Episode 299: Cynthia Thurlow: Intermittent Fasting Transformation, The Monthly Hormonal Cycle, Hormonal Dysregulation, Extended Fasting, PCOS & Thyroid Dysregulation, Getting Enough Oxytocin, And More!

Intermittent Fasting


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Jan 08

Welcome to Episode 299 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:

LMNT: For Fasting Or Low-Carb Diets Electrolytes Are Key For Relieving Hunger, Cramps, Headaches, Tiredness, And Dizziness. With No Sugar, Artificial Ingredients, Coloring, And Only 2 Grams Of Carbs Per Packet, Try LMNT For Complete And Total Hydration. For A Limited Time Go To drinklmnt.com/ifpodcast To Get A FREE Sample Pack With Any Purchase!

mANUKORA: Support optimal immune and digestive health with Manukora. delicious, raw, sustainable, traceable Manuka honey from New Zealand. Manukora superpower honey is high in antioxidants, prebiotics, and the natural antibacterial MGO compound. Go to manukora.com/ifpodcast for a FREE pack of honey sticks with your order!

NUTRISENSE: Get Your Own Personal Continuous Glucose Monitor (CGM) To See How Your Blood Sugar Responds 24/7 To Your Food, Fasting, And Exercise! The Nutrisense CGM Program Helps You Interpret The Data And Take Charge Of Your Metabolic Health! Get $30 Off A CGM At Nutrisense.Io/Ifpodcast With The Code IFPODCAST!

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


2:15 - LMNT: For A Limited Time Go To drinklmnt.com/ifpodcast To Get A FREE Sample Pack With Any Purchase! Learn All About Electrolytes In Episode 237 - Our Interview With Robb Wolf!

5:20 - 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 #59 - Cynthia Thurlow 

Intermittent Fasting Transformation: The 45-Day Program For Women To Lose Stubborn Weight, Improve Hormonal Health, And Slow Aging

Everyday Wellness Podcast 

12:40 - Cynthia's Personal Journey With Fasting

Intermittent Fasting: Transformational Technique | Cynthia Thurlow | TEDxGreenville

16:25 - Best Practices For Fasting For Women?

17:55 - OMAD

21:35 - Fasting And Feeding For Your Cycle; Is It Intuitive?

24:00 - The First Two Weeks Of Your Cycle

25:35 - Nutrition For Your Cycle

27:30 - The Lack Of Research On Cycling Women

Ep. 188 – Troubleshooting Your Fasting Method With Megan Ramos

32:20 - Extended Fasting

35:40 - What Can Effect Our Cycles The Most?

40:20 - MANUKORA: Go to manukora.com/ifpodcast for a FREE pack of honey sticks with your order!

44:30 - Amenorrhea

45:00 - Hormonal Dysregulation

52:45 - The Effect Of Fasting On Hormones; PCOS & Thyroid Regulation

55:00 - Weight Loss And Adipose Tissue

56:50 - Autoimmunity

1:00:10 - Carbohydrate Intake, Low Carb Diets

The Melanie Avalon Podcast Episode #75 - Joel Greene (Part 1)

The Melanie Avalon Podcast Episode #88 - Joel Greene (Part 2)

1:06:10 - Cortisol

1:13:00 - Testing Cortisol

1:14:40 - What Should We Be Testing?

1:18:00 - Oxytocin

1:20:40 - NUTRISENSE: Get $30 Off A CGM At Nutrisense.Io/Ifpodcast With The Code IFPODCAST

1:24:00 - Clean Fasting, Breaking Your Fast

1:28:45 - Coffee

1:30:20 - Using A Glucometer

1:31:30 - DHEA

1:34:50 - Having Your Sleep And Stress Dialed In Before Beginning Fasting

1:37:10 - Melatonin

The Melanie Avalon Biohacking Podcast Episode #112 - Dr. John Lieurance

1:41:30 - CBD

1:43:25 - Perimenopause

1:53:00 - Mindset

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 299 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: A 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging. For more on us, check out ifpodcast.com, melanieavalon.com, and cynthiathurlow.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment and no doctor-patient relationship is formed. So, pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time and get ready for The Intermittent Fasting Podcast.

Hi everybody, and welcome. This is episode number 299 of the Intermittent Fasting podcast. I'm Melanie Avalon, and we have a special episode for you today. We are actually going to air an episode from 2022 when Cynthia Thurlow came on my other show, the Melanie Avalon Biohacking Podcast, to talk about her book Intermittent Fasting Transformation. I was recently looking at the downloads, all from 2022, and this episode was actually one of my most popular episodes of last year. It's a really great deep dive into all things fasting, especially for women. I really think you guys will enjoy this. These show notes for the episode will be at ifpodcast.com/episode299. Of course, we are normally a listener, Q&A format style show. If you would like to submit your own questions for the show, just directly email questions@ifpodcast.com or you can go to ifpodcast.com and you can submit questions there. You can also follow us on Instagram. We are @ifpodcast, I am @melanieavalon, Cynthia is @cynthia_thurlow_. Without further ado, please enjoy this wonderful conversation with me and Cynthia Thurlow.

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

Conventional lipstick, for example, often tests high in lead and the half-life of lead is up to 30 years. That means, when you put on some conventional lipstick, 30 years later, maybe half of that lead has left your bones. On top of that there is essentially no regulation of these products on the shelves. That's why it's up to us to choose brands that are changing this. The brand that is working the hardest to do this is Beautycounter. They were founded on a mission to change this. Every single ingredient is extensively tested to be safe for your skin, so, you can truly feel good about what you put on. And friends, these products really, really work. They are incredible. They have counter time for anti-aging, counter match for normal skin, counter control for acne and oily prone, and counter start for sensitive. I use their overnight resurfacing peel and vitamin C serum every single night of my life. And their makeup is amazing. Check out 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, friends. Welcome back to the show. I am so incredibly excited about the conversation that I am about to have. It is with, first of all, a repeat guest, which I guess that my audience absolutely loved the first episode that we did. But not only that, this guest is such a good friend of mine. I was actually thinking about this right before starting, how there are some people in your life that it's weird to think of a time when you didn't know them or when they weren't in their life because I'm here with Cynthia Thurlow and Cynthia, I was thinking back to when we first met and how did we get connected originally?

Cynthia Thurlow: I think you had reached out after that second TED Talk. I just recall it was like summer of 2019, 2020.

Melanie Avalon: It might have been through Gin, maybe, Is that possible?

Cynthia Thurlow: Could have been, absolutely. I just remember how polite you were.


Melanie Avalon: Oh, my goodness. Good times. In any case, I'm here with Cynthia Thurlow, she is a nurse practitioner, CEO, and founder of the Everyday Wellness Project. Like she just mentioned, she has two TED Talks on Intermittent Fasting, which kind of really catapulted her into the intermittent fasting fame world. She has a new book coming out, which is so exciting. That's why we're bringing her back on the show. I had her on the show earlier. I'll put a link to that in the show notes, and it was just intermittent fasting and women and female and hormones and all the things. Her new book coming out is called Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging. I will say this book, listeners, as you may be familiar, I'm also the host of the Intermittent Fasting Podcast.

I'm thinking about intermittent fasting all the time, I'm talking about it all the time. I'm always really curious when a new book comes out that's focusing on it because I'm always just wondering, what approach are they going to take? What am I going to learn? What type of information will be in this book? Friends, listeners I cannot encourage you enough. Men and women, but especially women out there, get this book. It is so comprehensive, so amazing. It covers everything about intermittent fasting, how to do it, a really wonderful approach, in my opinion, to the role of diet and diet quality and macronutrients and what to focus on with all of that. A deep deep dive into hormones, into women's cycles. It's just such an incredible resource. I'm grateful, Cynthia, that you wrote this book, and I'm thrilled for it to release. I'm really excited for you. So, listeners, I will put a link to that in the show notes, Cynthia, thank you so much for being here.

Cynthia Thurlow: No, thank you for having me in. That of course, wonderful introduction. For listeners that are listening to this, as I tell everyone, I'm just a shy introvert who did a talk that really changed the trajectory of everything I was doing. I feel really committed to helping women navigate irrespective of their age or their stage of life they're in, to be able to make decisions and new strategies that can allow them to live their best lives.

Melanie Avalon: You are definitely doing that. I will also put a plug; you also host the Everyday Wellness Podcast, if listeners are not listening to that podcast as well. Really, really awesome podcast. A lot of overlap, a lot of the guests that I've had on my show as well, a nice focus on, again, women, hormones, all of that. So, definitely check out that podcast. I actually have a question about your personal story to start things off, and you talk about your personal story in the book, which is really valuable, about the intermittent fasting. Did you anticipate I think about this with my own journey because when I first wrote my book, it was intermittent fasting, paleo, and wine, I didn't anticipate that intermittent fasting was going to become like the thing. I know your TED Talk was about it, but prior to that, did you anticipate that it was going to become the sensation that it is today? How much of a role does it actually play in your day-to-day practice with patients?

Cynthia Thurlow: Yeah, that's a great question. I myself fell down the intermittent fasting rabbit hole in 2015. Initially, it was just something I did. It was something I did to help support my health. I was in a position where I was stuck with a weight loss issue relevant to perimenopause. It just started to literally bleed into the work I was doing with women. Of course, I left clinical medicine in 2016 and really became part of nearly every program I worked in with women. The irony is, in 2018, I decided to do a TED Talk. I thought that would be a challenging thing to do as an introvert, a safe thing to do. Initially, my first talk was on perimenopause and around the time that I accepted that talk, I was approached about doing another one in the state that I was born in, which was really special to me, largely because South Carolina, I have so many wonderful memories from spending my summers with my grandmother in South Carolina.

Obviously, you can't do a second TED Talk that is even vaguely reminiscent to your first. I looked at my husband and this is probably December of 2018, and said, what do I know a lot about? He said intermittent fasting. I told the organizers; I'm going to talk about intermittent fasting. It was that easy of a decision. No, I never would have guessed that would have been a strategy that I would be really well known for. I can tell you I just about fell over when that talk started going viral, largely because I had gotten so sick prior to giving it. I love the fact that as a traditional allopathic trained nurse practitioner, I can empower men and women to embrace a strategy that really isn't new or novel. I think on so many levels, individuals really believe that it's something new. I just remind them as I'm sure you and Gin do on your own podcasts, that are specific to fasting, that it really dates back to biblical times.

