Dr Gundry 0:13
Welcome to the Dr. Gundry podcast. All too often women’s health issues are misdiagnosed dismissed as something less critical or chalked up as a normal part of aging. And unfortunately, many women in particular go years or even their entire lifetimes left in the dark when it comes to how to best support their health. That’s why today I brought on Cynthia Thurlow, a time controlled eating advocate, nurse educator and nurse practitioner who is empowering women across the globe to live their most vibrant, healthy lives. Cynthia is also the author of the book intermittent fasting transformation, the 45 day program for women to lose stubborn weight, improve Hormonal Health and slow aging. And in just a minute, Cynthia and I will dive into some of these unique health issues women face, and why they should not be following all the same health advice as men will also share how you can use time controlled eating, and other powerful health techniques to help lose stubborn fat, slow the effects of aging and gain back your energy. So don’t go away. Whether you’re a man or a woman. This is an episode everyone will benefit from. We’ll be right back. Cynthia, welcome to the show. It’s great to have you.
Cynthia Thurlow 1:36
Thank you. It’s really I’ve been looking forward to this conversation and reconnecting with you.
Dr Gundry 1:41
You know, unlike myself, who still sees patients six days a week, you decided to step back from clinical medicine, because you wanted to have a bigger impact. Tell us more. In fact, what point in your story and your story is so compelling. Did you embark on what you’re doing? Now? Let’s let’s start with that.
Cynthia Thurlow 2:02
Yeah, it’s a great question. I think for me, I probably was practicing as a nurse practitioner, my first love is cardiology, I was an ER nurse and then transitioned effortlessly to cardiology, I loved everything about clinical medicine, but probably 10 years into being a nurse practitioner kept asking myself, you know, I’m prescribing a lot of medication cardiology, there’s a lot of beds, I’m seeing patients in the hospital, and I’m seeing patients in clinic. And I feel like a lot of what is persisting the symptoms and the expression of disease and the progression of disease is mediated by lifestyle. And at that point, nurse practitioners in the state that I’m in, we’re not autonomous, so we weren’t able to practice unless we had a physician agreement. And so, you know, I continued to toe the party line, and I started a Ph. D program and that didn’t like the app. And then I did a wellness coaching program. And that didn’t make me excited. But what did make me excited was to talk about food and to talk about nutrition as medicine. And so I, you know, had young kids, my husband did a lot of travel, and I just got to a point I woke up one morning and I said I cannot write another prescription, there has to be a better way. I really fervently believe that lifestyle medicine is the focus that that I should be doing that that is the root of a lot of the health and metabolic health issues I’m seeing every single day. And my patient population just kept getting younger, I was seeing 35 year olds, 30 year olds, 37 year olds with diabetes and cardiovascular disease and all these largely in many ways, preventative lifestyle diseases. And I woke up one morning and said I can’t write another prescription. I didn’t have a business plan. I don’t recommend people do this, I took a leap of faith gave my notice my practice tried everything they could do to convince me to not leave. And I really leaped into the entrepreneurial space. And nearly instantaneously, I started attracting women that were at my stage of life, you know, early 40s, Peri menopausal. And that started this trajectory of not only me figuring out things for myself at that stage of life, but helping other women do the same. And I still love cardiology, but I get to practice right alongside my colleagues, but just in a very different capacity, and one that allows me to feel fulfilled, and feel like I’m still making a tremendous difference.
Dr Gundry 4:19
Now during this whole time. Like you write in your introduction to your book, your health issues, were challenging. I think that’s that’s important for our viewers and listeners to understand that yeah, you you weren’t just writing prescriptions and got tired of doing that. You were kind of tired of where your health was. Can you go into that?
