The Melanie Avalon Biohacking Podcast Episode #166 - Megan Ramos

TRANSCRIPT

Melanie Avalon: Hi, friends, welcome back to the show. I am so incredibly excited about the conversation that I'm about to have. I'm always really excited on this show when I get to interview somebody that I've been following for so, so long, and especially when they had a pivotal role in my own personal journey. As you guys know, I am a huge fan of intermittent fasting. I also cohost the Intermittent Fasting Podcast with Cynthia Thurlow. And way back in the day, because I've been doing that for so long but there were really a few key figures that I followed to learn more about the intermittent fasting lifestyle. One of the first people that I followed was Dr. Jason Fung, who I've also had on the show, actually not for an episode on fasting, it was for his book about cancer, which was fascinating. I'll put a link to that in the show notes. He did a lot of work with the fabulous Megan Ramos. They had a podcast together back in the day that I used to listen to you. I've been following Megan's work for just so, so long. 

She is actually the co-author with Jason on a book that came out in April 2020 called, Life in the Fasting Lane: How to Make Intermittent Fasting a Lifestyle—and Reap the Benefits of Weight Loss and Better Health. That book was equally fabulous and amazing. I really, really wanted to interview Megan, and it was hoping it would manifest someday. And then our mutual friend Cynthia Thurlow, offered to connect me to Megan. Actually Megan, Cynthia, told me that her interview with you, I think has been one of her most popular episodes of like all time, which is incredible. I was so excited to be connected and to have her here now for this conversation. So, this is going to be great. Megan, thank you so much for being here.

Megan Ramos: Thanks so much for having me on, Melanie. I appreciate that intro.

Melanie Avalon: I love your book, Life in the Fasting Lane, which I should mention is a New York Times bestseller. You share a lot about your personal story in that book. A lot of listeners are probably pretty familiar with you but for those who are not, could you tell them a little bit about your personal journey? You have a really interesting experience with your own weight history, which might be a little bit different than some people's normal weight history journeys. And how you came to meet Jason, I'm super curious and doing what you're doing now. What led you to this?

Megan Ramos: Yeah. It's so funny, because I grew up an insanely private person and from an insanely private family. And now I share all this information about myself and my family to the masses. But I learned that I needed to because I was really young when I went through a lot of my health struggles, whereas a lot of the community that I served in the medical field are much older, and they did understand how I could relate to them. I said, "I might not have the years under my belt, but I have had just as many trials and tribulations." As people 20, 30, 40 years older than me and I'm sitting here in front of you today happy and healthy and fit looking because I'm the light at the end of the tunnel. So even though, I'm much younger than you, there's hope because I started off exactly where you are regardless of how much older you are than me. 

My interest in preventative medicine started really young. My mom's got all these weird conditions like Neurofibromatosis type 2, she had Cushing's, now she has Addison's. I grew up in hospitals because of my mom and just really was able to recognize from middle school. They were just treating all of her symptoms. No one was actually trying to help her out with her disease or the root cause of her conditions. When I was 15, I decided I want to go into medicine and some field but I really want to be all about preventative medicine. Ironically, my dad had a very good friends who was director of this large nephrology, so large kidney disease program. They're actually the largest clinical medical research department of any kind in North America. And it was just half an hour away from our home. 

Very ironically, his friend had two kids who both wanted to go to law school and be lawyers and had also decided that the same time I decided I wanted to go into preventive medicine, so my dad arranged with his friends to do a kid swap. The friend's kids went to work at my dad's law firm and I went to work at this kidney program in the Scarborough area of Toronto. I was 15, and I was assigned to work with a young new nephrologist who had just join the group, he is fresh out of his fellowship and when nephrologist join that group, they had to do several research projects to sort of in doctorate them and to the community. I was a student assigned to this very young doctor named Jason Fung. I was 15, I just turned 38, a couple of weeks ago. So, we have a very long history of working together. 

Yeah, I love the focus on preventative medicine there. And I just stuck it out there for all my education and everything. And then I went to lead several studies there, after I was done with school. But we were doing all of the traditional things. If you follow the Canadian food guideline, calories in, calories out, eat a dozen times a day now, don't go two seconds without eating kind of advice. Like we were giving all of this lifestyle advice. And it broke my heart because we had one study, where we had 2800 patients sign up, who had very, very mild kidney disease, and over 38% died before the study was over within three years from severe kidney disease. I thought, "My goodness. Everything we do, it seems like we're slowing up the progression of their disease, not slowing it down. We should almost be doing the opposite of everything that we do." And I became just really frazzled. I'm like, "Oh, maybe I should have gone into law because I wouldn't have these emotional attachment, that you get to these patients." I mean, dialysis patients you see three times a week, they're there for four to six hours at a time. They become your family, study patients are coming in all the time for bloodwork, they become family. And it's just heartbreaking because these people were literally passing away every day, it was bad news. I wasn't quite sure what I was going to do with my life but one thing I knew is, I needed to take my own health more seriously. 

I was 12 and I when diagnosed with fatty liver, and 14 when I was diagnosed with polycystic ovary syndrome. For some reason, my BMI was always classified as underweight, and the doctors all told my parents not to stress, I would grow out of it. It didn't make sense that I had diseases of obesity when I wasn't obese, so it's just kind of some fluke. I remember a doctor at The Hospital for Sick Kids in Toronto, was a famous hospital saying this to my mom, "It's just a fluke. She will grow out of it, don’t change anything. She'll be fine." In retrospect now, I know I had a very awful body composition. I was not strong. I used to break my bones all the time. I would be more tired and fatigued and things like gym class and sports than any of my friends. I wasn't very strong, PE class was not my best subject, whereas I could rock the calculus and the biology classroom. It was challenging from that aspect. 

I was just little, I was what we call TOFI, thin on the outside but fat on the inside. So, I went undiagnosed with real metabolic syndrome for a very long time. So here I'm in my mid-20s, my heart is broken over all these patients dying. Jason's approaching 40, his heart's broken over-- he's like, "All these people, they just have diabetes. As a kidney doctor, the diabetes is killing the kidneys, and there's not a damn thing I can do to help the kidneys. I just monitor them till I give them the bad news, that they need to go on the transplant list or get dialysis, or both." 

We're both heartbroken and I thought, "Okay, Megan, you got this terrible family history. Maybe if you start implementing these interventions that you're giving these patients of yours, you start implementing them now, younger, at 26 years old, you'll have a better outcome than these patients." Well, I didn't. Just like our patients, I had a rapid decline. And in a year, I had gained over 60 pounds. I just before my 27th birthday was diagnosed with diabetes, mind you, it was kind of borderline, it was 6.4%. But I got the same spiel for my primary care. "You've got three months to lose some weight and bring this down. I'm going to put you on Metformin and we're going to have to talk about insulin," and blah, blah, blah, like all of the conversation that I dread from watching people die from diabetes all around me as a career. 

Jason and I were kind of going through our own little upheavals, while I was working on implementing all these dietary interventions that were leading to my demise, Jason was doing research. And a friend had talked to him about fasting. She has started fasting after divorce for spiritual reasons, but notice all of these health benefits. And Jason and I worked in the most diverse city in the world in the most diverse niche efficacity. We had patients that like 20% of our patients participated in Ramadan every year and it was always such a huge pain because we'd have to see them before Ramadan to adjust their medications because their blood pressure would go down, their blood sugars would go down, and then we'd have to see them again three weeks after Ramadan because their blood sugars and their blood pressures will be back up. So, this is a huge lightbulb conversation for Jason. And he went down the rabbit hole of fasting in religious practices because there's got to be more to it than spiritual beliefs if it's included in literally every religious practice.

