Episode 289: Halloween Candy, Flavored Coffees, Autophagy, Atherosclerosis, Berberine, PMDD, Type 1 Diabetes, And More!

Intermittent Fasting


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Oct 30

Welcome to Episode 289 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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Listener Q&A: Amanda - Insulin release

The Melanie Avalon Biohacking Podcast Episode #167 - Mark Shatzker

Listener Q&A: Vanesa - Autophagy and atherosclerosis

Noncanonical inhibition of caspase-3 by a nuclear microRNA confers endothelial protection by autophagy in atherosclerosis

Role of autophagy in atherosclerosis: foe or friend?

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Listener Q&A: Angela - PMDD

Listener Q&A: Jessica - Type 1 diabetes and intermittent fasting

The Melanie Avalon Podcast Episode #44- Cyrus Khambatta, PHD and Robby Barbaro, MPH

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

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Hi, everybody and welcome. This is episode number 289 of The Intermittent Fasting Podcast. I'm Melanie Avalon and I'm here with Cynthia Thurlow.

Cynthia Thurlow: Hi, Melanie.

Melanie Avalon: I have a question for you, Cynthia. 

Cynthia Thurlow: Okay.

Melanie Avalon: This episode actually airs on Halloween. I have two questions. One question is, how do you feel about Halloween? Is it one of the holidays where you go all out or not so much? And then I have a fasting food-related question to it. But I guess first, yeah, what's Halloween like in your family?

Cynthia Thurlow: Well, I can tell you that when my kids were younger, so they're teenagers now. When they were younger, we went all out. Decorating the house and getting all excited about their costumes. And now, they're teenagers and I think my 15-year-old who's a freshman, he'll probably go out with his buddies. My older son will probably stay home and want to hand out candy. But in our neighborhood-- our new neighborhood, people are like serious. They have some serious Halloween displays to the point where people are spending thousands of dollars on two story skeletons that light up, are animated and spiders. And so, it's interesting. Last year, I think I was so consumed by having just gotten into the house, and the book launch, and all those things that I didn't pay as much attention, but there's some serious decorating game in our neighborhood. We just have like mums and pumpkins like fall flowers, and a few like, I would say in terms of décor, we have a lot of pumpkins inside our house. I do enjoy decorating for the fall. It is my favorite season. But in comparison to my neighbors, we're probably low into the game. It's impressive in our neighborhood. I should take some photos and share them on Instagram. 

Melanie Avalon: Oh, please do. I love looking at that stuff. 

Cynthia Thurlow: I love Halloween because I like creepy fun Halloween movies. I love all that. I like being scared about things that are highly improbable. I don't like the stuff that is creepy and potentially could happen, but I was one of those kids that loved Stephen King movies and love being creeped out. Kids of the 80s, we had Children of the Corn and all the Stephen King movies. And so, I love suspenseful, scary stuff, but my husband not so much. So, we don't get to watch a lot of those movies unless I want to watch them by myself. How about you?

Melanie Avalon: Yeah, I'm all about it. Growing up, I loved it. I love the decorations. I'm just thinking now though about the timeline of, because when you're a kid, you get to dress up. And then I remember wanting to still dress up in high school probably and my parents being like, "You're too old for this." Or, I remember the last year I wanted to go trick or treating. I don't know what age it was and my parents were like, "You can't go." I was like, "Yes, I can." And then it's funny because when you go into the dry period, I feel of Halloween. But then when you become an adult, it gets fun again. I'm really excited. My sister and I are going to dress up like on Anna and Elsa from Frozen. 

Cynthia Thurlow: Oh, I love it. 

Melanie Avalon: I literally ordered I think seven Frozen costumes, because I have to find the perfect one. I think I'm going to combine too. I think I'm actually going to use-- I found this gorgeous blue prom dress, all sequins. And I think I'm going to combine it with the Elsa costume to make like the perfect costume.

Cynthia Thurlow: I love the dedication.

Melanie Avalon: For like an hour last night, I was trying them on and then I would go to my computer and watch the Let It Go song on YouTube and stare at the costume and try to figure out what color it was exactly. And then stare at the costumes and figure out if I could cut them up. I don't know how to sew. So, we'll see how this goes.

Cynthia Thurlow: I love your dedication. I think that's awesome. I would say that I'm a big fan of adults enjoying the process of Halloween. I was just at event in Scottsdale and the first big night of this event, it was like a costume party with a theme. And truth be told, I'm not like a big costume person. I'm all game for having fun with my friends. But I bought the bare minimum costume accessories and just decided at Scottsdale, it's like 100 degrees. I don't want to be in anything that I have to wear too much clothing, I don't want to wear something super skimpy. And so, I loved seeing how like some will really get into the costume theme. I marvel at the creativity of people. I really do. I just love to just watch. I think it's so interesting.

Melanie Avalon: Was this where I saw the costume from Gin? 

Cynthia Thurlow: Yes, I took a video and send it to Melanie of Gin. [laughs] 

Melanie Avalon: It's on Gin's Instagram I think, I laughed so-- Please, listeners, please go look at Gin Stephens's Instagram.

Cynthia Thurlow: She was so excited about her costume. She was like, "Wait till you see my costume." And I literally-- She had the best time, she looked so happy.