Cynthia Thurlow 4:42
Yeah, and I think for so many of us what we do in our 20s and 30s no longer works for us effectively and this I mean, I was probably not sleeping enough. I was probably over exercising. I think I had started low carb and I felt good on low carb. But when you’re a Peri menopausal woman, you know the 10 15 years preceding menopause, the game changes, you can’t do the same things and expect the same result. And I actually started becoming weight loss resistant. And when you’re five foot three, five to 10 pounds makes a big difference in how you feel and how you look. And all the things I used to be able to do effortlessly, were no longer effective. And so through my journey of figuring out that I needed to remove gluten and dairy, and I was probably abiding by the guidelines, I recommended to patients, you know, eat frequently stoke your metabolism, eat snacks and many meals. And when I started changing how frequently I was eating and what I was eating, that’s when I was able to see some tremendous impact along with changing, prioritizing sleep, and not exercising quite as vigorously, like I had that made a big difference.
Dr Gundry 5:48
Was there a tipping point for you that, you know, finally said, you know, enough is enough, or did this evolve as you started coaching women and what worked? What didn’t work?
Cynthia Thurlow 6:01
For me personally, the tipping point was when I could, I didn’t have enough energy to get out of bed, that I was really tired. And I knew I wasn’t clinically depressed. But I really didn’t understand even as a western medicine trained provider, I did not understand the changes that were occurring in my body in perimenopause that were exacerbating a lot of what I was experiencing. And then add in the fact that I learned I had a parasite infection and I was over, you know, over taxing the body, we become less stress resilience. And so for me, the tipping point was when I didn’t have enough energy to be the mom that I was to be the clinician, that I was to be the wife that I was that I had to take some very hard looks at what I was doing, and to recognize that I needed to make some changes. Because if I continued on that path, I was not going to continue being a healthy person, I was going to head in a direction that I wasn’t willing to go. And I think for so many women in particular, but it happens to men as well, we’re conditioned to believe that because we are north of 35, or 40, or 45 or 50, that whatever’s happening is a function of aging. Now for some people that provides them reassurance for me, it just made me angry, I didn’t want to be told that I was like I don’t I don’t lean into those limiting beliefs, I do believe that there’s a better way I just need to figure it out. And so once I was able to figure it out, then I started discussing and sharing it with anyone and anyone that was willing to listen to me, because I felt like it was in many ways the missing piece for so many individuals, again, not just women, but men as well,
Dr Gundry 7:32
because you were a practicing nurse practitioner. I mean, did you go to your colleagues and say, hey, you know, this is happening me this isn’t, you know, this is weird. And did you get the usual response of well, of course, you know, you’re perimenopause, or you’re 40 years old, and you’ve got two young kids. Of course, you’re tired and you work full time. Yes. I don’t want to put words in your mouth. But I bet you heard that I did. And
Cynthia Thurlow 7:58
what’s interesting is, you know, I work for this amazing cardiology practice, many of my colleagues are my own age, so their wives are experiencing the same things, many of the colleagues I work with that were 20 years older than me. And more often than not, they’re like, Oh, this is our nurse practitioner likes to talk about nutrition, like, they would almost like pat me on the back, like, Oh, this is so cute. You know, we’ll send patients to her so she can talk about food. So I think the younger the younger physicians were certainly sensitive to it, because their wives are experiencing the same thing. The older physicians that I worked with both men and women would just say, Oh, just get used to it only gets better from here. And so I think on a lot of levels, there’s a poor understanding of the role of metabolic health and conventional medicine. And instead of fixating on symptoms, if we’re really looking at the root cause of a lot of what we’re seeing, it will give us a different appreciation. And to me, it was like an SOS, my body was telling me or screaming, you have to change what you’re doing. And if you don’t guess what’s going to come next. And so I just wasn’t willing to lean into that. But, you know, I would say the bulk of my colleagues were very supportive. Even some of the MPs thought it the food piece was cute. I mean, that was how they kind of put me in that box of this nurse practitioners interested in talking about preventative nutrition and lifestyle medicine. And we don’t have time to talk about that, but we’ll just send them to her and she’ll help our patients.
