Episode 277: Manifestation, Vision Boards, Cholesterol, Fasting Insulin, Cassava Flour, Headaches, Cephalic Phase Insulin Response, And More!

Intermittent Fasting


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Aug 07

Welcome to Episode 277 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:

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The Melanie Avalon Biohacking Podcast Episode #41 - Dr. Shawn Baker

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Listener Q&A: Holly - Cholesterol Conundrum

The Melanie Avalon Biohacking Podcast Episode #126 - Azure Grant

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Listener Q&A: Karen - Cassava Flour

Ep. 198 – Dispelling Myths About Hormone Replacement Therapy

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Listener Q&A: Florence - Headaches/Smells

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 277 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 a 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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And one more thing before we jump in, are you fasting clean inside and out? 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 you know 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.

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All right, now, back to the show.

Melanie Avalon: Hi, everybody and welcome. This is Episode number 277 of The Intermittent Fasting Podcast. I'm Melanie Avalon and I'm here with Cynthia Thurlow. 

Cynthia Thurlow: Hey, Melanie. How are you?

Melanie Avalon: I'm good. I feel like it's been such a long time since we've talked.

Cynthia Thurlow: [laughs] I know. Business travel is wonderful, but it's also hard to fit in all the things alongside that. And so, thank you for letting me have the bandwidth because I didn't get home, I had four hours asleep when I got home on Sunday, and probably would not have been as mentally sharp and acute as I am right now after having a good amount of sleep for a few days in a row. I love doing business events and certainly KetoCon was fantastic. But three solid days of an introvert trying to pretend to be an extrovert is challenging.

Melanie Avalon: Yes, we were just talking about this, our common introvertedness. I'm really curious about KetoCon. Okay, have you attended KetoCon before?

Cynthia Thurlow: I had not. I had not and I was asked to keynote the first day, which was really cool. And so many of my close friends in the low carb Keto community were there. And so, it was really nice to see people in person again and connect with so many people that have been impacted by this podcast, my other podcast, and the book. And so, to me, I was very heartfelt. I do fervently believe that the Keto community is one of the most supportive communities in which events that I've spoken to. And so, for me, it's a lot of connecting with friends and meeting people. Austin's a great foodie city. It was nice to participate in that. For me, so much of its reconnecting with our roots really having the ability to connect with people that we impact their lives so profoundly and that's really a blessing. 

And so, as hard as it is for me as an introvert to spend three days being, going from full day events into parties or events in the evening. I always remind myself how incredibly fortunate I am to have a platform to stand on to be able to advocate for women. And so, I come home and then I can't talk for two days. I'm just so wiped out, but I really had a great. I think they were having some massive heat surge while I was there. It was like 105. And they would talk about it being humid. But you and I know it humid weather. It’s like it didn't feel humid to me as an East Coast or it just felt like an oven. It genuinely felt like an oven and that was fascinating. I was like, “How do people deal with this heat being so intense?” It's hot all day long. It's not like you get up in the morning and it's 20 degrees cooler. It was like an oven 24/7. And so, that I found that really fascinating. That's one of the things I love about traveling is just experiencing new weather, new people, new things.

Melanie Avalon: Did you meet any podcast listeners from this show?

Cynthia Thurlow: Not specifically, although. It was interesting. I kept having people introduce me as, “This is Cynthia Thurlow, she has her own podcast, and then she also has a podcast with Melanie.” And so, definitely, there's some recognizableness within that community of individuals who were aware of IF Podcast and so.

Melanie Avalon: Oh, cool. Other people would say that when they were--? 

Cynthia Thurlow: Yeah.

Melanie Avalon: That's fun.

Cynthia Thurlow: Yeah. No, and it's nice. It's nice to have that added side. When I would talk about the fact, like, I have my own podcast and then I cohost a podcast with a good friend of mine, and people would oftentimes say like, “Did you and Melanie just were had you been friends up until that point?” I was like, “Yeah, we've been friends for three years.” So, it was very serendipitous when this opportunity came up. To me, podcasting is one of the best ways for people to get to know you, and to get to know what you stand for, and what you advocate for. And so, as you and I always say, podcasting is some of the best networking you can do. For me, meeting a lot of people that I had been on their podcast or they have been online was really neat. 

As an example, Dr. Gabrielle Lyon and I are good friends. We text multiple times a week and talk on the phone, much like you and I do. And then meeting like Shawn Baker, and Shawn Baker, for anyone who doesn't know, he's 6’5”, 225 pound, just this massive orthopedic surgeon who is this gentle giant. It was so enjoyable to meet him in person, just a really nice, low-key guy who's changing the narrative about meat and certainly, anti-inflammatory diets. And so, to me, it's always a blessing when the person that you think someone is ends up being exactly how they are. 

Melanie Avalon: Oh, I love that. Yeah, for listeners, he's like the carnivore guy. You've had him on your show as well, right?