Melanie Avalon: It's so funny. I couldn't figure it out at first when you sent me the video. I was like, "Wait, what"? From the video you sent, it literally looks like not a costume. It looks she's-- [laughs] It's an alien abduction costume for listeners. I always want to find a costume that's attractive. I want like a girly girl costume is what I always go for. Although, one year when I was a kid, I dressed up like a marshmallow and everybody thought I was a roll of toilet paper, [laughs] which is appropriate given all my bowel issues I have these days.

Cynthia Thurlow: That is humorous. There's most definitely a theme.

Melanie Avalon: Really last quick, rapid-fire question. Did you ever-- because Halloween is very centered around like candy and all of that. How did you handle that with your kids growing up and did you ever get into the--? Some people will hand out like healthy treats or they'll do that snack swap thing.

Cynthia Thurlow: It's interesting. My older son has peanut and tree nut allergies. That has always been a concern like exposure, cross-contamination. When he was little, we could bring all the candy home and go through it. My husband loves Snickers bar. He would keep all the Snickers bars for himself. Whatever the age the kids were, that's how many pieces of candy they kept. Well, they got to a point where they started to eat the candy while they were trick or treating because they knew they could then consume more. I tend to be very much a realist. When my kids were preschool age, early elementary school age, yeah, I could hand out healthy treats. It was always a healthier version of the conventional Halloween candy. And then I just got to a point where I was like, "You know what, most people don't appreciate it." I'm spending exorbitant amounts of money. Really what's most important is making sure that my kids are not eating the stuff 24/7. So, I've relaxed some of my rules. 

I have some hard and fast about certain things, I can't actually buy Halloween candy early because the teenagers will find it. It doesn't matter where I put it. It's almost like they have a beacon, they find it. It becomes a running joke. My husband can't even keep a clean peanut buttercup in the house because the 15-year-old finds it and just despite him will eat it. [laughs] In my house, it's one day out of the year. I let them enjoy themselves. I don't allow them to keep candy in their rooms, which they did one year when we were living in a rental and I didn't know any better because we have dogs and I'm like, "What if the dogs get into it and they get sick?" That's a problem. I think for everyone that's out there, it's one day. I tend to buy the candy that I don't like. So, it's never tempting, which drives my husband crazy. He's like, "I don't understand that reasoning, that thought process." I said, "It's simple. By buying stuff I don't like, I'm not going to eat it. I want you to be tempted to eat it."

Melanie Avalon: What is that? What do you not like?

Cynthia Thurlow: Most stuff, because I don't feel good when I eat it. I'm not attracted to Snickers or Reese's peanut buttercups. I can buy that stuff, but it's crack for my husband. So, I have to be very balanced. I tried to give all the candy away. That's my other strategy. "Give it all away, then you don't have any left." Things like Skittles that are horrible. [laughs] I just--

Melanie Avalon: I never liked Skittles, either. They gave me a headache.

Cynthia Thurlow: Yeah. Well, there are so many artificial colors and God knows what else. To me, my strategy is, I buy stuff. Liam is my 15-year-old and usually he comes with me to purchase that candy. I always tell my methodology is, I buy stuff that I don't like and then it's not tempting at all, which he doesn't agree with at all. But he'll usually direct me to what do the kids like right now. He's my conductor. But the goal is to get rid of all the candy. I'm the parent that is handing out handful of candy to get rid of it, which everyone loves to come to our house because I'm giving out some unlike, I don't want to take any of them to my house. The other thing in my neighborhood that's interesting, everyone has very long driveways. Usually, people are at the end of their driveway to hand out said candy, it's very orderly. 

Melanie Avalon: Oh, woah, they wait out there?

Cynthia Thurlow: Yeah. Most people set up tables at the end of their driveway. 

Melanie Avalon: Tables? [laughs] Oh, my goodness.

Cynthia Thurlow: Yeah, I've got a very long driveway. It's actually nice. The other thing is people are not trick or treating late at night. When it gets dark usually everything ends, which is wonderful. Because the last neighborhood I was in, you'd get your doorbell 9, 10 o'clock at night. Kids were still coming around. Here, not as much. They're younger, so the parents take them out early, which is fantastic. So, it's a quite an interesting process. But I love seeing all the costumes and getting rid of all of the Thurlow candy, which my family doesn't agree with, but I do.

Melanie Avalon: I totally forgot about this. I guess I really always have been an entrepreneur. Before Halloween, I would go stock up on all the candy. I had these little vending machine things. They were so cute. I had two of them. I'd fill them up with candy and then I would sell candy to my brother and sister. And then I didn't find out until literally adulthood that they would sneak into my room and steal my candy. I didn't know that. They were getting away with it. Yeah, I would sell it for like a dime, like a Snickers bar. 

Cynthia Thurlow: That's hilarious. 

Melanie Avalon: I would actually love listeners to write in, even though it'll be after Halloween, but I'd be really curious to hear how people handle candy and Halloween in their lives with their family.

Cynthia Thurlow: I think it's all about balance. I think people when they get really rigid, there were years where they'd have the switch-witch or when your kids are really young and they have no clue what's going on, that's very different than when they're very vested in the candy game, and parties, and trick or treating, and they have an agenda, and Halloween trick or treating independently of their parents. You have to just release some control. In all honesty that's the best method of pick your battles. I think that's really important because you can't control everything. So, you might as well zone in on one or two things that's important and trust that your children will make good choices.

Melanie Avalon: I think that's very good advice. 

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Melanie Avalon: Shall we jump into some questions for today? 

Cynthia Thurlow: Sure. 

