Episode 286: Thyroid Regulation, Iodine, Fasting For Your Cycle, Insulin, Glucagon, High Protein Diets, Surgical Menopause, Prescription Medication, And More!

Intermittent Fasting


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Oct 09

Welcome to Episode 286 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Cynthia Thurlow, author of Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging.

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

BUTCHERBOX: Grass-Fed Beef, Organic Chicken, Heritage Pork, Wild-Caught Seafood: Nutrient-Rich, Raised Sustainably The Way Nature Intended, And Shipped Straight To Your Door! For A Limited Time Go To Butcherbox.com/ifpodcast And Get A 10 oz New York strip steaks and 8 oz of lobster claw and knuckle meat FREE in your first order!

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


BUTCHERBOX: For A Limited Time Go To butcherbox.com/ifpodcast And Get A 10 Oz New York Strip Steaks And 8 Oz Of Lobster Claw And Knuckle Meat FREE In Your First Order!

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

The Melanie Avalon Biohacking Podcast Episode #12 - Elle Russ

Ep. 129 – Middle Age, Menopause, and Mindset: How These Components Affect Your Thyroid Health with Elle Russ

Ep. 105 Thyroid Physiology and Chronic Illness – with Dr. Eric Balcavage

Ep. 166 How to Maintain a Healthier Thyroid: Interesting Thyroid Physiology Health & Preventative Care with Dr. Eric Balcavage

The Melanie Avalon Biohacking Podcast Episode #1 - Dr. Alan Christianson

Ep. 154 How to Normalize Your Thyroid Function: What You Can Do To Help Support Your Body with Dr. Alan Christianson

Get On The Email List To Stay Up To Date With All The Special Offers And News About Melanie's New Supplements At avalonx.us/emaillist, And Use The Code Melanieavalon For 10% On Any Order At Avalonx.Us And MDlogichealth.Com!

Text "AVALONX" To 877-861-8318 For A One Time 20% Off Code for avalonx.us

BEAUTY AND THE BROTH: Go To melanieavalon.com/broth To Get 15% Off Any Order With The Code MelanieAvalon!

Listener Q&A: Ashley - Struggling with consistency

Listener Q&A: Monica - 3rd time is a charm?

High dietary protein intake, reducing or eliciting insulin resistance?

Effects of high-protein diet on glycemic control, insulin resistance and blood pressure in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

Protein: metabolism and effect on blood glucose levels

Ep. 109 How To Transform Your Health With Diet And Exercise – With Dr. Ted Naiman

The Melanie Avalon Podcast Episode # 30 William Shewfelt And Ted Naiman

The Melanie Avalon Biohacking Podcast Episode #94 - Marty Kendall

Listener Q&A: Jessica - Menopause, HRT, etc

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 286 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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There is a lot of confusion out there when it comes to transparency regarding raising practices, what is actually in our food, how animals are being treated. I did so much research on ButcherBox, you can actually check out my blog post all about it at melanieavalon.com/butcherbox. But I am so grateful for all of the information that I learned about their company. All of their beef is 100% grass fed and grass finished. That's really hard to find. They work personally with all the farmers to truly support the regenerative agriculture system. I also did an interview with Robb Wolf on my show, The Melanie Avalon Biohacking Podcast, all about the massive importance of supporting regenerative agriculture for the sustainability of not only ourselves but the planet. This is so important to me. I'll put a link to that in the show notes.

The value is incredible, the average cost is actually less than $6 per meal. And it's so easy. Everything ships directly to your door. I am a huge steak lover. Every time I go to a restaurant, I usually order the steak. Oh, my goodness, the ButcherBox steaks are amazing. And we are so excited because ButcherBox has an incredible offer just for our audience. You can get some of those steaks for free and lobster to go with it. You can go to butcherbox.com/ifpodcast and get two 10-ounce, grass-fed, grass-finished, New York strips and one-half pound of wild caught sustainably raised lobster meat all for free in your first box. Yes, completely free. That's butcherbox.com/ifpodcast and we'll put all this information in the show notes.

And one more thing before we jump in. Are you fasting clean inside and out? 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 eight thousand compounds found in conventional skincare and makeup in the US due to their toxicity. These include endocrine disruptors, which mess with your hormones, carcinogens linked to cancer, and obesogens, which literally can cause your body to store and gain weight. Basically, when we're using conventional skincare and makeup, we are giving these obesogenic compounds direct access to our bloodstream. And then in our bodies, studies have shown they do things like reduce our satiety hormones, increase our hunger hormones, make fat cells more likely to store fat, and more resistant to burning fat, and so much more. If you have stubborn fat, friends, your skincare and makeup maybe playing a role in that.

Beyond weight gain and weight loss, these compounds have very detrimental effects on our health, and they affect the health of our future generations. That's because ladies, when we have babies, a huge percent of those toxic compounds go through the placenta into the newborn. It is so, so shocking and the effects last for years. Conventional lipstick, for example, often tests high in lead and the half-life of lead is up to 30 years. That means, when you put on some conventional lipstick, 30 years later, maybe half of that lead has left your bones. On top of that, there is essentially no regulation of these products on the shelves.

That's why it's up to us to choose brands that are changing this. The brand that is working the hardest to do this is Beautycounter. They were founded on a mission to change this. Every single ingredient is extensively tested to be safe for your skin, so, you can truly feel good about what you put on. And friends, these products really, really work. They are incredible, they have Countertime for anti-aging, Countermatch for normal skin, Countercontrol for acne and oily prone, and Counterstart for sensitive. I use their overnight resurfacing peel and vitamin C serum every single night of my life. And their makeup is amazing. Check on my Instagram to see what it looks like. Tina Fey even wore all Beautycounter makeup when she hosted The Golden Globes. So, yes, it is high-definition camera ready. They have so many other products, deodorant, shampoo and conditioner that I love, products for babies, and so much more.

You can shop with us at beautycounter.com/melanieavalon or beautycounter.com/cynthiathurlow and use the coupon code, CLEANFORALL20, to get 20% off your first order. Also, make sure to get on my clean beauty email list. That's at melanieavalon.com/cleanbeauty. I give away a lot of free things on that list. So, definitely check it out. You can join me in my Facebook group, Clean Beauty and Safe Skincare with Melanie Avalon. People share their experiences, ask questions, give product reviews, and I do a giveaway every single week in that group as well.