Cynthia Thurlow: I have, I have. I've been on his podcast and he's just very low key, which I think is really refreshing, because there are people in the health and wellness space that are loud and obnoxious. Thankfully, not a lot of them. But there are people that are out there that there's nothing subtle about their message. I recognize we have to make space for everyone. Everyone may have a different approach. I tend to have a softer approach. But to me, it's really nice when you meet someone in person and they're as they appear to be. That's how I would say it. And certainly, Ben Azadi, and Dr. Anna Cabeca, and Mindy Pelz, and so many people that I know in that space, it was really fortuitous and nice. It's just a nice community of humans. Everyone that was there really a great lineup of professionals. There was actually someone I was thinking about for you for your podcast when bringing your mind, Chris Palmer. He's a Harvard MD, but he talks about metabolic health in relationship to mental health and has a book coming out this fall. When I was talking to him, I was like, “Oh, my gosh, I absolutely need to bring you on, because that's a totally different angle than not a lot of people are talking about.” And so, there were some really cool people there.

Melanie Avalon: I do remember interviewing Shawn Baker, because I remember I had interviewed Paul Saladino a few times. He's very intense in his messaging. I remember interviewing Shawn Baker and thinking, “Okay, this will be the approachable episode for people who might less intense, more welcoming, more casual in general, and just approachable.” I really like him.

Cynthia Thurlow: Yeah. I'll never forget having a conversation with JJ Virgin recently, and she was saying how important it is for people to remain humble. She's like, “No matter someone's success. No one wants to be around an asshat.” I was like, “That is true. That is so true.” That's my PC way of saying conceptualizing that. Some people get really famous and they're not particularly nice individuals. So, it's always a pleasure when you can connect with people and find out that what you see online is really how they are.

Melanie Avalon: I agree. Can I tell you a really funny story that happened to me? So, I saw this past weekend Blue Man Group, have you seen Blue Man Group before? 

Cynthia Thurlow: I have not, but I know what they are. 

Melanie Avalon: I was really excited to see them. I sat in the front row, which is really exciting. I remember thinking, because I launched my Magnesium the night before, actually. So, that was launch day of the magnesium and I was thinking, “Man, I wish I could somehow get my Magnesium to the Blue Man,” because I'm sure could help with their drumming, and their intense activity, and everything. And if listeners would like to learn more about the Magnesium, actually, last week, Episode 276 was with Cynthia and Scott, our partner at MD Logic. So, check out that interview. That was like a little baby goal, but I wasn't going to actively pursue it. I saw the show, I sat in the front row, it was fabulous. I went home, posted about the group on my stories, and then I followed some of the members. One of the Blue Man from that show DMed me and said like, “Hey, I saw you in the front row--” 

I had been posting about the Magnesium. So, he said, “Hey, I saw you in the front row. It's nice to see that your magnesium fam. My mother just sent me this to help with the drumming and everything and it was BiOptimizers Magnesium.” I was like, “What are the odds?” Then I was like, “Oh, that's actually the magnesium.” I was like, “We are sponsor” and that's actually how I formulate in mine based on theirs what I liked from theirs and just making it a little bit better for me personally. So, I sent the whole group some of my Magnesium.

Cynthia Thurlow: Yeah. You manifested that. That's awesome. 

Melanie Avalon: Isn't that hysterical?

Cynthia Thurlow: I love it. It’s serendipitous.

Melanie Avalon: I know. What are the odds that what do I get my damn box, but a picture BiOptimizers Magnesium from the Blue Man? 

Cynthia Thurlow: Yeah. That’s the thing. Manifestation, so, my 14-year-old hates that word. He's very black and white. And so, I was trying to explain to him. Last week, I had shared with you. I put someone on a vision board four years ago and their team reached out and wanted me to come on the podcast. It was really one of those moments that manifestation is really powerful. And so, you were thinking about, you wanted to find a way to interact with them and then ended up happening. And so, I think, for all of us listening have a vision board. Have something that you, or a goal, or something that's very concrete and you can make it happen.

Melanie Avalon: And the fact that I specifically was thinking like, “Oh, how do I get some Magnesium in their hands” and then literally came to me. [laughs] So, yeah. But I do really recommend them, by the way, for anybody who has not seen that show. It was really fabulous.

Cynthia Thurlow: I really liked theater. I feel the past two years has really thrown that off, because we used to live in Washington, D.C. and we went to the Kennedy Center and my kids grew up seeing theater. I grew up seeing the theater in New York City. And so, for me, I feel we took this to your pause which was such a bummer. We really get some great performances in the Washington, D.C. area. And so, I was actually saying to the kids, I was like, “Maybe we should do Hamilton, but we'll do that in New York. I think that would be awesome in the fall.”

Melanie Avalon: Hamilton is amazing. You will love it.

Cynthia Thurlow: I know. That's like they're old enough. Now, we can trek up there, and see that, and enjoy it, and come back, because now, we're in a smaller city and the statistical likelihood we're going to have Hamilton come here is probably a little smaller.

Melanie Avalon: Yeah, I absolutely, absolutely love that show. It’d be excited to hear if you do see it.

Cynthia Thurlow: Yeah, I have it on my list of things. I'm like, “Okay, the things that will happen are--" 

Melanie Avalon: [unintelligible [00:18:38] [chuckles] And actually, I just realized, I probably should do a quick plug. The Blue Man guy who messaged me about the Magnesium, his name was Steven and he actually has a very cool company. I'll put a link to in the show notes. It's called studiowendt.com. It's studio W-E-N-D-T dotcom. And he actually melts down jewelry and makes it into new jewelry. That's very cool. So, if people are looking for unique custom jewelry, you can order direct, I think from him or you can get your own stuff melted down and remade. So, I'll put a link to that in the show notes. 