Jason said to me, "You've got to fast, you've got to fast." I was a little overwhelmed. And then the next day, one of my colleagues came into our research facility, and she said, "Dr. Fung is going around saying that you can cure type 2 diabetes through starvation." And all of the research coordinators started to laugh, but Jason would say things out of the box here and there, but Jason was always right and they were always very simple ideas, and he was always right. This point, I'd worked with him for over a decade, and you knew to not take his words lightly. So, that same evening, I overheard him giving a talk to some of his patients about fasting, and I decided to sit in and watch. And everything just made sense. I went through a whole range of emotions, anger at professors, anger at the government, anger at my very intelligent parents who should have figured this all out, anger about all of the disease that had been building up in my body, and then I'm felt true empowerment, because I now know that I can fast and I can reverse my disease. 

So, the clinic had been giving Jason a really hard time, not letting him on a fast anybody because it was just crazy. He wanted to go after the insulin dependent diabetics and that's just crazy in mainstream medicine. But I wasn't a patient, and everybody had watched me get so sick, and then everybody got a chance to watch me get so much better. They couldn't stop me from fasting. They couldn't stop Jason from monitoring me. And then eventually, all of our colleagues said, "Please post your bloodwork, please share your updates, we want to know how much weight you've lost." "Oh, my God, you've come back to life." Then finally, the director of our program, he called me in one day, and he said, "Megan, this patient's got three months to lose 30 pounds or she's going to miss this opportunity she has for transplant. I'm waving the white flag. You and Jason take her and do what you need to do, so she can get this 30 pounds and her diabetes taking care of so she can get this transplant and that was it." I went on vacation for a couple weeks and I came back and we started our fasting clinic in office in Toronto. 

And then prior to COVID, just because of the boom and people out there really wanting to reverse their diabetes and the popularity of our books, we moved everything online. Jason and I cofounded our program The Fasting Method, so we do coaching, small group one-on-one, we have a community, we do bootcamps that we call Masterclasses. We're launching telemedicine later this year. So everything that you used to be able to get in our clinic in Toronto, you can now get online, and it's just been really crazy to see the boom and fasting since we started back in 2012.

Melanie Avalon: Wow. That was a riveting story. That is incredible. I'm super curious, you released the, Life in the Fasting Lane April 2020 at the beginning of the pandemic, how do you think that affected people being open to fasting? And I'm super curious if it affected book sales, the timing of that.

Megan Ramos: I'll tell you our publisher, who is Harper Wave and HarperCollins, they were not thrilled about the timing of the book release. I mean that book was literally constructed in a few months. We cleared a bunch of things to get that book out there. And it was really to help people lose weight before the summer and then it took on a whole new meaning with COVID coming into play earlier that year. I think initially, the book came out, I think the whole world shut down at some point in March for a few weeks. Then initially, I think a lot of people that supported Jason and I went out and purchase the book, and that's why it made the New York Times bestseller list. But then there was a dry spell. And then what we saw was in the fall, books sales really start to increase and this sort of coincided with what we were hearing from people. 

We saw March, April, most people in North America were locked down in some capacity. If you're in my native home of Toronto, and we were locked down for 2 years. I left at some point to San Francisco but it was a crazy time. And if you're in Canada, you heard the Canadian Dietetic Association telling you to eat no matter what when you were at home, and that it was perfectly okay to comfort eat on cake and potato chips and all of the stuff because it was better to eat than to not eat. That's literally what the Canadian Dietetic Association, that was advice they're giving. I think all of these people, they didn't know their businesses, their careers their jobs, there's all of this stuff looming. The media was just nuts, wasn't helping and then you're hearing from these organizations like, "Eat coffee cake all hours of the day because it's better than not eating if you're feeling pressured or overwhelmed."

We saw a lot of people just not prioritize their health, and then COVID lock downs of whatnot, and then they weren't going away, or they were being radically reversed after a few weeks. So, what we saw was a lot of people in the fall start to say, "Well, what the hell? This is not ending anytime soon. And we've got to stop and we've got to undo this 30 pounds that we've gained since March." We saw a lot of interest then in fasting in September. And I mean, that was reflected in our book sales as well. But I actually think it was the perfect book at the perfect time. Many people who are listeners of this podcast, are familiar with all of Jason's writings. I'd say this is probably not his most technical book. And we definitely saw this in the Amazon reviews. There certainly wasn't as deep in the science as The Obesity Code, The Diabetes Code, The Cancer Code, The PCOS Plan. But this book whatever was intended to be, it was actually intended for a very new audience because we would have all these people come to us and say, "How do I gently get my sister, my cousin, my aunt, my brother to start doing this?" 

Our friend Eve had this really interesting emotional journey with weight loss. She tried all of these crazy things and then that resulted in a whole bunch of failures and hundreds of thousands of dollars spent until she reluctantly tried fasting and it was kind of a miracle for her. She went through divorces over her weight, she went through all kinds of trauma, she was on Forbes top 10 list of females in marketing and she'd be ridiculed on stage with the likes of Gary Vee, because of her weight and her appearance. There is this really emotional aspect that Jason and I wanted to share because there're so many people out there just pointing fingers, and just ridiculing people for their weight, it's a behavioral issue. Sure there's behavioral components to it, but we're giving everybody such bad advice, and then we're punishing them and belittling them for the bad advice that they're being given. 

We really felt for people with the emotional aspect of it. It's like a younger woman, I feel all kinds of pressure to be a size two and to look a certain way all the time. I couldn't imagine going through a life of what Eve did, but I would see it time and time again with the patients, and I had my own little taste of that, too. So, we wanted to share Eve's story to let people know that they're not the only one's that spouses are turning off the light at night, because they don't want to see them naked because they're overweight. All these things that she shares in the book. People don't talk about that. They just suffer in silence with the trauma of that. Then we wanted to explain why all of these different dietary interventions she used along the way didn't work, and why fasting did work, and then how you could fast and how you could fit it because you can really fit it into any lifestyle. There's an infinite number of ways you can fast and still get results. 

I thought that that the book ended up having kind of an ironic timing, because there was a lot of people losing their health insurance. There are a lot of people that were just desperate to lose weight that they had gain at the start of COVID and they didn't know where to start. There's a lot of emotions going on just because of the state of the world at the time too and everything became heightened. I say, "Here's this woman that I can really relate to and now I understand why all these things didn't work. Now, hey, I have this tool that could help me lose 30 pounds that I gained during this lockdown and the 30 pounds I had gained before that, 30 pounds I never lost after giving birth." I thought it was interesting timing for sure. So, it's not deep, deep in the science but it's really explains the emotional side why things and the traditional means of weight loss don't work and why fasting does and what you can do about it.

Melanie Avalon: I thought it was great because I mean it's what people need as far as being super approachable and touching all these topics that I think are so important. That was actually one of the most eye-opening parts of the book was something you just touched on. Now, with the role of weight stigma and gender and society, and you talked about how women tend to make more if they weigh less, and men have higher salaries if they make more, which is just pretty shocking and a big issue. Okay, I have so many questions. 

Going back to your own journey and your experience, I was mentioning how you had a sort of different weight experience and what I was hinting at was what you talked about with being underweight and having metabolic syndrome which eventually you did gain weight. I'm super curious, first of all, this concept of metabolic syndrome in people who don't look like it, who are not overweight. Why does that happen with the fat cells and everything. The second part of the question is, you did end up gaining weight. I'm super curious was that a tipping point situation? Does the body hit a point where it finally decides to start making new fat cells to deal with the metabolic syndrome or had you significantly changed your diet when that happened?