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

Hi everybody and welcome, this is episode number 286, 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: Good, how about you?

Cynthia Thurlow: We were just commiserating about this. But when your thyroid medication gets changed, it can sometimes be a little bit of a bumpy ride. So, I'm feeling I need to prop up my eyes with toothpicks today.

Melanie Avalon: I've been on the same bus that you've been on with trying all different forms of thyroid medication. It's just so complicated because there's so many opinions and there's so many options. And it can be hard to really find what works for you.

Cynthia Thurlow: Totally, I think if anyone that has an underactive thyroid that's listening, I know you understand [chuckles]. I know you understand, so I'm trying to just wait it out. My functional medicine doc is encouraging me to wait it out another week and get my labs checked. Goodness, I feel I need a power injection in the afternoon because I feel like I need a nap. And who has time for that every day?

Melanie Avalon: Well, I will say, this actually made me think about this. Sort of recently, I was in a period where I was feeling I needed a nap every day. And I just realized you know how you don't really notice when the negative things are gone? I just feel when I'm experiencing something negative once it actually goes away, I don't you may normally realize it. I just realized, "Oh, I haven't been needing a nap every day." I think the difference is, when I got sick a few weeks ago and started really high dosing the NMN and I stayed on the NMN every day at a higher dose. I don't need naps anymore. I think that's what it is, I don't know what else it would be. Although I have realized I feel a little bit more wired at night as well. So, I'm maybe I'm too high dosing. So, that's a benefit. I didn't used to be a nap person, and then I was and I'm not. How about you?

Cynthia Thurlow: Every once in a while, might need it but I generally, power through my day. And on a lot of levels, the fact that I consistently every single day, I'm this tired, the only variable that's changed is the thyroid medicine. And I knew this would happen because what typically happens is I get insomnia. And then, I have a crash in the afternoon. That has been a consistent pattern. Even though they've increased my T4, they lowered my T3. And my functional medicine doc said, and I quote, "You have the most interesting thyroid panel I've ever seen." And I said I don't want to be interesting I just want to be normal. I'm trusting the process. And he's absolutely brilliant and one of the smartest physicians I've ever met, so I am trusting in the process but in between, I will need naps in order to function.

Melanie Avalon: Do you think you'll increase your T3?

Cynthia Thurlow: He might. I think it's interesting, I'm supposed to have lab, he wanted labs drawn two weeks after I started the medication. So, I've already got that appointment set up, and I knew as soon as I started, I knew that there would be this bumpy-- this has been the pattern every single time they've changed my medications. In fact, I thought for a moment, because I keep all my old medicines just to describe to people, I'm not kidding, I really have been on 10 different prescriptions in the past two years. And it's a bag of thyroid medicine. And my husband was like, "What is that?" And I was like, "I don't know, it's a trophy. I'm keeping this for posterity's sake, I'm not sure." But to really demonstrate this is what people go through. And I'm a clinician and we still haven't gotten it right, so it goes on to just suggest that many people listening, are probably struggling with the same thing. So, that's why I wanted to share, to be transparent and say, "Yes, I'm a clinician. But yes, I'm still struggling to get the right combination of medications."

Melanie Avalon: I don't love that you're experiencing that. But [chuckles] I love it that's your approach. And yeah, some good resources for listeners. Have you interviewed Elle Russ?

Cynthia Thurlow: I have Elle and Eric Balcavage, Balcavage, sorry, I just mangled his last name, he's wonderful. He does a great Thyroid Thursday on Instagram. So does a lot of teaching. I think he's a great resource. And we both have had Alan Christenson on, but I would say Eric does a lot of didactic teaching as a clinician, which I love. And then Elle is all about empowerment, which is fantastic.

Melanie Avalon: Yeah. And Dr. Alan Christianson, who you just mentioned, it's funny, when I first met him, I was really struggling with my own thyroid panels. He is the nicest person ever because I literally just met him, and we've been vaguely emailing actually about intermittent fasting stuff. We were debating the literature on it. I guess at some point, my own thyroid issues came up and he was so nice. At one point, he was like, "Well, send me your labs to look at." I sent them to him, and he called me, he was like, "I have to talk to you about this [laughs] We have to get this fixed now." I was like, "Oh my goodness. You're the nicest person ever." He has a book called The Thyroid Reset Diet. He was actually my first episode of the The Melanie Avalon Biohacking Podcast.

Cynthia Thurlow: You what's funny, so fast facts. Alan was part of my Mastermind. When I joined it, and I recall the very first time I met him in person, I was sitting next to him at a lunch, and I was trying to be really cool. Because sometimes when you meet these people that you've been following them for years, and then you're socially around them. All I say to myself is, "Just be cool. He is a normal guy." And he is as nice as nice could be. I just think Midwesterners in general are just such nice, down to earth, human beings. And he really is as nice as he appears to be, and very quiet and introverted and I really enjoyed the time that I had with him, but I think he's a great resource.

Another funny thing to share with you is that the podcast team that I had at the time that I recorded a podcast with him about his new book about iodine, the podcast title was Intermittent Fasting and Thyroid Health, and I just about had a minor heart attack, because he's not a big fan of Intermittent Fasting. And I literally was like, "You cannot put that out. You cannot do that." And then, I had to explain the context. I was like, that is absolutely the worst title you could ever come up with.

Melanie Avalon: It's funny, the way I met him actually was-- I don't know if it was him or it was probably his publisher, or publicist, or somebody. They pitched him to come on this show. And it was for his metabolic reset diet. And literally at that time, he literally had a video on YouTube about-- it was basically deconstructing intermittent fasting. I wanted to engage with them. But Gin was not too excited about the idea. And so, that's why I started talking to him via email and started discussing the studies. And he actually took down that video, I think, after it because we talked about it some more and I think he realized there was a slightly more nuanced perspective on that specific content that he had created. And I just thought that was so impressive. But yeah, I know, I love his work. He has the thyroid reset diet, the adrenal reset diet. What's the book on iodine called?

Cynthia Thurlow: No.

Melanie Avalon: That's the thyroid reset diet.

Cynthia Thurlow: Yes.

Melanie Avalon: I'm still haunted by that. I still don't know what I think about it.

Cynthia Thurlow: I don't agree, politely I don't agree.