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Melanie Avalon: In any case, shall we jump into questions for today?

Cynthia Thurlow: Absolutely.

Melanie Avalon: All right. To start things off, we have a question from Holly and the subject is: “cholesterol conundrum.” And Holly says, “Hi, Melanie and Cynthia, I just heard the big news yesterday and I'm saddened that Gin will no longer be on the podcast, but I'm so excited to hear that Cynthia is joining you. I am such a super fan of you ladies. I just finished Cynthia's latest book and learned so much. I have been intermittent fasting since December 2019, and have lost close to 35 pounds overall, and I'm so happy with this lifestyle. I had the pleasure of being a guest on Gin’s, Intermittent Fasting Stories Podcast as well, Episode 153. Anyways, to my question, I recently had Regular Labs completed and although my primary doc said that all my levels are normal, I am concerned about my cholesterol. My total cholesterol was 217, and LDL was 132, HDL was 70 and trigs was 76. The last time I had Labs was September 2020 and my numbers were total cholesterol 205, LDL 124, HDL 66 and trigs 74. Also, my A1C was 5.6% in 2022 and 5.4% in 2020. I'm concerned because heart disease runs in my family. My grandfather passed away in his early 50s from a sudden heart attack and my father passed away at 72 due to heart disease. 

My question is, should I be concerned with the numbers creeping up? If so, what are some of the best ways to improve the numbers, a low fat diet, less saturated fat and more unsaturated? I know not all fats are bad and I'm just confused as to what would be the best fats for me in this situation, or is just trying to avoid saturated fats and inflammatory oils best. I love more direction particularly on how Cynthia might advise clients in similar situations. Not sure if this matters, but for background, I am 49 years young, 5’2”,115 pounds. I work out seven days per week, but nothing too strenuous. Mainly walking and strength training as well. I do eat relatively healthy such as Whole Foods with some dairies such as cheese, no milk, and eggs. I do love red meat, but maybe that might be an area to tweak, such as eating less red meat and increase seafood or lean meats. Thanks so much for the both of you for all you do and I look forward to hopefully hearing back soon. A sincere super fan, Holly.”

Cynthia Thurlow: Oh, well, Holly, thank you for the very detailed question and congratulations on the progress you've made. That's amazing so far. When you listed your Labs, I didn't see anything that looked statistically significant between the Labs from 2020 and currently. Your total cholesterol looks okay. LDL, the only thing that I would say and I don't think an LDL of 132 is bad at all is that if you're really curious to know, you can look for an advanced lipid analysis. Some internist and primary care providers are savvy with these types of Labs, others are not. When we're looking at particle size, it actually breaks down the LDL to look at whether or not you have light, fluffy, buoyant LDL or if you have a predominant of small, dense atherogenic, those that are more prone to producing plaque and inflammation. 

If we really look at what drives cardiovascular disease and heart attacks, and we know women present statistically very differently. Men typically present with a classic crushing chest pain, left arm pain. Women may have symptoms as subtle as fatigue or shortness of breath. I'm sure your primary care provider is monitoring you carefully. I'm not sure if you've actually had a baseline stress test that may be something to discuss with them. But when I start looking at strong family history, certainly, our grandparent’s generation, a lot of them smoked. And so, that can be a major risk factor for developing cardiovascular disease. I also think a great deal about insulin resistance. So, A1C is helpful to a point. But I actually order less of those now and order a great deal more targeted lab work like a fasting insulin. This is a test that's covered by insurance, I see a lot of perimenopausal women. And 49 years young and I'm glad that you use the word young. 

49 years of age, you are close to menopause, if not already there. Average age in the United States is 51 and we do become more insulin resistant as we get older and that has a lot to do with the fluctuating and reduction in estradiol, which is our predominant form of estrogen prior to going through menopause. I think at a minimum, you need a fasting insulin drawn. I would want to be looking at your fasting blood sugars, seeing the net impact of your meals. You didn't really identify if you prioritize protein. And certainly, in perimenopausal, menopausal females, it's absolutely critical that you are prioritizing protein for a number of different reasons. I know everyone hears me talk about this a lot. The role of sarcopenia, which is muscle loss with aging can also contribute to insulin resistance. As you're losing muscle, you are losing this metabolically active tissue. And so, if you're not getting sufficient amounts of protein in your diet and I can't tell from what you've identified here. Animal-based protein is going to be superior to plant-based protein in terms of the amino acid composition. 

I just listened to a lecture with Dr. Gabrielle Lyon at KetoCon last week and I love that she was providing some context of what her recommendations are. And so, no less than hundred grams of protein a day as a female and then also no more than 30 to 40 grams of carbohydrate per meal. That is important, especially in a middle-aged person. So, not really fully understanding what types of protein you're gravitating towards. I think that's also very important. Getting the additional labs fasting insulin, inflammatory markers like high sensitivity, CRP, really looking at homocysteine, really, really looking more deeply at your LDL particle size, which I would imagine would probably be quite good. And then I think about other hormones. Thyroid hormone, sex hormones, really digging deep. IGF-1, which is a clinical marker for growth hormone, how that is going on as well. I think I would want to get more information. 