It was just as much a surprise to my family as it was to me that this is now what I'm known for. The irony is, this book really came out of the work I was doing with women. The IF:45 plan that is depicted in the book was what came out of all of a sudden, I had to scramble to try to create things to meet the needs of people that were coming to me saying, "Hey, if you're someone that really knows how to strategize about fasting, can you help me?" This has really become three years' worth of work to be able to then share the programs that I've created with the masses. Some more people, maybe not everyone, can work with me personally, but they now can have some insights into my background and methodologies for this program that I created.

Melanie Avalon: Yeah, that was actually a huge question I had about the programs and the book and everything because there are so many different intermittent fasting approaches. Obviously one of the biggest questions we get on the Intermittent Fasting Podcast and just in general, is fasting is safe for women and how should women approach be fasting. In your experience working with women, like the IF:45 plan, did that precede the book? What IF windows did you ultimately find work best for women? Should there be concerns about fasting for women? Like, what are your thoughts on that? Like 16:8 versus one meal a day? Oh, all the plans?

Cynthia Thurlow: I think it gets so much more confusing with women because I would say postmenopausal women and men have a much easier time making fasting work for themselves. I think the beauty of women that are still in their reproductive years, that are still getting their menstrual cycle, there are a couple of extra steps you have to think about. To answer your initial question, I think an 18:6 is a good starting point for women. I think overall, obviously, each woman is her own individual. You have to look at a lot of different factors to determine what is the best way to proceed. Let's be clear, there are times when we shouldn't fast as women, and then there are times it's completely reasonable. What I don't like is when men try to tell women that fasting is unsafe. That actually makes me a little bit upset and cranky, I have to be honest with you because it's very reductionist.

I think we as a culture we want to boil everything down that there's this one size fits all. I would argue that an 18:6 is a good starting point. I'm not a huge fan of OMAD for women, largely because I feel as if most women can't get enough macronutrients in that feeding window. Now, I know there are men out there on, Twitter is a good example. There're a lot of men on Twitter that fast, and they'll say, "OMAD, I get 2000 calories in a meal." I just think to myself, there's just no way in heck that could ever happen for me. There's no way I could get 2000 calories into one meal. I wouldn't be able to move. I would probably vomit. I think I like OMAD if it's around a holiday or maybe you've overindulged the day before, but I think it can set women up in a cycle where they're just not going to get enough macronutrients, not enough protein, not enough healthy fats, and certainly not enough healthy carbohydrates.

I think that when people talk about OMAD for women, I always want to put an asterisk to say, let's clarify that. Is that something you can do as needed? Sure, it's probably okay. Do I occasionally do it? Yes. It is not something I do on a day-to-day basis. I think the big thing about this book in particular is that I want people to have a starting point like here's a reasonable starting point to navigate success with this as a strategy that is specific to where you are in your menstrual cycle that is specific to where you are lifestyle wise and that even includes this nebulous period of perimenopause that a lot of people, including myself, had never been aware of. No one had ever talked to me about it until I literally fell into it. I think that's really a good starting place for people to say, this is what we're going to work you towards.

Once you have success with that, then there's all these other options. It's almost like, and this is a terrible example, it's almost like you go to a buffet, and the buffet for fasting, you get lots of different options. As you're moving towards that buffet, you have a starting point. You need to be able to succeed with this basic 18:6 before you open up into a lot of more challenging fasts or varying your fast significantly. It's like I always say, we want to start with the basics. We want to ensure that we have great success with those before we start entering more advanced strategies.

Melanie Avalon: Funny that you started saying the thing about what frustrates you. I was like, I know what she's going to say. Also, I'm really glad that you clarified about defining one meal a day. Like, for example, I always say that I do one meal a day but I'm not eating that one meal a day for me is a minimum usually 4 hours. It's actually more like 20:4 and sometimes it's even longer. I think that's actually really important to clarify. Something I love you open up the book talking about the differences between men and women and I learned so much about how women are different biologically. Like, you pointed out that our brains are actually younger than men and you point out how we actually need more sleep because our brains are more complicated than men, which works for me, just in the differences between men and women.

When it comes to fasting and eating and just for listeners, again, I'm going to refer you to this book because it goes into the details of the actual plan and what to do and the recommendations and there is a path to follow. Definitely get the book because the path is not going to be all in today's conversation. But that said, how intuitive? Because you talk, for example, about how to eat according to your cycle or you just talked about right now about fasting, how it might change based on your age and where you are in your life cycle, how intuitive is that? Do we need a plan? Or like when it comes to food and exercise and fasting for your cycle, for example, do we need an actual plan on paper that we implement, or could we just be really intuitive? Like I'm craving these types of foods now and I want to fast like this now. Like how intuitive can we be versus needing a plan?

Cynthia Thurlow: I think that's a really great distinction. I feel like many women are not intuitive or they're not connected to their intuition and that's not a criticism. I think we've gotten to the point with our patient population that we've been telling people what to think, what to do for such a long period of time that women's intuition that we should lean into, we have largely gotten disconnected from it. I would love if every woman that I worked with would really lean into their intuition. I do find that there are people who don't trust their intuition. They're not ready to do that. This is a perfect example of why having something on paper can provide the reinforcement, the encouragement, the support that they may need because maybe they're not at a point where they feel they may not lean into what foods make them feel good. They may be on synthetic hormones that make it more challenging for them to acknowledge that there's a follicular cycle, there's an ovulatory cycle, there's a luteal phase in our menstrual cycle, or there could be in this, as I refer to effectually the nebulous period of perimenopause five to ten years prior to going through menopause.

I think on so many levels it has been more my experience working with females that they initially want the structure and accountability of a plan as opposed to just barreling forward and saying, "Okay, today I'm craving meat, so I'm going to have more meat, or I'm noticing I'm craving more starchy carbohydrates, I might be close to my menstrual cycle, so let me lean into that." I think it's a good starting point to say that having a plan available to people can be very reassuring and also the knowledge and recognition that on so many levels, having that information is really validating to say, "Hey, no one ever told me that I needed to look out for these things." Let me just give you a heads up because as an example the first two weeks from the day we start bleeding till right before ovulation, that's when estrogen predominates in our menstrual cycle.

That's the time that we can push the lever on a lot of things. We can do harder workouts; we can do longer fast once we've gotten the basics. It's a time when sleep, I don't want to say sleep isn't important, we may not need as much sleep, we might have more energy. Really leaning into the fact that this menstrual cycle or this infradian rhythm, this 28-day period of time when we are having this menstrual cycle, is really a time to just acknowledge that through different phases, we have to honor our bodies in different ways. I think that it's probably more the minority of women that don't feel like they need as much structure. It's been my experience, especially when trying a new strategy, especially with a lot of misinformation that's out there. I'm sure you would agree with me, there's a lot of misinformation, fear-mongering, et cetera, about women in fasting, really acknowledging our own unique needs and our own bio-individuality so that we can ensure that we're getting the best results, we're getting the best feedback from our bodies. Eventually we'll get to a point where we can lean into that intuition confidently as opposed to leaning into it skeptically.

Melanie Avalon: I agree. Even for myself, when I started intermittent fasting, I started with a regimented plan that I stuck to. When I first started, I mean, paleo, for example, I was following more of a regimen than I do now. And now it is "More intuitive." Eating for your cycle, because you dive deep into the book again, it's very laid out and you talk about the specific nutrients and the different foods to focus on for the different parts of your cycle. So, two-part question, one just for listeners who are not familiar. Could we have a little educational moment where you just briefly outline the four phases of the cycle and then two, finding the foods that work for the different phases? What is that based on? Is that in the clinical literature, is that based on working with your patients? I'm just curious where that knowledge comes from.

Cynthia Thurlow: First and foremost, there's not enough research on cycling women. I think this is something that I'm sure you have found to be the case as well. And, for me, after working with thousands of women so let me just back up. My whole background is in ER medicine and cardiology. Over the last six years, having the opportunity to use a lot of trial and error, but also leaning into looking to see what my peers, other healthcare professionals, MDs, NPs, nurses, et cetera, that are working with women and seeing what works successfully for them. It could be an end of a couple of thousand, but it hasn't necessarily been done in clinical research. There is good information about the infradian rhythm, there is good information about ways to honor where we are in our menstrual cycle, there is good information on what happens to our bodies as we go through our menstrual cycle.

The concept of lifestyle medicine, the concept of marrying, stress management, sleep quality, nutrition, exercise, etc., that is a newer kind of methodology, that's a newer perspective on how to honor our bodies as women. I do think research opportunities will be forthcoming. I think, unfortunately, there isn't enough research done on cycling women. I think there's been for many years, a fear of it's too complicated, there's too much to it. I mean, there are researchers out there. I can think of one in particular. She's a female Ph.D., she works with female athletes and she is not pro-fasting. I do respect the work that she's doing and we do acknowledge that during the menstrual cycle, a lot of her work is what I kind of leaned into looking at how do we support our bodies at different phases exercise-wise throughout our cycle. There's good research there in terms of exercise in women's physiology, but certainly not enough and not enough done on humans versus lab animals like you and I both know, and probably many of the listeners do as well because they listen to the high-quality podcasts that you have that you can't compare per se, lab animals, ovulatory cycles, lactation and pregnancy to humans.

That's where the waters get a little muddied. I always say anecdotal evidence is not inferior in the sense that it's not a randomized controlled trial, but it's a good starting point. To say this is information that we should be taking to, whether it's a research institution or a research facility. Saying we really think this is information that needs to be followed up on. Like, here's my hypothesis and let's see if we can create a research model around this that might be able to yield and validate the findings that many of us are experiencing. It's interesting. I recently had a great podcast with Megan Ramos, who works with Dr. Jason Fung, and she and I were both talking about the fact that it's upsetting that so many women are fearful to fast even in a small amount of time because of bad information that's out there.

I think that if we were in a position where we had really good research done on women throughout their lifetime, not just obese postmenopausal women, which there's plenty of research there, I think that would put some of these fears to rest. I do want to believe that they're well-meaning individuals that are out their fear-mongering. I do have moments where I just kind of shake my head and I think to myself if we look at the lack of metabolic flexibility, how incredibly unhealthy we are as Americans, we should be doing everything we can to find strategies to help men and women become healthier. And so, what's the harm in trying? That's kind of where I come from. I think the other piece of that is I've just watched people get sicker over the last 20 years. That to me is so disheartening as a nurse practitioner that clinically don't do a very good job with prevention.

