use ancestral supplements. If I make my own organ supplements down the line, I definitely want to make a spleen one. But that might be something to try. I can put a link in the show notes. I have a discount code for them, I think. But yeah, the iron one is tricky. So, really quickly do you have thoughts on her taking the ibuprofen for the periods?
Cynthia Thurlow: I know that it helps with prostaglandins and I think that's part of it. When I read that, I was like, “Oh, she's estrogen dominant.” And so, until you address that, that persists and then it goes into the synthetic hormones, and IUD, and ablation, and hysterectomy. That's what's coming for her, unfortunately. That's the allopathic model. I managed to get through perimenopause without any of the above. I'm happy to say, “Thank God.”
Melanie Avalon: Congrats. All right, well, hopefully, that was helpful, Michelle and definitely feel free to update us with anything. This has been absolutely wonderful. A few things for listeners before we go. If you would like to submit your own questions for the show, you can directly firstname.lastname@example.org, where you can go to ifpodcast.com and you can submit questions there. This was definitely an episode where you want to check out the show notes. We had talked about so many things. Everything as well as a transcript will be at ifpodcast.com/episode272. And then you can follow us on Instagram. I am @melanieavalon, Cynthia is @cynthia_thurlow_ and we are @ifpodcast and definitely tune in next week. Again, I mentioned it before, but Rick Johnson will be our special guest next week. And Cynthia have fun on your travels.
Cynthia Thurlow: I will. I'm so excited. It's hard to believe the past two years, we have not been back to Europe. And so, we are headed to the Czech Republic, and we start in Prague, and end up in Budapest. So, I haven't been to Eastern Europe with my kids. I'm super excited to unplug with them.
Melanie Avalon: I'm really excited for you. You deserve it after all of the book launch. You're coming out of like the storm.
Cynthia Thurlow: Oh, yeah, that's a whole conversation in and of itself. I'm like, “I'm burned out, I need a break.” So, I'm super excited. But in my absence, I know everyone will love hearing from Rick, who I put on a pedestal.
Melanie Avalon: I know. It'll be great. All right, I'll talk to you in a few weeks then.
Cynthia Thurlow: Sounds good.
Melanie Avalon: Bye.
Cynthia Thurlow: 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.
STUFF WE LIKE
Check out the Stuff We Like page for links to any of the books/supplements/products etc. mentioned on the podcast that we like!
Melanie's What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine
Cynthia's Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging
More on Melanie: MelanieAvalon.com
More on Cynthia: cynthiathurlow.com
Theme Music Composed By Leland Cox: LelandCox.com
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