I don't think it sounds like you're doing anything wrong. But I do think with your baseline family history, a baseline treadmill stress test, I know a lot of clinicians and cardiologists are leaning towards chemical stress tests or stress values, which I think are completely reasonable. Meaning, they can put you on a treadmill and also give you a specific tracer to see what's going on with blood flow to the heart is certainly very reasonable. But I would think from my perspective, I would really want to make sure that your insulin sensitivity is optimized. You're not a very big person, but I do see some degree of insulin resistance even in smaller, more petite women. And so, I think looking at things from a very comprehensive perspective would allow us to be able to give more targeted recommendations. So, what I'm saying is, I think you're doing a lot of really good things. We need more information, more Labs, I'd love to know what your macro breakdown is. I love that you're already omitting inflammatory seed oil. So, lots of protein, right types of healthy fats, optimizing your carbohydrate intake, and that really is something that is a very powerful N of 1. If you're not using a glucometer or continuous glucose monitor, I would also advocate that we have a sense of what your blood sugar response is to your food intake as well. What do you think, Melanie?

Melanie Avalon: I thought that was extremely comprehensive and fabulous. Yeah, just some quick comments. For listeners, they might benefit from listening to my interview with Azure Grant. She does a lot of work with ultradian rhythms, which are 24-hour rhythms in the body. A lot of her work was used to develop work with Oura Ring. So, that's why I had her on the show. But she has a really fast seating study, where they-- It was a small study. I thought it was very telling, where they looked at, I don't remember how many people were in it. It wasn't that many, but they basically tested their cholesterol levels like we do with the CGM testing or blood sugar all day, but they did it with their cholesterol all day. Every single participant in the group fluctuated wildly with their cholesterol levels based on just the moment to moment like we do with our blood sugar. And actually, every single person in the study at one point had one of their markers crossed into a risk factor category, which I thought was just really fascinating. 

Basically, the takeaway is not to be concerned about your cholesterol. It's that Holly's test right there was just a snapshot of that one moment. And so, it could have been different, even within that day significantly. And so, it's hard to even know how different it is from the two years prior that she tested, because just to how much it can change. There's that factor. How do you feel Cynthia about the HDL to trig ratio or is it trig-to HDL? Wait, what’s the order of it?

Cynthia Thurlow: Usually, trig to HDL, typically.

Melanie Avalon: How do you feel about that?

Cynthia Thurlow: I kind of eyeball. Meaning, I'll look at the triglycerides, 76 to 70 and then I decide if I need to actually make that calculation, a lot of the insulin resistant, obese overweight patients I used to work with would sometimes have triglycerides in the 300s or 400s, and then they would have very low logic, HDL, so, 20, 30. And then I would be forced to calculate it to really hone in on them that there's really a lot of work to do. But when I see them at a normalized ratio, sometimes, what I'll look at is the fasting insulin to have a sense of how much work we need to do. I'll give an example. I recently had a woman talk a lot about weight loss resistance, which hack-- So many of us deal with that, right? It's very common. Her primary is only doing fasting glucose and A1C, and of course, they “looked fine.” I said, “Ask for a fasting insulin. Just ask for one Lab.” And so, they did fasting insulin and it was 12. I said, “Well, now, we know. Fasting insulin’s up, then you're going to struggle to lose weight.” And so, we worked very targetedly. Did I just make up a word?

Melanie Avalon: Targetedly.

Cynthia Thurlow: Yeah, targetedly. We made some very targeted recommendations, so that she could improve her insulin sensitivity. And three months later, when she retested, it was within normal limits. I think on a lot of levels, when I'm looking at labs, it's big picture to decide like, “What do we need to do next?” But yes, in a lot of instances, you're looking at that comparison of triglycerides to HDL to really get a sense of, is someone really metabolically healthy or are they not and they have work to do?

Melanie Avalon: Awesome. And then I wanted to comment. We were talking a little bit before this, but your comment about the A1C, it's interesting, because I actually, of course, I mentioned Peter Attia on every episode. I was listening to an episode recently where he was going on and on about the problems with HbA1c and how basically, a big factor in it can be how fast your red blood cells turnover. So, basically, if they're turning over faster, you might have a seemingly better A1C, but you actually might still have issues. Whereas if you have longer living red blood cells, that gives them a longer time to become glycated. And so, then you have a higher A1C, but it might not actually be telling about what's actually happening with your blood sugar levels, which is why Cynthia said, wearing a continuous glucose monitor, for example, might be something to check out. 

For those who would like to try out a continuous glucose monitor, NutriSense is a great option for that. We actually do have a link for them. If you go to nutrisense.io/ifpodcast, the coupon code, IFPODCAST will get you $30 off any of their programs. Subscription programs, I believe. So, that's definitely a great resource for listeners. 

The only other thing I was going to comment on was that she was asking a lot about the types of fats and things like that. And Cynthia did comment on that. The cholesterol thing is something that-- It's funny. I haven't had an episode on it yet, dedicated to it yet on the Melanie Avalon Biohacking Podcast. Because I feel I've just been passively gathering information for years. Dave Feldman, right?

Cynthia Thurlow: And listeners will be hammered to have me say this. I almost got a lipidologist There was a certification that we could take and some of the MPs and MDs did, and I got very close to doing it, and I opted not which was a good decision. But so, I can very much nerd out on lipids. Dave is next level. I had a conversation with Dave at an event in Salt Lake City and about 15 minutes into the conversation, I was like, “Timeout.” Any conceptual concept I had ever known and I do understand things at a very deep level, he's next level. He's an engineer with a very fresh perspective. I think you would completely love nerding out with him about cholesterol, and the lipid hypothesis, and lean mass hyper responders. It's fascinating.