Megan Ramos: Yeah. I grew up with a really sick mom and very privileged home. So even if there was a home cooked meal, if I didn't like it, I could order pizza. Then when mom was sick, it was eat whatever junk you want. I was 30 years old the first time I ate broccoli. Just to help listeners, put that into perspective. Like you said, and I mentioned I was very thin, I was classified as underweight by BMI, which just takes the number on the scale, that's your weight, and puts it in the ratio of your height and punches out this calculation that determines whether you're obese or not, and find that underweight. But there's this whole concept of weight and then body composition. When you stand on the scale, it tells you your total weight. So that includes things like fat mass, water mass, bone mass, muscle mass, but it doesn't tell you how much of each of those things that you weigh. 

So, it's kind of funny, in my adulthood, I have been 97 pounds, and I had been morbidly obese, because I had brittle bones, and I had not very much muscle. When I stood on that scale, and it shone back to me 97 pounds, I stand up 5'3", so 97 pounds, I was mostly fat. I was tired, I was unhealthy, I had fatty liver, PCOS issues then. Today, I stand at 120 pounds, but I'm actually not obese at all. I'm much less obese than I was at 97 pounds, because I have stronger bones, I have a lot more less muscle mass, and I have a lot less fat. And muscles a lot more dense than body fat and bones, obviously a lot more dense than body fat. It's really about body composition, so that scale can be very, very tricky. So, we see these individuals, and they look slender, and they may be healthier, they may be unhealthy, we've really got to know their body composition. But a lot of the times if they're unhealthy, and this is going to start to show up in their lab work pretty quickly. 

It's important to understand, we have different types of fat in the body and genetics can sometimes play a role as to where that fat is stored, but for simplicity purposes, let's say we have visceral fat, and we have subcutaneous fat. Subcutaneous fat lies underneath the skin, but above the abdominal cavity. So inside, you have all of your organs and glands and intestines and everything. And then you've got this shield, if you want to think of it as like a shield from a superhero type of movie, and that's called your abdominal cavity. Then there's this space between your abdominal cavity and your skin that covers your belly. And subcutaneous fat primarily lives outside of that shield between the skin and the shield. It's separated from your organs by the shield, by the abdominal cavity. So, it's not able to infiltrate them and cause issues with them. It just sits there, and this is the fat that we don't necessarily like when we're at the beach and we're trying to wear a bikini or are trying to fit into a tiny dress or a nice suit. We don't like this fat because it's what society has typically labeled as unsexy and we associate this type of fat to be the fat that comes with disease. 

Well, yes, you can accumulate it, accumulate it and put enough strain on the body, it can lead to disease and to problems. But what's actually more dangerous is the visceral fat, not the subcutaneous fat. The visceral fat, that's the fat that's underneath that abdominal cavity. Meaning, that it can infiltrate inside your organs and wrap around your glands and your organs, it's like putting headphones on your organs, because it prevents them from being able to hear signals that are being sent from other organs and other glands to use certain functions in the body, or will just so infiltrate them with fat that they're unable to function properly. Something that we all very commonly hear about these days is nonalcoholic fatty liver disease. When you have an ultrasound done or CT scan done that diagnosis this, you'll see phrases like mild, moderate and severe fatty liver infiltration. So that's just how much of the liver, the gland has been infiltrated by fat. We'll see things like this happen with pancreatic function. So, we'll actually see tons of fatty pancreas now on CT scans and ultrasounds and that was really wild because I've been looking at these results since I was 15, never. And then when I was like 26-27, I started to see these coming up on ultrasound and CT scan results. Then I saw a fatty spleen ones, and I'm like, "What the heck is a fatty spleen?" And I'm calling radiology. I'm like, "There's a typo here, this is a big typo," and it's not. So, you get this infiltration, and then that really disrupts organ and gland functioning and communication that leads to a lot of diseases and causes a ton of inflammation in the body as a result, so this is really scary. These people are usually walking around thinking that they could afford to eat an extra cheeseburger because they don't have a lot of the subcutaneous fat. So, they're what we call thin on the outside, fat on the inside. We hear from these people all the time. We're a type 2 diabetic, we're not type 1 but we don't understand. 

We had this one patient came in. She was very petite, she was 4'10" and she was like 80-89 pounds, but she was all fat. By body composition standard she was morbidly obese. I mean, the idea was not to make her 50 pounds, and when I was 97 pounds is not to make me 50 pounds, but it's to make sure that you've got a healthy body composition by shifting the ratios around less fat and more lean mass, more bone and muscle mass. That's why 120 pounds, I'm size two and I'm less obesity when I was at 97 pounds. I wore a bigger size at 97 pounds because I had more fat mass. Body composition and body fat, it's kind of a finicky thing. Sometimes genetics plays a role in where you gain the spot, sometimes you'll see families where everybody's very slender, but they will have type 2 diabetes and metabolic syndrome, when you'll see families that are all very perhaps overweight, because they have a lot of subcutaneous fat, but they don't have heart disease, they don't have type 2 diabetes. And then you're really kind of unfortunate if you get a mixture of both the visceral and the subcutaneous fat, because that visible fat, they really feel awful about themselves, because society is just set us up to feel that we must fit a perfect box all of the time. So, there's these different types of fat and they can sort of manifests in different ways but it's actually those atrophies, they're at the highest risk for serious cardiovascular complications, serious diabetic complications, so they're the ones that really need to focus on adjusting their body composition the most.

Melanie Avalon: This is just so, so fascinating. And is this often the case in Asian populations, the reason that Asians are often thought to be thinner, but struggle with metabolic syndrome. 

Megan Ramos: It partially is. Then it's also some of the different food types that they go through and then the processing that has happened to those food types over the years. Now, if you go to a lot of Asian countries today, everything's been so westernized and so processed differently, that there is sort of just tons of visual obesity as well. Not necessarily atrophies, but it's a lot of visceral fat that we see and more of these slender populations with type 2 diabetes.

Melanie Avalon: Okay. I don't know if you've thought about this before, if you have any thoughts on this. I'm wondering when you work with patients in the clinic, do you experience this whole concept of body weight setpoints, and do you see people losing weight? Does it seem like their brain fights to maintain a certain body weight? And then the more granular question, the reason I thought of it is, so like that visceral fat versus that subcutaneous fat, do you think the body preferentially tries to maintain either of those, if you lose visceral fat, does the hypothalamus think, "Oh, we've got to replace that visceral fat compared to subcutaneous fat?" Does it have that response? I don't know if you've ever thought about that. I've never really thought about it until now.

Megan Ramos: We've actually found that the body really targets that first. Anyone who comes in with fatty liver disease, so you could say, 300 pounds over your desired weight. We're talking in need of serious weight loss and have fatty liver disease, and I can reverse depending on how committed you are. Say you're moderately committed; you're going to do 80% of what I say. You're not going to do 100% all the time, but 70% to 80%, other time you're going to listen to what I say in terms of nutrition and fasting. Well, in three to four months, you can totally eliminate fatty liver disease. I was diagnosed when I was 12 and I distinctly remember them telling my parents I grew out of it because I was old enough to know that this was serious and that my liver was important. I paid attention, and it never got better. My ALT, my enzymes, they weren't wild, they weren't terrible, but they were not good. And all my ultrasounds and CT scans on follow up never got worse, they never got better. As I got older, I just naturally started fasting all the time, but I just ate like garbage when I did eat. 

There'd be days with exams where I would do one meal a day, but it would be an entire Domino's pizza so it wasn't-- I was counteracting some of it with fasting. But I was not giving myself enough space to get better during those times. If people really sort of commit, like I was 12, and in less than 6 months I had totally reversed that fatty liver disease that I could never reverse. Someone who's 300 pounds overweight with metabolic disease, you can reverse your fatty liver in three to four months. You don't even need to do crazy fasting to do that. You can just follow 24 hour 3 times a week protocol, make some changes to your diet, and voila, like your fatty livers, even moderate to severe fatty liver can be reversed in that time. 