Dr Gundry 9:22
All right. Well, let’s talk about nutrition. Now, one of the myths that you like to bust in your book, and I’ve been trying for many years, is this idea that we ought to eat, oh, six small meals a day to keep our metabolism revved up. And that’s probably one of the farthest from the truth things that most of us either learn personally, or we see it in our patients every day. So I suspect that you were doing that like most of us did, because that was the smart thing to do. And maybe even because of a cardiology You practice you were eating a low fat diet. And so why is that prevailing idea that the six small meals a day snack throughout the day revs up our metabolism? What’s wrong with that concept?
Cynthia Thurlow 10:16
Oh, I love this question. I think on a lot of levels, it’s this conventional dogma that we’ve all been schooled with or experienced from a societal perspective. And when I think about what the net impact is, of someone eating frequently throughout the day, where you really look at this, this model of insulin, and insulin is not a bad hormone that unfortunately has gotten a bad rap. And understand that every time we eat our blood sugar, depending on what we’re consuming, whether it’s carbohydrates, fats, or protein, there’s a resultant rise in blood sugar. And when your glucose goes up, your insulin is secreted to bring your blood sugar back down. Of course, this is an oversimplification. But if you’re doing this, and you’re giving yourself four to five hours in between your insulin levels, and blood sugar will come back down. That’s how we’re optimized and that our bodies are able to be more metabolically flexible. But if we are eating every two hours, guess what happens, that threshold for glucose, insulin secreted comes back down, but then you eat again. And so the cumulative net impact over a day, a week, a month over time, is that you are not burning the food that you’re efficiently, you’re consuming. You’re storing it, like almost like these hibernating animals, they’re storing fat for winter. But you’re doing this all day long. And I think the other piece is that if you look at these ancestral Health Perspectives, and you really understand that, throughout human history, we’re our bodies are designed to be able to sustain themselves and points of time when we have feast or famine. And unfortunately, we live in an overabundance all the time. And so we are conditioning our patients and our clients that they need to eat frequently to quote unquote stoke their metabolism, it’s actually going to do the exact opposite. And I remind people that the way that our bodies are designed to thrive is that we are eating less frequently. I know the word intermittent faster, the words intermittent fasting, the phrase can sometimes be triggering, but I remind people that that is how our bodies are designed to thrive, but the concept or the rigid dogmatism about the meal frequency, and eating to Stoke, your metabolism could not be farther from the truth. And the fact that our metabolic health is declining at such a rapid rate here in the United States, in many industrialized countries, is really demonstrating for us that things need to change.
Dr Gundry 12:31
So since you brought up intermittent fasting, and of course, that’s the name of your book, intermittent fasting transformation, you actually and I are advocates of time controlled eating, or time restricted eating. And I want to take a minute just to mush around, there is a difference between intermittent fasting and time restricted eating and I’ll start intermittent fasting actually came about from mouse studies where you could control when they ate, and the mouse studies which are fascinating. One day, the mouse got to eat the next day he didn’t eat. And even mice who were compared to mice who ate every day, they got the exact same amount of calories, they got two days worth on one day and nothing and the next day, they lived all out longer than the mice that ate every day. And it was called intermittent fasting because they literally were fasting, intermittently, it became popularized with the five two diet, which five days of regular eating two days of not fasting, but actually less calories, five to 600 calories. And so those, let’s call them intermittent fasting, what you’re proposing in your book, and correct me if I’m wrong, and what I propose since actually 2006, when I first wrote about it, I’m, I think I’m the first person to ever write about it is time restricted eating or time controlled eating. Would you agree?
Cynthia Thurlow 14:06
I would agree, I think sometimes the terminology gets interwoven together. And I think there can be some degree of confusion. But I would agree with you that there are periods of time when we eat and periods of time when we do not eat. And so I think that that is the prevailing theme that we’re both trying to embrace and to recommend to people that they they lean into that and not be fearful of going periods of time without eating.
