The Melanie Avalon Podcast Episode #59 - Cynthia Thurlow
Cynthia Thurlow is a globally recognized expert in nutrition & intermittent fasting, highly sought after speaker, CEO and founder of Everyday Wellness Project. She's been a nurse practitioner for 20+ years, is a 2x TEDx speaker: her 2nd talk on intermittent fasting has been viewed nearly 6 million times. She has been featured on ABC, FOX5, KTLA, CW and in Medium and Entrepreneur. She's also the host of Everyday Wellness podcast, which was listed as "20 Podcasts That Will Help You Grow in 2020" by Entrepreneur magazine.
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1:30 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!
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6:40 - Cynthia's Story
12:30 - Food Allergies
14:30 - Covid And Children
15:00 - Endocrine Disrupting Chemicals
18:00 - the Role of hormones in our body - Transitioning into peri-menopause
21:20 - Hitting a wall at middle age: progesterone and estrogen dominance
24:00 - men vs women
24:50 - Is Cortisol Bad?
26:10 - Endocrine Disruptors In Skincare
28:00 - IS IF good for women?
31:00 - The Role Of Bio-individuality
32:10 - Prep Dish Is An Awesome Meal Planning Service Which Sends You Weekly Grocery And Recipe Lists, So You Can Do All Your Meal Preparation At Once, And Be Good To Go For The Week! The Meals Are All Gluten Free Or Paleo, Which Is Fantastic If You're Already Doing So, But Also A Wonderful Way To "Try Out" Gluten Free Or Paleo With Delicious Meals, And No Feelings Of Restriction! Get A Free 2 Week Trial At Prepdish.Com/Melanieavalon
34:35 - Fasting During The Menstrual Cycle And The Importance of Carbs
36:20 - The Importance Of Variety and Experimenting with fasting Windows
37:40 - Alternate Day Fasting
39:15 - How Intuitive Is Fasting? Is OMAD Not For Women?
41:40 - fasting and eating disorders
44:15 - Bio-identical Hormones
49:30 - What Is The Shortest Eating Window Appropriate For Women
53:10 - What to test?
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57:40 - Working With doctors
58:40 - Ideal Study?
1:01:40 - Bio-individuality, Especially with medicine
Melanie Avalon: Hi friends, welcome back to the show. I am so excited about the conversation I'm about to have. It is a hot, hot topic. Whenever I'm prepping for these shows, I post in my Facebook group and ask for questions for the guests, and I posted this question about the potential topics that we will talk about today and just got hit with a day orders of questions. People are dying to know about some of the things we're going to talk about. I am beyond honored to be here with Cynthia Thurlow.
She is a globally recognized expert in nutrition and intermittent fasting. She knows all about female hormones, all of the things. She's actually been a nurse practitioner for 20 plus years and you might have seen her because she's been all over the place. She's had two TEDx speaking events, one which has actually been viewed nearly 6 million times, which is a mind-blowing number. She's been on ABC, on Fox 5, KTLA, she's been on Medium, Entrepreneur, basically all the things. And one of the go-to experts on not only a passion of mine and my audience, which is intermittent fasting, like I said, but also specifically women and hormones, and how all of that relates. So, I am excited about having you here. Thank you so much for being here.
Cynthia Thurlow: Yeah, I'm really excited. I didn't realize that you are now on the East Coast. So, you're suffering through this sultry hot summer with the rest of us.
Melanie Avalon: I am. You and I both at this moment. So, to start things off, a lot of my listeners are probably very familiar with your work, but would you like to tell listeners a little bit about your personal story and what did lead you to where you are today with your current focus in the health and nutrition world?
Cynthia Thurlow: Well, it's probably a pretty interesting story because it's not the typical pivot for a nurse practitioner or a nurse for that matter. But I think after many years of working as a nurse practitioner and then becoming a parent, it really changed my perspectives. My oldest son who's now 15, which is hard to wrap my head around, he actually developed life-threatening food allergies. And so, I started to look at food very differently. He was exclusively breastfed and was otherwise a very happy, healthy, well-adjusted infant and toddler, and child, but had horrendous eczema. And so, I kept looking for answers and my traditionally trained peers just kept telling me, put the steroid cream on and carry your EpiPen and keep your mouth shut, you'll be good. I just was never satisfied with that answer.
I read a book called The Unhealthy Truth and I always like to credit Robyn O'Brien. I have no affiliation with her, but reading her book really changed my life. It opened up my eyes to a whole other perspective about how much nutrition can impact our health. Let me be clear, I trained at a leading research institution both for undergrad and grad school, and nutrition was not something that any of us spent much time on. We've got a very cursory overview. We were told to leave it to the registered dietitians and to keep stay in our lane, “You're nurses, stay in your lane.”
What I came to find out was that, for me, I started looking at my patient population very differently. I started asking different questions. I became intensely interested in the lifestyle piece and because I was working in cardiology as an NP, most the time that our patients came to us either in the hospital or in clinic, they already had disease. They were diabetic, they were vasculopaths, which is a fancy way of saying that they had diffuse vascular disease head to toe, or they had a heart attack, or they were significantly overweight and inflamed and pretty sick.
I started challenging my patients a little bit differently. Not just let's get your blood pressure down, let's manage your blood sugar better. But, do you think we can maybe dial in on the way you're eating? And I would say 90% of my patients kind of tune me out, they're like, “Cynthia, I'm not going to change the way I eat. I'm not going to stop smoking. I'm not going to exercise more. I'm not going to better earlier, just give me the pill. I like you, you're cute. Just leave me be.”
For me, I drove down a rabbit hole of trying-- I tried one class in a doctoral program. I did a wellness coaching program, that didn't let me up. But what finally let me up was a Functional Nutrition program, and I then discovered that was what I was really meant to do. And so, I continued to work in my nurse practitioner job. My husband continued to think this was becoming a hobby and not really something I would ever generate an income from.