Melanie Avalon: To start things off, we have a question from Amanda and the subject is "Insulin release." And Amanda says, "Hello, there. I enjoy your podcast so much. I have been listening and fasting since January 2020 and I've made my way through all of the episodes. You're my favorite podcast and I listen to a lot. Anyway, I recently watched a YouTube video with Dr. Mindy Pelz, where she says, "You can test if something is breaking your fast by checking your blood sugar prior to having insert item here and then after having whatever you're testing." I decided to check to see if coffee is causing a response. I drink it black, but I drink Dunkin Donuts brand coffee, and it is caramel coffee cake flavor. I don't think it has a sweet taste, but I was curious if it is causing any response. I checked my blood sugar at around 6 AM prior to my coffee, this would have been 12 hours fasted. I was shocked to see my blood sugar was 122. I'm not diabetic and I've never had an abnormal fasting blood sugar when tested at the doctor's office. Is it the dawn phenomenon? I'm confused. I'm a nurse and in my world, this would be concerning. Anyway, I went ahead and drank my coffee and around 7:00 AM, I rechecked my blood sugar and it was 112. 

Now, Dr. Pelz said, "If you see an increase by 5 to 10 that would mean you had a response." In my mind, I'm thinking that the decrease could be a response too. If I had an insulin response, wouldn't that lower my blood sugar? The coffee may not spike my blood sugar, but cause an insulin response therefore lowering it. I hope I made that clear enough to understand. What I'm not sure about is if my result of 122 was caused by the dawn phenomenon. I checked it around 6:00 AM and from my understanding that occurs between 4:00 to 8:00 AM. Wouldn't it be on the decrease when I checked it later at 7:00 AM? I did check again around 9:00 AM and it was 114. I was still drinking my coffee, second cup. I'm just curious on what you two think and if anyone has ever brought this up, if it helps, I'm 36 years old. I've been fasting since January 2020. I started out 18:6 and I've worked up to one meal a day. I fast every day and love it. I can't thank you ladies enough for all you have taught me," Amanda.

Cynthia Thurlow: Well, Amanda, thank you so much for all of your support and the fact that you get so much out of the podcast. There are a lot of things that I think about as I'm reading and listening to your question. First and foremost, where are you in your menstrual cycle? Because you're going to be less insulin sensitive heading into your luteal phase and especially the week before your menstrual cycle. Are you using a glucometer or are you using a continuous glucose monitor? If you're using a glucometer, has it been calibrated? Does it need to be calibrated? It's not typical that your blood sugar, per se, would go down after consuming a potentially-- I don't know what the caramel coffee cake flavor is. The potentiality of, perhaps, an artificial sugar or whatever that is flavored with, I would imagine it would probably break your fast.

There're so many things here that it's hard for me to say because fasting blood sugar is only one piece of the puzzle. I think really looking at fasting insulin and looking at other inflammatory markers is certainly more helpful. Just one or two blood sugar values to me doesn't give a full clinical picture. Dawn phenomena, yes, that is a real thing. Typically, I don't see that in insulin sensitive individuals that are young, not with any great regularity. I saw quite a bit of it in the hospital with older, even middle-aged or older patients. I would say at this point, where are you in your cycle? Is it a glucometer, has it been calibrated? Is it a CGM? Where are you in your cycle? 

The other thing is, you're 36 years old. You're obviously still very young. We have to remember that intermittent fasting is a form of hormesis. It is a hormetic stressor in the right amount at the right time. You're also doing OMAD, which I know that it may not be as popular for me to express this opinion on the podcast, but I just think that that's not the right strategy for a younger woman. I get concerned that you're not getting enough protein macronutrients in particular into such a tight feeding window and that in and of itself could potentially be of concern. So, there're a lot of different variables.

It could be that maybe your glucometer needs to be calibrated. It could be that simple. If we know your insulin sensitive, if you haven't had a fasting insulin checked, I would definitely ask your primary care provider to do that. It's a very inexpensive test. It runs about $12 that is covered by insurance. A lot of traditional allopathic trained providers don't know how to interpret it, but we want to see that value between 2 to 5. That's ideally what we're looking for and that's actually a better biomarker for insulin sensitivity than a fasting blood sugar. What are your thoughts, Melanie?

Melanie Avalon: Yes, I would piggyback and agree that because it sounds like she might be doing a CGM, but probably not. I would definitely recommend Amanda doing a two-week trial at least of a CGM. And just to define it, it's basically a sensor that you very easily apply to your arm. I have videos on my Instagram of what it looks like to put it on. It will continuously monitor your blood sugar over 24 hours. The benefit of that is that you will see the slope and the curve of what is actually happening in the morning with that wake-up dawn phenomenon as well as the coffee and everything thereafter. You'll also see the entire 24 hours the impact of your blood sugar levels and what your average is. We actually do have a coupon code for the podcast. So, if you go to nutrisense.io/ifpodcast, the code, IFPODCAST will get you $30 off any subscription to a CGM program. So, that definitely might be helpful. 

At least what I've experienced and what I've seen a lot of people share is that, especially if they're having a dawn phenomenon response in the morning, which basically what it is, is a cortisol release in the morning that is prepping your body to get ready to move. And so, the purpose is to release glycogen from the liver. You release stored sugar, stored glucose and that's what causes that spike. That's normal. What I've seen and what I think a lot of people see is, if you do have that spike and it's up, and then on top of that you have coffee, especially if you're having coffee for a while. Coffee also, because of the caffeine causes the liver to dump glycogen. I think it can basically not give your body a chance to bring those blood sugars down and maybe even perpetuate it a little bit. That might be what is happening. If you've got a CGM and experiment you could try, is you could try a day with coffee and a day without coffee and see what's happening with all of that. 