We found the body when in a fasted state generally prefers to start eliminating that. I mean, our bodies aren't always our friend, if it was [chuckles] there weren't the autoimmune conditions. But in general, our body sometimes it does these things to help us out. And when we're fasting really targeting that visceral fat, so like we'll see fatty pancreas improve very quickly to when someone starts to fast. I've only seen a couple of fatty spleen but we've seen a ton of things like fatty pancreas, and that stuff all clears up quite quickly when someone starts to fast, so we know that the fasting is really targeting that visceral fat, and so it's going for the most disease fat first and sort of getting rid of it. The subcutaneous fat and other fat, I mean, cortisol can play a role in estrogen dominance and other hormonal, sex hormonal imbalances can sometimes make that a little bit more challenging to lose. But it really does seem with our therapeutic protocols that we do that the fasting makes a dramatic dent in that visceral fat right off the bat.

Melanie Avalon: Wow. Okay, so it sounds like to answer that question that perhaps the hypothalamus does not try to automatically replace the visceral fat, compared to subcutaneous which people aesthetically might want to lose, the body might be a little bit more resistant to burning that. That's very interesting. Super curious, so when you have fatty liver, how much actual fat is that or fatty spleen or fatty pancreas, is there a pound of fat in the liver or how much can it be? 

Megan Ramos: Well, everyone's livers can vary in size, and even a mild amount of fat in the liver, that's even just a couple of ounces can cause a lot of disruption. I think if you're to have all full pounds of fat in the liver, it would cause a tremendous amount of disruption. There probably be a lot of cirrhosis at that point but I'm not quite sure how to exactly quantify that. 

Melanie Avalon: Okay. I've always wondered that. I was just super curious. Some other questions. So, markers, I've wondered this for so long, because I would listen to your work and doctor Fung's work and you guys always talk about the clinic. I have a very vague picture of what that looks like, so what is it like actually working with these patients? How often do you see them? What bloodwork do you do? Do you coach them? What is that whole experience like?

Megan Ramos: We're all online now. Our online models, the exact same that it was in clinic online just enables us to have a broader reach. We had a three year wait less than clinic, but we're confined by clinic space and hours and insurance coverage and stuff like that. It's now online. It's a little bit different than going to the doctor's office, but it still functions the same. So typically, if someone was to sort of engage in all aspects of the practice, if they're an insulin dependent diabetic for about three months, they're going to be seen weekly by their doctor, and weekly by their health coach. When someone is a diabetic on oral medications only, they're seen every two weeks by the doctor until they're off of those medications. And they're also seen every two weeks, week to two weeks by their health coach depending on how much support that they need. If someone is looking for weight loss only, then they're typically seen by the telemedicine docs once a month. And then their amount of engagement with their health coach can vary from weekly to biweekly. 

The health coaches are there, the doctors in general make a prescribed fasting and nutritional recommendation and the health coaches are there to help the individuals optimize that. Say, Dr. Li or Dr. Pateguana, or if someone's working with me, and I want the client to do a combination of three 24 to 42-hour fasts a week, which is not totally uncommon, that we want a client to work our way up to. The health coach would then help the client work their way up to that. So, it might be starting off with 14-hour fast daily, and slowly working to 24s and mixing in some longer fasts. And then the health coach helps troubleshoot the different side effects that they're having. And then the telemedicine doc helps troubleshoot medical side effects. So medical side effects could be someone has a gout flare-up when they start fasting, for example, that would have to be managed through medications. So, they kind of split the duties on helping to manage the side effects.

Then we offer group support as well, because not many people in our communities are actually doing this. With COVID, it being stuck at home a little bit more, because I was in Toronto, for the first year of the pandemic. My unit was my husband and I, and we eat the same. Then we relocated to California, during COVID and a lot of our friends out here are very real food oriented. They all work in Silicon Valley and they all do TRE and try to do a 24-hour fast once a week so it was really cool. Then recently, I had a birthday, I've been going through some stuff this year, and a bunch of my friends thought it would be great to fly down from Toronto. I haven't really lived life with these people since 2019, because of COVID and our move. And I just couldn't believe the way that they ate. It's just mind boggling to me. I found myself reaching out to my team, because it was tough to watch people I care about eating certain way, don't want to be preachy, you want your friends to enjoy their time with you, but you want to find a balance between helping them and leading by example. And then certain restaurants that was just total garbage, like fast food, where they wanted to stop. It was just difficult. 

We do a lot of these large group supports on various topics, from diabetic, to women and weight loss, to people doing extended fasts, to different dietary approaches. I truly don't necessarily agree with any one whole approach as long as there's a real food base. I've seen carnivore radically changed somebody's life, and I've seen carnivore not necessarily be the best dietary choice for some individual. Then there's someone like me who I would love to thrive off of it. I love to just be a carnivore, but it does not work for me or my hormones very, very well. I am through nutrigenomics testing and just knowing common sense by how I respond to foods, still love my animal protein and my animal foods, but they're not the dominant part of my diet. 

We offer all these different supports for these different types of dietary protocols. There's a lot of support group engagement, we do challenges so people can do it together. I mean, I've always found this to be really cool in my household. My husband and I are doing a unique protocol right now. And it's just so cool to be able to have someone that's doing the same thing to be able to check in with, so you wanted to make sure that our people that are going through this had those options too, where they didn't have to be doing this alone, because they didn't have the good fortune of their household doing it with them as well.

Melanie Avalon: First of all, happy late birthday. This is something I think about a lot, which is I when it comes to diet and other people, I really don't want to try to convince anybody to do anything. I just want people to live their lives but it is hard, especially when you see like you mentioned friends and family engaging in eating habits that you know are probably just having really detrimental effect on their health. And then the thing that really gets to me, that makes me sad is like all of these Instagram and social media of moms with their young kids and making all of these desserts and treats and everything. And I'm just like, "Ah," because if at least if you're an adult, you're making the choices, but when we're young kids, we're eating what we're fed. I think there's a big issue there in society, and I don't really know what the answer is.

Megan Ramos: That's really tough. This morning, actually, I saw from the [unintelligible [00:39:57] from home, and her and her son were drinking this horrendous sugar icy concoction thing. I'm like, "Oh, my gosh, this kid has speech delay issues and learning delayed issues. What are you doing?" But it really makes it tough. The social relationships are really, really difficult. I think what the common friend that brought us together was Cynthia Thurlow. She's someone I've really been able to sort of lean on while. I've gone through some health stuff this year, because I knew she can get it. It's not even just for the information. It's just for that mutual understanding, because it can make it really difficult when people don't, and it's hard with kids, I think I noticed that I was a really private person until recently, until the pandemic, and we had life in the fasting link coming out. And I wanted people to read that book and not just think, I look 10 years younger than I am, those are the only good genes I inherited. But I know part of it's due to my lifestyle too, but I look younger than I am. And I look quite healthy and I want people to really take me seriously. I've walked in your shoes, I know what it's like, I'm not just some young healthy person making suggestions out of thin air. I've lived, I breathed this stuff personally, not just working with people. 

I started telling my story on social media and really opening up. I never wanted people to follow me on social media. I didn't even use my real name for most of my time on social media, but all of that changed in 2020, because I'm like, "This book can help a lot of people and I need people to understand that. I'm worthwhile listening to because I've been there," so I started sharing. Actually, it's amazing the number of friends that distanced themselves from me when I started doing that. And in conversations it was because feared judgment about how I would look at what they're doing with their kids and how they just don't know what to do. And they're not also too busy and too unwell to even really figure out what to do. So, it's very complicated, I think.

Melanie Avalon: That part makes me sad too. That second part, because that is the effect I would not want to have because I do want to be accepting and I would never-- it makes me really sad to think people would think if I'm judging them. So, it's just such a complicated line. When did you get married?