And then, four years ago, I took a leap of faith. I woke up one morning and I said, “I'm tired of writing prescriptions.” For me, it really became a passion project to impact people on a greater level, not just in clinic, not just in the hospital. Well, over the course of a week I might interact with 100 patients, I can now impact thousands of people. And so, that's where I got to where I am. But what people are most interested in is how does an introvert go to public speaking?
I always come from the place of wanting to teach and wanting to educate, that's where I come from. And one of the ways that I challenge myself as an introvert is to do things that scare me a little bit, but aren't scary per se. You're not going to catch me jumping out of an airplane, but you will see me stand on a stage and talk to people about hormones and food and intermittent fasting and all these other things.
Two years ago, I told my husband, I wanted to do a TED Talk because I thought that seemed really scary. “I'm going to do a TED Talk.” But I’ll have to commit something to memory, which to me was hard, was terrifying. I can get up there with slides. That's easy, but I have to commit it to memory. And so, got one talk, got two. Second talk came pretty quickly after the first. I had to come up with a topic. And so, I picked something I knew a lot about. Really, the rest is history. My life changed, shifted enormously. I was obviously doing well within my business but it just goes to show you that people are really desperate to learn strategies that they can sustain to some extent or another throughout their lifetimes and they're tired of being literally fed the garbage that-- the CICO, calories in, calories out and that we have to eat min-meals and we have to stoke our metabolism and all this dogma that has largely been just proven on so many levels, much to the naysayers that are out there. But, yeah, that's a little bit of how I got to where I am today.
Obviously, the most important thing that I do in my life is be a mom to my boys. I have all boys including two doodles and a lizard. I'm just a female surrounded by all men, including my husband as well. But, yeah, that's like a snapshot into who I am and how I got to where I am right now.
Melanie Avalon: Oh my goodness, I love all of that so much. We’re so similar. I am very much an introvert. I think, especially as podcasters, they don't expect that because they're hearing us talk 24/7. But, no, I'm severely an introvert. Really quick question about your son and eczema and everything. Did you find the root cause? Was it a food sensitivity?
Cynthia Thurlow: Yeah, he actually had life-threatening food allergies. So, for him-- and I had the pediatrician really fighting me about, “He's too young. We don't need to do food allergy testing.” And I said, “My gosh. The kid eats what I eat pristinely. So, if it's something healthy that he's allergic to, then we need to know.” And it turned out he has life-threatening allergies to peanuts and tree nuts. And so, it's one of the 10 most common allergies to have, but only 20% to 30% of children will outgrow their food allergies. So, we have this nation of children that are growing up, existing -- and someone who was in a very sterile bubble, I'm not a believer in that. My son's very responsible, but very humbling. I don't think we ever ate out in a restaurant for the first two years because I was legitimately-- having taken care of anaphylactic life-threatening food allergy people for years as an ER nurse, it scared me to death to think of this little guy potentially getting so sick.
And then after a while, I had to tell myself I needed to pull the band-aid off and we couldn't live in a sterile environment for the rest of our lives, that wasn't realistic and he was going to eventually have to go to school and go to playdates and be outside the home and I had to be able to feel comfortable with that. I think it's a human intrinsic nature to want to protect those you love, but I think I was stunned. I thought maybe he had a food sensitivity. I was like, “Well, sometimes when he eats raspberries, he gets like really bad diaper--” In my mind, it was something really benign and it turned out to be legit. And he is still-- even at 15, still very highly allergic to those foods. He didn't [unintelligible [00:09:06] those allergies. And there's a whole other set of concerns as a parent as they're getting older because when they start dating and when they're not preparing their food in their own house and they're out and maybe they're not making good choices. You just start to think about all the ramifications.
Melanie Avalon: That's insane. And to that point, I wonder about, right now with COVID and quarantine, and everything, the implications of so many factors that are happening, the increased sterilization of everything, which obviously is warranted, but I do wonder about the long-term implications and then even things. Like I recently had Dr. David Perlmutter on, and we were talking about children growing up and not seeing as many faces and the role of masks. And there's just a lot going on right now.
Cynthia Thurlow: I have now become that crazy person because there's so many endocrine-disrupting chemicals in a lot of those hand sanitizers. Where I am, they're pretty strict in Northern Virginia, I'm going to be completely honest. So, I wear my mask, I do all the things to make sure I can go in and get my stuff from Whole Foods. But where I get my haircut, they require you to-- as soon as you walk in, they check your temperature, they make you use this hand sanitizer, and so I was getting so frustrated because I was like, “This is just crap.” So now, I bring my own in and I'm like, “Are you going to let me use my own?” I become that crazy person, now just decides I'd rather just wipe my hands with rubbing alcohol and I'll do that in front of you, and then, I know I'm not exposed to more endocrine-disrupting chemicals that I don't need in my body.
But I agree with you. I think the implications especially having teenagers-- unfortunate that my kids, I've one that's an introvert, one that's an extrovert, and trying to navigate this new normal with them and attempting to provide some degree of normalcy-- the things that I'm really grateful for at my house is that my kids genuinely enjoy being home, thank goodness. They genuinely enjoy eating at home. They prefer eating at home, so that hasn't been a challenge. I think in our area, there were a lot of families that just didn't really cook a lot for themselves. So, they were struggling with how to navigate like-- there was no takeout at least initially. And on so many levels, people were being forced to cook for their families. Maybe they hadn't done in a while, maybe they don't enjoy it, there's no judgment. But we genuinely enjoy eating and cooking at home. So, at least I'm grateful for that.