Melanie Avalon: I need to reread it, because it's interesting, because it's so contrary. It's not like it's slightly different than the popular idea. So basically, for listeners, a lot of people in the functional health world, and I guess nonfunctional as well, advocate needing more iodine to help thyroid and just health in general. And a majority of the book is about how iodine is actually the issue, and we actually need to be on a low-iodine diet. So, yeah, I don't know.

Cynthia Thurlow: I think it's important to entertain the possibility that there may be aspects to that argument that are applicable, but I don't necessarily agree but I don't have enough background, I'm not an iodine specialist, but I do ask my functional medicine friends and I would say iodine is a controversial issue because you have people like Brownstein, who is pro iodine, and wrote the book, The Iodine Crisis. And then, you have other doctors that feel differently. So, we have to agree to disagree. And I don't feel I know enough to feel I could take a stand on it. I'm in a state of flux.

Melanie Avalon: Reading his book, it's very convincing. And I do think there's probably a lot to maybe the difference between people who are eating a conventional diet, so they're getting iodized salt, compared to people who might not be having conventional salt, and so not having that source, I do wonder what role that plays. I do know iodine-- I know I've shared this on the show before I don't know if I've told you before. It's the only supplement that I experimented with that I had such obvious scary reaction that I was like, "I'm never taken this ever again." My eyes literally turned bloodshot red.

Cynthia Thurlow: Really?

Melanie Avalon: Yeah, that's kind of frightening [chuckles]. I remember I can't-- I can't even know if I can go to work. It was when I was still waiting tables. Yeah, so we will put links in the show notes. To the interviews we have had with all of these individuals.

One little announcement I do want to share with listeners, by the time this comes out, I feel bad because I think that this special will have already ended but the concept is still available, which is all the more reason you need to be on my email list for my AvalonX Supplements, which is avalonx.us/emaillist. And also, you can actually get text updates, and a 20% off one time code. I'm so excited, I set up text updates. If you text 'AvalonX' to 877-861-8318-- I'm just going to emphasize for clarity, Cynthia, have you ever set up a text service?

I have not. It's really funny because I say text 'AvalonX', all of the iterations I get of people texting that it's not AvalonX, people will text Avalons, or, give me the code or all these things. I'm like, "No, you have to text just the word AvalonX." So, it's a kind of like-- I don't know, it's just really funny to see all the messages. So, that's A-V-A-L-O-N-X to 877-861-8318. And if you are on that list, you would have known that we launched magnesium subscriptions. And we actually had a two-week window where you could get grandfathered in for life at a 25% discount, which is the largest discount we should technically probably ever do. And you get it for life as long as you stay on the subscription, which you can also pause. So, that's amazing, if you didn't snag the 25% you can still get a subscription now at 15%, so that's an option. Anything else from you, Cynthia?

Cynthia Thurlow: I am hopeful that we will finalize a package for the creatine so that I can get a date that this will be available. That is, I've got my fingers crossed.

Melanie Avalon: I'm very excited for you. Then someday, you'll have subscriptions on that as well, probably?

Cynthia Thurlow: Yes, you'll be able to tell me all about text options too.

Melanie Avalon: That's the thing I've learned, is be very clear in what people text to you.

Cynthia Thurlow: Keep it simple.

Melanie Avalon: It is simple, but people just extrapolate and text all the things and I'm like, "No, that is not what it says."

Cynthia Thurlow: It says not direct access to Melanie 24/7.

Melanie Avalon: Is not what it says.

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By the way, bone broth does break your fast. This is something that you want to have in your eating window. In fact, it's an amazing way to open your eating window, because when you're in that fasted state, when you take in bone broth as the first thing, all of those rich nutrients and collagen go straight to your gut, help heal your gut, help with leaky gut, help digestive issues. And again, you can go to thebeautyandthebroth.com and use the coupon code MELANIEAVALON for 15% off. I'll put all this information in the show notes. All right, now, back to the show.

Shall we jump into everything for today?

Cynthia Thurlow: Absolutely.

Melanie Avalon: To start things off, we have a question from Ashley and the subject is "Struggling with consistency." And Ashley says, "Hi, I have been a fan and I've listened to your podcast from the start, which means I started IF back in April of 2017. I wish I could say I have done IF every single day since then. But no, it has been the struggle bus for me to do it consistently." Typically, since 2017, I IF on average four to five days a week. Some weeks are better than others when I can complete six to seven days of IF, where other weeks are harder one to two days. My window varies from 16 hours to 24 hours. Really at this point, I have been in maintenance, at times losing and gaining 5 pounds.

Now that I'm approaching my third year of IF, I've hit a roadblock in the mornings. I find myself so hungry. I usually close my window at 7pm the night before having dinner with my husband is very important to me, which is why I don't want to break my fast in the morning. It seems lately, I can only make it to 12 hours before caving on eating something some days. What I'm getting at is, do you all have tips or advice for getting through these humps? Have you ever experienced it before? I'm disappointed in myself with the inconsistency I've done with fasting over the past couple of years, which I know leads to not getting the best results. I do love the health benefits of IF and never regret it when I do fast for at least 16. It's just some days I find myself starving, and then I cave. Any recommendations you have, I would appreciate so much. Thank you."

Cynthia Thurlow: Well, Ashley, I don't know how old you are. So, I'm going to just keep this a broad response. When a woman is telling me she really struggles to get to 12, 13,14 hours, I think you need to look at your macros. Are you getting enough protein? Are the meals that you're consuming in that feeding window, are they sufficient enough calorically to be able to fill your body? Where are you on your menstrual cycle? We know the follicular phase from the day you start bleeding up until before ovulation is a time that you can get away with longer fast. And then as you transition to the luteal phase, as you're getting closer to when you're going to get your menstrual cycle, I generally recommend women fast no more than 12 or 13 hours. So, I don't know if you're in a premenstrual situation and the end stage of luteal phase and that's why you're struggling. I would really dig into if you're feeling you're a little bit weight loss resistant, how's your sleep? How are you managing your stress? Are you getting enough macros in? Are you over exercising? So, there's a lot of variables that aren't entirely clear. And I just start to see a lot of women that get into these situations where they start to feel they're not seeing the results. So, they restrict more, they're just not feeling their bodies. And I get concerned that your body may in response to not feeling it's getting enough food and is really pushing the envelope. And if you're that hungry, I would definitely recommend breaking your fast, but also understanding that there are things you can do that could potentiate your fast, but I just feel I need more information to be more specific than I already have been. How about you, Melanie?