Dr Gundry 14:31
Yeah. And you’re right. It’s clearly built into our genetic in fact, interestingly enough, breakfast is a very modern concept, and breakfast the word comes from break fast, and from my reading and actually became prevalent in Victorian England over 100 years ago with the Industrial Revolution away. And men had to go to factories early in the morning, they did not eat lunch, they did not have breaks. And there was nothing that they ate until the evening when they came home. And from my reading wise have prepared the man a break fast before they went was actually the Ramadan diet. And you write about the Ramadan diet in your book, as do I. So yeah, breakfast is a very modern concept. It’s interesting because
Cynthia Thurlow 15:31
the concept of breaking your fast can really happen at any point. It’s what you choose to break your fast with, that I think is of greatest significance to set up the rest of your day. And the modern day perspectives on breaking your fast is with carbohydrate laden products that are going to set you up for a significant degree of blood sugar dysregulation as opposed to having an omelet or sitting down and having you know, leftovers from last night that tend to be higher in protein and maybe some vegetables. But it’s the modern day concept of breakfast that in many ways is really setting people up to not succeed throughout their day and to deal with those blood sugar fluctuations and hungriness, hangry Enos, that’s my new word, when they’re hungry, and they’re angry, and they’re grumpy, just like I have teenagers now. And just like when they were toddlers, and they got hungry, they got grumpy, kind of the same thing we’re dealing with. Now, at this stage of life.
Dr Gundry 16:26
Yeah, I get a chuckle, Kellogg’s cornflakes was actually advertised as the first pre digested meal. And you think about that for a second. And the last thing you and I would actually want is to have whatever we’re eating already pre adjusted, which means it will instantly become sugar in our bloodstream. And yet Kellogg’s proudly actually advertised that it was the first pre digested meal. Isn’t that wonderful?
Cynthia Thurlow 17:03
It’s really a disgusting concept. You know, I think about birds and when Mother birds are feeding their babies, and they will actually give them pre digested meals, and it makes sense for a baby bird. But certainly not for adult humans for sure.
Dr Gundry 17:17
No, that’s right. All right, let’s switch gears for just a second. You know, when women experience health issues, they are more likely to be misdiagnosed or dismissed by doctors as something less critical, like, Oh, it’s a normal period pain. In fact, one study published in academic Emergency Medicine found that women who went to the emergency room with severe stomach pain had to wait almost 33% longer than men with the exact same symptoms. And one of the reasons I wanted you on today is to offer tactics for our female audience to take back their power and get the care there they need. So a lot of this has to do that you write about in the book with women and hormonal hormonal fluctuations? So what’s normal? And what are the signs of a hormone imbalance?
Cynthia Thurlow 18:12
It’s a great question. And I can honestly say that working in cardiology, we would see women that always showed up later with heart attacks, and other types of issues, because they take women are caretakers, we take care of everyone in our lives and worry about ourselves last, but when we’re talking about hormonal fluctuations for women at their peak, cycling years, peak fertility years, you know, 35 and under, they have a menstrual cycle every month. So they’re having fluctuations in their sex hormones their estrogen, estradiol, testosterone and progesterone week to week, day to day throughout the menstrual cycle. So that’s a normal fluctuation. But as we’re starting to see more and more women dealing with infertility, polycystic ovarian syndrome, which is the number one endocrine disorder in the country, it’s not an underactive thyroid. As we’re starting to see more and more women that are dealing with metabolic disease slash and or hormonal imbalances, you’re starting to see more people that are not having regular menstrual cycles, and that can show up as very heavy bleeding, irregular cycles, weight gain, they can have hirsutism, which is inappropriate hair growth, they can deal with acne, they can deal with a multiplicity of symptoms that they can go through, but what’s of interest to me is, as women are getting closer to perimenopause, so this 10 to 15 years prior to menopause, average age of menopause, United States is 51. perimenopause is an interesting time for women because all of a sudden we’re having less progesterone secreted by the ovaries, which exacerbates underlying depression, anxiety and sleep issues. We also have this relative imbalance of estrogen so this is when women will sometimes see much heavier periods, women would describe them into the crime scene period very