I try to take the small wins. It's like, “Okay, let's be grateful about the things that have worked out more easily for us than maybe some other families,” because I know there are people in my community and elsewhere that as soon as some of the restaurants were doing takeout, they were doing takeout every day. And we were just like-- we're kind of picky. Trying to go somewhere, we want to support the local businesses. I was just buying like-- I would buy gift cards just to-- I'm like, “Okay, if I buy $100 gift card, I feel like I'm doing my part, but I don't necessarily have to eat there right now while I'm doing this.” But yeah, it's such a strange, strange place to navigate these days for sure.
Melanie Avalon: I've always been a cook-at-home person. My cohost, Gin, we're complete opposites on this because she's always like, “The meal delivery service and the restaurants,” and I'm like, “Nope, I've got to go to the grocery store every day. I've got to pick up my food. I got to come home and cook it.” It was funny when the whole quarantine COVID thing started, because I eat mostly whole foods, I go and I buy massive amounts of food every day because like fruit vegetables. And so, I would go and purchase my normal amount of food but I felt like I looked like-- when you're right at the beginning where some people were stocking up and other people were raising eyebrows, I wanted to be like, “No, I always purchase this many cucumbers every day.”
Cynthia Thurlow: Funny, yeah. Food scarcity, toilet paper scarcity, it was all very interesting for sure.
Melanie Avalon: It was. But so glad you brought up the endocrine-disruptors because I think that is such a huge problem today. Actually, a question I wanted to ask you, so hormones, especially female hormones. Obviously, they have such a massive impact on how our body functions. Women might be doing a certain dietary practice for the longest time, and then different stages of their life hit, pre-menopause, menopause, post-menopause, and all of a sudden, what they've been doing doesn't work anymore. So, with that, do you think, especially when women enter a new life stage and experience hormonal changes, do you think the struggles that they experience with their diet, their activity levels, their weight, is it all hormones? Is it also aging? What is the role of hormones in maintaining our healthy body that we're also happy with on the weight side of things which I know brings in a whole another aspect of things, but the role of hormones?
Cynthia Thurlow: Well, we have hormones that are carefully orchestrated throughout our lifetime. And obviously, I think when women and boys go through puberty in their teen years, that's a very different experience. And 20s and 30s, I think our hormones for most women-- we're cycling usually every month, we have one hormone that predominates the beginning half of the menstrual cycle, which is estrogen. We have another that predominates in the second half of the menstrual cycle, which is progesterone. And it's really a delicate balance. I think as women get closer to middle age, so ladies, I know no one likes to hear this, but if you're in your late 30s, early 40s, you are there. When we are transitioning into perimenopause, which is the five to seven years preceding menopause, that is when things get a little more interesting.
And I say interesting because I always like to keep a positive spin. I'm a huge advocate of the power of our mind and I don't like women to fear getting older. I think that's really critical to maintain your sanity because what's the alternative? I don't know about anyone that's listening, but for me, I want to live as vibrantly for as long as possible.
The bulk of the information that our body processes in for the endocrine system is filtered through our brain, the hypothalamus-pituitary axis. And so, there's this gentle orchestration between perceived information, and information and stimuli that our body takes in from the outside as well as what we process on the inside both physically and emotionally. And what I find is that as women are making this transition into perimenopause and beyond as I like to say, that on many levels if they have not been taking care of themselves, their lives get a whole lot more interesting. And by this I mean, if you are the typical type A that does not sleep enough, that over-exercises, that has no stress reduction strategies, that doesn't eat an anti-inflammatory diet, and that could look a little different for each one of us, that doesn't have enough downtime, you are really going to struggle a whole heck of a lot more.
What I affectionately refer to it as, a lot of women will fly to this wall at middle age and what typically ends up happening is that their progesterone, which is predominantly produced in cycling women from their ovaries starts to lessen, and these are all generalities, but they get this relative estrogen dominance, which can impact their periods and PMS and things like that. And it can impact cortisol levels because our bodies are now leaning on the adrenal glands a bit more to get the progesterone that our body is anxious to have enough of. And so, you start to see these imbalances.
I like to think of it as a three-legged stool. As one leg of the stool is imbalanced, then the whole stool is imbalanced. And so, that visual representation of how critical all these hormones are and obviously, there are tons of hormones, but the key ones that people think about are cortisol, and insulin, and oxytocin, and things like progesterone and testosterone and estrogen, as well as many others. But the imbalances between these things can impact weight gain and can impact sleep and can impact stress management, and can impact our gut integrity so we can suddenly start developing food sensitivities, which is not fun. It's so, so critical for us to be aware of the chemicals that can disrupt our hormones in negative ways and we get exposed to them through many different avenues. It could be the food we eat. It could be our personal care products, which is a huge one, when you think about our skin is our largest organ, as well as the fact that our input just in our environment. It's a lot for people to process.
For many women, I always say you got to dip your toe in the pond. You may not be ready for all the information. But small subtle changes can impact our hormones in such profoundly beneficial ways, as well as profoundly detrimental ways. And so, a lot of the work that I do with women is really helping them determine what's going on with their body? How can they support it differently? How can they work closely with their primary care provider and be an advocate for themselves? I like to remind people that any strategy that I talk about, most men can do and they seem to do it effortlessly or eat more easily than women do. We are governed by so many things. And what makes us unique, is also what makes us a little bit more complicated.
I always like to use the example of, if I'm working with a husband and a wife, and I give them the same general instructions, the man will instantly lose 10 or 15 pounds and the woman will struggle to lose 5. And so, I have to really have this conversation that because of our hormones, it's both a blessing and a curse in many ways, but it sometimes can make it a bit more challenging and middle age is when the boxing gloves come off. You got to really do the work. It's not sexy. People don't like to hear that. They just keep saying, “Give me a pill, I don't want to change my diet. I don't want to sleep more. I don't want to--” the chronic cardio queens that maybe got away with that in their 20s and 30s, you can't do that when you're older. You just can't. Not only is it not detrimental, it'll just raise your cortisol even higher.