Megan Ramos: We got married in 2016. 

Melanie Avalon: Okay. You mentioned that even at the wedding, I want to make sure it was you, and not Eve. Didn’t use even like small plates at the wedding on purpose? 

Megan Ramos: It was a smaller wedding, we had small plates. We married at this Spanish tapas steakhouse. Everything, all of the plates and everything was a little bit on the tinier side of thing. But that's a strategy that we have too, because my husband will eat whatever's on his plate and this is something he picked up early on our relationship. And you realize that if he had a large plate, he'd eat everything, but if he had a smaller plate, he would eat everything and he'll still be satisfied. So, the objective of finishing his plate and clearing it is what satisfied him. He realized he didn't need as much food. So having small plates and doing that intentionally has been a big part of our relationship and celebrations that we have with people and purchasing choices at Crate & Barrel. [laughs] We need new dishes. But, yes, we had small plates and tapas and steak at our wedding.

Melanie Avalon: You mentioned something in the book about how, I think when you're talking to the wedding planner, or whoever it was, and they've never really been asked to have smaller plates at the wedding. I think it's so great. There's a lot of stuff in the book about just practical implementations you can make, because I'm all about optimizing your environment to be in your favor. So, for your husband, so does he do fasting with you at all? Or what is that like?

Megan Ramos: It's so funny. I met my husband at an engagement party in Orlando. I was living in Toronto, and he was living in San Francisco. And then he was just very persistent. So next thing I knew I was in a long-distance relationship, and then the next thing I was engaged because the long-distance relationship was nuts. We got married a year after our first date. 13 months after our first date, rather. So, everything happened pretty quickly. For the first few months of our relationship, I only saw him like every other week. I would go to San Francisco, he come to Toronto. I didn't have clinics Thursday afternoon or Friday so. It made it more easy for me to come and as to be able to maintain a long-distance relationship, that and American Express travel points, [laughs] so we saw each other. It was pretty easy to kind of hide my fasting and my diet when we ate together. 

He did notice even on our first date that I didn't shy away from eating fatty foods, and he commented on that, that he thought it was pretty cool because I think he thought getting a serious female companion partner meant that he was going to have to say goodbye to butter. But he commented, and then finally, like things were happening. The Obesity Code, we were going through edits for that. It was good to come out. I said to him, "Okay, I need to explain to you more about what I also do for a living," because I was also doing nephrology still at that point too. I was kind of 50-50 split, because it wasn't really till The Obesity Code came out, things started to go absolutely insane and we suddenly had two, three years wait list. But my husband's a scientist, and he's also the youngest child, so I think the combination of both can make him a very rebellious person. 

He loved this idea right away off the cuff, without even looking at it that maybe things are wrong. He had struggled with weight after grad school and he just didn't think it should have been as difficult because he was doing all of the right things. He was just so quick to regain the weight. He went on our website and devoured our blog. Then I gave him an advanced copy of The Obesity Code. It wasn't the final edit but it was one we were allowed to circulate to certain people and that was it. He was like, "This makes perfect sense." So, his rebellious nature made him curious and his scientist, made it very easy for him to understand and he began implementing it. 

Actually, before we got married, he lost almost 40 pounds, which is very cool. He was able to lose that postgrad school weight that he had been struggling with. It was just really neat. We typically follow the same eating routine all of the time. Recently, we've been trying to conceive. He started working back in office and gained a little bit of weight, after sort of indulging and actually working with colleagues again in person, and just eating out a little bit too much. He's been doing more fasting than I have, but right now he's trying to gain some muscle mass after losing some weight. We're doing an interesting spin on the 24-hour protocol right now. Most people think of the 24- hour protocol as you would just fast from dinner last night to dinner tonight for approximately 24-hours. Today, the thick of your fasting day, you would skip breakfast and lunch, but because of him struggling a little bit with some things and my fertility journey and trying to get sort of the best of everything right now, because I'm recovering from some bizarre side effects of taking Berberine earlier this year in liver damage. So, I'm trying to do some fasting but get in a ton of micronutrients. 

So, we're doing this weird spin where we're eating two meals a day, but we're still getting in a 24-hour fast. So today is a breakfast and lunch day, mind you our breakfast is like two three hours after we wake up and he's gone to the gym already. So, breakfast and lunch, and tomorrow, we'll do lunch and dinner, then we'll do breakfast and lunch, and then lunch and dinner, and breakfast and lunch, and lunch and dinner. I'm still getting in all of the nutrients. I think now I need them more than ever after being so sick with acute liver failure for six weeks, so getting in all of those micronutrients, but still getting in some really therapeutic fasting time to boost my mitochondrial health and just to help with the recovery from the liver issues. That's the protocol. I haven't actually worked with a client before, and I was actually trying to help my husband out and try to figure out his weight training. 

You get to a point sometimes in maintenance we often see with people where they don't really eat but they don't really fast and it's not necessarily disordered, but the body ends up becoming a bit deficient. I have to tell his adrenals are getting pretty taxed. So, we're just trying to make sure he's getting an adequate protein with everything that he's doing, still getting in fasting, still getting in that human growth hormone that's going to help them gain lean mass too. This is a protocol we're trying. So, it's my husband's second week starting today. He did it last week, and it's my first week trying it out. So, we often sync up in our household on our plans.

Melanie Avalon: I was super curious about how you met him and how you handled all of that with your eating because I was wondering if it was going to be similar to me because I just find it so funny that I've been doing intermittent fasting for so long. I have a top iTunes show called The Intermittent Fasting Podcast. And still, when I meet people, I am nervous about bringing it up, not as much as I used to be. It's like you have to ease in until they find out. They like find out what you do with your diet and lifestyle choices. So how long were you dating him before you gave him The Obesity Code galley?

Megan Ramos: It was our sixth date and we were about three and a half months in because we can see each other all the time. We have these three-to-four-day long dates periodically. This date, he said, "I don't expect you to move to California. I'm perfectly fine moving to Toronto. I know all of your family's there. You keep talking about this interesting side project that you're doing at the clinic." I had told him like, I don’t want to jinx it, I wasn't going to go into it too much. He said, "Obviously, you're really passionate to see where this goes and hopefully one day, we will talk about it a bit more. But I just feel that you should know that I'm really committed. And I don't want you to end this relationship because you don't want to move to San Francisco. I want you to know that I will move to Toronto." It's just so funny. I was like, "Well, about that side project I'm doing," and so I explained to him my health journey and our space with the clinic, and Jason's findings and what we started to do with patients. And it was so funny, because he's a medicinal chemist by trade and he was working at a pharmaceutical company on a drug for nonalcoholic fatty liver disease. They were getting shot down left, right and center. It was disastrous. There's no medicine pharmaceuticals out there for fatty liver disease. Everything dies in phase 1 or phase 2 trials. He had a different type of understanding of this process and he was just so uniquely intrigued. 

He grew up in a Puerto Rican household, and he grew up with an avocado tree in his backyard yard in Central Florida. I mean, he grew up eating things like tons of pork, and pork fat and avocados. They didn't have money growing up. It was a single mother household, his dad wasn't there, two young boys that she had to feed, so everything was home cooked, home cooked, home cooked. They didn't have the luxury that I did, of not liking what was for dinner and ordering pizza, Pizza Hut or Dominos or McDonald's. Those were not luxurious to them. So, in my husband side growing up, we were always super slender, very healthy but when he went off to grad school, and he had more money from grants and scholarships, and he started partaking, and late hen night and all of the beers of Eugene, Oregon, because that's where he went to grad school, he very easily started to pack on the pounds. 