Melanie Avalon: Where does he exist-- if it can even be said succinctly, where does he exist in the--? People on carnivore diets or low carb diets who actually have really high LDL levels and say, “It's not a problem,” does he have thoughts on that very basic idea?

Cynthia Thurlow: Yes. We actually spoke about an individual that we both know, who has very, very high LDL while on a carnivore diet. He himself and I witnessed a meeting multiple times over the weekend. He's definitely carnivore-ish, low carb ketogenic in his approach and that works really well for him. But he had some interesting insights. He's doing a lot of research, which-- I think most importantly, he's changing the narrative for clinicians and he's doing it in a way that is generating a great deal of high-quality research. And bravo to the engineers in the world. They have just very unique angles.

Melanie Avalon: I love that. I'm definitely happy to connect with him. 

Cynthia Thurlow: Yeah, I'll be happy to do an intro. He's lovely.

Melanie Avalon: Thank you. I love that. My like which is very, not super informed, but just from the-- I feel I've been passively absorbing information regarding cholesterol through osmosis for years. I'm trying to just build up my bank of thoughts about it, because I'm very much torn about a lot of the debates surrounding it. Just like the saturated fat one, for example. I know people on the low carb and carnivore sphere will often say that, “It doesn't matter and all the saturated fat.” But that does seem one thing, where if you do switch saturated fats for mono unsaturated fats, for example or more unsaturated fats, that it possibly can have a favorable effect on those levels. I'm not going to ponder what that actually means, but I think that is something that is seen. So, it's definitely something that people can try. That's a very vague approach to that.

Cynthia Thurlow: I think it's important to find balance. There are people who tend to be more focused on saturated fat found in animal meats and they don't eat as many of the-- And I'm rarely will you hear me use this term, plan- based fats. But I think they're equally important. And so, for me, personally, I do better as an example with leaner meat, but I can do fats in the plant-based variety and digest them really well. And so, maybe doing a little bit of experimentation to see what makes you feel good, I think is completely reasonable. But not to fear, fat, that is unfortunate that we have propagated that as a medical community for a long, long time.

Melanie Avalon: I think because there was that fat fear, then there was a counter regulatory response that was very intense in the other direction, which was like, “All the saturated fat and all the butter forever and ever and pounds of it.” I don't know that that is necessarily the best thing, either. [laughs] Maybe there's just a more nuanced approach to everything. 

Cynthia Thurlow: Well, I agree with you, Melanie. I think that one of the mistakes I see, women in particular making is, their husband does keto, their boyfriend, their significant other, their mom, their dad does keto and loses a bunch of weight, and it's not to suggest that a low carb lifestyle is not a good idea. It's how we go about doing it. Fat is calorically more dense than protein and carbs. And so, it's just important to understand that a whole avocado although the healthy, yes, has a lot more calories than people realize. And so, the quantity of fats that you have to be careful about, it might be that you just measure. I always say, “I tolerate a quarter of an avocado.” I'm a 50-year-old woman, I'm okay with that, I measure my nuts, I love macadamia nuts, I measure them out. I measure MCT oil, I measure olive oil for me personally, because it is easy to overeat. And then, all of a sudden, you've derailed your best efforts at managing an anti-inflammatory nutrient dense diet.

Melanie Avalon: Exactly. I agree. If people are eating all Whole Foods base or I guess, even not Whole Foods base, but a lot of times, we will be eating up ancestral type diet. But if there's some foods that will, I think easily encourage weight gain, it's nuts and dairy products.

Cynthia Thurlow: Absolutely. Slippery slope. 

Melanie Avalon: Yep. So, okay, Holly, hopefully, that was helpful. Shall we go on to our next question?

Cynthia Thurlow: Absolutely. This is Karen. The subject is: “cassava flour.” “Hi, Melanie and Cynthia. I've been listening to you for three years now and love every episode. I'm a 63-year-old retired OB nurse.” Yay. “Since I've retired, I started watching my weight, sugars and flours due to increase weight gain. I have been intermittent fasting and, in the beginning, lost weight, but now, have regained 15 pounds and can't seem to lose anything. I still do 16 to 18-hour fast, clean and unclean. Wore a CGM for a month to see if I have sugar problems. Had blood work and I'm not insulin resistant. I use the sweeteners that are safe and oils that are not toxic. I exercise three times a week at the gym, do walking and weightlifting, and I don't overdo it. I feel frustrated. I get confused about foods. 

Recently, I've been trying different grain-free pasta and found one by jovial made with cassava flour, but heard that it might be a toxic grain. I would like both your opinions on it and sorghum pasta as well. I have lymphocytic colitis and I'm supposed to be doing lectin free. I bought Dr. Gundry’s books and try to follow lectin free as much as I can. I love pasta and I have tried zoodle noodles, but I just don't like them. I know this is a lot to talk about. Thanks for all the great research and work you both do. I look forward to listening to you at the gym and I've learned so much from your podcast. Thanks, and good luck with your careers. Karen.”