One thing that I want to just touch on is that cortisol is not a bad hormone. I think there's this perception that cortisol is bad and other hormones are good, and I always remind people that all hormones have the ability to have negative impacts on our bodies if they're not properly balanced. And so, cortisol and insulin, in particular, seem to be two that are getting a lot of exposure right now.
I always like to talk a little bit about--- Jason Fung has a great book called The Obesity Code. And it's a little bit more in-depth for some people. It's not as user friendly, perhaps as some other books that are out there, but it's a great book for content. And when people start putting together, it's almost like putting these puzzle pieces together. It's like, “Oh, this is why I can eat 16 times a day,” or, “Drink something sugary 16 times a day,” because if I'm spiking insulin all day long, that's going to lead to weight gain, and that's not good.
So, that's probably a more long-winded explanation than what you had originally intended. But I think kind of gives people some perspective about this very delicate system in our bodies, the endocrine system and where it's primarily governed and how important it is, it takes in all this input from outside our body as well as inside of our body to make decisions about how to run things efficiently or inefficiently.
Melanie Avalon: I love that so much. You've touched on so many topics I wanted to talk about. Anyway, it's absolutely perfect. Yeah, for example, the exposure that we get to endocrine disruptors, I think it's hard to take seriously because I think a lot of people think when they eat food-- obviously, you might want to clean up your food, you're putting it straight into your body. But we just don't realize that like with skincare and makeup, for example, that also is going directly into our body. And on top of that, conventional skincare makeup in the US, I've done so much research on it and the ingredients that are allowed is shocking. The fact that there are thousands of chemicals in Europe that are banned because of being endocrine disruptors, toxic, carcinogens, obesogens, and the US has banned less than 10. It's just very, very shocking.
And then you touched on the difference between men and women. Even the scientific literature up into this point is so heavily focused on men, it can be even hard to know how things apply to women. There is a lot of literature on women but still, especially with a topic like intermittent fasting, for example, which I'd love to dive into because I feel a lot of females, they feel diets won't work for them, they've done the calorie restriction, they've done the chronic exercise, they've done all these things, and then they will try intermittent fasting. And all of a sudden, it seems like the magic bullet. It just does what they've been wanting for so long. It just fixes so many things.
But then, there's this second piece to the story, where fears and concerns creep in, very valid and warranted in my opinion of how does fasting affect the female body? Is there too much fasting? Is fasting only appropriate at certain times? Should you change your fasting when you're at different stages? Intermittent fasting for females specifically, do you think it's always therapeutic and healing? Can all females do it? Other things we should consider? I know it's a big question, but a question. [laughs]
Cynthia Thurlow: You're right. There is such a little research, and women are left out of research. I understand intellectually why they like to leave women out of research because there's so many fears and concerns about fertility and pregnancy and all these things, but it loses out opportunities to really understand how the female body is impacted by fasting methodology. The answer is bio-individuality rules. If there are 200 people listening right at this time, just as an example, you might have a third of people who can do it easily and effortlessly. You might have a third of people who have to cycle in and out of intermittent fasting. And then, you have a third that it wouldn't be appropriate for.
When I'm talking to women that are in a cycling phase of their lives, I'm very clear about the fact that if their cycle as an example, gets a little flubbed up one or two cycles, that's not a big deal. But if it remains that way, or they suddenly stop having a period, that's a sign that it's too much. I just think we as a nation are so focused on forcing results that sometimes we don't take into account that maybe this is not the right strategy for us right now, even though we want to make it work. We've seen all these people talking about all these amazing ways that we can support our body, but it doesn't necessarily mean it applies to every woman at every time. As it pertains to cycling women, I think using their menstrual cycle as a barometer, if you will, is really critical. Perimenopausal women who are still getting cycles, their cycles are going to be wonky. That may or may not impact their cycle negatively. But that's the point in their lives that if everything else isn't ratcheted in, they haven't ratcheted in the stress management, they're over-exercising, they're eating crappy food and drinking too much wine, or menopause.
I like to remind people, and let me just backtrack, the A number one reason why people come to me is because they want to lose weight. They believe that I'm the person that's going to be able to help them figure that out. And we do, we always do. It's always a different combination of reasons for different people. But when it comes to intermittent fasting, I have to remind people that if you're not already sleeping, intermittent fasting is not going to help you lose weight. If you have a wonky cycle, intermittent fasting is another stressor that we're adding to your body. So, we have to make sure your body's ready to accept that additional stress, all these hormetic stressors that we talk about.
And then lastly, if someone doesn't feel good by intermittent fasting, and by that, I mean they don't have more energy, they don’t have more mental clarity, it might not be the right strategy for you. I have women who try to force a square peg into a round hole. And it's both sad for me that they're so determined to make it work. And I just keep telling, “Your body is telling you right now it's not ready. We have to listen to your body. Bio-individuality rules." “I know but my best friend, my sister, my mom, my this-- it all worked for them.” And sometimes, we have to take a step back and we have to dig a little deeper. We have to peel off another layer of onion, and we really have to look and see what potentially could be making it challenging for them at that point in time. And it doesn't mean never, it might just be not right then.
But I do agree with you that we are not many men, and that men seem to take to intermittent fasting on many levels unless they're highly carb dependent, insulin resistant, sometimes can take a little longer. But the average guy, they're like a duck to water with intermittent fasting. Whereas we as women, sometimes it's like a crash landing. We're trying to make it work and it doesn't work as effortlessly as we would like it to.
Melanie Avalon: I love everything that you said so, so much. It's very freeing to hear that response because I feel people are so often kind of what you've said. They are either fasting works for everybody all the time, make it work. And then, there's the opposite side where it's like, it's too stressful for females, females shouldn't be fasting. So, to hear that it is very bio-individual, which is how I feel like pretty much everything in life is, is really, really wonderful. Actually, do you have thoughts on-- because I have read specifically that fasting during certain phases of a female's menstrual cycle might be more or less appropriate? I'd read that during the follicular phase, you should not be fasting and during the luteal phase, you should be fasting. Do you have thoughts on that?