Melanie Avalon: Yeah, I thought that was great. I love how comprehensive that there are so many potential factors going on. I would just add to it that I think a lot of people, when they're having issues with and this is what you're talking about, but a lot people when they have issues with finding the fasting hours that work for them, they think the answer is in the fasting hours, like adjusting when they're fasting. But I personally find that looking at the food intake side of things can often be potentially just as helpful or more helpful than that. Especially when people send in questions, because we have a pattern of people who send in questions.

Some people, when they're discussing fasting and their issues, they also paint a very clear picture what they're eating. Some people don't mention it at all, it doesn't even come up in the question like this one. And I don't know this is the case but that says to me that it's possible that there's not as much of a focus on what you're eating as there could be that would possibly really, really help. So, making sure that you're getting adequate protein in your eating window, which we have a question about protein coming up. And for some people, it's looking at the macros that you're eating can actually be super helpful for satiety levels. So, some people do better with the lower carb approach, and that's what really helps them tap into fat burning and not be hungry. Some people do better with a higher carb approach, and actually, those carbs are what keeps them satiated. So, I would definitely look at what you're eating, there's a lot of potential to find something there, in addition to all of the other amazing things that Cynthia brought up.

Cynthia Thurlow: Now, it's such a good point, I think we have to look at things comprehensively. When a strategy is not working, it's okay to take a break from fasting. That's the other thing that I don't hear enough people talking about, that there are times and cycles in our lives when fasting really does well for us and times when it does not and it's okay to take a break. If you feel your body's really communicating that it's not working, there are definitely ways around that.

Melanie Avalon: Yes, exactly. Especially tying into-- I was just looking at the part where she's talking about how it's some weeks that are good, and some weeks that are harder. And I really, really wonder, you were talking about with the menstrual cycle, if it does align that way. I think oftentimes people, with the menstrual cycle, they don't make the connection that there's that connection going on there.

Cynthia Thurlow: Yep. Absolutely.

Melanie Avalon: All righty. Shall we go into our next question?

Cynthia Thurlow: Absolutely, this question is from Monica. And the subject is "Third time's a charm." "I've listened to your whole podcast. I love all the information. It has seriously been so helpful in my fasting journey. Fasting has helped me overcome so much. Major hormone imbalances and an obsession over food that is totally mellowed out with the control I feel with fasting. It's wonderful and truly life changing. My question is something I never really thought could be an issue. But I found an article that said otherwise. Can a diet focused primarily around protein contribute to insulin resistance? I follow Dr. Ted Naiman who is a huge fan of protein over pretty much all else. But if you're constantly getting the spike in insulin from protein, could not have the same effect on our tolerance of insulin as sugar does. For example, a diet of low carb high protein low to moderate fat. I'd love to hear your thoughts and research. Love you guys. Seriously keep it up."

Melanie Avalon: Okay, Monica, thank you so much for your question. Really, I got so excited about researching this question, and I did a lot of research. So, I'm so excited to talk about this. So, yes, protein does release insulin. The difference between how it releases insulin compared to carbohydrates, for example, it varies. I was looking at a lot of different literature and there are charts on different foods and insulin release. And some charts will say, for example, that beef releases more insulin than carbs. But then, something else I was looking at was saying that protein requires about half of the insulin of carbs. So, it seems to be all over the place. But the point is, they both do release insulin in substantial amounts compared to fat, which is very, very minimal.

The difference with protein is it also releases a hormone called glucagon. And you can think of glucagon as the counter-regulatory hormones to insulin. So, insulin reduces blood sugar, puts sugar into storage. Glucagon actually spurs the liver to release glucose into the bloodstream. Let's say you're just eating protein, and you are nondiabetic, and you are good with your insulin regulation in general, in theory, you would eat some protein. And because you're not eating carbs with it, this is my example, the insulin would lower your blood sugar, actually, and then glucagon would actually encourage your liver to release glucose. And then, you just have a straight-line response, and you wouldn't really have those dips and swings.

All of that said, there can be some issues, potentially with, one, the fact that protein does release insulin. So, if we are eating a lot of protein constantly, we could be getting-- it could potentially encourage insulin resistance from all that insulin release, especially in the context of if you're eating a mixed diet, and you're also getting insulin released from carbs and things like that. And then, releasing the glucagon can actually also potentially be a problem, because now not only are we releasing insulin to store carbs that we might be eating with a meal, but we're also potentially releasing glucose from the liver, which might create a longer-term blood sugar insulin issue.

On top of that, the constant release of-- protein stimulates something called mTOR, which actually, it's a growth signal in the body. And there are studies on mTOR and insulin sensitivity, and too much stimulation of mTOR constantly, might also encourage insulin resistance. And then on top of that, there's a lot of studies on BCAAs. So, those are branched chain amino acids. They are some of the potential amino acids that we can get from protein. And studies are pretty consistent that high levels of those in the blood tend to correlate to insulin resistance. But the problem is, we don't know if it's chicken or egg. We don't know if high BCAAs in the blood cause insulin resistance. Or if when you are insulin resistant, your body is unable to properly get those BCAAs out of the blood. And the studies are very conflicting and inconclusive on the BCAAs.

I found a very amazing study that literally looks at this question that Monica had. It's from July 2014 and it's called, "High dietary protein intake, reducing or eliciting insulin resistance?" And it looked at all the studies to date. So again, it's a little bit older of a study, 2014. But it was looking at the studies to date that all looked at high protein intakes in different situations, and how did it affect insulin resistance and glucose control in the subjects. And I actually, because there's a lot-- It's a very long article. I actually went through and counted, because they didn't really give a graph. I just went through and counted what they actually found. I'm going to tell you because I find it very telling.