Melanie Avalon: All right, Karen. So, thank you so much for your question. I did a deep dive into all of these different flours. It's funny. There's so many alternative flours in the grain free world. The go to ones are usually coconut and almond flour. I find but they are these other different ones. So, cassava? I learned so much about cassava. Do you ever cook with cassava, Cynthia?

Cynthia Thurlow: I do, because I have a kiddo with a nut allergy. And so, I've had to balance finding gluten free flours that are nut free. And so, I think cassava flour, especially, Otto’s is the flour that for me most mimics what wheat flour does when you bake with it. And so, we've had a lot of success. But it's not low carb. So, let me just make that clear. It's not a low carb option, but it's a nice option to have.

Melanie Avalon: It's funny. Basically, just hit all the points I had about it. [laughs] They were that it's paleo, but it's also AIP and it is nut free. So, check. Closest in texture and properties to all regular, all-purpose flour. You just said that. Check. And then that it's not low carb, that it's actually pretty high carb. It's actually fun fact. The third highest yield of carbohydrates per person in many parts of the world following sugar cane and sugar beets. It's also low oxalate. So, that's a nice benefit. And the toxin I guess, she's referring to is it has a toxin in it called cyanogenic glycosides. Those are actually also found in almonds and spinach, but I believe they are addressed in how it is processed or cooked. But I'm guessing that's what she's referring to. It sounds like it's a good flour. And Cynthia has used it as well, but it is high carb. Keep in mind. I didn't realize that tapioca starch is actually made from cassava as well.

Cynthia Thurlow: Yeah. It's interesting. Obviously, I have teenage boys, and they're both very athletic and lean. So, they can manage the carbohydrate influx. I made banana bread with cassava flour, and then I basically told my family, “They need to eat it or I'm going to chuck it, because I can't eat it. It's just too high carb it for me.” But I think that it's certainly an option for those people that are out there that need a gluten free option for sure.

Melanie Avalon: Oh, and then also interesting, something I didn't know was that arrowroot starch, I always thought arrow-- I learned so much, Karen, with this question. I always thought arrowroot starch was that it was a thing. Arrowroot was a plant, but it's not. It's actually a combination of different things, one of which is tapioca starch. That blew my mind. I was like, “Oh, okay.” Well then, the other one she asked about was sorghum and that actually is a green, but it's gluten free and it's low glycemic, higher and fiber and protein. Have you tried sorghum? I have not.

Cynthia Thurlow: I have not. I'll be honest and this may be controversial. But when I decided to go gluten free, I found I didn't miss pasta. My mother is Italian. She would probably be disappointed to hear that. I really don't miss pasta. I've been able to get away with spaghetti squash and zoodles. I generally sometimes miss bread, but for me, I haven't tried all the varieties of gluten free pastas. They're out there, because I think for me, I just got more interested in feeling better and I just don't do well with the alternatives. I don't feel good, I know it messes up my blood sugar. As I said, when I was talking about being around like-minded people at this event last week, I was like, “It's nice to be around people who don't have to explain myself.” So, I think each one of us have to decide what works for us and what impacts our blood sugar. Obviously, finding healthier alternatives and things that you really love that you're no longer eating, probably, a long explanation, but it's an honest one.

Melanie Avalon: Like my favorite meal, pre-dietary changes was definitely like Alfredo pasta. I just couldn't eat it now probably, because I think I wouldn't digest it well. It would just sit in me. When it comes to the flours, I've used the coconut flour and the almond flour for making baked good type things. But I haven't used these ones that she talked about. Cynthia, did you say that you'd looked up some options?

Cynthia Thurlow: I did. Cappello is one that's made with almond flour. If you're not oxalate sensitive, that might be an option. It's usually refrigerated. They have pizza crusts and all sorts of pasta options. There were things like hearts of palm, which I've tried and I can honestly say, I've tried it multiple ways in an effort to be able to recommend it. It was just a mushy mess, so that probably wouldn't be my first suggestion. There are some things like chickpea pastas and I'm fervently a believer that the processed food industry is desperately trying to corner the market continuing to encourage people to eat pasta despite this. I've just come to find that some of the bonza pastas that are made with chickpea flour, some people enjoy them. I just think it requires a degree of flexibility. 

And certainly, depending on where your live stage monitoring your blood sugar response, because maybe Karen as an example can have some chickpea pasta and to be completely 100% fair. I don't know, where that falls in the lectin category or not, because that's just not an area of focus of mine. But finding an alternative and maybe keeping the portion small, if that's something you really love and really miss. But Cappello is because it's almond flour is going to be a lower carb option than many of these other suggestions we've talked about.

Melanie Avalon: I actually also really like pumpkin seed flour. I've had that before. There's a one I really like. I think I talked about it when we were talking about vegan protein powder alternatives. Did you ever go through--? I went through this phase when I first went low carb and I feel a lot of people did, the shirataki noodles. 

Cynthia Thurlow: They smell bad. That was something I wrote down in my notes, but I actually, just like the hearts of palm, the shirataki noodles smell bad. I'm one of those people like, if something doesn't smell appealing, I can't eat it. 

Melanie Avalon: They smell like formaldehyde. 

Cynthia Thurlow: Yes. They smell very much like a preservative laden product. And so, I bought them once. Once. I know people swear by them, but they stunk. Just like the hearts of palm, that was a mushy mess. And so, it's hard for me to find something that mimics what I recall pasta really acting like. But the Cappello's, in my house, it has been popular. But my kids are going through this phase as teenagers that they want to be able to eat whatever they want. And so, we've had to bring in some organic pasta into the house to appease their desires to still eat gluten containing pasta.