If there's a strategy that women can utilize that can help them become healthier, and more metabolically flexible, I'm all for it. But I think that's a great question. It really speaks to the fact that we need to be demanding more, we as women need to be demanding more of the research community, asking them to not be fearful to utilize women at peak fertility years and even beyond for research purposes. Don't just use it on lab animals, which I know that can be helpful, it's a good starting point. There are plenty of clinicians like myself that have just seen such significant changes in people's health. Not only that, their biophysical markers and their sleep quality and so many things that are so important in terms of lifestyle medicine.

Melanie Avalon: Yeah, just speaking to that with the rodent studies, and we might have talked about this last time you came on, but I think it's very valuable to have animal studies and you have to start somewhere. If you're studying something like longevity and rodents, that would be easier to study because you could see how things just affect longevity. It's a broader thing that's not affected by "Let me further clarify, I'm not clarifying myself here." Let's compare studying longevity and a rodent to like fertility. Longevity is more a broader thing you could see is the rodent living longer, but then when it comes to fertility, so like a rodent fertility cycle, they're reproducing all the time, and so they're much more sensitive to things that would throw that off. And then on top of that, fasting. this is the thing that gets me the most, is that when they test fasting in a rodent, it'll be like a normal fast for us, like 24-hour fast, that's the equivalent of days in a rodent. Basically, the majority of the literature, I believe, on fertility in rodents and fasting is not intermittent fasting. It's like the equivalent of extended fasting. I just think that's really important to point out, which actually, speaking of extended fasting, what do you qualify as extended fasting?

Cynthia Thurlow: Well, I was about to say what, in your vernacular, is extended fasting. I think when we're talking about 24 hours or longer, I know that there's a lot of interest in people doing three to five-day fast. And it was interesting. I was listening to Dr. Ted Naiman and Maria Emmerich having a conversation about this, and Ted, who's an engineer and also a physician, said there's this law of diminishing returns when people are already lean and they want to fast for a really long periods of time. I thought to myself that really makes sense. I think if someone is obese, metabolically unhealthy, I think longer fast can be a springboard into a consistent fasting regimen. I, per se, am not a huge fan of long fasts. I think it has something to do with the fact that in 2019, I wasn't able to eat for 13 days involuntarily because I was so sick.

Since that time, I haven't done anything more than 24- or 30-hour fast. I think it can be helpful for specific purposes. A lot of people talk about and I know you've had Valter Longo on stem cell activation when you're getting to that three to five-day period, wanting to kind of improve gut health and change the composition of the gut microbiome. I'm not a huge fan of people doing consistent long fasts and I do have women I always say they are the overachievers and I value that and I'm not being critical at all. The women who start right out of the gate and they're like, "I want to do a 48-hour fast, I want to do a 36-hour fast, I want to do a 24-hour fast. "I'm like, okay, let's ensure we can get through the basics first, and then as you have success, yes, opening that up for some people that are plateau-busting, it can be a great opportunity for people to do a 24-hour fast every week.

I think it really ultimately depends on where are you in your menstrual cycle, what are your goals, what are you hoping to achieve. I think the more metabolically flexible you are-- this is my personal, my N of a couple thousand. The more metabolically flexible you are, I think it becomes this law of diminishing returns in terms of what are you looking to obtain from doing longer fasts. We know that digestive rest, bumps in autophagy, growth hormone, etc., I mean, those are all wonderful things to want to focus on, but I think you have to be careful. Especially if someone's peak fertility years and I say 35 and under predominantly, and especially if you're very lean, I just think those longer fasts can set your body up for putting you into this feast-famine mindset. We know that the hypothalamus-pituitary is very sensitive to nutrient depletion.

I really think you have to be careful in that age range. I know we could springboard into a thousand different conversations from here. I'm not opposed to prolonged fasting, but I do think people have to be very clear about their goals. I think they have to be very transparent about where they are in their life cycle. Are you peak fertility years, perimenopause, menopause? Menopausal women can generally get away with as much as men. Our hormones are a little more stable. But being really honest and transparent about where you are, I think is really critically important.

Melanie Avalon: I'm really glad that you touched on the potential sensitivity of women to fasting. Working with all of your patients that you've worked with as far as, like, things that affect a woman's cycle, so fasting, calories, overexercising, undernutrition, maybe stress, lack of sleep, is there one that tends to cause problems more for women when it comes to cycle issues or being too, "Restrictive?" Or is it really an individual case-by-case basis?

Cynthia Thurlow: There're definitely factors that I think are bigger insults to the body than others and so stress and sleep, like how many women don't sleep well and they think it's no big deal? Well, what you get away with in your 20s and 30, you oftentimes can't in your 40s and 50s. A lot of that's just the changes that occur physiologically. I would say the people I get most concerned about are the over-exercisers who under nourish their bodies and then they don't have proper mechanisms to address sleep and they sure as heck don't manage their stress properly. I would say those are probably the four big things that I look at. Obviously, it's a case-by-case basis, but I think on so many levels we have primed our patients to think this way. We tell them calories in, calories out. We tell them you have to overexercise to deal with the surplus of calories you just took in.

We've been giving bad information out to our patients for a long period of time. Of course, in their minds it makes sense. I'm just going to do 2 hours of cardio to counteract the deluge of crap I ate when I went out last night. It's this concept of punishing our bodies, the self-flagellatory mindset that is so toxic. Like I would say it's that toxic mentality that we have unfortunately ingrained not only with our patient population but also in our culture. What's the newest box of crap that's out there or potion or powder that's somehow going to magically make everything work? We want fast results. We don't want anything that's going to take a long period of time. We've, unfortunately, and I say we as clinicians contributed to this. Melanie, I think that's such a great question and I think bio-individuality rules. You'll hear me use that term a lot in the book.

Ultimately, it's really dependent on who we are as individuals. I could also add into there like "How lean are you?" I have a lot of women who are very lean. Like their body fat is nearly nonexistent. They might also be on the precipice of amenorrhea where they're not even getting their menstrual cycles, or they could even be in their 30s and 40s and they're skipping cycles regularly. One thing I want to emphasize is that I want women to use their menstrual cycle as a barometer for how much stress they are putting themselves under, whether it's physiologic, physical, etc. Because if you are getting your menstrual cycle every month, great. If you start fasting or you're already not regularly getting your menstrual cycle and you don't know why and you add in fasting, that might be the tipping point for your body to say, time out, you're not taking care of me.

Therefore, I'm going to put the brakes on everything because I'm thinking that there's not enough sleep, there's not enough stress management, there's not enough nutrition coming into this body. I want to make sure that there's no way I have to support the potential pregnancy. I think that really adding in to that equation is learning and being honest and saying what's my menstrual cycle like? Because when a woman tells me she starts menstruating or she starts fasting and loses her menstrual cycle, that's like a danger sign. To me that's like we got to back up the bus. We need to look at everything you're doing. We need to work on making sure your body is properly nourished on every level. I don't want to sound woo-woo, but on so many levels it's not just the food we put in our mouth, it's like the toxicities in our environment, and are we being kind to ourselves?

I think on many levels people come to fasting, women in particular because they want to change their body composition. They want to lose weight and that becomes their very myopic view of that's health is looking at the number on the scale. I think that can be profoundly unhealthy. It's like, "Okay, let's make sure we get healthy to lose weight," that needs to be the mentality as opposed to intermittent fasting isn't working for me because I am not losing weight. It's like, wait, no. We have to kind of reframe these thoughts so that we can put ourselves in a healthier state of mind before attempting to do any of that.

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Yeah, that was one of the things I loved about your book so much, is just how comprehensive it is on the full picture of everything. It's not just the fasting, it's the mindset, it's the diet, the sleep, it's all the things. It's interesting that you were saying about how some of your patients are really lean and the factor that that might play because I was actually reading a study and it was looking at the effects on women's cycles in-- I'd have to find it. I think it was endurance athletes. What was really interesting was getting amenorrhea did not relate to the amount of exercise. It correlated instead to their body weight. If they were too low of weight, the level of exercise, it was a problem compared to women that had much more ample fat, they could exercise a lot more and it not affect the cycle.

I almost didn't want to mention that study, though, because then that makes it sound like it's a blanket statement, but when it's going to be individual. Yeah, I thought that was really interesting. Speaking of hormonal issues with women and I'd love to go into perimenopause and menopause and all of that, but just in general. You dive deep, deep, deep into all of the hormones, which made me so excited because I love learning. Like when I was reading the part of the book that was going over insulin, cortisol, estrogen, progesterone, testosterone, DHEA and all the things, I was just loving it. I was like this is amazing, so comprehensive, I learned so much. Okay, hormonal issues. There are so many hormonal issues out there, PMS, PMDD, PCOS, I'm sure we'll go into perimenopause and things like that. Are hormonal issues inevitable? Do all women experience them? How common are they? With your patients, do you see that they necessarily do correlate to lifestyle? Or can some women be doing all the things and still experience hormonal issues?

Cynthia Thurlow: I think that's a great question, Melanie. I think in our increasingly kind of toxic world that we live in, when I say toxic, I'm talking about things we're exposed to in our environment, our personal care products, and our nutrition, we're bombarded by toxins that can influence our hormones, how they're balanced, adding in the volume of individuals that are on synthetic hormones. I mean, I'll be the first person to say I was put on synthetic hormones in early adulthood because I had amenorrheic cycles, probably because I had very mild PCOS, which is a whole separate conversation. I think being on oral contraceptives as an example didn't allow me to ever deal with what was really the issue for me as an individual. I think that it is a byproduct of our westernized lifestyle that most, if not all individuals and again, we've touched on a little bit about metabolic flexibility, that most, if not all of us are not as hormonally balanced as we should be.

Many people assume whatever symptoms they're experiencing, bad PMS, even more, significant PMDD or having luteal phase defects where they have this significant precipitous drop in progesterone during their luteal phase that begets the PMS, the PMDD, also can create some menstrual regularities, can create this estrogen dominance where people have very heavy cycles and weight gain and breast tenderness, etc. We're just talking about people still at their peak fertile years, so I do think it's a byproduct of the environment that we live in in this kind of traditional westernized society. Not to mention the fact that most people are not eating to nourish their bodies. Again, it's not because they don't want to. It's they've been conditioned that everything in the supermarket is healthy, everything that is in a box, a bag, or a can is nourishment. I know you and I would argue against that, but it's also the information that we get from the FDA, the USDA, the food guide pyramid is now kind of spawned into my plate.