In studies of healthy people who are not obese, who are not losing weight, so this is a short-term, energy-balanced high protein diet. Basically, just going on a high protein diet for the short term, not calorie restricted, not losing weight. Three other studies found that when they compare that to a normal diet, there was no effect on insulin resistance, so we didn't see a negative effect there. And then, one study found a benefit, so that's favorable. The second category was people who are overweight also doing the same thing. Short term, they're eating a high protein diet, but they are not losing weight. One of the studies found that when they made the protein high diet with whey protein that there was a benefit. And when I say benefit, I'm talking about on insulin resistance. One study found that there was no change, so there wasn't any difference. One study found when they use casein and whey that there was no change. Another study was six weeks, it was high protein, and the protein was from legumes and whey, and they found that it actually-- the high protein decreased insulin sensitivity, but then it actually normalized the longer the people were on it. Another study in diabetics with that setup found that the high protein improved insulin sensitivity. The conclusion was that it's inconclusive.

Then, they looked at people who are on short-term diets where they were calorie restricted and high protein, and losing weight. And in those, well, they started off by saying that most weight loss diets leading to weight loss increase insulin resistance. So, if you're on a high protein diet and you lose weight, you're probably going to see a benefit in insulin sensitivity. But it's hard to know if it's from the protein or if it's from the weight loss. They found that two studies compared high protein diets to other calorie-restricted diets for weight loss and the high protein diets had more of a benefit. One study found, comparing it to a control, so not to a calorie-restricted diet, it found a benefit. One study found that the high protein diet did not have as beneficial of an effect on Homa IR, which is a good marker of insulin sensitivity, but it did have a better effect on beta cell function and the pancreas. So, that's a little bit confusing. And then, two studies found that it was the same benefit. And then, one study found that it was looking at high protein versus high carb in a calorie-restricted situation, and the high carb was superior.

Last category, I'm almost done. And then, the section looking at long-term intake of high protein diets, one study looked at six months of people who are healthy on high protein diets. And they found that those on the higher protein diets had higher insulin resistance and more glucose issues. A collection of observational studies on diabetes found that high protein diets led to more issues. But then The Nurses' Health Study looked at low carb high protein diets and they did not find those issues. And then they actually did find that long-term intake of high protein from vegetable protein actually benefited insulin resistance. And then, there was another meta-analysis that they referenced. And that looked at 15 randomized control trials of more than 12 months on the long-term effects of diets high in protein. And it showed neither a positive nor a negative effect on glycemic control compared to diet low in protein in both healthy and insulin-resistant subjects.

Okay, sorry that that was so much information. But basically, there's been a lot of studies looking at this issue. Like I just went through all of those, the effects seem to be pretty mixed. It's interesting, because the study I was referencing, they concluded that high-protein diets and insulin action are not univocal, which means unambiguous. So basically, it is ambiguous. And that insulin sensitivity seems to have a beneficial effect in high-protein diets when people are overweight or insulin resistant, and they are losing weight. In the short term, having a high protein diet doesn't seem to really affect insulin action. But in the long term, there might be a-- or they say it seems to be deleterious when the intake is prolonged. And that this goes along with seeing high plasma BCAA levels in the blood, like I was talking about. Their ultimate conclusion is that in the long term, increased insulin secretion and consequent hyperinsulinemia might lead to reduced hepatic insulin sensitivity. Increased hepatic glucose output results in a decrease glucose control, although a direct effect in insulin action and insulin sensitive tissues can also have a role.

My thoughts stepping away from all of this is that yes, if you are doing high protein-- well, especially if you're doing high protein in the context of energy-toxic diet, a diet with too much energy in the long term, I think definitely can encourage an issue, contribute to an issue. If you're eating protein constantly 24/7, it could have those issues with mTOR. It could have basically all of these issues. In the context of weight loss, I don't think most people would need to worry about this at all. In maintenance as well. I'm not sure but I do feel for people who are doing intermittent fasting, we're getting that period during the fast of low insulin. We're getting that period of low mTOR. I think it's crucial that we get adequate if not high protein when we do eat. So basically, I really think that the issue here is energy toxicity, not protein completely. That was a really long answer. Cynthia, do you have thoughts?

Cynthia Thurlow: No, I am in awe of the research that you did. My clinical context, just thinking thoughtfully about this question is, I'm 100% in agreement that the energy toxicity, meaning you're eating too much food, is really the issue. Now, when we look at the bulk of the population, we know 92-93% is metabolically inflexible and unhealthy, it is likely not too much protein, that's the issue. It's the overall there's just too much caloric or the macros are imbalanced. It's overwhelming the body's storage sites. And it is less about protein, and more about all of the other factors. Most people, perhaps not our listeners, but most individuals here in the United States are drinking caloric beverages all day long. They're eating anywhere from 6 to 10 times a day. And when you're really looking at the degree of meal frequency, the average American is doing-- average westernized person combined with those beverages, I think that is a greater issue. And for them, if they suddenly go high protein, and they still have all these other behaviors that I've identified, then that can become a larger issue.

And it's interesting, Ted Naiman, I've interviewed and I'm very aligned with him on many, many things. And he has this amazing book that is only an electronic book, which means I don't own it, because I like having physical books for most of my things that I want to reference. But he posts a lot of fantastic content on Twitter and YouTube. And it's a great resource. And he talks about how a certain amount of protein and fats will shut that satiety, you'll hit those satiety hormones that you just physically can't consume more food. And I think that's an important distinction along with everything else that you said. But I'm so grateful you did all that amazing research. I'm just going to speak to it as a clinician, and I think it has everything to do with an overconsumption of calories, in general, that is creating this toxicity and this degree of lack of metabolic flexibility and insulin resistance.

Melanie Avalon: Yeah, what you just said is basically exactly how I feel. And I think the nuance as well is that, so say we are in energy toxicity situation on a low protein diet, the energy toxicity is primarily coming from carbs and fat. Just stepping aside, in general, energy toxicity is, I think, the issue. If you have low protein, the factor that you don't have going on in that situation, is that you're not getting that glucagon stimulation, that would be prompting the liver to be constantly also releasing glucose from the liver, which would be further exacerbating issues as well as the potential buildup of those amino acids in the bloodstream. Compared to when you do have the protein, you've got that secondary issue going on.

And I did want to throw in, because I left out one other thing because that was 2014. There was actually a 2020 meta-analysis, and it looked at 12 articles with 13 studies including patients with diabetes, and they actually concluded that a high protein diet does not significantly improve glycemic control and blood pressure. They didn't say that it hurt it, they just said it doesn't improve it. But it can lower LDL, TC, TG and Homa IR levels in patients with type 2 diabetes. Further studies are needed to clarify the effects of high protein diet and glycemic control, insulin resistance and blood pressure control and type 2 diabetes. I just want to throw that one in there because I left it out.