Cynthia Thurlow: Yeah, I do. Actually, I read a book by Dr. Daniel Pompa last year, which really resonated with me because on so many levels, it intrinsically made sense that we would differentiate how we would fast preceding our menstrual cycle, the five to seven days. And so, he is an advocate and actually now I've implemented this with my own patients, five to seven days preceding your menstrual cycle, you actually will have a shorter fasting window. When we start thinking about carbohydrates, I will ask my ladies to increase their carbs from that five to seven-day period. I really stress root vegetables and squash and low-glycemic berries and things like that over bread and pasta, the more processed carbohydrates. And I find that their cravings go down, they've increased insulin sensitivity. So, their body is really primed to be able to accept a higher carbohydrate diet. And then, the day that they start menstruating, they go back to their normal fasting schedule. I've come to find that's really beneficial for cycling women.
For a lot of the women in perimenopause and menopause, once they're fat-adapted, once their body is using ketones as the primary fuel source, then I will encourage them to consider varying their schedule. So much like we wouldn't do the same exercise program every single day of our lives, I'm an advocate, once your fat-adapted to have variety. Our bodies like variety in just about every way imaginable. And so, this is a time when I will encourage people to experiment with their fasting windows. So, maybe they're doing a 24-hour fast, maybe they're doing a shorter fast. Just really liking people to be not only attuned to their bodies-- because listen, we're going to have days we're a whole lot hungrier than we are normally. And there's no shame in saying, “Okay, instead of fasting for 18 hours, I did it for 15 because I was really, really hungry. I had a couple really tough training days or maybe my macros were off the last couple days. And my body told me that it needed more food today.” And it just reminds our bodies that we're not starving, and so I think that's a really important distinction.
For anyone that's listening, the really nice thing about intermittent fasting is the flexibility piece. So, don't be rigid about the dogma. I always say dogma is what gets us in trouble. There are very few things about intermittent fasting I'm rigid about, but I know that all of us are on the same page about clean versus dirty fasting. So, beyond that, I always say experiment, find what works for your body, listen to how your body feels, how are you sleeping, what's your energy like? And then, proceed from there.
Melanie Avalon: Love it. Do you have thoughts on alternate day fasting specifically?
Cynthia Thurlow: I think that can be a methodology that can be effective for people. I have a few people who prefer that. We know based on study research, there could be a lot of benefits garnered from that, but I think it really depends on what works best for your lifestyle. For me, I'd rather eat every day than fast every other day. For me, it's more of a mindset switch. But it's really finding what strategy and what philosophy and what structure works best for your professional and personal lives.
Melanie Avalon: Gotcha. Yeah, I'm so intrigued by it because there does seem to be a ton of research on it specifically, and I'm really intrigued by the longevity benefits. Sometimes they'll do it with a 500-day calorie “fasting day,” but I always have to have my really big meals every day. I'm such fail in that camp.
Cynthia Thurlow: Well, but I think it's also like what works for you. For me, I'd rather do one 24-hour fast, then have a sub-500-calorie day when I just feel the whole day I'm fixated on the lack. And that's not my mentality normally, but for me, it's the lack. It's like, “Oh, well, I really should be having more. But no, I'm just not going to have more.”
Melanie Avalon: I've done a lot of research on the fasting-mimicking diet. And we even had Valter Longo on the Intermittent Fasting Podcast quite a while ago. But I actually tried it recently and again, such a fail. But the point is, I think we keep saying that bio-individuality is key, and question to that about the intuition. You were talking about the importance of mixing things up and sending different signals, what if a female is doing an intermittent fasting protocol, not switching it up a lot, one meal a day, for example, and they feel really good on it, is it intuitive or is it possible that they still should be switching it up? Can you just ride the intuition boat or do you think it is important to send signals occasionally of, “Oh, we're not fasting right now”?
Cynthia Thurlow: Well, I don't like one meal a day sustained for women. I just don't. If it's around a holiday, if it's around a vacation, I think It's fine. Like, “Oh, I ate too much, and I'm just going to reset myself tomorrow.” I just think over time, you are not going to get your macros in. I'm very, very OCD about telling my patients, my clients, most of us are protein deficient. So, that's really a big focus is that there's no way over the course of a week, you're going to get enough protein in a two-hour feeding window. That's just impossible. Maybe a dude can, maybe a guy can have a four-hour eating window and they eat a massive meal, and maybe then they hit their-- but I just find women just can't consume enough. I couldn't consume 115 grams of protein in a meal, that would be completely impossible.
I think it's fine as every-once-in-a-while strategy, but I still think even in that instance, you don't want your body to think you're starving. That's why the shaking it up and varying what you're doing is so critical and important. I'm knee-deep on a book proposal right now and so I feel like all this is really, really, really fresh in my mind as I'm trying to illuminate this philosophy. There is an intuitiveness to intermittent fasting, I agree with you. But there's also for some people, and this would be part of the camp of people who really shouldn't be doing intermittent fasting, there are a lot of women who hide their orthorexia and anorexia in their intermittent fasting. I see far too many of them, I'm not going to call anyone out on social media, but it's really apparent to me who those individuals are. It's an eating disorder guised as intermittent fasting.
I just think that for someone who's very mentally healthy, has a healthy relationship with food, likes food, likes the way their body feels when they're fueled, it's a great strategy. And then, there are people who use it as a means to cover up an eating disorder, and that's very different. And that's an important distinction to kind of shed a little bit of light on because I feel it would be doing women a disservice if we didn't talk about that because that's the-- sometimes I call it the ugly side of fasting that there are definitely people who on occasion use it as a strategy to hide some unhealthy behaviors. Does that make sense?
