The Melanie Avalon Biohacking Podcast Episode #135 - Cynthia Thurlow

TRANSCRIPT

Melanie Avalon: 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. Cynthia, I was thinking back to when we first met, how did we get connected, originally?

Cynthia Thurlow: I think you had reached out after that second TED talk. I just recall, it was summer of the 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. [laughs] 

Melanie Avalon: [laughs] 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. She just mentioned, she has two TED talks on intermittent fasting, which really catapulted her into the intermittent fasting fame world. She has a new book coming out, which is so, so exciting. That's why I bring 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 in women and female, and hormones, and all the things. But 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, so, this book, listeners, as you may be familiar, I'm also the host of the Intermittent Fasting Podcast. So, I'm thinking about intermittent fasting all the time, I'm talking about it all the time. I'm always really, 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, 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. Then 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 and 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 and I feel really, really committed to helping women navigate irrespective of their age or their stage of life they're in, they'll be able make decisions and use strategies that can allow them to live their best lives.

Melanie Avalon: Well, you are definitely doing that and 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, lot of the guests that I've had on my show as well. A nice focus on again, women, hormones, all of that. Definitely check out that podcast. I actually have a question about your personal story to start things off. You talk about your personal story in the book, which is really, 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, and 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 and 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 the 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. Then the irony is in 2018, I decided to do a TED talk. I thought that that would a challenging thing to do as an introvert [laughs], a safe thing to do. Initially, my first talk was on perimenopause. 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 has 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 was probably December of 2018 and said, "What do we 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 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, but 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 and 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. 

Yeah, 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 and 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're so many different intermittent fasting approaches and obviously, one of the biggest questions we get on the Intermittent Fasting Podcast and just in general is, "Is fasting safe for women and how should women approach fasting?" In your experience, working with women, the IF:45 plan, did that precede the book? What IF windows did you ultimately find work best for women and should there be concerns about fasting for women? What are your thoughts on that, 16:8 versus one meal a day, all the plans?

Cynthia Thurlow: Yeah, no, 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 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 and 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 in that feeding window. Now, I know there are men out there on-- Twitter's a good example. There're a lot of men on Twitter that fast and they'll say, "Oh, my OMAD, I get 2,000 calories in a meal and 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 2,000 calories into one meal. I wouldn't be able to move, I would probably vomit. I think that OMAD-- 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, it's always with-- 

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. But 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 that's really a good starting place for people to say, "This is what we're going to work towards," and then once you have success with that, then there's all these other options. This is a terrible example. It's almost like, you go to a buffet, in the buffet for fasting, you get lots of different options. But 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. 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: So funny that you started saying the thing about what frustrates you and I was like, "I know what she's going to say." I'm also I'm really glad that you clarified about defining one meal a day. 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 minimum usually four hours. It's actually more 20:4. Sometimes, it's even longer. I think that's actually really important to clarify. Something I love that you open up the book talking about the differences between men and women and I learned so much about how women are different biologically. 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, [giggles] that works for me. But so just in the differences between men and women, and then 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. So, 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 when it comes to the food, and exercise, and fasting for your cycle, for example, do we need an actual plan on paper that we implement or can we just be really intuitive? I'm craving these types of foods now, and I want to fast like this now, how intuitive can we be versus needing a plan?

Cynthia Thurlow: I think that's a really great distinction. I feel many, 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 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. But 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 they could be in this, as I refer to it as actually the nebulous period of perimenopause five to 10 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. So, let me just give you a heads up." Because as an example, so 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're 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 they need as much structure, but 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, fearmongering, etc., about women and 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. So, eventually, we'll get to a point where we can lean into that intuition confidently and 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, 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, the different foods to focus on for the different parts of your cycle. 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? 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: Yeah, 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. 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, etc., that are working with women and seeing what works successfully for them. It could be an 'n' of a couple thousand, but it hasn't necessarily been done in the clinical research. But 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. But 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, many years of fear of it's too complicated. There's too much to it. There are researchers out there, I can think of one in particular. She's a female PhD. She works with female athletes and she is not pro fasting. But 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 leaned into looking at how do we support our bodies at different phases exercise wise throughout our cycles? There's good research there in terms of exercise and women's physiology, but certainly, not enough and not enough done on humans versus lab animals. You and I both know and probably many of the listeners do as well, because they listen to the high-quality podcast that you have that you can't compare per se, lab animals' ovulatory cycles, lactation in 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 control 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 and saying, "We really think this is information that needs to be followed up." I'm 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. She and I were both talking about the fact that it's upsetting that so many women are fearful to fast even at 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 that would put some of these fears to rest. I do want to believe that they're well-meaning individuals that are out there fearmongering [giggles], but I do have moments where I just 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." So, what's the harm in trying? That's where I come from. 