Yeah, and it might be a situation where you realize that having your coffee in a slightly different pattern is actually more beneficial for your blood sugar. Maybe it's not sipping it as long or maybe it's just having a caffeinated one and switching to decaf or something like that. Then I wanted to point out a few other just quick comments. One is that I like to clarify it, because we always talk about things, breaking the fast, which is true. Things can create an insulin response. I just like to clarify that. Your body can have those responses to things that people wouldn't consider breaking the fast. This is just an esoteric conversation about this topic. But the example would be, you could do some high intensity exercise and have the same blood sugar raising effects or you could go do some breathing exercises and have the same blood sugar lowering effects. So, I just like to point out that-- I guess the reason I'm pointing this out is, you're still fasted is my point. I do think it's very important to have a "clean fast," water, coffee, and not take in things like these flavored coffees. But I just like to add that subtle nuance, because I think people think that they're not fasted anymore, which is not true. The way you're not fasted is by eating food.

That said, I have a little story to share. I recently released an episode with Mark Schatzker. He wrote a book called The Dorito Effect, as well as The End of Craving. It's honestly been one of my most fascinating interviews to date. I've talked about it a lot in the show. I'll put a link to it in the show notes. But he talks a lot in his book about the role of these artificial flavors. After reading it, it makes you very hesitant about taking them in. Basically, they're very confusing signals to our bodies. He makes the case that they can be doing a lot of metabolic damage. I actually had an experience recently. I had bought some artificial cake flavor, and I had it in my refrigerator. If I ever have like a holiday or something or my birthday, I'm going to make a paleo birthday cake flavored thing and I'm going to use this flavoring. It was in my refrigerator. I was cleaning out my refrigerator and I broke the bottle. And so, it spilled all over my kitchen. I was thinking about Mark's book, because he talks about the potency of that flavoring chemical and how potent it is. And that smell, my whole apartment smelled like Disney World for like-- You know how Disney smells like? Would you go to Disney ever, Cynthia?

Cynthia Thurlow: I haven't been there since my kids were four and six.

Melanie Avalon: Oh, Disney is the place my family is obsessed with. I don't know, if you remember, like, Main Street smells like a baked cookie basically. My whole apartment smelled like Disney World and I had a headache for three days. After that, I was like, "I can't believe I've been ingesting this," if just smelling it is making me feel this way. So, just a little cautionary tale about removing these if possible, if you're open to it, removing artificial flavors. Any other thoughts from you?

Cynthia Thurlow: No, I think it's much like anything. I used to tell patients that I never took one or two values unless it's an exception. I never really took it at face value. I was like, "Okay, we need more information before we can determine what's going on." There're so many things that can impact blood sugar and food consumption. All these things can definitely be impacted by many, many variables.

Melanie Avalon: Yes, I agree. I didn't know this until recently. They make at home. It's like a glucometer, but it's HbA1c tests.

Cynthia Thurlow: I don't know if I find a lot. I honestly don't see a ton of value in A1cs anymore. I think when they came out 20 years ago, it was such a remarkable test. And now, I really lean into other biomarkers like fasting insulin, uric acid that I think provide a much more comprehensive picture of what could potentially be going on. It doesn't mean that does it help. It certainly doesn't hurt. But I think there are other blood values that I think are far more important. Even triglycerides, HDL, that is more valuable to me.

Melanie Avalon: Yeah, I think it's a problem because of the false-- Well, it's not false positive, false negative, because it's not black and white like that. But the implications of your actual red blood cells can affect, like the size of them and how long they're sticking around. Their longevity can affect the readings. I think the value is, if you're regularly testing HbA1c, then presumably you could see over time if you're having a significant drop or rise in general. I think that's probably the most benefit. So, shall we go on to our next question?

Cynthia Thurlow: Absolutely. Our next question is from Vanessa. "Hi, Cynthia and Melanie, I love your podcast. I listen all of the time and learn something new every time. This morning on my commute I listened to episode 162 where you discuss at length some studies. I enjoyed listening to the discussion so much. I'm at the end of a graduate program and reading studies has been my life for the last few years. I love that you normalize how complicated research can be, while at the same time sticking with it, and then bringing us the information. Thank you for being women with high standards. In my Google Chrome feed, I came across this study and would love to hear your thoughts. From what I gathered, autophagy protects, if not reverses atherosclerosis. If this is true, this is super exciting as heart disease runs in my family. I came to intermittent fasting for weight loss and have found a way of life that has surpassed my expectations as far as health benefits. Thank you so much," Vanessa.

Melanie Avalon: All right. Vanessa, thank you for your question. This is a great question. The article that she sent us a link to was very specific, very granular, and it's a rodent study. The title is noncanonical inhibition of caspase-3 by nuclear microRNA confers endothelial protection by autophagy and athero-- I can never say this word for my life, atherosclerosis. I remember when I was recording my book, I have that word in it a few times and it's the word I just can't say. In any case, so this was published in Science Translational Medicine in June 2020. I looked at it briefly and honestly it was very specific. It was about very specific pathways in rodents and autophagy, and the role and that word, I can't say. I decided to be more beneficial to look at other research rather than this specific study. And so, I found a really good journal article that I'll put a link in the show notes too. It's called role of autophagy and atherosclerosis: foe or friend? It's 2019 May in the Journal of Inflammation, London. And I read all of it. It is very long. It's very interesting, I learned a lot about autophagy that I did not know. It goes into all the different types of autophagy and all of the different immune-related factors involved like macrophages, and cytokines, and things like that. 