He ate all of these healthy fats, he need half a dozen eggs for breakfast as a teenage boy growing up, but he wouldn't eat any of this junk, so he was really intrigued the whole insulin hypothesis and meal timing aspect of things. They didn't grow up with snack foods at home because they couldn't afford them. And then when he got into university and grad school, and started snacking all the time, the weight really started creeping up. So, a lot of this made sense, not just from his scientific standpoint or mind perspective, and may sound from his own personal experience with his weight gain journey too.

Melanie Avalon: Another question. You're currently working on the fertility treatment and everything for, hopefully, conceiving kids. We get so many questions about this on the Intermittent Fasting Podcast. Fasting and women there are so many misconceptions, we know, will it hurt fertility? Will it help fertility? How should you handle fertility? So, what have you found in the clinic and with yourself as far as fasting and females. Is it dangerous at all? Can women fast daily? So many, so much fear.

Megan Ramos: There's so many crazy things out there from so many people that have never fasted, women, in their life. And it's so bizarre what I read online. Yeah, we've worked with over 40,000 people worldwide at this point, with about 70% of them being females ranging in all different age groups. We have one colleague, Dr. Nadia Pateguana, she co-authored The PCOS Plan with Jason, and we joke she's our baby whisperer. And what we do when it comes to fertility and a lot of these younger woman with PCOS or even sort of middle-aged woman. I'm a middle-aged woman, my young husband had to do the math on that the other day [laughs] when I declare that, but that we're looking to conceive that had PCOS. We treat the PCOS first. With them, we do pretty advanced therapeutic fasting protocols. Three to 24 to 42 hour fasts a week or two 48 hour fasts a week. We'll do this for about six months, and we find-- even if a woman does have a bit of a regular period, that it will be irregular for about three, four months, but that's a good sign that it's working.

And then by about six months, everything starts to normalize, and then the PMS symptoms and everything are gone. For women who don't have a regular period, usually within about four to six months, they start to have a very regular predictable cycle. There's one young woman in the clinic, she's 21, your typical 21-year-old. She's a great young woman, we're still in touch. Her mom dragged her in. She's like, "My daughter doesn't want kids now. But she's going to want to have the option in 10 years from now. I don't want her stupidness [laughs] to haunt her at that point. I want her to have options. She hasn't had a period in two years." So, the mom left the room and the daughter said, "Listen, I work at McDonald's. I'm a college student. I live off of loans and government support. I'm not going out and buying a bunch of fancy food. I have to work 40 hours a week while going to school. So, I don't have time to cook fancy food or cook any food, and I get free food at work." I said "Okay, so we shook on a fasting protocol for her." And I wasn't going to bug her about her eating, but she could snack. 

On her eating day, she could only eat two 60-minute windows, 60 to 90 minute window, so that was it. She could eat say from 12:00 to 1:30 and say from 5:00 to 6:30, but she couldn't eat in between. And if she did this fasting protocol, I won't bug her about any food. Three months later, she had her first period. She's now in her mid-20s and we connect all the time. And she just turned 27. She's had regular periods since and now she's all into optimizing her diet, and it's really kind of evolved. And she's grateful for the choices that she's made. So, we do these more intensive protocols in women to fix the insulin issues. PCOS is largely insulin driven problem. We fix the insulin resistance and we fix the PCOS first with these women. 

Then once that issue has been rectified, then we focus more on meal timing and nutrient density with these women as they go into trying to conceive. So that's sort of our general approach, doing two 24-hour fast here and there's perfectly fine. Doing the longer odd fast or longer fast is also not going to be problematic but what was so funny years ago, there's a slew a woman that started having fraternal twins, after doing a longer fasts. And I just never really connected the dots and neither did Jason. Why would they start suddenly having twins? They have no family history of twins, always fraternal twins. And it just seemed bizarre. And we all figured, "Oh, there's got to be some family history of twins that they don't know about." We had no rhyme or reason for it. But now that I'm going through some fertility stuff because I've been having issues since the liver reaction to berberine earlier this year. We're just realizing I'm about to start my second round of IVF to make some embryos. And this time they're putting me on human growth hormone. And I didn't really put together the dots, so we got the email from the clinic of what my meds are going to be and then the email from the pharmacy with the costs. So, the human growth hormone, of course, is crazy expensive. 

My husband just turned to me and he's like, "Can you just do a five day fast? We can save $3,000 [laughs] here." I just started to laugh. I was like, for ovarian stimulation. So, I'm like all these women are doing five day fasts and producing all this human growth hormone and stimulating their ovaries at the right time in their cycle and they're producing multiple mature eggs. That's why they end up that we have all these like twins, the keto fasting community's kind of neat and put the dots together until my own experience with this now and my husband's quirky joke because he'd rather that money go towards his sportscar fund than the human growth hormone. It was kind of funny. Usually once the reverse the insulin issues and we just really focus on the nutrients. What we're dealing with, especially in the PCOS generation is we have a combination of women being extremely over nourished and malnourished at the same time. 

They're over nourished in the sense that they have tons of fat, tons of storage food fuel, but none of that fat or none of foods that they consumed that rise their insulin and cause the fat storage were nutrient dense. In fact, they're very nutrient depleting and causing other issues like leaky gut and gut dysbiosis and gastric issues like IBS that made it even more difficult to absorb whatever little nutrients were in those foods to start with. So, we've got these people that are over nourished in the sense of body fat, but undernourished in the sense that they have all of these nutrient deficiencies. So, micronutrients are so important for egg quality and just for fetal development, so what we'll do is we'll tackle the insulin, we'll do pretty aggressive fasting. And then once the PCOS issue is resolved, then we'll work more on meal timing and more on what their diet looks like and the micronutrients.

Melanie Avalon: I always assumed that twins was just a genetic thing or a chance thing, but there is literature on the actual number of eggs or the setup for the human growth hormone and how that correlates to twins.

Megan Ramos: Well. Not exactly from a fasting perspective, but it's a very commonly used medication when women are going under IVF treatments. The most common protocol is called the Antagonist Protocol, and that doesn't require a human growth hormone but usually for women 40 or older, that are looking to try to conceive-- the antagonist protocol works well for the younger PCOS women. So as the woman gets older, their ovaries need more stimulation. I know I'm coming out of the tail end of nearly dying from bloody berberine, and so my body-- I'm fighting with it to get healthy to want to conceive. So, my ovaries need a little bit of a kick in the butt because prior to my liver issue, I had tons of follicles all on my own without simulation. Then I had the liver issue and my body is struggling to recover a bit. So if you're in an issue where you have decreased ovarian reserves, your ovaries are a little bit sluggish to respond for various reasons, but usually for women it's just aging. They will give you human growth hormone to help stimulate your ovaries, so you produce more follicles and produce more mature follicles, so you're going to get more eggs. 

This is very common in IVF practices for women that are 40 and older, woman with low ovarian reserves to take human growth hormone as part of their protocol. So, like the one I'm referring to is the Lupron Microdose Flare Protocol and this one commonly uses human growth hormone for ovarian stimulation as part of it with the Lupron for ovarian stimulation. There's tons and infertility research that shows if you give a woman human growth hormone, you're going to stimulate their ovaries, they're going to produce more follicles, which will likely produce more eggs, and more eggs to be release. So, I'm taking or I'm about to start taking this on Thursday to help my body produce more mature eggs. When I do have my egg retrieval, I'll have 20-25 eggs for them to collect. 