Melanie Avalon: 100%. I'm so glad you brought that up. Although I might be the exception to the female not able to eat that much protein at one sitting. Protein is my thing. I can't not do the protein. I've probably eaten for the past 10 years, every night, like pounds of protein. I'm like the one exception.
Cynthia Thurlow: Yeah, you might be because when people-- I'll say to them just track your macros for a couple days and show me, and they're like 50 grams of protein a day, 16, I'm looking at them going, “Dude, you are so far off, that is not healthy.”
Melanie Avalon: It's funny. People will say to me like, “Oh, I did a higher protein day, I ate 80 grams.” I'm like, “That would be so low protein for me.”
Cynthia Thurlow: No, you are an exception, you're definitely an outlier, I find that-- Then you start having the conversations that what sarcopenia is and why that's a concern. I can look at women as a clinician, their body habitus. Looking at their bodies, I was like, “Oh, you've got significant muscle wasting,” you're skinny, but you're not healthy. And so that's the distinction in my mind of wanting to support people and healthy habits. I just find we're a very carb centric culture as a rule, and so that becomes problematic as we're trying to navigate these conversations. It's like I'm the most lovingly supportive person, but sometimes I have to call it out. It's like, okay, where's the snark. I grew up in New Jersey, every once in a while, it comes out. I'm like, I can't help myself.
Melanie Avalon: Some further resources for listeners. If you'd like to learn more about the protein thing, I had Ted Naiman and William Shewfelt on podcast. I'll put a link to that interview. I also wanted to provide a link for listeners because I had Dr. Pompa on as well. He is the best, I just love him. He has a heart of gold. And we talked a lot about the carbs and all that stuff. So, that'll all be in the show notes.
Big question for you, how do you feel about bioidentical hormones for women actually of all ages, because I know they're often used in the later cycles of menopause and post-menopause and things like that. But I know, when I was 20, something, I saw a nurse practitioner, and my hormones were all normal, but I had insomnia and stuff like that. She put me on a low dose of progesterone and I wonder to this day, how does that affect the body? So, what are your thoughts on bioidentical hormones?
Cynthia Thurlow: Lots of pieces to undig there. When we're looking at bioidentical hormones, there are options that women can consider. It's unpacking a lot, synthetic hormones have been the mainstay, people put on oral contraceptives and hormonal IUDs and things like that. So, I think it's a very personal decision. I'm not typically a fan of prescribing bioidenticals while women are still cycling. Based on a conversation I had with some peers last week, I feel pretty comfortable saying that there's not a lot of great research to do that. Progesterone cream that is used to help support sleep, I'm not sure if that was the indication that the nurse practitioner was using it for. That I think of as being pretty benign.
Melanie Avalon: That's what it was.
Cynthia Thurlow: Yeah. We're talking about estradiol which is non-synthetic estrogen and testosterone and progesterone. You really have to work on all the other pieces supporting the endocrine system first because if you just slap the hormones on there and they're still not sleeping well and their stress is out of control and their food choices are crappy, it's a band-aid. It's not like a band-aid, it is a band-aid. For that reason, I think you have to be really careful, not only who you choose to work with, but making sure that you're really well informed.
I'm not taking bioidenticals at this point in my life. I have ongoing discussions, it's not uncommon sometimes for women to be put on bioidenticals in their perimenopausal years, so mid to late 40s, early 40s depending on who you are, but I think if you're properly balancing your body, if you're sleeping well, your stress is dialed in, you're not over-exercising, your food choices are pretty good, if you've got a firm foundation-- I was just talking to my nurse-midwife about this last week. She said you have about 10 years after you go through menopause in which to decide if you want to take bioidenticals to maximize the benefits. The benefits are usually focused on bone, brain, and heart health. And so, I think there are a lot of women who are very fearful of bioidenticals. I think there are people that live in parts of the country or outside the United States that they're so fearful that they may miss the opportunities to be able to harness some of the benefits.
But there are different camps, there are some people who are very rigid and say everyone needs to be on bioidenticals before they go through menopause or after menopause. And then, you have other individuals who are seeming a little bit more open-minded. And it's such a personal decision. I've only had one patient in the last year who I looked at her, her testing, and based on her symptoms, she was so miserable. We had done all the foundational work and I just said, “I think you're at a point where your brain needs estrogen.” There are a lot of estrogen receptors in our brains.
Here's the other piece. We know that we have estrogen receptors throughout our body and one of the places that we have estrogen receptors is on our muscle. When we were talking about protein-- this is my segue into talking about the interrelationship between estrogen, estradiol signaling, and muscle protein synthesis. And there's an amazing physician, Dr. Gabrielle Lyon, who introduced me to this concept. Sarcopenia is this muscle loss that accelerates after the age of 40. Whether people are lifting weights and/or hopefully also eating lots of protein, it's a way to starve off this muscle wasting, but it also ensures that-- muscle is the organ of longevity, it also ensures that you are able to properly package up insulin. And you aren't going to be less insulin resistant, you're more metabolically flexible because, let's be honest, that's what we all want. We want to be metabolically flexible, irrespective of our ages. And that's one of the ways to do it.
There's so many things that have to be unpacked from that conversation. I'm not pro, I'm not anti. I exist in a gray space. I think it's really dependent on the individual, who they're working with, what their lifestyle is like. If you hear there's consistent themes throughout this conversation for me, or I say to people, if you can't sleep and your diet is crappy, and you over-exercise, and you're super stressed out, putting you on hormones is not going to be the band-aid. You've got to work on all that other stuff first and then you move on to the hormones. That's my belief system. That's where I am at this point in my life.
Melanie Avalon: I love that so incredibly much. Actually, question I meant to ask you because you talked about one meal a day probably not being appropriate for females. So, what is in your opinion, the shortest eating window that is still safe, or the longest fasting window that is still appropriate? I know my listeners are going to be like, “How long can I fast?”