It's the imbalanced macros where people are encouraged to eat heart healthy grains or they're encouraged to eat what I think is dessert for breakfast. These are further contributing to this hormonal dysregulation. We're like a hedonistic culture where we have accessibility to information 24/7. It's very different than when I was growing up. The TV went off at like 01:00 in the morning, and there was no cable TV when I was really young. Now we could be on our computers or iPad or iPhones or social media all the time. Our bodies are just inundated with artificial light and all of these factors disrupt this orchestration between all these hormones, which are governed by our brain and the endocrine system. That's kind of an overly simplistic way of saying I think most, if not all of us are navigating our 20s, 30s, 40s, 50s, and beyond with some degree of hormonal imbalances.

It may not be until we find a symptom that's particularly troubling, for a lot of women it's the weight gain piece. Like when you have what I call weight loss resistance when that happens, then people start digging, they're like, this is not acceptable, something must be off. They're told maybe they've got a thyroid problem or again synthetic hormones are offered, or surgical interventions. I mean that certainly was the case with me and perimenopause. I think on so many levels it doesn't have to be that way, but it would not be the norm for women who I work with. Again, I'm in a niche within my industry. It would not be the norm that women wouldn't be coming to me with specific problems, like sleep problems, you know waking up in the middle of the night. They've got really heavy periods, they have stubborn weight gain, they have energy issues, and those are all a sign of hormonal imbalances.

On every level that I can think of, I think our modern-day lifestyle is creating, "The perfect environment for these hormonal imbalances." I think it's more the norm that we are conditioned to believe whether it's the limiting belief of "Oh, this is just the way things are because I'm X age, whether it's 35, 40, 45, 50 or beyond, or this is just the way things are because now I'm a parent, or this is just the way things are because I have a very demanding job and a travel schedule. Don't even mention the fact we're all in year two of a global pandemic. And so we're in unprecedented times. I do think our lifestyle is a reflection of the fact that we are so far off base as a culture in terms of really honoring the way that our bodies are designed to thrive and not just survive.

That is a huge distinction for me. I feel like on every level I've been able to see it from being a clinician in a broken medical system to being a clinician that's an entrepreneur and seeing things from a different angle. In many ways, we have created this environment that our patients are living in, and they're not thriving in, most of them are not they're feeling stuck. It's an unfortunate situation, but I think as more of us become educated and obviously, you have such a great platform for this as well, Melanie, being able to help educate people about all the things in their environment and things that we can be doing to making ourselves healthier. We're starting to slowly kind of turn the corner on this. I think in years to come, women are going to be better educated about the changes that are going to occur and be able to do more to support themselves.

Melanie Avalon: Yeah, the nuance of that answer that I love is that it's both, in a way, inevitable. Like you just said, our environment is so toxic. I mean, even like, we're born into this because we know now that the stress and the lifestyles of our mom and even prior generations carries through to future generations. On the one hand, it's like we're in this inevitable soup of toxicity, but at the same time, there's great agency, and we're not destined to that like, we can make changes. So, I love that so much. One of my favorite things about your book that I'm sure listeners will love, love, love, is that in the book, Cynthia goes through all of these different hormones, how they affect the body, and then she actually talks about how fasting affects those hormones, which was just so incredible. A question about fasting and affecting hormonal issues, because there are so many, like I said, so many different things that women experience, but I think there are two that I'd love to touch on, two things that I think a lot of women experience.

One of them, it's generally accepted that intermittent fasting helps it and the other, it's generally accepted that intermittent fasting might hurt it. I'd love to hear your thoughts on both of those. One would be PCOS and the other would be thyroid issues. I'm just using that as an example for those issues, for example, what are your thoughts on fasting and those?

Cynthia Thurlow: Yeah, great question. PCOS is something that I unknowingly had, even though I'm a thin phenotype, so I'm a thin woman probably contributed to why I struggled with infertility getting pregnant with my children. I especially feel this in my heart. The basis of PCOS or polycystic ovarian syndrome is the fact that most women are insulin resistant or have some degree of insulin resistance. We know that changing our diet, not only changing our diet, going to a more nutrient-dense, whole-food diet, focusing on animal-based protein and non-starchy vegetables and healthy fats along with periods of eating less often, can be hugely instrumental in rebalancing insulin. It's just one. The more common phenotype with PCOS is to have someone who's obese or someone who's overweight. I've had such incredible success working with women who were at this unique situation and my heart goes out to them because I know what that was like, that impacted my fertility.

That's really how it manifested and why I was on oral contraceptives for 1000 years, because it was, "Fixing the problem." Not really, was putting a Band-Aid on it. I do feel that in particular when you're looking at PCOS, where typically you've got insulin resistance, you generally-- a lot of people, your androgen levels, your testosterone levels are higher than normal. I do see some resolution, especially with weight loss, that you are. Let me back up a little bit, when we're looking at adipose tissue, which is in and of itself its own organ in the body, it's so sophisticated, it's not just fat, it has so much signaling that goes on in inflammatory markers. We know that many women when they lose weight, they're priming this estrogen pump. What ends up happening with PCOS oftentimes is you have this aromatization. You have all this testosterone that is going from being testosterone aromatized into estrogen and you can get this relative estrogen dominance.

With weight loss, you are getting this net resultant lowered levels of estradiol, the predominant form of estrogen in our bodies prior to going through menopause. I think that it is critically important when someone has PCOS to consider looking very closely at nutrition, looking very closely at weight reduction. One of the ways you can do that is by intermittent fasting. It doesn't have to be done excessively. You could even just start with 12 and 10 or 12 and 14, 12 hours fast with a 12-hour eating window just as a starter, just kind of meandering to that. Now, coincidentally I also have an underactive thyroid, which I think is a byproduct of the age and stage of life that I'm in. It's much more common as women are navigating perimenopause five to ten years to see episodes of underactive thyroid. The predominant reason why women will develop hypothyroidism in any age group is related to an autoimmune issue called Hashimoto's thyroiditis.

In fact, it's very few people, it's like one to 2% of people with hypothyroidism don't have Hashimoto's, even if you've had negative antibodies like me. I was about 44, that's when I was diagnosed. People ask me all the time; do you think that fasting-- Do you think that's what drove the hypothyroidism? I always say no, because autoimmune issues are almost always driven by gut health issues and I've had two other autoimmune issues. Once you have one, you just are more prone to others, which is unfortunate, but that's even based on research. I think that the average person who has an underactive thyroid or an overactive thyroid like Graves' disease, you can successfully navigate fasting. It always goes back to those pillars that we've talked about earlier, stress management, sleep quality, nutrition, really looking not overexercising, because you can have hypothyroidism and still exercise, still get high-quality sleep, still manage your stress properly and you can do beautifully.

If you have hypothyroidism and you get less than 6 hours a night of sleep and your stress is out of control and you're the CrossFit or Orangetheory bunny and you're doing that five days a week and there are plenty of women doing it and you over restrict your macros then you are setting yourself up for tanking or thyroid. Tanking obviously is not a clinical term, but you're not going to do your thyroid any favors. I really want women to understand that the endocrine system in the body really is this complex interaction between our body's perception of stressors, sleep, stress, management, nutrition, exercise, and our response to it. You can successfully navigate fasting with hypothyroidism or thyroid disorders where you could also make it harder on your body. The other thing to touch on is that there's a lot of misinformation about you need so much carbohydrate in order to go from inactive to active thyroid hormone.

I really don't necessarily believe that it has to be that you have to have so much carbohydrate in order to have this proper conversion. I think it's more a reflection of your degree of metabolic flexibility, so let me be clear about this. When you are obese or overweight, you're not as metabolically flexible. The choice of carbohydrates for you, it's going to be very focused on portion and the quality, even more so than for anyone else. It's not to suggest that you can't be lower carb or even ketogenic and also fast and also do all these other things, but a lot of its bio-individual. You also have to be very very attuned to how flexible is your body. Because what I might be able to get away with as a middle-aged woman might be very different than someone else at the same age stage who maybe hasn't taken as good care of themselves.

It's really getting very honest with yourself about what's the lifestyle pieces, how well are you taking care of yourself before you add in another stressor. We have to really define intermittent fasting as a hormetic stress. The beneficial stress in the right amount at the right time can be beautiful for honoring our bodies. If it's not the right time, if it's too much stress, if our body perceives that it's under threat, it is not going to do well with that type of stress. Really being very clear, but I do think both PCOS and thyroid issues can do beautifully with fasting, but you have to look at all those other pieces of the puzzle as well.

Melanie Avalon: It is really interesting that at least when I would review the clinical literature on fasting and women that there were a lot of studies on PCOS and women, which I always thought was really interesting and they're pretty much favorable for it. I have some more questions about the hormones. Since you did touch on the macros just now and the carb intake and all of that, what are your thoughts on a low-carb diet? In your IF:45 plan which includes three phases, like the induction phase that you have, what is the role of carbs and low carbs?

Cynthia Thurlow: It's a good question. I do think so if we look statistically, I think it's a 2018 study from UNC. At that time, this is pre-pandemic, it was 88.2% of Americans are not metabolically healthy. When people come to IF:45, the first thing I say is, listen, if the average American is consuming 200 to 300 g of carbs and that's conservatively per day, if we really want to get our bodies primed to be able to fast, there are a couple of things we need to do, and one of them is reducing our carbohydrate intake and really focusing on whole carbohydrates. And that means the unprocessed varieties. I'm not anti-carb, I do eat carbohydrates, I want to be really clear about that, but in that induction phase, it's really to get people ready so that when they start fasting, they're going to have better success.

And so I'm not anti-carb. I do think low carbohydrate diets can be very helpful for women, especially if they're wanting to change body composition, wanting to lose weight. For a lot of people, unfortunately, they've had the complete opposite. For most of their adult life they've sat down with a big plate of pasta, they've had bread with every meal, they've had rice or grains with every meal, or they've had unfettered access to tropical fruit. It's just an example and it's never a judgment. I'm just being observational and I find that women that are able to limit or moderate their carbohydrates and really focus on animal-based protein and healthy fats are going to have much more satiety. They're going to be much more satiated. They are going to be much more successful by readjusting those macros. For a lot of people that's why we have a whole week of induction because it can be very, very challenging.

There are a lot of people that are really emotional eaters. Again, not a criticism, just an observation. I think on many levels it gets people really ready to understand like we are going to learn how to fuel our bodies in a way that we are going to feel full, satisfied, and be able to step away from the table as opposed to feeling like we have to constantly snack. Because I'm sure you see this with the women that you interact with as well, that we've been conditioned that we need to have three meals a day and snacks and we have to, like, rip the Band-Aid off and start with the basics. So, I get very granular like these are the things we need to do. We have to limit our carbs. We need to stop snacking. I want you to adjust your macros because I want people to have a lifelong strategy that they can embrace as opposed to this. Unfortunately, it's huge here in the United States. The latest, greatest thing that's going to help them lose weight really fast and they're not going to be able to sustain their results because yo-yo dieting as you and I both know is detrimental metabolically to our bodies.