heavy weight loss resistance, they may have trouble sleeping. They may struggle with food sensitive tivities all of a sudden, maybe they’ve been able to tolerate certain foods like gluten and dairy and grains and all of a sudden they’re not. And then as they’re transitioning to menopause, which is 12 months about a menstrual cycle, and women are dealing with this cascade and fluctuations of, you know, waning ovarian reserve so less circulating progesterone, sometimes women in perimenopause will have the highest levels of estrogen throughout their lifetime because their body is acclimating to this reverse puberty situation. And estrogen is starting to falter up and down depending on where they are. So it shows up as these irregular cycles. And then as they get closer to menopause, and they have lower and lower levels of estrogen, which can contribute to bone health issues, they can start having palpitations, they may experience hot flashes, which for anyone who’s listening has ever experienced, they’re not fun. And then you go 12 months with that eventual cycle and the decision needs to be made about whether or not someone’s leading into replacement of those hormones or going through menopause without hormones, but the lifestyle piece in perimenopause and menopause becomes much more of an issue. And those are just kind of the highlights in terms of hormonal imbalances that you can see. The other thing that I think is really relevant to our conversation is to talk about the role of estrogen or estradiol, which is the predominant form of estrogen a woman’s body makes, but when women are navigating perimenopause, and they’re having fluctuating amounts of estrogen that impacts insulin sensitivity, as we’re losing muscle mass and impacts insulin sensitivity. So there’s this double whammy. And people assume that our metabolism both men and women’s slows as we get older, we know based on research that really doesn’t happen until after age 60. And it’s only 0.7% each year. So it’s a fairly small amount. But what I think becomes problematic for a lot of people north of 40 is this loss of estrogen signaling, the pro inflammatory state, more oxidative stress, less insulin sensitivity, all of a sudden, you know, becomes this domino effect that can really impact the way that we view ourselves and our world around us.
Dr Gundry 22:02
Okay, that’s a great segue into Okay, so what does all this have to do with time controlled eating for women? So And second question, in what way? Should this be particularly different for how women practice time controlled eating, than what men can do or should do?
Cynthia Thurlow 22:23
Yeah, well, I’m going to answer the gender piece first, because I think this is important. You know, when we’re looking at men and women, I always say if you look at the research and my clinical experience men and menopausal women, so women that have not had a menstrual cycle for more than 12 months and average age here in the United States is 51. They tend to have an easier time with time restricted eating, because there’s not as much hormonal fluctuation day to day, week to week, month to month. Now, what I do think is important that younger women so women 35 And under that tend to be at peak fertile years have to be particularly attuned to their menstrual cycle. So I’m going to make an oversimplification, we have the follicular phase when estrogen predominates when we can get away with more fasting, more carbohydrate restriction, where our bodies are more resilient to more stress from you know, more rigorous physical activity is very different than when in our menstrual cycle progesterone predominates in the luteal phase, when we generally have to back off on the type of activity, we amend our fasting window or in our time restricted eating window. And we probably need to be doing more rest, we probably need to be doing more yoga, we may need more carbohydrate at that stage of our menstrual cycle than we do in our follicular phase. So I always say that women have this this very important stage in their lives, that peak fertility. There’s a time in your menstrual cycle when you can get away with fasting. And there’s a time when I generally recommend no more than 12 hours of digestive rest. And that’s what I call it. Everyone should really be doing digestive rest. And then you know, pushing the levers depending on where we are in regards to perimenopause, because I think this is important as we’re making that transition. And we have these fluctuating estrogen and progesterone signaling that’s going on in the body. This is when I remind women that lifestyle is important. So what’s your sleep quality? Like? How do you manage your stress? And that’s not five minutes and meditation once a week, you know, what’s your nutrition like? You know, I know that you speak and you really lean into the nutrition piece. But this is when I start talking about inflammatory foods. The standard American diet is has no place in our diets. But looking at the role of gluten and