But I'm glad you brought up Ted Naiman, I love him, we can put links to the episodes that we've had with him. I also really love Marty Kendall. He had a really good article on the glucagon aspect of this that I was reading, and he actually referenced Ted Naiman in that study as well. All that to say I agree with-- what you just said is what I agree with that. I think the issue is the energy toxicity.

Cynthia Thurlow: No, it definitely makes sense.

Melanie Avalon: Okay, I don't know if Monica expected that long of an answer. [Cynthia laughs] All right, we have a question from Jessica, and the subject is "Menopause, HRT, etc." Jessica says, "Hi, I love this podcast and I learned so much about IF. My doctor advised me to start IF a month ago when she put me on HRT. I'm 37 and still breastfeeding my daughter aged one, but I'm also postmenopausal as my ovaries were removed in December. My doctor advised HRT because my estrogen was unsurprisingly very low, and my DHEA and testosterone were very high. I've been doing IF starting at 16:8 a month ago, and now usually doing 18:6 and sometimes 20:4. I have not lost a single pound. My clothes do not fit differently. I am at my highest weight ever and getting so discouraged every time I step on the scale.

I have now been on low doses of bioidentical estrogen and progesterone for a month while doing IF. And although I feel some benefits, it's helped some digestive issues. I need the scale to move in order to feel my health is improving. Losing even a few pounds would give me hope, but it is just not happening. How long do I stick with this before it's time to admit it is not working for me? I'm also a vegetarian, but I sometimes eat the occasional fish. I'm reading that the research on IF for women is mixed, and it may have negative consequences for postmenopausal women. Is it possible this just isn’t for me? I hope that's not the case. Because this is the only diet, I've ever tried that I felt was sustainable. Thanks in advance, keep up the good work."

Cynthia Thurlow: Ah, Jessica, you have a lot going on. Oh, my goodness. You're still a very young woman, and we know women that have their ovaries removed before the age of 42 are at greater risk for developing cognitive issues. So, I'm grateful that your doctor is being very proactive and considering hormone replacement therapy. My concern is, and I'm just going to start from the top, I'm not in agreement with women breastfeeding or being pregnant and fasting. You're wanting to lose fat, but your body is still feeding a baby. And I'm sure if she's one, she's probably eating a lot of solids. And so, her breastfeeding might be brief and just a few times a day. But just something to think about in the position that you're in, you're giving your body mixed signals. You want it to lose fat, but you still want to be able to sustain being able to breastfeed, and I find for most women while they're breastfeeding, it's harder for them to lose body fat. So, that's number one. Since you're so young, I'm curious to know why your ovaries were removed at such a young age because that's very significant.

You're mentioning that your testosterone was high. The question is why. Did you have polycystic ovarian syndrome? When I start thinking about the reasons why women can have high testosterone, that's almost always the first thing I think about. Does your husband take supplemental testosterone? Probably not, because you're both very young, but you can sometimes get exogenous exposure that way. Just in thinking about the bioidentical hormones, it could be a combination of too much stress on the body, breastfeeding, fasting. Going into menopause is a big adjustment, and you have surgical menopause, meaning the average age of a woman in the United States to go through menopause is 51. You're 37. So, you're very, very young. And so, from my perspective, it's trying to get a sense from what you've shared as to what could be going on.

The other thing that I get concerned about is most vegetarians in my clinical experience consume too many carbohydrates, not enough protein. And you really have to work at that very diligently. If you're eating very limited, animal-based protein, hopefully, you're eating some eggs, which will make that easier. But the challenge is, if you're trying to fuel weight loss and you are vegetarian, you're very likely overconsuming carbohydrates. And then, you're also breastfeeding, and your body needs a little bit of extra fuel to be able to make that happen. I wrote a whole book about women and fasting.

And I generally will suggest the women check that out. There is research on postmenopausal women. And I find the women that generally do the best are the women who have stable hormones, meaning, when you're no longer menstruating, your hormone levels are stable, much more stable day to day, week to week than a woman who's still in peak fertile years, or even a perimenopausal woman-- there's a lot of good research that women can do very well in menopause, with intermittent fasting, provided that they're sleeping high quality sleep, they're managing their stress. And as a new mom, it's not unstressful to have a little baby at home and then stressing about trying to lose weight. I mean, those are two big things, eating anti-inflammatory nutrition, and really thinking about, things that fuel insulin sensitivity. And I think about walking after a meal, and lifting weights and things like that.

So, there's a lot to unpack here, I would give it more time. If you're breastfeeding, you need to give yourself some time. I used to always say six months was always that time period that I felt most of my patients got to a point where they were starting to see some weight loss, 12 to 18 months. And if you're still breastfeeding, it's going to make it a whole lot harder to lose weight. So, please give yourself some grace. Make sure you're getting your hormones tested, make sure you've got a DUTCH as well as serum blood labs. I think that would be very helpful. And the other question that dovetails into that is why is your testosterone so high? Did you have PCOS? What was the precipitant for removing your ovaries? That's a pretty drastic surgery for such a young woman. I would imagine there's a good reason, but just not a reason that's entirely clear to me right now. What do you think, Melanie?

Melanie Avalon: Well, I thought that was absolutely amazing and comprehensive. That was one of the takeaways I really took away from reading your book, Intermittent Fasting Transformation, was the difference with fasting in pre-menopausal and postmenopausal women and where do you think this idea-- because people ask this a lot or say this, that there are negative consequences for postmenopausal. But have you seen that? I mean, would the concern be I guess sarcopenia, not getting enough protein? I'm just wondering where this idea is coming from.