Melanie Avalon: Oh, I think it is so detrimental. It reminds me of Joel Greene's work. I know you interviewed him as well and his book is like mind-blown moment after mind-blown moment, but he talks about the actual-- and I'll put a link in the show notes to the two-part episode that I did with him. After reading his book, I finally understood why yo-yo dieting makes it harder and harder to lose weight. It basically has to do with how it affects something called the extracellular matrix surrounding fat cells, and they become stiffer the more that you lose and regain and lose and regain and it's just really fascinating.

Cynthia Thurlow: I think when I read his book, Melanie, I literally, like, my chin was on the table, and I remember saying to you, now I'm sure everyone that listens to you knows that you are like a copious researcher. I think I told you, I think I went through 20 pages of a legal notepad taking notes, and my husband was like, what are you doing? I said, "This man has written this book and it's completely blowing my mind." Like, it's so different than anything I've heard anywhere else. Yeah, he's just exceptional and I love that there are people out there that I would call disruptors who are not embracing this mindset of cognitive dissonance and are willing to think outside the box because that's really what we want people to do is really find something that works for you to keep you as healthy as possible.

Melanie Avalon: It's so funny. He's the only time that I emailed ahead of time, and I said, can we record for 4 hours so that I can make it a two-part episode? He was so kind and agreed, and I think we had, like, technical difficulties at the beginning, so I think it was like a five-hour experience. I'll put a link to that in the show notes. Going back to the hormones, there were some that I want to touch on specifically. Cortisol is a big one, and I think cortisol is one of the ones-- I think cortisol and Insulin are probably the two that well-- there might be more, but maybe the two that I see the most as far as people being really aware of them and thinking, even if they haven't tested thinking in their head, I have high insulin or I have high cortisol.

One thing I love is when you talk about cortisol, you actually start by talking about the benefits of cortisol, and you kind of dismantle the idea out there that cortisol is just a bad hormone. So, could you talk a little bit about cortisol, why it actually is beneficial, but then the problems when it goes awry, specifically how it can encourage visceral fat storage and things like that, so cortisol?

Cynthia Thurlow: Yeah, cortisol, I feel like cortisol is the bully on the block, meaning it's gotten such bad press, it needs a good PR group to come in and sweep in and help it out. I think when we think about cortisol, cortisol is designed to be an emergency backup system in the body. We talk about the sympathetic nervous system, which is part of the autonomic nervous system, and just acknowledging that cortisol's role predominantly is to be part of that fight or flight. You're being chased by a saber-toothed tiger. It makes you be able to focus. It shuts down digestion. You can't stop to poop. You aren't going to stop to have sex. Your body is being fueled with the energy to get away from this threat. The common misunderstanding about cortisol, though, is that in our over-harried, overstressed lives, very westernized lives, we're constantly in this hedonistic culture where we're just inundated by information 24/7.

Our bodies can no longer differentiate between acute stress on being chased by a rabid animal versus chronic stress. That's the first tipping point that is problematic about cortisol. Cortisol does a lot of things. It frees up glucose so that we can be fueled. When I tell people when they're dealing with chronic stress, the things that will show up for them, they're not going to sleep as well. Because think about it physiologically. If you're fleeing danger, your body is not going to allow you to fall asleep properly. You're not going to digest your food. You can't properly detoxify. You're not going to poop. You're going to deal with that as well. That's a whole separate conversation that we could have because the whole constipation thing is fascinating. We think about the fact that chronic stress is going to impact the reproductive system because our bodies are going to perceive that we're under this surveillance of threat.

I also think about the fact that as an example, people talk about the cortisol belly. Why do I have abdominal fat? I just remind them that we have 40 times more receptors in the abdomen for cortisol. If you're really chronically stressed and chronically dealing with high cortisol levels, at least initially, you may see some abdominal issues. You may be more prone to leaky gut. You may be more prone to sleep disturbances like I talked about. You may really struggle with infertility. The initial phase with cortisol is heightened, so it becomes elevated and then over time, if we're chronically debilitated by stress, we will have the opposite. Our body is trying and trying and trying to keep up, and then over time, we'll have lower cortisol levels, which can show up as fatigue. Like, you have no energy and you develop gastrointestinal problems, you develop a leaky gut. You're prone to developing opportunistic infections in the gut.

You may deal with digestive problems beyond that, again, reproductive issues. You can have brain fog, and there's this downstream effect because what people don't realize is that cortisol impacts estrogen and testosterone, it impacts DHEA, all these sex hormones that are designed to kind of reflect and manifest not only an outward appearance but our menstrual cycle, our libido, etc., can all take a massive hit. Cortisol is beneficial, but cortisol can also be a sign when our body is under constant stress. It's important to interject in here that if you are someone who's not sleeping well, who's chronically overstressed, we don't want to add more stressors. This is where fasting can be beneficial versus detrimental. If you're someone that is going through a divorce, has had a significant life stressor, you've lost a job, you've been in the hospital, this is a good time to indicate that your body is still recovering from this significant stressor.

Right now, let's be honest, we have macro stressors and micro stressors. There's a lot going on in the world. You better believe in 2019, when I was in the hospital for 13 days, I didn't fast for months because my body was just wrecked from being so sick. Cortisol, I think, Teri Cochrane calls it the dirty cupcake, but it's really kind of emphasizing for people that when your cortisol is properly balanced, you're going to be able to sleep and manage your stress. Your blood sugar is going to be better controlled. That's one thing I forgot to mention. If you're chronically stressed, you're going to have blood sugar dysregulation, which can manifest as insulin resistance. This is where we get this tie-in with insulin. It's really all about mastering these key hormones so that we can put ourselves in an advantageous position.

I talk quite a bit in the book about the things that you need to do to balance the body. Bring yourself back into the autonomic nervous system, where you're not so focused on the sympathetic, but you're focused on this rest and repose side. That's one of the key aspects of helping to properly balance cortisol, is to ensure that your body doesn't think you're running a marathon every day and that you're not being chased by a saber-toothed tiger. Let me just lastly interject that stress can show up in weird ways. I know you had David Perlmutter on and in his last book, he talked about how when we're really stressed, we override the prefrontal cortex and we can't make executive decisions. You're not going to sit down and do calculus; you're probably only going to manage being able to get out the door because you just can't sit down and do advanced level thinking because your body is just flooded with cortisol and the amygdala overrides that prefrontal cortex. You're not able to make really good decisions. It's when people make impulsive decisions that's when people do things that are, I hate to say this word stupid sometimes because they aren't able to really think through their decision-making processes. Certainly, the last couple of years have shown us that there's a lot of that going on.

Melanie Avalon: Question about cortisol because it is something that women can test or they can do like a urine test. How beneficial do you think that is actually testing cortisol? Or should women just assume that their cortisol is high? So, when it comes to actually testing.

Cynthia Thurlow: Oh, I love to test it's like one of my favorite things to talk about. I always say test, don't guess. That is my standard mantra. You can test cortisol levels with a couple of different substances. You can do it with saliva, you can do it with urine, you can do it with blood. I like a combination of all of the above. I think serum is helpful, it just gives you that snapshot. So, a serum is blood. Immediately at that point in time when your blood is drawn that's exactly what your levels are. I do like the DUTCH test, which is a dried urine and saliva testing, depending on which kit you get. That can be hugely beneficial because it can plot out your circadian rhythm. Cortisol follows a rhythm in the body kind of like the infrared rhythm, but it follows-- melatonin suppression is when cortisol is highest. We would expect cortisol to be highest in the morning.

It ebbs and flows throughout the day and is lowest at night, which tells our body to go to bed. The DUTCH is really helpful because it will plot it out throughout the day and it gives you controls like high and low and so you can see for yourself how is your body metabolizing cortisol? Does your body not make enough cortisone, which is the inactive form of cortisol to convert to cortisol? Do you not have enough circulating cortisol? Do you have too much-circulating cortisol? It maps out your sex hormones, your melatonin, all of these things are interrelated and so it can be hugely beneficial. I'm an enormous fan of the DUTCH in particular because it gives us a very unique way of looking at our hormones. The caveat for anyone that's listening is you have to work with someone who's looked at hundreds of them.

I say this with love, but there are a lot of people who end up becoming either they're in our groups or they're working with me one on one. They've had a well-meaning clinician order these tests, they are not inexpensive and then it's not properly interpreted. The caveat I would say is if you're going to do the testing, make sure the person you're working with has looked at hundreds of them. The DUTCH is a complicated test. I actually took a whole class to be able to interpret it. I have a binder that's gosh it's probably six inches thick. I'm not exaggerating. It took probably looking at 100 of them to feel comfortable/confident to be able to use that information. Because in the functional medicine, integrative medicine world, there're a lot of great tests that are available, but they're only as valuable as the person that knows how to interpret them. That's an important distinction that I think, certainly your listeners, they want to just make sure that whoever they're working with, it's someone that's worked with a lot of these so that they can provide the best advice.

Melanie Avalon: I'm really glad that you touched on that because I've done a cortisol DUTCH test once and I remember getting the results because I'm a self-researcher and I like to try to interpret things. I just remember looking at this and thinking how important it was to work with somebody knowledgeable who actually could interpret it. Hearing what you just said about all of the research and the binder and all the things that you definitely need to be working with a practitioner on that. The other hormones-- since you love testing, not guessing, out of all the hormones and all the things that can be tested with that, what can you test? Do you do insulin tests? What about estrogen levels? I know estrogen dominance is a problem today. Can that be tested?

Cynthia Thurlow: Yeah. Are you asking specifically to the DUTCH or just in general?

Melanie Avalon: Just in general, with women, do you do a full hormonal panel? When you do, what does that cover? Like, what should women be testing?

Cynthia Thurlow: Yeah, I think at a minimum, so we know progesterone as one example is better tested with blood as opposed to the DUTCH. Because when you do the DUTCH as an example, it's just a test between days 19 through 22 in your cycles to during your luteal phase, I do think testing for-- there're three predominant forms of estrogen. There's estriol, estrone, and estradiol. Estradiol is the predominant form of estrogen prior to going through menopause. Estrone is the predominant weaker form of estrogen that most women produce in fat tissue in menopause, kind of a bummer because that's when women really don't want to be adding to their fat stores. I think it's important to do a free and total testosterone, so really looking at that is very helpful. On the other side of that, I like to look at DHEA. I definitely like to look at fasting insulin.