grains and dairy if those work for you sugar, alcohol in particular, and understanding that once you are sleeping well you’re managing your stress, you’re removing those inflammatory foods, then yes, intermittent fasting can also be beneficial. But I think it’s just important to say that men and women do need to fast differently because our physiology is different. But I do find the bookends, men and menopausal women generally have a much easier time because there’s not as much fluctuation, but when we’re We’re looking at overall benefits to time restricted eating intermittent fasting, I start thinking about the basic ones like we were talking about, you know, poor metabolic health. So we know that fasting can help with reversing insulin resistance, it can prove hypertension or high blood pressure, our lipids, especially triglycerides, helping to lower LDL, looking at the inflammatory markers, high sensitivity CRP, some of the other lipid markers that I’m sure you probably have spoken about, also looking at how it helps improve neurocognitive function. So we know that as an example, many women are protected from neurocognitive issues until they go into menopause. And a lot of it is believed to be both an issue with insulin signaling and also this loss of estrogen. So lowered risk of Parkinson’s lowered risk of dementia, understanding that it improves gut function. If we fast long enough, we’ll get some stem cell activation, I know we’ll probably touch on that. And then understanding that for many of us, it’s as simple as we sleep better. We we lose weight, we change body composition, lowered inflammation in the body, I’m sure you’ve seen this with your own patients, but patients telling me my joints no longer hurt, I don’t have pain in my knee, I don’t have pain in my feet. So understanding that there are all of these interplays that go on with fasting, I think a lot of us like to focus on the body composition and weight loss improvements. But there’s so much more than that. I always say people stay for all those other benefits. And lastly, I would say just the mental clarity and energy from utilizing being able to utilize different types of fuel substrates. So being able to activate and utilize fatty acids are breaking down fats into fatty acids. And we know our brains love that. So this, you know, improved mental clarity and energy are two of the biggest things that I say,
Dr Gundry 26:47
Watch, talk about your program, because a lot of your book correctly states that most of us are insulin resistant, metabolically inflexible, and asking somebody as I’ve written about to suddenly, instead of eating breakfast at seven or eight o’clock in the morning, your first meal of the day is at noon is like falling off a cliff. And most people can’t do it. Because they cannot access their fat in their fat stores because of high insulin levels. And I like the fact that you’ve got this 40 Day transformation. Tell us what you’ve learned, obviously, and what I’ve learned that you gotta you gotta do this one step at a time, you don’t want to jump into the deep end.
Cynthia Thurlow 27:42
No, I agree with you, I think it’s not sustainable. If we are in a position where we feel like we’re in a lose, lose, like you’re asking me not to eat as frequently. But now I’m going to feel like I’m starving. And so it’s reminding people that it’s baby steps. It’s as simple as you know, the first week of my program really speaks to cleaning out your pantry, or you know, reducing the amount of carbs processed carbohydrates that you’re eating, if we know the average person is consuming 203 100 grams of carbs a day, lowering that can be terrifying, but understanding that, that we’re looking to do a couple different metrics, we’re looking to reduce our carbohydrates not to too low of a level, because moving too quickly can be problematic. And then we’re asking people to increase their protein. So we know protein can be very satiating protein is important, especially as we’re getting older, because we actually have more protein requirements as we’re aging as opposed to when we’re younger. And I find that if we start kind of making little changes, and by those little changes, it’s like, let’s reduce, or let’s be cognizant of how much carbohydrate we’re consuming. So start tracking macros, start being conscientious about eating a little bit more protein with your meal, maybe you’re having four ounces of chicken, triceps, and I find that that can be helpful. I think that’s the first thing. The other piece of it that I think is very important is is teaching people to stop snacking, because you have to rip off that band aid. Once people understand they don’t have a buffer in between meals, all of a sudden, they’re like, okay, if I’m not going to eat in between my meals, I needed to eat enough for breakfast and enough for lunch and enough for dinner to be able to get successfully to that next meal. So I think the snacking piece is also very, very important. And then the next big step is going from