Melanie Avalon: Well, I definitely went through that phase. If listeners haven't had it, if you remember high school lab when you would dissect things and that formaldehyde, that is what they smell like. It's actually not the noodles. It's what they're preserved in. I would like, “Boy, you can boil them and it goes away and you don't taste it.” But actually, the main problem for me was, they literally are just indigestible fiber. So, they have no calories and they would just sit-- If I would eat them now, they would probably sit in me for days. That was back when I was digesting things better. So, yes. But thank you for those resources. And also, do we want to comment on the first part of Karen's question, just her a little bit her issues with not losing weight?

Cynthia Thurlow: Weight loss resistance, that's definitely a common theme. I think when you're a menopausal female, you have to change your relationship with your macros and you have to be focused on protein, limiting carbohydrates, right types of healthy fats in the right quantities. I also think about sleep quality. Seven, eight hours of high-quality sleep, how do you define that? Cold dark room, waking up rested, being able to fall and stay asleep. Stress management? No, it's not a joke and it's not five minutes meditation once a week. As a menopausal female, you have to actively work at this. I speak from personal experience that I know when I'm not doing enough stress management and that has to be an active practice day to day. I think about just inflammation. Karen mentioned that she had worn a CGM. What's your fasting insulin? Well, these are common themes that I will respond to, but digging a little deeper, because of fasting blood sugar, your fasting blood sugars can still be decent. What's your response to your meals? 

If your blood sugar is going up? 25, 30, 40 points, you're not eating the right combination of. micronutrients. And then I also think about gut health and there's no menopausal or perimenopausal woman that I have looked at stool samples on that does not have some degree of dysbiosis. Dysbiosis is non-beneficial bacteria in the gut and it's exacerbated by stress. There's no one listening that hasn't experienced more stress in the last two years of our lives. And certainly, a nurse had a lot of stress in her occupation, but now, in retirement, maybe not as much but really looking at gut health due to latent infection. 

The other thing that I think about are just toxins in general that we're exposed to cumulatively throughout our lifetime. Environment, personal care products, food, all can tip over that bucket. When a woman in perimenopause or menopause is talking about weight loss resistance, you have to get honest with yourself. Sometimes, that's a hard thing to do. It may be, you really have to back off on intensely fasting, really making sure that you're eating enough food. I would imagine if you're doing 16 or 18-hour fast that you are very likely getting at least two meals in a day, but are you eating enough protein? Are you eating too many carbs? We can't eat unfortunately. In middle age, you cannot eat like you did when you were 20. It is a sad fact, but you can't. And so, there are many, many variables that I think could be at play. 

The unfortunate thing is, weight loss resistance is such a common, common problem that when a woman reports this to her internist, GYN, etc., sometimes, that gets brushed under the rug and you're told, “It's just the way things are at x age,” which I fervently disagree with. But also going back to what I was saying earlier, fasting insulin, what's your thyroid doing? Are you on hormone replacement therapy? No woman should be afraid of replacing hormones. No one. There's a great book. I actually interviewed Dr. Avrum Bluming and Carol Tavris on the podcast. The book is Estrogen Matters. There's a whole generation of women that are scared of taking HRT, there are a whole generation of clinicians that are afraid to prescribe HRT, and there are many, many variables. I know that was a lot of information, but it just goes to demonstrate that there are many, many factors of why middle-aged women can deal with weight loss resistance and it really requires diligence, and patience, and a little bit more digging.

Melanie Avalon: I agree with all of that. Yeah, one of the things I look at first and I guess, the first thing you mentioned was the macros, for example. Because it sounds like she's doing Dr. Gundry’s, which we've both interviewed Dr. Gundry. So, we can put links in the show notes to our interviews with him. Actually, maybe that's not the best diet we’ve following. Maybe lectin free isn't where the focus should be and it should be something else more comprehensive with the food like the macros. So, focusing on higher Whole Foods protein intake, I often say, trying either low carb or low fat. It might be, especially if she's doing cassava pasta, for example. It might be that she's at this spot of eating seemingly Whole Foods and lectin free, but eating both high carb and high fat together, she could be. And that might be a combination that's not quite working, where you actually need to be doing one or the other. So, that's something I really love to focus on, but there's a lot there. 

Cynthia Thurlow: Absolutely. 

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Melanie Avalon: I think we have time for one more question and this comes from Florence. And the subject is: “headaches/smells. And Florence says, “I've been experimenting with time restricted eating for about 18 months. But after reading Delay, Don't Deny and Fast. Feast. Repeat., I started proper IF in April of this year. Post the 28-day fast start, I've been doing one meal a day, Monday through Friday and approximately 14:10 eating window at the weekend since May, about six weeks now. I never weighed with scales. So, I can only go off how my clothes feel and using a tape measure. So far, I've definitely lost a few inches, but post the fast start, I was hoping it would have been a few more. I keep going through as I'm interested in the other health benefits, not just the weight loss or maintenance. Anyway, having binge listen to a lot of your episodes, I think it's probably the wine I drink at the weekend, which is holding me back. But my question today, isn't how to lose more inches? Although, any advice you may have about tweaks, I could make to my eating window would be appreciated. 