Cynthia Thurlow: So, it's always in the context of-- let's go back to like, how are you sleeping? What's your energy like? There are a lot of people who are very happy existing at 16 hours. Are you going to get more fat oxidation and more growth hormone secretion the longer you go? Yes. Again, it goes back to that-- it's almost this delicate seesaw. It's a hormetic stressor. How much stress are you putting on your body? Is it a day where you got up at 5:00 AM and got in the gym and did a really intense hit workout and then lifted, and then went home and restricted your eating window, and you didn't drink enough water and you've been super stressed? That person in that context is probably stressing their body more than they need to versus someone who maybe gets up, they do some yoga, they get outside in nature, they have some green tea, maybe they take a walk with their spouse or their kids later, they don't have as much stress. I just think it is always in the context of not being rigid, listening to your body.
When it comes to the typical framework that I see, 16 to 20 is typically where I see a lot of women like to hover. They don't necessarily want to do the 24-hour fast. Once they're fat adapted, 16 hours is easy. It's like breathing, that's usually what I hear. I think it's really being attuned to how your body feels on a given day. Acknowledging that there are days like-- I'll be honest with you, I am the kind of person I'm very attuned to how my body feels. And normally, once the gyms opened back up, I was back in the gym three or four days a week lifting. And I just took a month off from lifting. I did more walking, and I did more solid core, and I did more yoga than I'd done in a long time. I think our body needs us to be open-minded to changing things up on occasion.
So, I would invite anyone that's listening, to just be attuned to what your body is trying to tell you. And this is not woo-woo, and this is not invalidated science. This is, “Let's be realistic about where we are in time and space.” Depending on where I'm in my menstrual cycle. Do I really have a desire to push my body or am I or am I more tired? And do I need to do more yoga and more restorative work? Or am I going to push my body and maybe I'm pushing it too hard?
There's a very fine line and the things that I punished my body within my 20s and 30s, I don't do in my 40s. And now, maybe I'm older and wiser that I just don't think that's necessary and would encourage anyone that's listening to just to experiment a little bit. It's okay. I think there's a mindset shift that needs to occur where we just give ourselves some grace. And we acknowledge that part of the process and our life's journey is to just determine that at any given point in time, we may need to do things a little differently and that's totally okay.
Melanie Avalon: I keep saying that's why I love that so much. I feel probably one of the biggest switches for me in my life-- I hadn't really thought about this before, but the whole sleep piece, in college and everything, it's about the quote was always nobody remembers the night they got plenty of sleep or something, but now, sleep is so sacred to me. I'm like, I will do everything to support and it is super important. For listeners, for testing, how deep do listeners need to go with testing? Do you recommend doing full hormonal profiles, DUTCH tests, cortisol, thyroid?
Cynthia Thurlow: Oh, yeah, that's a great question. I know it's always in the context of what someone's experiencing but I'll give you an example what the average woman who comes to see me what we're testing. We do the Oxford MRT, which is food sensitivity testing done with blood. We do the GI-MAP, which is stool testing, looking at stool pathogens, looking at for candida, worms, parasites, dysbiosis. It gives you a good sense of the estrobolome. We will do the DUTCH. Obviously, there's different types of DUTCH testing. Some of it's for people who still wake up in the middle of the night and they'll get a cortisol rating, that's dried urine and saliva. But I would say general, more conventional labs that I'm looking at, I like to see a CBC, a CMP. I like to see a full thyroid panel, which from soup to nuts, that's usually 9 to 11 tests that you're looking at. Most people aren't having enough thyroid tests done. And yes, that includes thyroid antibodies if they have not been done before. I like to look at an iron panel. I like to look at fasting insulin, fasting glucose, and LDH, as well as the hemoglobin A1C, and that's a good starter. I don't necessarily rush to do inflammatory markers. I have a lot of people ask me, “What do you think about the high-sensitivity CRP?” And I said, “We drew them all the time in cardiology, and then we're like, what the hell do we do with that?” What do we do with that?
A fasting lipid profile because I like to see what triglycerides are doing. For people who tell me they're not eating a lot of carbs and then their triglycerides are like 400, I'm like, “Okay, you're eating way too many carbs.” I like to see triglycerides below 100, preferably lower. I think my last one was like 50. And then you can also get a look at their HDL, their LDL, their total cholesterol, but that's a good starting place. I think that's reasonable and feasible. I find I don't get a lot of pushback if I send someone to their primaries to get labs drawn. I usually have to spell out what a full thyroid panel is because conventionally sometimes it's a TSH and a free T4, but I want free and total T3 and T4. I want a reverse T3. I absolutely want to see their thyroid antibody markers. And then, there's a couple other things that I'll order on occasion.
And then, I always say I play well with others. So, if they get the labs done through their primaries, and they share them with me, then I'll sit down and go through their labs in fine-tooth comb, what we need to be looking for and what can be providing input about areas of deficiency or areas that require more support, but that's typically where I'll start.
Melanie Avalon: I'm so glad you brought that up about the testing and working with the primary doctor because I think so many people, it can be so difficult to navigate the conventional medical system and make it affordable based on the individual because a lot of people can get labs drawn through their insurance, through primary doctors, but it can be really hard to find somebody on their insurance who has the mindset and the approach. Somebody like you would have-- are you currently taking patients?
Cynthia Thurlow: I run a waitlist, but I do have another advanced practice nurse that’s part of my team who is taking people. I'll probably start taking people again in the fall.
Melanie Avalon: Okay, awesome. For listeners, as I mentioned in the beginning, there will be a transcript of this show at the show notes, because I know she mentioned a lot of things there, so you can definitely reference that. Reference that for everything. Two quick questions before we go. I'm just super curious if you had all the resources you needed, you had all the funding if you could construct any study in this the health world, what would you want to test?