When we look at fasting, we produce a ton of human growth hormone or fasting, 19 hours, 22 hours, 24 hours, 29 hours. There's a spike they get continues to go through these intermittent cycles of spiking for a solid 72 hours. And then even after that, it stays relatively high and stable and production. So, you get a woman that's doing a five day fast, I mean, it's taking human growth hormone injections for a week, like I'm about to start to do. It would definitely have an impact then on the ovary. So, just looking at regular research on infertility and IVF, there's tons of data to support the use of human growth hormones as a standard of care for simulating ovaries and increasing the number of eggs that are being produced each cycle. So, it's very interesting. I can never figure this out why. There's this one woman, I think she's gone off. She's done her PhD and nutrition, and she's now just a very busy mom, but chronic issues with infertility, IVF was never financially in the cards. She was just trying and struggling to lose weight. We were at Low Carb Breckenridge. Jason had just spoke, and then he was doing a Q&A afterwards. She went up, and she gave him a really hard time about why she wasn't losing weight. I think he was a little bit flabbergasted because she was really reaming into him. He said, "Well, just do a five day fast." She went home and she did a five day fast and the month later, she had a positive pregnancy test. And eight months later, she had twin boys, who are fraternal twins. And then she's since gone on to have a third child. And last time I chatted with her, she was actually going into doing research on this, but I think there's a strong connection. Anyways, there's tons of literature to support human growth hormone and regular infertility for simulating ovaries and producing eggs. It's just really fascinating, if you can do that with fasting.

Melanie Avalon: I have to ask you. The berberine, was that a unique experience for you or is that a concern for people taking berberine?

Megan Ramos: I never took it throughout my history with metabolic issues. I had fatty liver, PCOS, then it really got worse, then I suddenly gained weight, everything seemed to get worse, and then I developed type 2 diabetes. I went from skinny fat to just fat inside and outside and had all of these diseases. I was terrified. All I did was watch people I care about die day in and day out at the clinic. I was surrounded by motivation; every workday, and my work days were long, so it made it really easy for me to be compliant as heck with it. And in six months, I pawed through consistently and I reversed my condition. I never took berberine throughout my own journey but you learn about it, and you see some compelling data on it, and you hear other practitioners' results with it working with patients, and you hear the patients' results. So, it's something for years, I recommended professionally. 

And then when my husband and I are trying to conceive, I wanted to be a mom since like before, I could probably talk and express that I wanted to be a mom. It's been my biggest want in life, so sometimes when we're so blinded by passion for things, we don't necessarily do things that make sense. I'm very healthy individual usually. So, there was really no need for me to take berberine to heighten my insulin sensitivity and to balance my sex hormones. I was managing all of that very fine, everything was pretty optimal but this is my biggest goal was to be a mom. I am very fortunate to be immersed in such a unique community of wellness experts. And people said, "Well, it certainly won't hurt to take berberine and inositol." I have taken inositol here in there to help with some sleep, especially when I was bouncing back between Toronto and San Francisco during the early stages of my relationship with my husband, and I found that to be helpful. I thought it probably won't hurt. And about 10 days after I started taking just a low dose of berberine, I was taking thousand milligrams twice a day, but it's just sort of a standard dose for metabolic syndrome, and metabolic maintenance and then sleep. So, I was taking it twice a day. About 10 days later, I thought I had food poisoning. And then the food poisoning didn't go away. Then I thought I had stomach flu, and I thought I had maybe picked up like that norovirus because I love to eat oysters. Actually, we had been so busy and we've been eating at home a ton and we hadn't been going out as much and my husband's like, "We haven't had them. Unless it's like the world's longest delayed reaction for expressing symptoms to something." And then I just continued to get more and more sick. 

Now, the funny thing was during that time when if you've had food poisoning or the stomach flu, you know your stomach super sensitive, and you can really not tolerate a lot. Here I am, we're just starting fertility stuff and I'm all obsessed with wanting to get my nutrient status just perfect, appropriate amount of choline and this and that. I'm not letting myself fast very much, I'm trying not to. I would eat things like a little bit of soft sweet potato here and there very stupidly but because that's what I was eating, the only supplements I would take were then inositol in the berberine because I was having starchy foods, while my stomach was upset. Then I got been sick for six weeks, I've been in and out of the hospital. No one could figure out what was wrong, my liver numbers are awful. It was just massive. I surrendered, and I just fasted, like actually went for 10 days without having anything, not even broth, just water and the occasional cup of tea here and there and that was it. 

I lost like 14 pounds in two weeks at one point, it was just that, it was not good. But the only supplement that I was taking consistently because I'd sneak in some of the starch here and there was the berberine but during those 14 days where I fasted, I didn't take any berberine because I wasn't eating or I wasn't taking any inositol because I wasn't eating. So, if I had totally recovered then I started eating again, start taking those supplements and sure enough, everything meant to hack. I had this brilliant functional doctor who helped me put the pieces of the puzzle together one day, and he's like, "This is berberine." He's like, "I've never seen this reaction before. That's got to be it because you've taken inositol, and you're fine."

One day, I just took berberine, and no other supplements, and I sure enough, I ended up being very sick and I ended up going back into the hospital with dehydration, so it was just super wild. We don't know exactly what happened but once I literally threw out the berberine, three days later, I was totally fine. A week later, I ate a steak and I was totally fine. My GI system had gone back to almost normal pretty quickly, it was pretty gnarly. I was talking to Dr. James DiNicolantonio, and he thinks that it could be due to a weird B1 deficiency that he also shares on social media that he has. And I knew I had issues clearing some lactic acid because I would just have too much delayed onset muscle soreness, compared to peers after working out. I wonder not quite sure why that is, but the thing is my husband found this Reddit thread, where there's all these people that had the exact same reaction to me. They're usually low carbers in the community that were trying to take Berberine to help optimize things. About a week or two later had this terrible GI reaction, all thought it was food poisoning, then stomach flu, then they started eating some of the soft starches like I did, but would continue to take the berberine. And then several weeks later, they succumb to the fact that it was likely the berberine, stopped. A week later, they were feeling fine and they could eat what they wanted and it takes longer for the body and everything to recover on labs and just recover from the stress and the trauma of it all. That is really interesting, so there's this tons of these reports online. 

My husband sent me this Reddit thread, it was story after, story after, story. And then I went online, I found all these forums of people talking about it. And then I connected with a couple of other functional health practitioners. And they said that they had seen this sometimes too, but they can never really figure out why. I was just recently chatting with Cynthia Thurlow, and she had just had a conversation with a colleague, about how it's just overuse in the first place, and that it does cause some pretty intense gastric distress but is not as severe as I experienced. It was really wild, definitely really wild that experience. So right as we were trying to do IVF out of luxury, just so we could bank a bunch of embryos, because I'm getting older, and I don't want to be rushed to have kids. So, we had already started the process when this had happened. So, of course, under regular circumstances you wouldn't be able to conceive when you're experiencing liver trauma, liver failure, so our first round of IVF ended up just not being a worthwhile pursuit. But now I was able to start eating supplements and eating like a normal person again, at some point in May, we're hoping for better luck this round of IVF.

Melanie Avalon: First of all, I am so, so sorry that you went through that experience, that sounds really awful. It's really interesting to hear it especially because I'm a huge fan of berberine and I take it daily, and I'm going to produce a supplement version of it as well. I think that's so important for people understand that with any supplement that you could have a reaction like that. It's definitely something to keep in mind and be aware of. So, again, so sorry.

Megan Ramos: I shared it with my community too. I've seen it do some really awesome things, but it's just being aware that if you start to experience a week later some of the GI issues, maybe stop it. Don't try to push it and just a reminder to always just introduce one new thing at a time. So, I think I'm just that one fortunate one in 10 million in this particular case, or even one in 100,000 or whatever it is. I mean, kit has the potential to sort of be harmful to the particular individual. So, let's just approach things slowly and with caution, I think.

Melanie Avalon: Yes, definitely. When you have children or a child which I'm sure you will, putting it out to the universe, have you thought about how you would handle raising him or her in this whole diet world and fasting world, and food worlds? What would you do as a mom?