The basic takeaway is that autophagy-- Oh and what is autophagy? Let me define that for people. Autophagy is basically a process in the body where the body recycles old and damaged proteins. It's a cleanup process. It helps clean up ourselves, get rid of waste, keep things fresh and new. The process can actually just get rid of those materials or they can be recycled into new materials. It's used ongoing as a cleanup process. People think that you only get autophagy from fasting, which is just not true. It's happening all the time. Not some of the time, all of the time. It's ramped up by things like exercise, even coffee ramps it up, different compounds ramp it up. I'm going to circle back to that. Its normal purpose is like a cleanup and then when you're under times of intense stress, it gets a dual purpose and that it can actually be used to create building blocks for the body and energy. So, that's why fasting in particular can further activate it. It's interesting. 

I was listening to Peter Attia's most recent episode, I think, and he was talking more about his feelings on fasting and autophagy. I don't know if I agree with him on this, but he said he doesn't think fasting even creates any measurable difference of note in autophagy that you'd have to fast a really long time. I don't know the extent to which is upregulated from a daily type of fast, but it is a good thing to consider. All of that said, back to the question. For its role in atherosclerosis, it seems that in the beginning stages for people who have it, it is probably pretty beneficial in reducing inflammation, potentially mitigating that progression and being helpful. It has the potential to actually become inflammatory in later stages. And that's because the autophagy process, just basically, it can go a little bit awry and actually create more inflammation rather than less. I don't want to scare people away from it, but that was the conclusion of this article. I think in general, it's something that-- I wouldn't focus on autophagy as the thing to address this. I would focus on a healthy diet and lifestyle, and I think that will support an anti-inflammatory state, and that will support autophagy and the way you want it. I wouldn't get too distracted by it, if that makes sense. What are your thoughts, Cynthia?

Cynthia Thurlow: Ironically enough, I just interviewed Dr. Stephen Hussey talking about the heart and talking about cardiovascular disease. For that discussion, I was knee-deep in the role of the metabolic theory of cancer, and Otto Warburg, and the role of mitochondrial dysfunction and what's really at the basis for atherosclerosis. Dr. Hussey, he has type 1 diabetes, but young guy who had a negative coronary artery calcification score, hit a zero, and then went on to have a heart attack six months later for a variety of different reasons. But why this is particularly relevant is that I think a lot of the modern day thought process about what causes atherosclerosis is so far off base than what actually creates it. We know it's related to oxidative stress, and free radicals, and glycation, and really looking at the role of endotoxemia, heavy metals, and how these things all kind of interwoven together. I'm tongue-tied myself. I'm really at the basis of all this is metabolic inflexibility. What's one of the things that can help with metabolic flexibility is intermittent fasting vis-a-vis through a lot of different processes. 

As you mentioned, autophagy is one of them. But I really think our modern-day lifestyles are contributing to a lot of what we're seeing. If we reflect back on the fact that autophagy can be upregulated by many things. Not just fasting, but understanding that eating less frequently is a way to promote or to reduce inflammation, reduce oxidative stress, improve insulin sensitivity. It just makes sense to me intellectually as a clinician that this would validate this. I think there's more and more research coming out that's really looking at what are the drivers of atherosclerosis. One of the things that Dr. Hussey talked about is that as an example and we talk about Oura Rings and heart rate variability a lot, but HRV is the best measure of stress response. I think that was really surprising and looking at an imbalance in the autonomic nervous system, remember, one is fight or flight, that's sympathetic and then rest and repose when we can poop, and have an orgasm, and digest our food, and detoxify, that this imbalance stress response is another big contributor to why we are seeing escalating rates of atherosclerosis and heart attacks. 

I'll just mention a couple of statistics that I quite frankly was stupefied by. By 2035, 130 million people in the US will have some form of coronary artery disease or atherosclerosis. The annual direct and indirect costs of MI and stroke are $329.7 billion a year that came out of circulation. And lastly, in 2018, there were 720,000 first time myocardial infarcts which are heart attacks and 335,000 recurrent MIs in the US. I love that Vanessa addressed this atherosclerosis piece because it really does impact all of us whether or not you yourself, but more than likely with those statistics. You know of someone either or someone you're related to, someone you're friends with, someone you care about that's in your sphere of influence is going to be impacted by vascular disease. Maybe that's easier to say it that way. We used to call it CAD or CVD. Cardiovascular disease, it's an easier way of saying that, but really an important thing to consider. It's one of many reasons why I think upregulating autophagy with fasting or other types of hormesis is really incredibly beneficial. I think a lot of us want to focus on the body composition and the changes in weight loss, but really, it's deeper than that. 

Melanie Avalon: Two points to that. One is, because interestingly that study I linked to on autophagy, it didn't mention fasting once. It was talking about the role of fasting, like I mentioned happening as an ongoing process all the time, anyways. And so, I would imagine, I know I talked about how it concluded that autophagy could be detrimental in the later stages of-- So, is cardiovascular disease the same thing as atherosclerosis.