I know that a lot of well-meaning healthcare professionals will do like a complete blood count. They'll do a CMP, which is a comprehensive metabolic panel, which just looks at fasting glucose. We know that your fasting insulin can dysregulate, sometimes five to ten years, way before the glucose and hemoglobin A1c start becoming abnormal. Fasting insulin is, for me, the biomarker that I will look at. You can look at fasting leptin, which is oftentimes absolutely fascinating, although you'll oftentimes see abnormal fasting insulin as well as fasting leptin. This is when people say this is hedonistic, they can't stop eating. There's all this miscommunication between their brains and their stomach. Other things that I like to think about, I mentioned progesterone. I do like to look at a full thyroid panel, so TSH, free and total T3 and T4, reverse T3, looking at antibodies, I'm a huge fan of looking at iron panels, so total iron, TIBC, percent sat, ferritin, which is oftentimes a better marker of iron storage.

I do like to look at inflammatory markers, so a high-sensitivity CRP, I do like to look at homocysteine. This is just like a baseline. I'll look at like an RBC or red blood cell, magnesium, and zinc, iodine, folate, B12. That's a starting point. Obviously, each person is an individual, but I think it's a good place to start from so that you have a good sense of what's going on with your body. Now, obviously, a DUTCH is not covered by insurance, but I think doing those serum blood markers and urinary iodine can be very, very helpful.

Melanie Avalon: Awesome. Again, listeners, there is a full transcript in the show notes, so have no fear. If you get Cynthia's book, you'll have all the resources. Another hormone I'd love to briefly ask you about, you talk about oxytocin in the book. All of the things that can benefit that hormone, I did not realize. Well, first of all, you talk about oxytocin. Is oxytocin on or off or is it more like a dimmer switch? Also, you talk about how it lasts three to five minutes. Do we need to be doing oxytocin-stimulating things all the time? And what is the role of oxytocin?

Cynthia Thurlow: Yeah, so it's this amazing hormone that is secreted by the hypothalamus-pituitary gland. Think about it like when a woman is bonding with her baby, if she's breastfeeding her baby, it can be secreted by the uterus and the placenta, and so it can create this amazing bonding experience. It's why like hugging your pets, I'm laughing because one of my dogs is walking over to get his back scratched right now. It's this amazing hormone that when we're tapped into it and again you can't be in the super overly stressed environment 24/7 and think that you're going to get any good feelings from oxytocin. You get it from sexual intimacy, you can get it from hugs with your loved ones, and you can get it from rubbing your dog. It also contributes to staying full and having satiety. I remind people there's more to this hormone.

We kind of think of it as the mother hormone. It's the hormone that kind of begets all other hormones, how critically important it is to nourish it. And you're right, it doesn't last. That's why you need those. I love that I have dogs because now I have teenagers who are much less interested in being snuggly with their mom like they were when they were younger. Getting those little hits of oxytocin throughout the day can be super helpful, but it doesn't necessarily have to involve you being around other people. I mean, just even laughing, just having levity like watching something that makes you happy, doing something that brings you joy. I always get questions like; do I have to be around other people? No, not necessarily. If you love to garden, if you love to get out in nature, if getting on a bicycle or exercising brings you joy, I mean, there're other ways that we can stimulate this hormone.

It's really important to understand that it is critically important for staying full. Like, we have receptors all placed in our body, in our brain, in our uterus, our placenta, our ovaries. Our body is constantly taking information from the outside and kind of deciding, like, are we nourishing our bodies or are we depleting our bodies? This is a poorly understood, poorly appreciated hormone, but one that I think is so, so important.

Melanie Avalon: Hi, friends. We talk all the time on this show about the beneficial effects of intermittent fasting and especially how it can affect your blood sugar levels. How much do we talk about this? How diet affects them, how exercise affects them, how fasting affects them? But how do you actually know what your blood sugar levels are? Besides when you go to the doctor and get a snapshot of that one moment in time, or give yourself a finger prick, which again, is a snapshot of that one moment in time. What if you could know what your blood sugar was all the time? That would be revolutionary insight that could really help you meet your health and wellness goals. Guess what? You can do that now. I'm going to tell you how to save $30 off while doing it. We are obsessed with a company called NutriSense. They provide access to and interpretations of the data from the biosensors known as Continuous Glucose Monitors, aka CGMs.

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Yeah, I love you talk about the study in the book about, I think it was overweight men looking at delicious food and oxytocin reduced their appetite or their cravings, which is so cool. Again, listeners, all of the hormones are in the book. So some more fasting-related questions. I love to touch on a few of the things that I feel like at least on the Intermittent Fasting Podcast, we don't really talk about that much, or it's not something of a focus of ours that you do touch on because I think listeners would love to hear about it. As far as things, okay, I just laugh about this question because it's such a question on the other podcast. As far as what breaks a fast, what are your thoughts on what breaks a fast and the idea of clean fasting? In particular, I'd love to hear your thoughts on medicinal mushrooms because that's not something that I really play around with and Gin doesn't either. So, I'd love to hear about those. 

Cynthia Thurlow: Yeah. I think all of us are very aligned about the concept of clean fasting. I do like people to understand why when you're learning the basics it's important to distinguish between what will or will not break your fast. In my mind, and there are a lot of, again, well-meaning fit pros out there, and they'll say, "Oh, if it's under 50 calories, it doesn't count. I'm like, okay, well, the grapes that you just told someone to eat are definitely going to break their fast. I think about how certain supplements can break your fast, like branched-chain amino acids, flavored electrolytes. I think about the fact that-- this is just my personal feeling, we know that dairy products are insulinemic, and so when people think it's no big deal to put heavy cream in their coffee, and they're being very purposeful, like, what is your purpose of fasting?

Like, if you're trying to change body composition or lose weight, then those little things can add up. One of the funny things that my interview with Vinnie Tortorich on the podcast, and he was saying, when people tell you that they're putting healthy fats into their diet, always clarify. I always do that now, but what might be cream in my coffee might be half cream, half coffee, so those things can certainly add up fast. But I think about bone broth. I think about distinguishing between proteins we know will break a fast, being really clear about the fact that anything that is going to stimulate an insulin response and I know I was laughing a couple of days ago. I was watching something on YouTube and the concept of cephalic phase insulin response, which I know you all talk about as well. There were people that were fighting like they were splitting hairs over what would do that.

I thought it might be helpful just to say when we talk about that, it's the sight, smell, or taste of food that will secrete some insulin. We know it increases salivation, we know that it increases bile secretion, all because your body thinks food is coming, it increases gastric juices, it increases gut motility, and that alone can last eight to ten minutes. When people think it's no big deal to smell like grandma's apple pie, but I don't want anyone getting paranoid feeling like they can't enjoy being in a fasted state and smelling food. Just to understand, our bodies are very attuned to the environments we're in. When it comes to breaking your fast, I tend to be very much aligned with you and Jen. It's bitter teas, bitter being bitter, not meant to be sweet, plain coffee, filtered water, I think are absolutely fine, unfavored electrolytes are absolutely fine. The things that will break a fast are the things that are construed as food. Whether it's chewing gum, whether it is sucking on a mint, I've had people that get really upset. They don't like their keto breath and so they're always frustrated. I'm like, "Well, I guess you could chew on some fennel, but technically your body is going to think food is coming." I think it's important for people to understand there are things that can kind of amplify fast, things that can be beneficial, and I dove deep into the research on this. Things like-- think about Chaga or Reishi mushrooms. This is something that Siim Land talks quite a bit about as well. He's super well versed in the literature. I'm not sure if interviewed him on the podcast before.

Sulforaphanes like broccoli sprouts, just to potentiate autophagy, which is that waste and recycling process in the body. Turmeric and ginger, things that are certainly not sweet, but based on research can potentiate autophagy. There are also other things that can potentiate those things as well. I'm hoping I answered your question because I know that the concept of a clean fast is something that not necessarily everyone embraces. I know we both have had individuals on our podcast who feel differently. Like, you can have fiber and you can have all the fat you want. Yes, maybe fat may not be processed differently in the body, but I do like people to learn the basics so that they can have success. If you then go on and you're going to do a bone broth fast, but you're doing a different type of fasting, then that's a differentiator but when people are learning how to fast, I want them to learn how to do it clean so that they'll get the best results.

Melanie Avalon: Yes, exactly. One thing I love is you dive deep into coffee and the cost-benefit of coffee, especially because I think with coffee, it can be a really great aid for fasting, encourage fat burning and energy and reduce cravings, but then on the flipside, I think probably for some women that they might get too much of a cortisol response to it. What do you find with all the women that you've worked with as far as coffee goes? Do some women, it's just they can't do coffee because of the cortisol? Is tea a better option? What are your thoughts on coffee?

Cynthia Thurlow: Yeah, great question. When I think about coffee, there're two things. First, exposure to mycotoxin so if anyone's listening and the concept of mold, so making sure you use a clean brand, I think is the first thing. If someone suspects that they're either getting an exaggerated response, they feel jittery, they don't feel good, I encourage them to use a glucometer, like check your blood sugar before and check your blood sugar after because that can be very insightful. Sometimes people don't realize that their body gets stressed when they consume this coffee product. Maybe it's the caffeine. It may not even be the coffee per se, maybe it's the mycotoxin. Really getting granular if they really love coffee. Trying to figure out is it that brand of coffee, is it you're sensitive to caffeine. What can we do to try to honor your desire to have the therapeutic benefits from the polyphenols and other things?

Can you try green tea? What I do find for a lot of women is it's very insightful when they start using the glucometers to be able to determine what's their net impact. If their blood sugar goes from 70 to 100, it's like, okay, well, this might be something that's stressing your body. This might be unique to you. This could be a temporary blip. This might be that you've got too much stress going on and this is another stress or your body is just saying time out. Or maybe you need to consume a better-quality brand coffee, that is tested for mycotoxins. I know you probably have talked about this on your podcast quite a bit. I'm surprised at how many people have a genetic susceptibility, I'm one of them, that I'm very sensitive to mold exposure, whether it's in my environment or in my food.

Sometimes you have to take those extra steps. Either find a manufacturer that screens for mold or perhaps you need to try something else like green tea or black tea, a bitter tea that might work better for you, or take a break entirely to see how your N of 1. I always say the N of 1 is important, but it may be that for right now that's not the right substance for you to consume. That might be hugely impactful.