Megan Ramos: It's tough once they get to a certain age. I think before they go to school, our goal and things that my husband and I have talked about is, we love a vegetable garden, and do really getting kids into cooking. My parents never got me into cooking. Cooking was always thought to be this dreaded chore in the house. I heard this Edith Eger quote, "Your kids don't do what you say, they do what you do." I did what my parents did when it came to food, I dreaded cooking, I dreaded the whole experience of grocery shopping, but both my parents did. So just trying to do what I want them to do. Leading by example in our household. My husband grew up having to cook a lot and having to eat at home a lot. He's a chemist, so he loves cooking at home, since his lab in the house. So, sort of monopolizing on his desire and everything I've learned and just trying to make it fun, like really including them, making things really colorful, really tasty, and that being their initial experience with food when I can control it. Then it's, of course, when they go to school. 

I was actually thinking this morning. I saw like the whole Capri-Sun Recall thing, and I'm like, "Oh my gosh," people shouldn't be drinking that anyways, let alone when it's got cleaners that are improperly put into it. And they have to do this does recall, and I thought, "Oh my gosh, my kids going to friends' homes and my kids just even going to school, and all of the snacks that they try to feed you at school." We were actually in the UK, in London visiting friends, and our friends' kids at that time went to the same school as Prince William and Kate Middleton's oldest son and daughter. And I guess they're very active parents, so William was actually there dropping off Little Prince George and Princess Charlotte. So, we're talking, "This is not your school that’s in this dark alley, not very nice neighborhood." I mean, this is a very, like the tuition was nuts. Tuition is more than my mortgage every year. It was just kind of nuts for one student. And so there's a good chance that most of these kids ate breakfast at home. But as they were walking into school, and my friend brought me because he wanted to show me what this experience was like, they're literally handing out juice boxes and slices to toast to these kids when they're walking into school. 

He said, "Everyone here is paying thousands and thousands for their kids to be here. Look at us. I knew who he was. We're parked behind Prince William. These kids have food at home. We're not in neighborhoods of poverty here. And they're already feeding our kids a second breakfast the moment they walk into school at 8:00 AM," which is just wild. So, I'm nervous about that. I think at that point, I don't want to be too restrictive with them. I think they've got to learn how to make their own choices and navigate. So, set them up with a good foundation, really celebrate and enjoy the art of cooking at home, teach them, and see how they sort of respond when they go out there. I've admired Will Cole's approach. I've watched him over the years and his kids. His son is older now. And his son has made a funny comment, not that long ago I saw on Instagram. Where I guess Will was mad at him and his son said, "Dad just be happy the only thing I microdose is gluten." I wanted to sort of die laughing, but Will said they made food fun at home for the kids and they taught them and then they let them go out there and make their own choices but they realized when they did eat lots of sugar and did eat lots of processed junk food that they didn't feel good, and that they wanted to feel good. So, on their own, they started to make some wise decisions. So, there's people like him who I really watch and see what they do at home. I think Cynthia, for a friend, she's got two boys and I think they're quite healthy, successful young men. Obviously, her and her husband had done a great example of leading by example at home, eating well in and out of the household. So, I think that's just going to be my approach. But it is definitely a scary approach when I think of things like Halloween, and it's going to be tough to watch my kids have to navigate through some of those experiences. And you don't want to lock them up on Halloween and have them go trick or treating, something Ben Bikman does on holiday, like Halloween because everyone around here starting to get ready for it. Even though it's still a few months away, or a couple months away. As the kids are allowed to pick one candy and then they were allowed to trade candies for other toys or other things crafts that they were interested in. So, him and his wife would have some things and I thought that was really neat. 

I'm just trying to devour all of the approaches of these people around me and see how we can help them make these decisions and find a lifestyle that's going to be healthy for them amongst-- who knows what the world's going to look like. A person I know, a friend from this area have recently left a corporate barbecue because they only had Beyond Meat burgers at the corporate barbecue. They said, "Well, everybody can eat these." And they're like, "No, I eat real food. This is not real food. So not everybody can eat these." And they left. So, the world's going kind of weird, even more so every day with food. So, we'll see what the universe is like when we have them and they're open enough.

Melanie Avalon: I do think it's a little bit problematic because you don't want to enforce people to have to eat any certain way. But it's frustrating, because on the one hand, I feel there could be legalization around things that could have profound health effects. I know, I had Dr. Robert Lustig on the show for Metabolical, and I know he would love to see regulation on fructose, for example. So, it's like there's so much potential there, but then you don't want to force things on people. And then on the flip side though, we get this stuff where stuff does get enforced. I don't know that it's the best thing ever, like these Meatless Mondays and stuff in schools and it's just frustrating. What I'm really hoping is I would love to see a book from you all about, you could talk about like, females fasting and fertility. And then after you have kids, like having kids, there's so much. Do you think you'll write another book in the future?

Megan Ramos: Yeah. I have a book coming out June next year, that sort of just geared a little bit more towards like women with type 2 diabetes. We do talk about PCOS, but I just felt a little bit as my first solo project, talking about diabetes. I'm actually going to be launching a new website this fall. It's different from our fasting methods stuff because we really focus a lot on type 2 diabetes, metabolic syndrome. I want to start sharing with younger women my experience with all of this fertility stuff, and all of the things that I'm navigating as I'm trying to figure out breastfeeding and postpartum and recovery, which a lot is thyroid management, thyroid management, thyroid management, transitioning kids to foods. It's hard to find like a concrete resource out there. So that's a project for sure that I want to tackle in the upcoming years.

Melanie Avalon: Oh, I love it. Well, hopefully, I would love to have you back for the book that comes out in June, if you're down, that would be amazing. Well, this has been absolutely incredible. It's so wonderful to finally connect with you. I feel like I know you because I've just been following you for so long. The last question that I ask every single guest on this show, and it's just because I realize more and more how important mindset is, so what is something that you're grateful for?

Megan Ramos: Something that I am grateful for is, I was just reading it sort of in my gratitude journal this morning, is that I just know that I'm so capable of change and that's what this journey has taught me with nutrition now. If we really practice something that we are capable of change and growth, so that's just something that I'm really grateful for. If someone's out there is new to fasting or is thinking about doing this lifestyle, just consider it a practice, don't consider it necessarily a diet, just a practice. And if you just keep showing up and keep practicing little by little, it will get easier and it will change your life and that you are capable of change. Like if I can make this impact in my health, then anybody can I truly believe that. And if I can go from the diet of McDonald's and Domino's that I had to the diet that I have today, anybody could do that. I was thinking of it this morning because with my fertility, this liver recovery has been a little bit difficult, but I know I'm capable of that change and find something fasting has really taught me that I can really be in the driver's seat. But you just got to show up and then keep practicing every day. I'm not sure if that makes sense.

Melanie Avalon: I love that. That's something I really love about you is you're just so empowering and so approachable and really are making all of this very practical to people. So, you're having a profound effect on the world and I cannot thank you enough for what you're doing and I'm super excited for all of your future stuff. How can listeners best follow your work? You said you have a new website coming out.

Megan Ramos: Yeah. Everything will be linked from our parent website, thefastingmethod.com. So anytime we've got a new book or if you're interested, we have a podcast called The Fasting Method Podcast. Jason's author website where you'll get the information about new books he's got coming, links to my upcoming website about the fertility journey that I'm going to be sharing where you can find out all at thefastingmethod.com as well as all of our social links are will be there too.

Melanie Avalon: Awesome. Well for listeners, I will put links to all that in the show notes. And again, thank you just for all that you're doing and this fabulous conversation, and hopefully we can talk again in the future for one of your future books.

Megan Ramos: [chuckles] Thank you. That'd be lovely. I really appreciate you having me on today, Melanie. And happy fasting to everyone who's listening.

Melanie Avalon: Yes. Happy fasting. Have a good rest of your day.

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