dinner to breakfast. And for many people, they’re convinced, if they don’t have a snack before bed, if they don’t have dessert, if they don’t have that glass of wine, they’re going to starve and I remind them, even thin people have plenty of stored energy. We’re not going to starve, but we’re going to make sure you’re going to have a nice piece of protein, you’re gonna have some non starchy vegetables, you’re going to add in some fat, you’re going to be absolutely fine because you’re going to spend most of that time sleeping so a lot of what I’m doing is coaching people. And I know even in your book microcode you increase the fasting amount by an hour like Each week, which I think is brilliant, so you’re making it very sustainable. And I tell people that the more carbohydrate dependent they are, so if you’re someone that is metabolically unhealthy, insulin resistant, leptin resistant, etc, it’s going to take you longer to get to a point where you’re going to be able to go longer without eating, and that’s okay. So sometimes it takes people a couple of weeks to start being able to utilize fat as a fuel substrate, others, it takes longer, and that’s okay. But it’s really designed to be a step wise approach. And also, the other piece is the other lifestyle pieces like going getting a little more sleep becoming physically active. Many people really aren’t physically active, we’ve gotten conditioned, where we’re in a, you know, climate controlled environment 24/7 with very little physical activity, and you and I both know that insulin resistance starts in our muscles. So I remind people that you know, encourage them take a 10 minute walk after a meal. And sometimes they’re initially not understanding why that’s so important. But understanding that with each muscle contraction, your your body’s using up some of that glucose, or taking thinking of your muscles of the sponge, using up some of the blood sugar that’s circulating to be able to dissipate it and bring your blood sugar levels back down. But that’s like a kind of a high overview of my methodology, and one that I found has worked really well for 1000s of patients.
Dr Gundry 31:18
Yeah, I think in my first book, there’s a fascinating study, looking at people who were asked to walk for either 10 minutes before their meal, or 10 minutes after their meal, same distance, same speed, the people who walked before the meal didn’t lose any weight, the people who looked after the meal lost weight, even though it was the same meal. And again, I think this goes back to, you know, our ancestral signaling, if, if we walk, we gathered something, and then we ate, and Okay, we’re done. Let’s store that. On the other hand, if we eat, and then we start walking again, our computer program says, Wait a minute, I don’t know if this guy is going to walk for a mile or 20 miles. The last thing I want to do is store this stuff. You know, I want to make it available. And yeah, this is important signaling information. And, and that’s why in Europe, it’s fascinating the number of people who just stroll after a meal, they’re not running, they’re, you know, they’re, they’re just walking and enjoying the environment. And I think we can all learn from from that.
Cynthia Thurlow 32:33
Well, I think it’s ironic, my husband and I used to joke about all the middle aged people that used to walk in our neighborhood, and at the time when you’re in the throes of young kids, and you’re working and you know, it just became this thing that you observed. And now we have become the middle aged couple that walks in the morning walks in the evening with our dogs. And I really fervently believe that that type of I always think of it as neat exercise or neat physical activity, we know that degree of thermogenesis has so many benefits. And just walking for 10 or 15 minutes after a meal is such a great way. Like if you’re out to dinner and maybe over ate like take a walk after dinner stroll around. I mean, it’s such an easy way to help support your health without having to go to extreme lengths to do so.
Dr Gundry 33:19
And like I always say the best prescription I’ve ever written is to get a dog. I have two yeah, I’ve got four unfortunately. So two of them are rescue. So we can’t resist a rescue dog. Oh, well. But yeah, dogs make you go out and walk at least twice a day, whether you want to or not, even in the even in the dead of winter, they don’t care.
Cynthia Thurlow 33:44
They don’t I jokingly laugh about, you know, I have dogs that walk several miles in the morning and several miles in the afternoon. And they’re better behaved. Because of that same thing when I had, you know, my boys were younger, I used to tell my husband, my goal was to make them tired. So we did a lot of physical activity. And I think for so many of us, we just forget that parking a little farther away from the grocery store, you know, not taking the elevator, like there are little things that can add up to that degree of additional physical activity that can be very beneficial.