Melanie Avalon: So, another question, just because like I said, you talk about things that I don't personally really talk about on the other show and I think it's so important. So, the hormone DHEA, I remember forever ago before I was really into all of this stuff, I was reading about DHEA and I was like, "Oh, I'm going to supplement with DHEA. And then that did not go well. Since then I supplemented with something called 7-keto-DHEA. I was wondering what your thoughts are on DHEA.

Cynthia Thurlow: Yeah, I always like to look at a DUTCH before I render an opinion because the lifestyle piece always plays a role if DHEA is suppressed. Just to give an overview, like DHEA is another very important hormone downstream that effect is DHEA will cleave off and create testosterone and androgen metabolites. It's also supposed to work in conjunction with cortisol. They're just kind of balance one another out. If you have someone that is really depleted, your body will preferentially fuel production of cortisol over DHEA. It's the vitality hormone, it's a hormone that's important for energy. Obviously, if your DHEA is low, your libido may have gone poof. And so, I think supplementation is reasonable. 7-keto-DHEA I have used, the thought process is it's less likely to be aromatized into estrogen. That can be a huge problem with DHEA.

You don't know how the body is going to use it. It going to aromatize estrogen or is your body going to use it to kind of fuel those testosterone pathways? I think it's highly bio-individual. I like to do the DUTCH specifically to look at that. If testosterone levels are low, sometimes I want to look at serum testing to corroborate that. I do think it can be helpful, and I think for a lot of people, especially as they're getting closer to like middle age, like 40-ish and above, more often than not, we will supplement with some DHEA. Although what's interesting to me is that I see clinicians doing really high doses of DHEA, and I don't think I've seen enough research to suggest that they should be supplementing with like, 100 mg of DHA. I generally start pretty low because, for some people, it's very stimulating.

I take DHEA as does my husband and oftentimes it can be helpful for kind of priming the pumps, like, as our bodies are making less of these hormones as we're getting closer to menopause and andropause it can beneficial to help replete them. The foundational work always needs to be on the sleep, the stress, the not overexercising, etc. One thing that I think is really important for people to understand is that supplements are great. Supplements can be so beneficial on so many levels. Obviously, I talk about them in the book, but the real foundational approaches to health or what we have to do first before we start adding in supplements, because I think it's so easy to say, "Oh, I don't want to work on the sleep piece. I'm just going to take in supplements to help my sleep". I'm like, "You got to work on the sleep first and start adding supplements," as just one example. I'm sure, Melanie, you see quite a bit of that as well.

Melanie Avalon: That was something I highlighted in your book where you were saying "Starting intermittent fasting. I think you said that if your sleep is not in line or your stress, that's got to be dealt with first."

Cynthia Thurlow: Yeah, because I cannot tell you how many women and I don't fault them for this because I think this is human nature. They want to lose weight; they want to fast. I'm like, okay, let's back up the bus. We got to make sure we've got your sleep dialed in, because if your sleep and stress are out of control, your body is going to perceive we're heaping on another layer of stress, it's not going to be as amenable. Again, much like the menstrual cycle, I use sleep as a barometer for how well people are managing and mitigating their health, and what's their hormone balance like and I'm oversimplifying, of course there's far more to it than that. I know when my sleep is bad. I'm obsessed with my Oura Ring. Every day I look at my REM sleep and my deep sleep, and I tell my husband, like, I'll be darned. I don't want to be tethered to this thing, but I love it because I get up in the morning and the days I feel great, my data always correlates. It always-- The same thing if I have a crappy night of sleep, it's like my REM and my deep sleep are down. I'm like, "Ah, it's just validation."

Melanie Avalon: I love the Oura Ring and I talked about this on the other show and on my Instagram, but I recently had COVID and the effects it had on my Oura Ring because I didn't feel that bad, so I'm not sure that I would have thought necessarily it was COVID. My Oura Ring was like you're dying. Not really, but it gave me-- the scores were so fascinating and this is really interesting. Since then, I've been taking some medications for COVID and I think they've been affecting my sleep. But interestingly, I don't feel like I'm sleeping as well, but my Oura Ring has actually said that my sleep has been fine and I haven't been tired during the day. I think there's just something changing, this is completely N of 1 and probably not helpful for anybody, but it's like my experience of my sleep at night has been changing, and I don't really know what that means. Oh, another tangent. You talk about melatonin in the book, so have you interviewed John Lieurance?

Cynthia Thurlow: He is coming on next month. I cannot wait.

Melanie Avalon: Okay, so for listeners, he is the melatonin guy, and he's all about high-dose melatonin. This is so funny Cynthia, so I think two nights ago so I've been taking melatonin in part for COVID. It's the same brand as my digestive enzymes. I currently get Pure Encapsulations. The actual pills look the exact same. The bottle looks almost the exact same. I realized last night when I was pulling out my digestive enzymes, that I had thought the night before my melatonin bottle was my digestive enzyme bottle. I take a lot of digestive enzymes. So, I counted the pills out, I think I took like 15 melatonins the prior night.

Cynthia Thurlow: What was the amount that you took?

Melanie Avalon: Maybe 20, 3 mg. So, it probably ended up being somewhere, it might have been like 60 mg of melatonin.

Cynthia Thurlow: You know what's funny is that I've completely nerded out on sleep and melatonin in the last, like two months. I'm so glad you're asking me about this because now it's like bleeding into my work like every group person I'm talking about melatonin all the time. Probably a month ago, I decided I was going to step up my sleep game. I'm like you, I'm very conscientious about what I take when I take it. I started with the consent of my integrative medicine doc and started doing high-dose melatonin. His feeling was, let's do this to kind of replenish because after the age of 40, we don't make as much. I was doing 18 mg every night and it was like I went from having good sleep to great sleep. Like every night my REM and deep sleep were doubled. I mean, it was unbelievable. I'm doing all the other things and then I got the SandMan.

Melanie Avalon: Which is in my refrigerator, by the way.

Cynthia Thurlow: Oh my God. If you can get beyond the fact, yeah, so if you can get beyond putting it in your rectum because I know like, my whole family, I don't tell my whole family, but I was telling my husband. He was like, I don't even want to know. Don't even tell me. He's like but here's the thing. It's a very vascular part of your body. It's actually a really good place as an ER nurse, we used to put a lot of things, medications in the rectum. You have to put it in the rectum. Oh my God, you wake up the next morning, you're like, I had the most delicious, amazing night of sleep. I cannot wait to bring him on and pick his brain. I am all about the net impact of what melatonin does in the body. That's the thing that I've completely started really nerding out on is like the antioxidant benefits, especially we know with COVID that it's very helpful for healing COVID.

It's one of those things, like, I was trying to explain to someone that we think of melatonin just as a hormone. Like we think it's your sleep hormone. It works in opposition to cortisol and it gets suppressed in the morning when we get up and get light exposure. The antioxidant net impact of melatonin impacts every part of our bodies. We've got clocks, these suprachiasmatic clocks I don't know why I'm struggling to say that today, but we have these clocks in our gut, all over our body. Having melatonin healthy dose also has this net impact on serotonin and estrogen and it's amazing. Don't be afraid that you took that much because when you have the SandMan on board, I forget it's like 100 or 200 mg of melatonin. But I've been taking I did 18 mg and 12, now I'm down to six every night and it's almost like it's reset those melatonin receptors. It's really been fascinating.

Melanie Avalon: It was definitely a moment I was like, "Oh, my goodness." [laughs] And it's so interesting, like I said, I have the SandMan in my fridge, and I've been very open about this. I do all the things, like, I do colonics, I do coffee enemas. I don't know why I can't do the suppositories.

Cynthia Thurlow: Well, you know what's funny? I had to laugh. There's a woman on my team who's another advanced practice nurse, and so she got SandMan first. She's a fellow nurse. The two of us laughed on the phone when she told me all about her experience. She just said, I think nurses just have terrible potty humor because we just giggled like schoolgirls laughing about it. I think once you get over the fact that you're putting it in your bottom, it's like, not a big deal, but like, the net impact. I think the other thing is it's also expensive. Let me be clear, I'm not using this every night. I'm using it like once a week just because it's not inexpensive. But I cannot wait to interview him. Have you interviewed him yet?

Melanie Avalon: Yeah, I've become pretty good friends with him, so I'm probably going to text him after this and say that were fangirling over his work. Another suppository that just came in the mail, because this is the type of things that people send to me, a CBD suppository I just got in the mail. Do you take CBD, do you use it?

Cynthia Thurlow: Not regularly. I mean, I went through this period of time where I had a lot of either podcast sponsors or people who wanted to sponsor Instagram content. I was getting a lot of CBD products, and it became a running joke. Like, I had so much, I couldn't use it all. So now that is all slowed down. I think for me, I initially used it for sleep, but then I started feeling like there were other supplements that for me personally were more beneficial. So, I kind of let that go. I know the whole physiology behind, I think, CBD, if it's a good quality product, which I'm sure you received in the mail. It's all fascinating, but I've just found other things that are more beneficial for me for sleep or if I want an anti-anxiety thing, I'll grab GABA. That's just worked well for me.

Melanie Avalon: Because I found that CBD is definitely very individual. For me, it's a game changer.

Cynthia Thurlow: Really, that's awesome.

Melanie Avalon: Once I found my dosing, so I take it every single night. And it's just really amazing for me. I work historically with one brand because the problem is there're so many CBDs on the market now, and there's just no regulation and it's really a problem. I found Feals, and I love Feals and take Feals all the time. This company that reached out for you because I literally get approached by CBD companies probably weekly. It's crazy, but they reached out and this relates actually to everything we're talking about. They make lubricants and oils and a lot of that stuff and it's so hard to find.

Cynthia Thurlow: Clean stuff. I have some other stuff. It's good.

Melanie Avalon: Yeah. So, I was very excited about that. There's so much more that we could touch on, but there's one big topic that I did want to circle back to that we kept approaching but we didn't actually really discuss, and that is the perimenopause transition to menopause. Do all women go through perimenopause? I didn't realize, for example, that there's five phases. I learned that in your book, like with your patients, how many women struggle with it. Something I thought that was really interesting was you mentioned that for smokers and for women without kids that it might come earlier. Do you know why that is? Do you have any idea?