I think the other piece of that is, I've just watched people get sick, sicker over the last 20 years and that to me is so disheartening as a Nurse Practitioner that we 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, 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, but there are plenty of clinicians like myself that have just seen such significant changes in people's health and 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 setting something like longevity in 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 fertility. Longevity is more, a broader thing you could see is the rodent living longer. But then when it comes to fertility, so a rodent fertility cycle, they're reproducing all the time. They're much more sensitive to things that would throw that off. 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 a 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, the equivalent of extended fasting. So, 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 fasts. It was interesting. I was listening to Dr. Ted Naiman and Maria Emmerich having a conversation about this. 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 really long periods of time." I thought to myself that really makes sense. I think if someone is obese, metabolically unhealthy, I think longer fasts 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 a 24 or 30-hour fast. I think it can be helpful for specific purposes. 

A lot of people talk about and I know you had Valter Longo on stem cell activation when you're getting to that three-to-five-day period wanting to 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 that 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. But 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. Those are all wonderful things to want to focus on. But I think you have to be careful, and 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, 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 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's definitely factors that I think are bigger insults to the body than others. Stress and sleep, 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 30s, 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 two 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. 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 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, we as clinicians have contributed to this. 

Melanie, I think that's such a great question. 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. 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 that 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 as they timeout, 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. So, I want to make sure that there's no way I have to support the potential pregnancy." 

I think that really adding into that equation is leaning and being honest, and saying like, "What's my menstrual cycle like?" Because when a woman tells me she starts fasting and loses her menstrual cycle, that's 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 the toxicities in our environment. Are we being kind to ourselves? Because I think on many levels, people come to fasting, women in particular, because they want to change the body composition. They want to lose weight. 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 reframe these thoughts, so that we can put ourselves in a healthier state of mind before attempting to do any of that."

Melanie Avalon: 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 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 a 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 it's a blanket statement when it's going to be individual. Yeah, I thought that was really interesting. 

Speaking of hormonal issues with women and I love to go into perimenopause, and menopause, and all of that, but just in general, so, you dive deep, deep, deep into all of the hormones, which made me so excited, because I love learning. When I was reading the part of the book that was going over insulin, and cortisol, and estrogen, and progesterone, and testosterone, and DHEA, and all the things, I was like, "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, 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 someone 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 toxic world that we live in, and when I say toxic, I'm talking about things we're exposed to an environment or 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'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 of 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 and so 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 irregularities, 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. 

I do think it's a byproduct of the environment that we live in this 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, that everything that is in a box, or 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 spawned into my plate and 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 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 1 o'clock in the morning and there was no cable TV when I was really young. Now, we could be on our computers, or iPad, or iPhone, or social media all the time. Our bodies are just inundated with artificial light.

All of these factors that disrupt this orchestration between all these hormones, which are governed by our brain and the endocrine system. That's 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. 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, then they're told maybe they've got a thyroid problem or again, the synthetic hormones are offered or surgical interventions." That certainly was the case with me in 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. 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, and so 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 than 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," and don't even mention the fact we're all in year two of a global pandemic. 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, many ways, we have created this environment that our patients are living in, and they're not thriving, and 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 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. Even 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, 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. 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 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 the intermittent fasting might hurt it. So, I 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 like an example. But for those issues, for example, what are your thoughts on fasting and those?

Cynthia Thurlow: Yeah, no, 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, and at 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, it 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, because my heart goes out to them, because I know that impacted my fertility, that's really how it manifested, and I was on oral contraceptives for a thousand years, because it was "fixing the problem," not really just putting a Band-Aid on it. 