Cynthia Thurlow: I think there's a degree of fear mongering This is why I'm not a fan of OMAD. And that may upset people but I'm going to just say it, you just can't get your macros in. And once you're going through perimenopause, and menopause, physiologically, we are just much more at risk for muscle loss and the way that you need to think about how important and-- Gabrielle Lyon has been on your podcast, she has been on my podcast, she's a really close friend. I tell her all the time that her work completely changed everything that I talked about. But you want to think about muscles as a glucose reservoir. They're critically important for being metabolically healthy. And as you are losing muscle, and that's being replaced by fat--

I always talk about the filet, which is young muscle. Melanie has young muscle Melanie, so Melanie is a big fillet. And I'm 51, so my muscles, if I don't work really hard, are going to look like a ribeye and a ribeye is delicious. But we want to be a filet for as long as we can be. And I'm not talking about aesthetics. I'm talking about musculature, it's so important. And the concern I get is when postmenopausal women, perimenopausal women are just bucking this trend of, "I'm only hungry for one meal a day and that's all I eat," I just have to remind them, one of the reasons why you're not more-hungry, is you're starting to lose lean muscle mass. And as Gabrielle says, "You are not overfed, you're undermuscled." So, it's really important to understand that I think a lot of the concerns and fear about menopausal women is largely a byproduct of this concern that they are going to lose muscle mass if they're not eating at least two meals a day, we're not talking about 6 meals a day, or 10 meals a day, which I eat two meals a day so that you can get enough protein in your diet.

The other thing that I think is important note is that we're de facto less tolerant of stress as we head into perimenopause and menopause. It's a byproduct of the loss of progesterone from our ovaries, as our adrenals are stepping in to help support our body, we are just not as stress resilient. That doesn't mean we can't manage stress, we don't manage it as well. And so, I think on a lot of levels, there's this concern that if women head into their 40s, and 50s and beyond, and they're overfasting, overrestricting, not exercising or doing the wrong types of exercise, that they can put themselves at risk for a lot of inflammation, a lot of bodily stress. But I sometimes feel menopausal women have an easier time because they don't have to deal with the factors of a menstrual cycle and follicular phase and luteal phase. I would say men and menopausal women can sometimes have the easiest time fasting of all because they don't have to worry about this biology of procreation and conception and fertility and infertility that younger women have to worry about. But I do think it's a huge problem.

In fact, I'm not going to say this person's name, but there's a person who just had a book come out and they love to fearmonger about women and fasting. And I've had to have this discussion quite a bit. And I don't want anyone to perceive that. If you're sleeping well and you're dialing in on your nutrition and you're managing your stress and you're fasting for your cycle and you're not overexercising, that fasting can't be a part of or eating less often, can't be part of your strategies that you use to feel good about navigating whatever stage of life you're in. I think a lot of that comes from well-meaning people who don't really know what's going on. That's my feeling.

Melanie Avalon: I cannot agree more. It's actually similar or relates to the findings speaking of what you're talking about earlier with protein, on protein and longevity. There are so many people, researchers and such like Dr. Valter Longo, who I've had on the show-- he's actually been on this show, and he's been on the biohacking podcast, but he and people in his sphere are very much pro low protein for longevity up until, I think, age 60. And then, you need higher protein. So, I think that does relate to everything Cynthia was talking about, about when you are at that older age and the more difficulty it is to create and maintain muscle, women in particular really need the higher protein when they're older. I don't think that should be lumped in with the fasting, which I think can happen. It just might be like Cynthia was saying that you need a longer window to get in that adequate protein intake if you're not like me where I eat all the protein.

Cynthia Thurlow: The unicorn, but I think that's one of the reasons why I love podcasting with you as we really speak to such a wide age range of women. And I think that's really important because if we were both 50 somethings or if we're both 30 somethings, we would not necessarily totally represent our demographic, right?

Melanie Avalon: Yeah, exactly. It's funny before I even started the show, way back, I remember brainstorming about what did I want the show to look like. And at first, I was like "Oh, I want to cohost with somebody like my age. And it'll be two girls having wine night, two young people." But when I met Jen, I was "Oh, this is actually much more appropriate," because it's just so much helpful to give the broad perspective, and then it's even better when we're friends as well. It's all the good things.

Cynthia Thurlow: Exactly. And I think it's important for people to understand that there's a genuine camaraderie here. So, we can both benefit from our own experiences. My kids know who Melanie is. When we talk about Melanie's eating window, and her sleeping habits and how different we both are, and that's the beauty of it is that there's listeners who very likely-- there might be someone who has a long, evening eating window and stays up really late-- And I think, it's only when I was traveling in Europe that we overlapped at the same time, like we were awake for the longest stretch of time at the same time. I was like, "This is cool."

Melanie Avalon: Yeah. It's funny, I get DMs from people because I do think my approach is very rare. But there are? I know you guys are out there who actually do it very similar to me, and quite a few people DM me, and they're just like, "Thank you for letting me know I'm not alone in my crazy late night, feast every night." So, we are out there, but it definitely doesn't work for everybody, that is for sure.

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All right. Shall we answer one more question?

Cynthia Thurlow: Absolutely. This is Mary, "Prescription meds breaking fast." "Hello, I've just begun IF." So, her eating is either 19:5 for two days or 20:4. "I've long abstained from between meal eating, so this was a fairly easy transition for me. I am determined to have clean fast. However, I saw a comment today on Facebook regarding melatonin, and the word was that it does contain sugar, so realistically breaks the fast. I have a long list of prescription meds. So far, I've looked at four that are must-haves, and they all have that same ingredient. My feeding window is 12:30 to 4:30. I can take my evening pills right at 4:30 and some of my AM pills right at 12:30. But some must be taken 12 hours apart. My question is, if I take the must-haves when I wake up, does that wreck my clean fast? Eager to hear. I want to do this right. Thank you for your time, Mary."

Melanie Avalon: All right, Mary, thank you so much for your question. So, something to clarify, because I can see how this can happen. You talked about how you heard melatonin, and it contains sugar, and so, it breaks the fast. And maybe this goes without saying but with something like melatonin, which is not a prescription, there are many brands of melatonin, and they do not all contain sugar. So, melatonin does not equal sugar, does not require sugar to be taken. For melatonin, for example, you can find a melatonin that is fast friendly. We love melatonin from MD Logic for example. So definitely check them out. You can use the codes, MELANIEAVALON or CYNTHIA, to get a discount on that I know Cynthia in particular has really benefited from that melatonin. So that's supplements like non-prescriptive supplements, you can usually find a version that is clean, fast friendly, especially when it's not a prescription because there's normally lots of versions of it.