Cynthia Thurlow: I don't know. The smoking piece. I think just in general smokers tend to embrace less healthy habits. I think that's probably what it's based off of in terms of being we use the term nulliparous as you haven't had children, I'm not entirely sure. What I have seen clinically is that thinner women are going into menopause earlier. Like 47, 48. Average American is 51. So, does everyone go through perimenopause? Yes, if they live long enough. Hopefully, everyone listening is going to live long enough to go into perimenopause. For some people, it could be five to ten years preceding menopause. I think that the women that do best making that transition are the ones that are doing the work. You can get away with a lot in your 20s and 30s. I can officially say this as a middle-aged woman you can get away with a lot.

Like what I got away with in my 20s and 30s in terms of what I ate and how little I slept and not managing my stress. I have a super stressful job. Forty was definitely leveling the playing field. If you are not over-exercising, you've got an anti-inflammatory diet, you have a job that brings you tremendous joy, you have great relationships, you're getting good quality sleep, you're not over-exercising. You're going to have an easier transition than someone who's doing the opposite, standard American diet, very sedentary, smoking. Doesn't have a job that they love. Maybe they have a lot of significant financial and other types of stress in their lives, doesn't have a support system. Your perimenopausal transition is really a barometer of how well you're taking care of yourself. We as women tend to do a really great job of taking care of everyone but ourselves.

It's no surprise that this is the time when a lot of women start advocating. It's also the time a lot of women have children at home and maybe their parents are aging. It can be a very stressful time period. The women that I see that aren't riddled with horrible hot flashes and tremendous weight gain are the ones that are doing the work. I think that obviously I had that blip when I hit the wall of perimenopause but then I straightened everything out. I stopped doing 5:30 AM conditioning classes, I slept more, I didn't have such a-- I didn't perceive it was a restrictive diet, but probably too low carb for me. Managed my stress better, really took better care of myself. I do think women can get through that time period. That research that I found there's not a lot of great research on perimenopause because it's this nebulous time. For some people that might only have five years in perimenopause and then boom, their period stops and it's all over.

It's certainly been my experience that we recognize that hormones like estrogen, so obviously, at the beginning stages of perimenopause, you're going to have this relative estrogen dominance because progesterone is starting to wax and wane. The ovaries, you may not be ovulating every month, and you may not even be cognizant of it. Your symptoms might be as benign as you're waking up in the middle of the night. Maybe you have more anxiety and depression because progesterone is that kind of buffering mellow sister hormone. And you've got this relative estrogen dominance. So, you're gaining weight, you've got fibrocystic breasts, you got very heavy crime scene periods, as I affectionately used to refer to them. That can be kind of the beginning stages, but a lot of the rest of it can be very bio-individual. Something that's important for people to understand is the weight gain piece, which can be so distressing, especially when you're doing all the things that you should be doing to help maintain your weight.

It can really be a byproduct of cortisol being up. Remember we talked about these cortisol receptors? We've got 40 times more cortisol receptors on our abdomen. It can also be a byproduct of the fact that we lose the buffering effects of estrogen. So, estrogen is an insulin-sensitizing hormone. Meaning as you are getting closer to the end of your menstrual cycle for the rest of your life, you are going to be more prone to insulin resistance. Add in poor dietary choices, stress, sleep disturbances, it's like the perfect storm. It's really just kind of cruel. I look at my teenagers and they're hitting puberty, and mine was starting to peter off. The lens with which I look at perimenopause as a transitional point is that women do have control over a lot of things. And so that's always that reframe. What do you have control over? It goes back to those pillars that I've talked about throughout our conversation.

In my book, Intermittent Fasting Transformation is really honoring sleep quality, stress management, anti-inflammatory nutrition, not over-exercising, connecting with people, and doing things that you love as opposed to forcing yourself, doing things that you don't enjoy. Perimenopause can be a wonderful time for women. It can also be a harrowing stressful time. What I do find is for a lot of women that when they finally go 12 months without a cycle, it's a big sigh of relief. It's like one less thing to have to worry about. For a lot of people, there's a tremendous amount of shame and embarrassment with no longer being fertile, which I think really is a detriment as women that we really need to reframe it. We spend 40% of our lifetime in menopause. Why not make it wonderful? It's a time when people can have tremendous creative purposes. Their children may be grown, or they may be at a different point in their career, or they may be able to travel. 

There can be just a lot of wonderful things that come out of no longer having a menstrual cycle every month. Certainly, I'm an example of someone that made that transition pretty effortlessly. I think a lot of women can. They shouldn't look at it as something to fear. That's what I get DMs about, "Oh my God, what am I going to do?" I just say, "Hey, it's part of life. If we live long enough, it's going to happen." If it makes anyone feel better, men go through andropause it's just a little less dramatic.

Melanie Avalon: That is a beautiful reframe, which appropriately enough is one of the topics that is near the end of the book and also typically tends to be near the end of my episodes. But that is the role of mindset. You talk a lot about mindset. One thing I love in particular that you talk about is reframing limiting beliefs. One of the things I love about your book and talking about limiting beliefs is there are a lot of limiting beliefs surrounding dieting and fasting specifically. You talk about how to reframe them, but you would need the knowledge in order to properly reframe them, especially when it comes to concerns surrounding fasting like it's unsafe or I'll be hungry. You really do need that knowledge to know why that's not true. What are some of the mindset practices that you find really can benefit women? Limiting beliefs, gratitude. Oh, I love your good, better, best. I've talked about that on an episode of IF podcast for so long because I had never heard of that before, like that concept. It's the perfect solution for people like me and a lot of listeners who might be perfectionists. They're really intimidated by making changes or doing things because they think they have to be perfect. So, I just said a lot. But yeah, mindset, the role of mindset.

Cynthia Thurlow: Yeah, I think mindset is everything. I say that to my kids that probably makes them grow to hear their mother saying that ad nauseam. I really do think that whatever challenges we're presented with in our lifetime, it's all about the reframe. It's all about the mindset shift. It's all about finding the good, through adversity comes opportunity, which my kids here all the time. Even if you're having a crappy day, like finding one thing to be really grateful for. I think starting your day with gratitude, getting really granular, it could be as silly as "I'm grateful for day I woke up before my alarm clock." It could be that simple. But we know that it helps. It changes the physiology in the brain. We recognize how critically important it is to just look at life. It's not being pollyannaish, it's just acknowledging that there are going to be bumps in the road.

You're going to have a time when maybe you're traveling. This is an example of the good, better, best. Especially for, as Melanie said, those of you that are more perfectionistic, you're in a store or you're in a restaurant, and you can't get grass-fed, pastured anything. And so, it's good, better, best. It's like, what is the best option I can make at this restaurant? I'm going to eat it, I'm going to enjoy it, I'm going to let it go. Just giving yourself grace, that's another aspect that I would say for me, where I am in my lifetime is, I'm a reform people pleaser and I'm a reform perfectionist. I say this from the heart, is giving myself grace. Like, not every day is going to work out the way I wanted it to. Not everything is going to work out the way that I wanted to and I think it's so important as women that we acknowledge our uniqueness and how special we are, but also acknowledge that sometimes things just don't go the way we want, and that's okay, we can just roll with it.

I always say to my kids, there was something that happened professionally this week that was a total bummer, but I reframed it and said, okay, this is the way things are going to be at this time with this particular class. It's totally okay. We're going to work through it. It's that constant acknowledgment of looking at the good in your life, reframing things, expressing gratitude, understanding, like something as simple as learning something new. It doesn't have to be complicated. I've been nerding out on audiobooks recently, which I go through periods of time where I've fixated on one thing or another. I was saying to my husband, like, just being in my car, because every woman that's listening probably spends too much time in their cars, I was able to get through 15 hours of an audiobook, and it brought me so much joy because every time I got in my car, I could listen to the audiobook again.

Just acknowledging, like, learning something new can create more synapses is this concept of neuroplasticity, how critically important it is for us as women to make sure we've got, like, a healthy dialogue in our brains, because we can what wires together, fires together. I tell people all the time that your thoughts become your actions. So, again, that neuroplasticity piece is so important. I think far too many people think terrible things in their head and maybe they say nice things out of their mouths but your brain hears everything that you're thinking. It's really important that we're very dedicated to making sure that we're just as healthy-minded as we can be. I think, again, the past two years have taught us a lot, and I think at many levels, really were to celebrate that we're making it like, on the other side, we're all better for these past years what we've been through.

Just really acknowledging that creating a practice of proper mindset is something you work on every day. It's not like I wake up every day and I'm thinking everything is going to fall into place. There are days where I just happen to stumble across something. Mel Robbins, who I think is brilliant, has written and I'm like, "Oh my gosh, how did she know, this is exactly what I needed to see this morning to put a smile on my face." Just surrounding yourself with positive messaging people who are encouraging, creating boundaries, that's one other thing I probably didn't talk a lot about in the book. Creating boundaries for individuals, making sure the people that you spend time with you interact with are healthy, well-adjusted humans and not toxic people that take your energy from you.

Melanie Avalon: I could not agree more. I just think it's so important and I love how you're talking about trying new things and learning new things. Perhaps my favorite benefit about intermittent fasting is definitely up there, but it's one that's not quite anticipated by a lot of people, and it's just how much time you get back. At least for me, it opens up so much time and opportunity because you're not focused on eating 24/7, I love that. Well, this has been absolutely amazing. Listeners there is so much information in this book, you've got to get it, so many things we didn't even touch on, gut health and muscle and Cynthia dives deep into really specifics of all the different fears surrounding fasting and what to eat and traveling and prepping and just so many things. We'll put a link to in the show notes. Definitely get the book. The last question that I ask every single guest on this show. I asked you last time, but I will ask you it again, and it relates to everything that were just talking about. What is something that you're grateful for?

Cynthia Thurlow: Well, I would say one of the things that I posted on Instagram today is that one of the really cool things about my job is that I have opportunities to connect with amazing people in the health and wellness space. I'm so very grateful that we connected and we became friends and so on so many levels Melanie has added so much to my own podcasting journey and my own kind of perspectives on life. Right now, I'm grateful for your friendship, Melanie. So thank you for that.

Melanie Avalon: Aww, I am so grateful as well. I really, really, really am. You're one of the people that I'll just have moments randomly. Maybe it's when we're talking, maybe not, but I'm just like I'm just so grateful for Cynthia. Yeah. This has been so wonderful. I'm really excited because normally I record episodes and then they air months from now. We're going to time this around your book release so listeners get to hear it sooner rather than later. And I'm so excited. During this whole conversation, I've just been thinking, wow, listeners are going to love this. Thank you so much for all that you're doing. I am forever grateful for you and our friendship and your work and everything that you're doing, and I can't wait to see where it all goes from here.

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 re-composed by Steve Saunders. See you next week.

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