I do feel that in particular, when you're looking at PCOS, where typically you 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. But we know that many, 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 aromatize into estrogen, you can get this relative estrogen dominance. With weight loss, you are getting this net resultant lower 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 12 or 12 and 14. 12 hours fast with a 12-hour eating window just as a starter, just kind of meandering to that. 

Now, I also, coincidentally 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 the five to 10 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, 1% to 2% of people with hypothyroidism don't have Hashimoto's even if you've had negative antibodies like me. When I was about 44, that's when I was diagnosed. People ask me all the time, "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, but 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. But if you have hypothyroidism, and you get less than six hours a night of sleep, and your stress is out of control, and 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. So, 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. Let me be clear about this. When you are obese or overweight, you're not as metabolically flexible, and so, 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, but 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 a care of themselves. It's really getting very honest with yourself about what the lifestyle piece is, 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. But if it's not the right time, if it's too much stress or our body perceives that it's under threat, it is not going to do well with that type of stress. So, really being very, 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 in 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 [laughs] for it. I have some more questions about the hormones. But 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 and in your IF:45 plan, which includes three phases, like the induction phase that you have, what is the role of carbs and low carb? 

Cynthia Thurlow: It's a good question. If we look at statistically, I think it's a 2018 study from UNC, and 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 grams 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 things we need to do. One of them is reducing our carbohydrate intake and really focusing on whole carbohydrates." 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. 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 judgement. I'm just being observational. 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're going to be much more successful by readjusting those macros. For a lot of people, that's why we have a whole week of the induction, because it could 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 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 rip the Band-Aid off and start with the basics. 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 unfortunate-- It's 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, and it reminds me of Joel Greene's work, and I know you interviewed him as well, and his book is mind blown moment after mind blown moment, but he talks about the actual-- I'll put the 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, really fascinating.

Cynthia Thurlow: I think when I read his book, Melanie, I literally, my chin was on the table. I remember saying to you, I think now for I'm sure everyone that listens to you knows that you are like a copious researcher. But I think I told you, I think I went through 20 pages of a legal notepad taking notes and my husband's like, "What are you doing?" I said, "This man has written this book and it's completely blowing my mind. It's so different than anything I've heard anywhere else." Yeah, he's just exceptional. 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 four hours, so that I can make it a two-part episode?" He was so kind and agreed. I think we had technical difficulties at the beginning. I think it was a five-hour experience. So, 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. 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. Cortisol, one thing I love is when you talk about cortisol, you actually start by talking about the benefits of cortisol. You 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 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 it, 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. 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's 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, a very westernized lives, where 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 and 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 that 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's 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, so, you're going to deal with that as well, and that's a whole separate conversation that we could have, because the whole constipation thing is fascinating. But we think about the fact that chronic stress, it's 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?" It just reminds 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, cortisol is heightened. It becomes elevated. 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 will have lower cortisol levels, which can show up as fatigue like, you have no energy, and you develop gastrointestinal problems, you develop 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. 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 reflect and manifest not only in our appearance, but our menstrual cycle or libido, etc., can all take a massive hit. Cortisol is beneficial, but cortisol can also be assigned 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. But 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 Terry Cochran calls it 'The Dirty Cupcake.' But it's really 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 and this is where we get this tie in with insulin. But 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 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 years have shown us that there's a lot of that going on.

Melanie Avalon: Question about the cortisol, because it is something that women can test or they can do 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 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 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. 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 like the infradian rhythm, but it follows melatonin suppression is when cortisol is highest, we would expect cortisol the highest in the morning, it ebbs and flows throughout the day and it is lowest at night, which tells our body to go to bed. 

But the DUTCH is really helpful, because it will plot it out throughout the day and it gives you controls like high and low. 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? Then it maps out your sex hormones, your melatonin, all of these things are all interrelated. 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 is 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, and they've had a well-meaning clinician order the tests, they're 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 are 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 and I have a binder that's, gosh, it's probably six inches thick. I'm not exaggerating. it took probably looking at hundreds of them to feel comfortable/confident to be able to use that information, because in the functional medicine, integrative medicine world, there's 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, but 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. Since you love testing, not guessing, so, 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 specific to the DUTCH or just in general?

Melanie Avalon: Just in general with women. Do you do a full hormonal panel and when you do, what does that cover? What should women be testing?