Cynthia Thurlow: Mm-hmm. We don't call it. We used to call it coronary artery disease. Atherosclerosis can be diffuse, so it could be carotid arteries, peripheral vascular disease, coronary artery disease. Atherosclerosis can occur in any vascular vessel.

Melanie Avalon: Okay, gotcha. Yeah, so, I think the important context here would be autophagy in the context of fasting would be as well in an anti-inflammatory state compared to what it's talking about in that article, which is just the autophagy process not in that anti-inflammatory state. That might be something to keep in mind. Well, I'll put a link in the show notes. That interview sounds really, really fascinating. I'm glad you brought that up about the cardiac scores because that's something that-- I feel especially in the low-carb world and often I see it in the carnivore world are people on really, really high saturated fat diets and then they'll say, but I have a zero score. But really, when it comes to that, when you're young you should have a zero score. If you don't, there's a major issue. And then it can be argued that, if you don't have a zero score, things are already really bad. It's not the thing where you slowly start to see it progress. It's like it goes from zero to like there's an issue. So, I wouldn't rest in the seeming safety of a cardiac score, which I think was demonstrated by that guy's heart attack.

Cynthia Thurlow: Yeah. He's like 32. I think it's the diabetes, plus some other factors that he talked about, but really sobering.

Melanie Avalon: Yeah, the stats are really intense. And right before we go on to our next question, I wanted to mention one more thing. I was so excited when I was reading that article because it actually had a section on compounds that upregulate autophagy. The first one it mentioned was resveratrol, which is the compound that is made famous by red wine and you guys know I love red wine. But then even more exciting, the second compound I mentioned was berberine, which made me so excited, because the next supplement that I'll be releasing for AvalonX is actually berberine.

Going back to Amanda's question, if she is experiencing blood sugar issues, I realized we didn't even give her suggestions on what to do there. First and foremost, I think dietary approaches are paramount when it comes to blood sugar control, so looking at your diet and finding the diet that works with you. Again, that's a reason that a CGM can be so helpful because you can try out different dietary approaches and see how they're affecting your blood sugar levels and after or injunction or on top of something like berberine, it might be really helpful. It is actually a plant compound, an alkaloid, and it rivals the effects of metformin. Metformin is the primary prescribed medication for blood sugar issues, diabetes. It has a blood sugar-lowering effects of metformin without the side effects. Like I said, it's a natural plant compound. People often focus on it for the blood sugar-lowering effects. I personally take it. I take 1 gram every morning. When I started doing that, I saw a really nice effect on my blood sugar levels but it has so many other benefits as well. 

It actually has a lot of metabolic health benefits. So, I found one study that was talking about how it didn't reduce body weight, but it actually created a redistribution of fat. People ended up having less visceral fat, which is the inflammatory type of fat surrounding the organs and it's been shown to potentially have anti-cancer benefits. And then going back to topic that we were talking about that article was talking about how it actually is a very potent stimulator of autophagy. That's very exciting. That will be coming out sooner rather than later. To get text updates for that you can go to avalonx.us/emaillist or you can text AvalonX to 877-861-8318. When you sign up for text updates, not only will you get all of the latest specials and news because there will be a launch special. You also get a 20% off code when you sign up there. 

Hi, friends. I'm about to tell you how you can get $30 off one of the most incredible ways to track your blood sugar levels. See how your fasting is affecting you, see how your food choices are affecting you, and truly take charge of your health. That would be the NutriSense CGM program. If you've been listening to this show, you know that we are a little bit obsessed with continuous glucose monitors, also known as CGMs. If you know how your body is actually responding to different foods, amounts of sleep, stress, fasting, exercise, wine, anything else you're doing in your life, then you can truly achieve your health goals, so whether that's managing your weight, eating foods that make you feel good, having energy throughout the day, optimizing the longevity, understanding your blood glucose is important. And for example, you might even realize that your diet doesn't need to be super restrictive. It just needs to be the right diet for you that is sustainable. Here's the problem. True, you can check your blood at the doctor or you can randomly check it with a glucometer at home where you prick your finger. The problem is that's just a snapshot. It's a single picture of that brief moment in time. If I've learned one thing from wearing continuous glucose monitors is that your blood sugar can change a lot even from minute to minute. You really need to get a sense of how your blood sugar is changing all throughout the day.

When you wear a continuous glucose monitor, which is painless to put on, I promise, I have a lot of videos on my Instagram of how to put them on. So, definitely check those out. It gives you a picture of your blood glucose levels 24/7 for 14 days. What I love about the NutriSense CGM program is it has a super awesome app that helps you interpret the data and really understand what's going on. In the app, not only does it track your data, but you can log meals, see macronutrient breakdowns, and so much more. It even gives you an overall score for each of your meals based on your body's response, so you can really find what meals are working for you. Each subscription plan includes one month of free support from a registered dietitian. NutriSense dieticians will actually help you identify what you should be paying attention to, what that data actually means. They can really hold your hand if you're new to the space or if you're already knowledgeable, then they can provide you even more advanced tips and recommendations. They'll make sure that you adjust your diet and lifestyle to find what you enjoy doing, so that you can have long-term sustainable changes They'll even act as accountability partners on your journey. 

NutriSense also has a private Facebook group for members, where you can find support from other members and learn about their experience. I love wearing a CGM. I just think it is so profound. Even if you just do it once for 14 days, I think you will learn so, so much. But then, of course, lasting sustainable change can take time. Getting a longer term subscription can be an amazing option to consider.