When it comes to prescription medications, if you have to be taking your prescription medications, you have to be taking your prescription medications. Some of them might contain ingredients that break the fast like she has found out. I'd be curious what she found in it that was-- I'm wondering what the sugar ingredient that she's thinking. I'm wondering if it's something-- I'm just wondering what it is exactly. There are a few things. One, I think a lot of people don't realize this, but this is actually an option. You can actually get a lot of prescription medications compounded, I actually do. If you have a compounding pharmacy that you like and can work with, they can often make compounded versions of your medication with the exact fillers that you want, or even no fillers. It's not always a possibility. And sometimes if it's a possibility, it's extremely expensive, so then it's not really a possibility. But for some of the medications, it is a possibility. I've done that in the past for things.

If that's not the case and you need to go with the traditional prescription form, there are a lot of generic versions of a lot of prescription medications. You can look up the prescription and you can try to find the one that is the most "fast friendly." It does take a little bit of detective work, I'm thinking of little detective emoji in my head. But that is an option. And you can talk with your doctor if you want a specific generic version prescribed. All of that said, if you need to take the prescription medication and you cannot find a clean, fast friendly and you cannot get it compounded. It's okay, [chuckles] you have to take your medications when you have to take them. It's not like this is actual food. I'm not giving a greenlight to taking in minute amounts of sugar or anything that in general. But when it comes to medication, you have to take your medication. Don't stress about it. It will be very minimal, if anything. Those are my thoughts on medication. Cynthia?

Cynthia Thurlow: The irony is I have 45 cohort going right now, and we had our first group call. And that was the first question that I was asked today. And here's the thing, if you have to take a medication, you have to take a medication, period. There should be no stress about, does it break your fast, does it not breaks your fast? I'm always very transparent talk about the fact I take now compounded thyroid medicine, and I take that during my fasting window and that does not break my fast. Now, the issue with generics, and people may not know this, but you can get these tremendous variances. There are generics you can get sometimes like 20% variants. As an example, before I was taking compounded progesterone, I would sometimes wonder why some nights I'd sleep really well and some nights I wouldn't. My functional med doc actually pointed out, "Well, you realize, you probably remember this but for generic medications, even though it's a bioidentical, you still have this variance." And so, I would just state that-- sometimes the trade medications that you pay a little more for-- and by no means am I telling people to break their budget to do this, but if you feel you don't do as well on a generic, just understand it can be 20% different than the trade product. I had a lot of women, especially my thyroid patients, that would tell me they would not take generic Synthroid. They only took regular Synthroid because they had intolerances. I had patients on antihypertensive, so medications for their blood pressure, same thing. We're all individuals but please do not let the concern about breaking a clean fast be the reason why you perceive that you have to do all these different things to me make this work.

Now, there should be no sugar in melatonin. And if there is, then I would definitely look for another option. I speak very openly that the two options I use are Sandman, that's a whole other special conversation about that supplement. But the MD Logic melatonin is more efficacious, meaning it's stronger than the Designs for Health product I'd been using for several years, and I even used on myself as well as my patients. One capsule of MD logic was equivalent to three of the Designs for Health sustained release. To give you an idea, it's very cost effective, and I'm not sharing that to sell everyone on that brand, but just to share that's what works for me. Sandman is a per rectal melatonin, but it's also largely cost prohibitive for the average person, I probably use it twice a month. But with that being said, please don't let that be a concern. Now, if your supplement has sugar in it-- there was a woman in my other group who had a product that had 40 grams of sugar and 30 grams of carbs. And I was like, "First of all, you need to throw that in the garbage."

Melanie Avalon: In what? Supplement?

Cynthia Thurlow: Yeah, there were gummies. And I said, "Okay, well, a gummy is going to be full of sugar, because it's going to be soft and--" Anyway, a whole separate conversation. But the point of what I'm sharing is, we want to try to find the cleanest options that are out there. Things without gluten and dairy and grains and soy, just be diligent when you're selecting supplements to try to find really high-quality products. Yeah, that's my ramp. But please don't let concerns about your medication breaking your fast keep you from taking medications that you are prescribed and that you need.

Melanie Avalon: That's so fascinating. I know you said you've seen it in hypertensive medications as well. Do you find it is more the hormonal supplements where that's an issue or is it just across the board?

Cynthia Thurlow: Well, it's interesting, because many years ago, when I was taking oral contraceptives, I remember when I was a student at Hopkins, I had this one brand of oral contraceptives. And I also had mild phenotype PCOS, I had no idea why I had these crazy wild periods. Well, it's because I had PCOS and that's why I initially went on the pill. And the student health center was "Oh, we've got the generic version of what you're taking." I went on the generic and gained 10 pounds. And I remember them saying, "Oh, there's nothing different in this." And then, I remember talking to my faculty, and they were like generic is exactly that. They only have to have 80% of the formulation the same.

Melanie Avalon: Legally?

Cynthia Thurlow: Yeah, and you can have different fillers. There's lots of things that happen with these medications that I used to say-- Some people do fine with the generics, let me be clear, there's nothing wrong with generics. But I think there are definitely people who are much more sensitive to additional fillers and different formulations of medications. And so, that's where I think it's important to just have the conversation. If you're doing fine on what you're taking, great. If you're not, investigate what other options are available.

Melanie Avalon: Wow. It's interesting, because I had sort of vaguely wondered that in general about the generics, but I hadn't really looked into it.

Cynthia Thurlow: Yeah, up to 20%.

Melanie Avalon: Um, it's concerning.

Cynthia Thurlow: Yeah.

Melanie Avalon: Well, thank you. That's very valuable information. Thank you for sharing.

Cynthia Thurlow: You're welcome. It'd be a little depressing for everyone to hear. But the irony is one of my pharmacist friends and one of my doctor friends just happened to say that to me the other day, and I was like "Oh, my gosh, I forgot that. It's so true. It makes complete sense."

Melanie Avalon: Wow, wow, wow. Well, thank you.

Cynthia Thurlow: You're welcome.

Melanie Avalon: For listeners, if you would 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. The show notes for today's episode, which are going to have a lot of links, as well as a full transcript, will be @ifpodcast.com/episode286. And then, you can get all the stuff that we like at ifpodcast.com/stuffwelike. And you can follow us on Instagram. We are @ifpodcast. I am @melanieavalon, and Cynthia is @cynthia_thurlow_. All right. Well, this has been absolutely wonderful. And I will talk to you next week.

Cynthia Thurlow: It sounds good.

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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