Cynthia Thurlow: Yeah, I think at a minimum, so, we know progesterone is one example is better tested with blood as opposed to the DUTCH, because when you do the DUTCH as an example is just a test between days 19 through 22 in your cycles or during your luteal phase. I do think testing, there's three predominant forms of estrogen. There's estriol, estrone, 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 a total testosterone. 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 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 10 years way before the glucose and hemoglobin A1C start becoming abnormal. So, 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 hedonist that 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. TSH free and total T3 and T4. reverse T3 looking at antibodies. I'm a huge fan of looking at iron panels. Total iron, TIBC, percent sat, ferritin which is oftentimes a better marker of iron storage. I do like to look at inflammatory markers, so high sensitivity CRP. I do like to look at homocysteine and then I like to look at-- this is just a baseline, I'll look at an RBC, so red blood cell, magnesium, and zinc, iodine, folate B12. That's a starting point, obviously each person's 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 a urinary iodine can be very, very helpful.

Melanie Avalon: Awesome, 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. Well, first of all, you talk about oxytocin. Is oxytocin on or off or is it more a dimmer switch? Then also, you talk about how it lasts three to five minutes. Do we need to be doing oxytocin stimulating things all the time? What is the role of oxytocin?

Cynthia Thurlow: Yeah. 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. It can create this amazing bonding experience. It's why hugging your pets, I'm laughing, because one of my dogs is walking over to get his back scratched right now. But it's 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, you can get it from rubbing your dog. But it also contributes to staying full and having satiety. I remind people there's more to this hormone. We think of it as the mother hormone. It's the hormone that begets all other hormones. How critically important it is to nourish it. 

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, it can be super helpful, but it doesn't necessarily have to involve you being around other people. 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. But if you love to garden, if you love to get out in nature, if getting on a bicycle or exercising brings you joy, there're other ways that we can stimulate this hormone. But it's really important to understand that it is critically important for staying full. We have receptors all placed in our body. In our brain, in our uterus, in our placenta, our ovaries. Our body's constantly taking in information from the outside and deciding like, "Are we nourishing our bodies or are we depleting our bodies?" So, this is a poorly understood, [laughs] poorly appreciated hormone, but one that I think is so, so important.

Melanie Avalon: 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, so cool. Yeah, again, listeners, all of the hormones are in the book. Some more fasting related questions. I love to touch on a few of the things that I feel 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. Okay. I just laugh about this question, because it's such a question on the other podcast. But as far as, what breaks the fast, what are your thoughts on what breaks fast and the idea of clean fasting? Then, 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, so, 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. Branched chain amino acids, flavored electrolytes, I think about the fact that when you-- This is just my personal feeling. We know that dairy products are insulinemic. 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? 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. [laughs] Those things can certainly add up fats. But I think about bone broth. I think about distinguishing between protein. We know will break a fast. Being really clear about the fact that anything that is going to stimulate an insulin response. I know I was laughing a couple days ago, I was watching something on YouTube, and the concept is cephalic phase insulin response, which I know you all talk about as well, and 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 10 minutes. 

When people think it's no big deal to smell like grandmother'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. But 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 Gin. It's bitter teas, bitter meaning bitter, not meant to be sweet, plain coffee, filtered water, I think are absolutely fine, unflavored electrolytes are absolutely fine. But the things that will break our fast or the things that are construed as food and so 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, [giggles] they're always frustrated. I'm like, "Well, I guess, you could chew on some fennel, but technically, your body's going to think food is coming." But I think it's important for people to understand there are things that can amplify a fast, things that can be beneficial. I dove deep into the research on this. 

Things like-- think about chaga, 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 sure you've interviewed him on the podcast before. Sulforaphane, so like broccoli sprouts, there's just a potentiate autophagy, which is that waste and recycling process in the body, turmeric and ginger, so things that they're certainly not sweet. But based on research can potentiate autophagy. There're also other things that can potentially eat 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 podcasts who feel differently. You can have fiber, and you can have all the fat you want, and yes, maybe fat is 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 and do some women 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 mycotoxins. 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 and may not even be the coffee per se, maybe it's the mycotoxin. Really getting granular if they really, 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, [laughs] 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 stressor your body's just saying timeout, 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, or bitter tea that might work better for you, or take a break entirely to see how your 'n' of 1. I would 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: 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, so important. The hormone, DHEA, so 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 that did not go well. Then since then I supplement it with something called 7-keto-DHEA. I was wondering what your thoughts are on DHEA?