NutriSense has 6 and 12-month subscriptions and those are cheaper per month allowing you to not only achieve your health goals, but also ensure that you stick to your new healthy lifestyle for the long term. It's helped me realize for example, how low carb versus low fat affect my blood sugar levels, how berberine has an amazing effect at lowering my blood sugar, and so much more. You can get $30 off any subscription to a NutriSense CGM program. Just go to nutrisense.io/ifpodcast and use the coupon code, IFPODCAST for $30 off. That's N-U-T-R-I-S-E-N-S-E dot I-O slash IFPODCAST with the coupon code, IFPODCAST for $30 off any subscription to a CGM program. There's a reason Cynthia and I talk about CGMs all the time. We love them. NutriSense is giving you guys access to them. So, definitely check this out. And we'll put all this information in the show notes. All right, now back to the show.

Melanie Avalon: We have a question from Angela. Subject is "PMDD." And Angela says, "I have PMDD. I was diagnosed in November of 2018. I was put on Prozac for 14 days a month. It helped for two months, then stopped working. I first started IF doing mostly 16:8 in July of 2019. I did great until October. My symptoms greatly decreased. Then I slowly started closing my window sooner and sooner until I was back to my old eating ways, which is eating all day long. I gained back all the weight. I had lost about 15 pounds. January of 2020, I decided to try it again. It's now March. So, I've been through two cycles of PMDD and I was curious as to how long you would think it would take the food cravings to go away. The food cravings during those two weeks from ovulation to the start of the menstrual cycle are like no other cravings. They are worse than my pregnancy cravings. I do so good with 16:8 during two weeks, then that hit and bam. It's so hard to stick with IF. Please give me any suggestions that might help. I've tried keeping busy, drinking more water, eating more protein. IF has seemed to help all the other symptoms from PMDD, besides the food cravings. Sorry for jumping all around, but I desperately need help." Okay.

Cynthia Thurlow: Well, Angela, my heart goes out to you. And for listeners that are not familiar with PMDD, this is the most severe form of premenstrual symptoms. First and foremost, I have to give you a lot of credit that you are being so diligent about trying to determine what is exacerbating your symptoms. If you're at all familiar with my work, I'm not really a fan of women doing a lot of fasting prior to their menstrual cycle, especially five to seven days. Preceding that, you could certainly do 12 hours of fasting. I would also look very closely at what you're eating. Are you really leaning into enough protein? Because those powerful cravings could very well be that you need more high-quality carbohydrate along with high-quality protein.

I actually did a podcast with Dr. Chris Palmer, which unfortunately I can't release until November. His publisher has made it very clear that they don't want his podcast being released until the week of publication. But he is a Harvard trained psychiatrist and he has a very unique lens on mental health issues and metabolic health. And so, we had a really vibrant discussion about the interrelationship between the foods that we're eating, the types of neurotransmitters that we're creating, and a lot of those neurotransmitters are predominantly created in the gut. 

I would really be thinking about gut health, the types and qualities of foods that you're consuming. Leaning into protein, high-quality carbohydrates which are going to be the unprocessed variety, healthy fats, you may benefit from getting some testing done to look at the gut microbiome. I'm a huge fan of the GI map, or even working with an integrative medicine or functional medicine, physician or nurse practitioner to dive a little bit deeper. Because it sounds like your symptoms are really significant. I do think there are other ways of tackling PMDD. But absolutely positively, no fasting the week before your menstrual cycle, that explains why you're saying I feel good in my follicular phase when I'm fasting. I don't feel good. I feel I'm really struggling with fasting and that's your body's way of telling you. We need to liberalize what you're doing. 

The other thing that I would really encourage you to do is make sure that you are working with someone that can do a proper evaluation and testing. I know you tried Prozac before. There are other drugs that may be of benefit. There are newer SSRIs that are out there, as well as other types of treatment modalities. And again, I wish Dr. Palmer's podcast episode with me would be out concurrently with when this is released. But definitely look for that in November. I think he's really making incredible strides, making the interrelationship between mental health issues and also metabolic health that they're all very closely interrelated.

Melanie Avalon: Awesome. Yeah, I think that was all really amazing. Cynthia knows much more about the actual hormonal stuff than I do. The only thing I would add is that focusing on nutrient rich food, I think can be really, really helpful. If you think about it like pregnancy cravings in particular, obviously, there's the craving for actual energy because you're growing another human being inside of you. People get very specific cravings. That's likely because the body is needing more of a specific nutrient that it's associating with that craving for better or worse, which goes back to Mark Schatzker's book that I mentioned earlier about how these things can be misleading. The signals can signal to the body that they have a certain nutrient and then when they actually don't. But in any case, the reason I am talking about that is, you get cravings from pregnancy. And now, she's comparing it to that saying, "This is worse though." Focusing on protein is great and also focusing on the nutrient rich sources of foods I think can be really helpful. Things like egg yolks, and liver, and salmon and-- 

There's a study that came out recently that I want to find-- I've heard Chris Kresser talking about it on a few shows. I got to find it. Apparently, it's a list of-- They recently came up with a nutrient score for all of these foods based on mineral density and things like that. It was shocking. He was talking about, I think, on Robb Wolf's podcast and he was talking about the number score shift from, I think the top was like liver and something else. And then the shift down to the next foods was so huge because basically, there're a few foods that are just overwhelmingly nutrient rich. Yeah, so, I just wanted to add that piece about the food, but I think Cynthia's advice was very helpful.