My main question is about headaches. I still experienced them and I worry that fasting could be causing them Should I just power through? I'm definitely clean fasting and I drink a lot of water, but I worry that other things like smells can be triggering an insulin response which caused my headaches. For example, the smell of my kids’ bagels in the morning or helping the kids at school chop up their dinner at lunch. There's not a lot I can do to avoid smells, though, is there? But I do wonder whether I should take supplements in case my headaches are due to a lack of magnesium or something like that. Currently, I take a multivitamin and my eating window as an insurance policy. Other than the headaches, I feel good fasting and I especially find it easy when I'm busy at work. 

I'm a primary school teacher. I have just as much if not more energy during the school day, but I will get a slump at lunchtime. When the kids have gone home and I'm reaching for the painkillers more than I'd like. Did I have headaches before IF? Yes, but not as many. Food use to help them go away. Thanks for any advice you're able to give. Best wishes, Florence.” All right, headaches and smells. Cynthia, do you have thoughts?

Cynthia Thurlow: I do. My thoughts are all over the place. I think about water and electrolytes and I would imagine that a teacher probably can't stay as hydrated ideally as she would like to be given the fact she's in front of a classroom of students all day long. I think about where is she in her menstrual cycle, if she's still getting a cycle, because we know that there is an uptick and propensity for developing headaches, especially as women are north of 35 north of 40, there's usually a preponderance of more headaches prior to menopause. It could be cyclical. I also think about magnesium is a slow muscle relaxant and so, could it be a tension headache? She doesn't describe what sounds like typical migraine symptoms. And so, my first thought would be, hydration and electrolytes, potentially the right formulation of magnesium. 

I also think about where she is life stage, because we definitely see more women reporting headaches symptoms in perimenopause. Again, I don't know how young Florence is. Heading up into menopause that a lot of women that have had headaches throughout their lifetime, once they go through menopause, they have much less headaches. And then the piece about alcohol, I don't know if per se there's a interrelationship, but I definitely see a lot of weight loss resistance around just alcohol use. There's a lot of research that's starting to support this as well. Again, life stages important. If you're in perimenopause, the 10 to 15 years preceding menopause, that could be a larger issue. But I think based on what she's suggesting here, it's more that the headaches are of greater concern. How about you?

Melanie Avalon: I was going to say that about electrolytes for sure. And actually, LMNT is a sponsor on today's show. So, check out the ad that we ran for them. We have a really great offer for them. They're actually giving a free sample pack with any purchase. So, we'll put a link to that in the show notes. But that is at drinklmnt.com/ifpodcast. And just a note about that, the unflavored raw one, that's the one that is clean, fast, friendly. All the other ones would be for during your eating window. But yes, I was thinking electrolytes, also thinking magnesium. So, my AvalonX Magnesium might be a great thing to try. I'm really fascinated by-- Well, her thoughts that smelling something releases insulin, which causes the headaches. Would that be from a drop in blood sugar that would cause the headaches? What would be the mechanism there?

Cynthia Thurlow: Yeah. Could you get a headache when you're hypoglycemic? Absolutely. She did mention that she gets slumps at lunchtime. I don't know, if that's preceding or after eating meals. There's definitely things that could precipitate that-- The fact that she's sensitive to smells makes me think there could be a migraine component to this, because I used to have migraines prior to going gluten free and I was very sensitive to smells. That was oftentimes, a little bit of a precursor to when I would develop a headache. I think that there's probably multiple things. Dehydration is a common reason for developing a headache. And hypoglycemia is a common reason for why people can develop headaches. So, I think there probably needs to be some experimentation there. Maybe she should not be fasting as long and see if that improves, because she mentions farther down that she wasn't getting as many headaches prior to intermittent fasting.

Melanie Avalon: She's having to reach for the painkillers a lot, even things like that, there's a lot of potential here to get out of a spiral that's not quite working for you. Because even with the painkillers, there's something causing the headaches. Taking the painkillers, it doesn't really address the root cause. If we find the root cause, hopefully, you could be taking less and less of those. And even painkillers themselves can have a pretty not so good effect on the gut causing intestinal permeability and things like that. And gut health is so connected to everything. So, I definitely think there's a solution and I'm hoping that you can find that. It's interesting, the fact that the food makes it go away. To me, it does say that it might involve either blood sugar issues or electrolyte issues. So, hopefully, something works, Florence and you can report back and let us know. 

Cynthia Thurlow: Yeah, definitely do.

Melanie Avalon: All righty. Well, this has been absolutely wonderful. A few things for listeners before we go. If you'd like to submit your own questions for the 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 the stuff that we like at ifpodcast.com/stuffwelike. The show notes for today's episode, which will be very helpful, because we talked about a lot of things. So, there will be links and a full transcript. That’ll be at ifpodcast.com/episode277. And then you can follow us on Instagram. We are @ ifpodcast, I am @melanieavalon, Cynthia is @cynthia_thurlow_ and I believe that is all the things.

Cynthia Thurlow: Awesome. Well, another fabulous podcast. Keep all those questions coming.

Melanie Avalon: I know I'm really, really enjoying them. Well, this has been absolutely wonderful and I will talk to you next week. 

Cynthia Thurlow: Sounds great. 

Melanie Avalon: Bye. 

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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