Cynthia Thurlow: Yeah, no, I think for and 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, DHEA is another very important hormone. Downstream net effect is DHEA will cleave off and create testosterone and androgen metabolites, but it's also just to work in conjunction with cortisol, just to balance one another out. But 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 be have gone poof. I think supplementation is reasonable. 7-keto-DHEA, I have used and 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. Is it going to aromatize to estrogen or is your body going to use it to feel 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. I think for a lot of people, especially as they're getting closer to 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. I don't think I've seen enough research to suggest that they should be supplementing with 100 milligrams of DHEA. I generally start pretty low, because for some people, it's very stimulating. I take DHEA as does my husband. In oftentimes, it can be helpful for priming the pumps. As our bodies are making less of these hormones, as we're getting closer to menopause and andropause, it can be beneficial to help replete them. But 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 and supplements can be so beneficial on so many levels. Obviously, I talk about them in the book, but the real foundational approaches to health are 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 sleepiest. 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're saying, starting intermittent fasting, and 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, and 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's going to perceive. It's like 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, what's their hormone balance like? I'm over simplifying of course, there's far more to it than that. But I know when my sleep is bad, I'm obsessed with my Oura Ring, and 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 does. Same thing if I have a crappy night asleep. My REM and my deep sleep are down, I'm like, "Oh." 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. I'm not sure that I would have thought necessarily, it was COVID. But my Oura Ring was like, "You're dying." Not really, but it gave me-- The scores were so fascinating. Then interestingly-- 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 is completely and of one and probably not helpful for anybody, but it's my experience of my sleep at night has been changing, and I don't really know what that means. Oh, another tangent, but 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. For listeners, he is the melatonin guy and he's all about high-dose melatonin. This is so funny, Cynthia. 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 and I take a lot of digestive enzymes. So, I counted the pills out. I think I took 15 melatonin the prior night.

Cynthia Thurlow: What was the amount that you took? 

Melanie Avalon: Maybe 20. 3 milligrams. It probably ended up being-- Yeah, somewhere, it might have been 60 milligrams of melatonin. 

Cynthia Thurlow: But you know what's funny is that, I've completely nerded out on sleep and melatonin in the last two months. I'm so glad you're asking me about this, because now it's bleeding into my work with 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, and I started with the consent of my integrative medicine doc, started doing high-dose melatonin and his feeling was, "Let's do this to replenish because after the age of 40, we don't make as much." I was doing 80 milligrams every night and I went from having good sleep to great sleep every night. My REM and deep sleep were doubled. It was unbelievable. I'm doing all the other things. Then I got the SandMan.

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

Cynthia Thurlow: Oh, my God. Yeah, so, if you can get beyond putting it in your rectum, because my whole family, I don't tell my whole family, but it's only my husband and he was like, "I don't even want to know, don't even tell me." But here's the thing. It's a very, very vascular part of your body. It's actually a really good place to-- As an ER nurse, we used to put a lot of things, medications in the rectum. You have to put in the rectum, but 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. But 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, very helpful for healing COVID, but it's one of those things like, I was trying to explain to someone that we think of melatonin just as a hormone. 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. But the antioxidant net impact of melatonin impacts every part of our bodies. 

We've got clocks, these superchiasmatic 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 and so having melatonin in healthy doses 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 onboard, I forget it's 100 or 200 milligrams of melatonin. But I did 18 milligrams and 12, now, I'm down to six every night, and it's almost 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] Yeah, 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. I do colonics, I do coffee enemas, I don't know why I can't do the suppository.

Cynthia Thurlow: Well, it's funny, I had to laugh. There's a woman on my team who's another advanced practice nurse. 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, and 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 not a big deal. But the net impact-- I think the other thing is, it's also expensive. Let me be clear, like, I'm not using this every night. I'm using it 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. I'm probably going to text him after this and say that we 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 [laughs], CBD suppository I just got in the mail. Do you take CBD? Do you use it?