Cynthia Thurlow: Well, I think I definitely would want to be able to look at, and this is probably because this is my niche, but I would really like to look at the impact of biohacking strategies on women of middle age. So, perimenopause and menopause because there's such little focus on women at these stages. It's almost like I always say, and this is no offense to anyone who's at a different life stage, but I know when I was getting my period every month, then I was on the contraceptive years, the pregnancy, pre-pregnancy, postpartum, etc., there was a lot of focus. I, even as a western medicine trained provider, no one talked to me about perimenopause until I hit a wall.
So, I think that women of a certain age deserve-- all women. Let's be honest, all women, cycling women, noncycling women, we all deserve to have research done to see the impact of a lot of these biohacking technologies. I'm knee-deep in Siim Land’s new book on stress.
Melanie Avalon: Oh, Stronger By Stress? It's so great. I was reading it last night.
Cynthia Thurlow: We're both dorks together. I said that in a very loving way. I always say like, I'm proud of the fact that I like to expand my mind. But the point being that it would really be nice to see study data that's not done on rodents and isn't done on men because we have our unique characteristics about our physiology and our hormones that it would really benefit from having more information.
I don't like fearmongering and I see a lot of fearmongering. There's a very well-known biohacker who someone on his team wrote the very long article, let's just put it that way, about how fasting, it doesn't work for women, and maybe it's just menopausal women will work for. And I was like, “Well, that was kind of depressing.” This was written with such a slant. And then, of course, the person who wrote the article made sure that that the reader knew it was a female. But I said this just goes back to say it's this fear-mongering mentality. I've seen women that are cycling, perimenopausal, and menopausal harness intermittent fasting and do it well. But there's so many factors that impact that and that's what I think would be curious to know more about.
Melanie Avalon: I love it. Actually, when you were talking earlier so much about the theme of this podcast of bio-individuality and too much stress or less stress, I like it. Like you, I've been reading Siim’s book, his new book. And I don't know when this comes out because I'm interviewing him for it. So, listeners, if you're more interested in that, I'll put a link to that as well. But, yeah, it's really, really hard to find in this world, people with the perspective I feel I hold, like you hold where it has the nuance and it has the bio-individuality and it realizes there's just so much more to the puzzle than one right answer.
Cynthia Thurlow: Yeah. Well, I was trying to explain to someone the other day, they said, “Well, explain to me what bio-individuality is?” And I said, I take 10 patients-- this used to be my life. 10 patients, they all have high blood pressure, they all need a medication, and many of my peers would just give everyone the same med, and I would like look at one go. "Okay, you need 2.5 and you need 5." And, no, these three, can't even give them that drug. And it's not a criticism. I was very thoughtful about what was realistic. I would say you don't take an elephant gun to kill a mouse. We need to be very mindful of the fact that just because the patient's blood pressure in our office is X, that doesn't mean what it is at home, so don't go overboard. So much like to that same extreme, I feel each person that's working with me, I try to look at it from a unique lens. There's not this one size fits all kind of philosophy.
Melanie Avalon: I approve. I support. That brings me to the last question I ask every single guest on this podcast, and it's just because I'm realizing more and more every second of every day how important mindset is surrounding everything. So, what is something that you're grateful for?
Cynthia Thurlow: Oh, my family, undoubtedly. I think the social distancing and COVID has just hit home for me that they're my people, they're my everything. There's no place I'd rather be than with my boys and my husband and my dogs. We've had so much time together since March that I always say, if you can still be around everyone after a lot of togetherness, that says a lot. We've picked well. You did well with your picker.
Melanie Avalon: That is so true. Well, thank you so much, Cynthia. I am so grateful for what you're doing, for your work, for everything. I would love to bring you back on when you release your new book. That's so exciting. Do you have a date for when that's coming out?
Cynthia Thurlow: Not yet. I'm crossing my fingers that this is the proposal that my lead agent has been anxiously waiting for. It's a couple iterations and from what I'm told that's normal, but it's been challenging to get my brain focus when everyone's been at home. There's been lots of distractions.
Melanie Avalon: Yeah, it's so crazy for people who haven't been in the book world, the proposal itself is like a book.
Cynthia Thurlow: Oh, yeah, there have been blood, sweat, tears, lots of tears. I'm married to an engineer and so, he's always good to bounce ideas off of because his normal response is, “But that doesn't make sense.” I'm like, “Well, of course, it does.” He's like, “No, it doesn't.” And it's because in his mind, it has to be crystal clear. He's been my pre-editor, book reader, and then I send it off and then I cross my fingers and then I get feedback and like, “Okay, we're going for the [unintelligible [00:55:29].”
Melanie Avalon: I wish you the best with that. I'm sure it will materialize exactly the way it's supposed to be. And I'm super excited for how that does happen. Are there any links you'd like to put out for listeners to further follow your work?
Cynthia Thurlow: Yeah, I would say my website’s a good first stop and that's www.cynthiathurlow.com. I'm also active on Instagram, Twitter, and Facebook. I have a free group, Intermittent Fasting Lifestyle/Cynthia Thurlow. Obviously, I have a podcast called the Everyday Wellness podcast where I get to bring on really cool people and pick their brains. I just had Ted Naiman on, we did an interview most recently, Nadia Pateguana, and JJ Virgin. And so, I've had some really cool guests that-- I always say I love bringing on people that will provide value and make us think a little bit differently. I think that's the purpose of these discussions and why podcasts are so cool.
Melanie Avalon: They're just the best. Speaking of things grateful for, I'm just so grateful for this podcast because of what you just said. Having these conversations are just, I don't know, so grateful for it every single day. And then, hearing how listeners respond, hearing their thoughts, it's just wonderful.
Cynthia Thurlow: Yeah, absolutely.
Melanie Avalon: All right. Well, thank you so much. Enjoy the rest of your day, and hopefully we'll talk again in the future.
Cynthia Thurlow: That’s good.
Melanie Avalon: Thanks, Cynthia.