Cynthia Thurlow: And yours as well. 

Melanie Avalon: Awesome. Shall we answer one more question?

Cynthia Thurlow: Sure. This is from Jessica. Subject is "Type 1 diabetes and intermittent fasting." "Hi, I've been intermittent fasting for a month and a half now. I started in the hopes of losing some weight. I have an added challenge and that I am a type 1 diabetic for 13 years now. I take precautions during my fast and always monitor my blood sugar. My question is about taking insulin during my fast. Especially in the mornings, the dawn effect makes my sugars climb and I don't hesitate to take insulin to correct it. I was curious if this breaks my fast and stops the benefit of it. Of course, I won't stop correcting no matter what the answer is, but I'm still technically getting anything out of it while I'm doing this. Thanks."

Melanie Avalon: Awesome. Well, thank you, Jessica, for your question. I'm actually glad to circle back to this question because I felt I was going on a tangent earlier about the nuance of the breaking the fast question and I forgot that this question was in here because this is the reason I like to emphasize that nuance. She wants to know if she's getting anything out of her fasting by taking insulin and does insulin stop the benefits of the fast. Well, now, I'm going to add further nuance to the nuance. You are still fasted-- If you're not taking in food, you're still fasted and especially in your situation, Jessica, where you're type 1 diabetic and you must be monitoring and addressing and for lack of a better word, controlling your blood sugar levels with exogenous insulin. That means that's just the way it has to be. It's not breaking your fast. It's not going to make you not fasted. The nuance I wanted to add to it because she's saying, "Does it stop the benefits?" 

One could argue in general stepping a little bit apart from Jessica's question that insulin release can make people, especially if they're in the fat burning state and then they release insulin, then it can turn off the ease of using the fat stores for fuel. So, it can have that negative effect to the fast. But everything, I don't say everything, but you're still getting the autophagy like we talked about earlier, you're getting the low mTOR, the low IGF-1 signaling, the reduced inflammation. I don't want to make a blanket statement, but it's really this insulin piece which is the one thing that's being affected, but it's very different releasing insulin, fasted compared to while eating. For people with type 1 diabetes, you have to take insulin. The way you're taking it, keep taking it. You are still getting the benefits from the fast. So, I would not stress about that. What are your thoughts, Cynthia?

Cynthia Thurlow: I'm a little conflicted. I have to be honest with you. Typically, I like to look at the questions before we sit down and record and I didn't have that luxury this week. It's been super busy. A lot of my patients when they start using insulin, start gaining weight and so it could be very challenging when you're trying to lose weight and you are using injectable insulin because your body doesn't have the endogenous ability to secrete insulin. As a type 1, you have an autoimmune issue and that means the beta cells are destroyed. And so, I really sit in kind of a neutral position. I'm not one direction or the other, but I think it can be challenging to be type 1 to be using injectable forms of insulin and trying to lose weight simultaneously. 

I think it's a very sticky wicket. I would probably endeavor to connect with some of my endocrinology friends because from my perspective, it has always been the case that went. By the time my patients are using insulin, they're usually struggling with weight loss resistance to some extreme or another. And so, I think the diet has to really be dialed in if you're counting your carb hydrates, if you're ketogenic or low carb. I think that will definitely improve things, but type 1 is very different than type 2. Type 2 diabetes is a lifestyle issue generally from too much carbohydrate, inadequate amounts of protein intake. I'm going to have to sit on the fence and I'll definitely on one of our subsequent podcasts, I will do a little bit of digging and see if I can rectify or change my opinion. But I think it's going to be a little bit challenging to lose weight.

Melanie Avalon: I totally miss that in the beginning about I started in the hopes of losing weight. I didn't even focus on that my answer, and I think that's a really good, salient point. And so, maybe the purpose of our discussion right now, because I'm really glad you brought that up and I do agree. Rather than focusing on the insulin and that being the hindrance to the weight loss, if Jessica, she doesn't talk at all about what she's eating or the diet that she's on. It's very possible. I know she's type 1 diabetic, not type 2, but it's very possible that she could find a diet that would make her just not have as many issues with the blood sugar spikes and actually reduce in general her insulin use.

Often, people think low carb for that. But then just to play devil's advocate or throw in the contrary opinion, you have Cyrus and Robby, who wrote a book called Mastering Diabetes that I've had on my show. I think they're both type-- One of them is type 1 for sure. They're both type 1, I think. I have to double-check that. They actually manage their diabetes with a high-carb, low-fat diet. It's very possible that a dietary approach could maybe be the best of both worlds in helping reduce the amount of insulin needed in the first place. So, then Jessica doesn't run into this problem that Cynthia is talking about where weight loss becomes a very difficult issue while taking exogenous insulin. Any other thoughts?

Cynthia Thurlow: No, I am going to reserve my opinion and do a little bit of research.

Melanie Avalon: Awesome. All right. 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 follow us on Instagram. We are @ifpodcast. I am @melanieavalon, Cynthia is @cynthia_thurlow_. The show notes for today's episode will be at ifpodcast.com/289. The show notes will have a full transcript. So, definitely check that out. I will just plug again. If you want to get the latest for my berberine, definitely text AvalonX to 877-861-8318. I am super-duper excited about that. And yes, I think that is all the things. So, everybody have a fabulous Halloween and we will see you next week. 

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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