Cynthia Thurlow: Not regularly. 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. Now, that has all slowed down. I think for me, I initially used it for sleep, but then I started feeling there were other supplements that for me personally were more beneficial, so I let that go. The whole physiology behind, I think CBD it's a good quality product, which I'm sure you received in the mail, it's all fascinating, but I just found other things that are more beneficial for me for sleep or if I want an antianxiety 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 in 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, but this company that reached out for ya, because I literally get approached by CBD companies, probably weekly. It's crazy. But they reached out and this relates actually to everything worth 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. 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. That is the perimenopause, transition to menopause. Do all women go through perimenopause? I didn't realize, for example that there're five phases. I learned that in your book. 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 as a 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. Does everyone go through perimenopause? Yes, if they live long enough. Hopefully, people, everyone listening is going to live long enough to go into perimenopause. But for some people, it could be five to 10 years preceding menopause. I think 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 get away with a lot. 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 had a super stressful job. 40 was definitely a leveling the playing field. If you are not overexercising, you've got an anti-inflammatory diet, you have a job you that brings you tremendous joy, you have great relationships, you're getting good quality sleep, you're not overexercising, 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. So, it can be a very stressful time period. But 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 perceive it as 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 they 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 in 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 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've got very heavy crime scene periods as I affectionately used to refer to them. So, that can be the beginning stages. But a lot of the rest of it can be very bio individual. But 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. 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 the perfect storm. It's really just cruel. I look at my teenagers, and they're hitting puberty, and mine was starting to peter off. So, the lens with which I look at perimenopause as a transitional point is that women do have control over a lot of things. That's always that reframe. What do you have control over it? It goes back to those pillars that I've talked about throughout our conversation and in my book, Intermittent Fasting Transformation is really honoring sleep quality, stress management, anti-inflammatory, nutrition, not overexercising, 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. But 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 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 is really 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 and 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?" And I just say, "Hey, it's part of life. 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 it's 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 and you talked about how to reframe them. But actually, you would need the knowledge in order to properly reframe them, especially when it comes to concerns surrounding fasting. It's unsafe, or I'll be hungry, or and 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 never heard of that before, that concept. It's the perfect solution for people like me and a lot of listeners, who might be perfectionist. 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 groan to hear their mother saying that ad nauseam. But I really do think that whatever challenges were 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 when through adversity comes opportunity, which my kids hear all the time. But even if you're having a crappy day, 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 pollyannish. 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 a Good, Better, Best, especially 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. 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 reformed people pleaser and I'm a reformed perfectionist. So, I say this from the heart is giving myself grace. 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 acknowledgement of looking at the good in your life, reframing things, expressing gratitude, understanding 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'm fixated on one thing or another and I was saying to my husband just being in my car, because every woman that's listening probably spends too much time in their cars. But 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 learning something new can create more synapsis. This concept of neuroplasticity, how critically important it is for us as women to make sure we've got a healthy dialogue in our brains, because what wires together fires together, and I tell people all the time that your thoughts become your actions. 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 mouth. But your brain hears everything that you're thinking. So, 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 last two years have taught us a lot and I think at many levels really were to celebrate that we're making it on the other side. We're all better for these past years what we've been through, and just really acknowledging that creating a practice of proper mindset is something you work on every day. It's not I wake up every day and I'm thinking everything's 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." But 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, so important and I love how you're talking about trying new things and learning new things. Perhaps, my favorite benefit about intermittent fasting, it's 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, and it opens 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, 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. So, I asked you it last time, but I will ask you it again, and it relates to everything that we were just talking about. But what is something that you're grateful for?

Cynthia Thurlow: Oh, 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. In so many levels, Melanie has added so much to my own podcasting journey, and my own perspectives on life, and right now I'm grateful for your friendship, Melanie. So, thank you for that.

Melanie Avalon: Oh, I am so grateful as well. [giggles] I 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. I'm just like, "I'm just so grateful for Cynthia." Yeah, this has been so, so wonderful and I'm really excited, because normally, I record the episodes and then they air months from now, but we're going to time this around your book release. Listeners get to hear it sooner rather than later. I'm so excited. During this whole conversation, I've just been thinking wow, like, listeners are going to love this. So, 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.

Cynthia Thurlow: Thank you, my friend. It's been a pleasure. 

Melanie Avalon: All right. I will talk to you later.1