Dr Gundry 34:15
Yeah, you’re right. You know, I’ve always advocated Look, folks take the elevator up, but then walk down the stairs. And there’s this amazing Austrian study that I cite of people who were either asked to walk up a ski lift and then ride the ski lift down or ride up the ski lift and walk down. And it turns out that they thought that the people hiking up were gonna get much better, you know, effect turns out it was exactly the same because you’re actually working against gravity both ways. So that’s okay, take the elevator up and walk down. It’s a good way to just get in some exercise that isn’t too painful.
Cynthia Thurlow 34:59
Yeah, absolutely. I think on a lot of levels, one thing that I think people find interesting is they’ll go to a very intense class boot camp CrossFit. And then they’ll sit all day at work. And I have to remind people, I don’t care if you set a timer so that every hour you walk to the bathroom, or you get some water, or maybe you do two laps in your office space. But if you go and do intense exercise, and then sit for 10 or 12 hours a day, you have just undone all the benefit of what you were doing in the gym or at your local bootcamp class. So just encouraging people to be physically active throughout their lifetime. And I am sure both of us, you know, I saw so many of my patients that were in their 70s 80s and 90s. And the ones that were thriving, I always, I always wanted to know, what do you do, that you think has moved the needle the farthest for you. And some of them talked about mindset. And some of them talked about remaining like, on top of, you know, electronics, so they could still communicate with their younger family members. And then many of them would say, I walk in nature, every day, I do yoga, I do meditation. And so I might very much reflect on how much my patients have taught me over the years and the things that have always stood out. And I’m like, I get it now. Like, I understand why they always encourage you to be active, like, don’t just sit in your house, or sit at work, and then drive home and then be sedentary for the bulk of your day. Because that has a huge negative impact on your on your health in general. You brought
Dr Gundry 36:26
up you know, women who were in their reproductive years, and the internet is full of horror stories, warning women in their reproductive years do not do fasting and time controlled eating. So what’s a you? Yeah,
Cynthia Thurlow 36:44
I probably get asked this question or I get tagged and things on social media almost daily. So this is this is something I’m well prepared for. I think it’s always in context, I think we always have to be thinking about the N of one the power of each individual. So if you are a young woman who’s 25, who’s an athlete who is very lean, or your body is already dealing with a tremendous amount of additional hormesis or beneficial stress, guess what, I don’t think you’re going to get a lot of benefit from adding more stress to an already very lean individual that’s already putting their body underneath a great deal of physical effort. So it’s always in the context of how old are you? What is your stress level like are you already really lean, then I’d probably say you don’t need 12 hours a digestive rest or what I said go back to the 12 hours of digestive rest is not going to hurt you and you want to feel your body for the degree of physical activity you’re doing on the other side, I think about the PCOS, polycystic ovarian syndrome patient that’s young, that is insulin resistant, is it just very inflamed and is struggling with metabolic poor health. That woman can definitely benefit from some time restricted eating or intermittent fasting because they’ve got underlying insulin resistance, which is not the basis. So the basis of PCOS is inflammation, oxidative stress and insulin resistance, you are going to benefit from eating less frequently, you are going to benefit from adjusting your macros your protein, fat and carbohydrates, you are going to benefit enormously. Again, depending on where you are in your cycle. And most PCOS SIRs are not cyclin Neva, they have a luteal phase defect, they’ve got a progesterone deficiency. But I find for many, many women that have PCOS, when they start fasting, things start to fall into place. And obviously working in conjunction with a with a knowledgeable GYN, or MD or NP that can help support them as well. These are people that you know, I lean into specific types of, of nutriceuticals, that can be very beneficial. Now, to suggest that intermittent fasting or time restricted eating is not beneficial for women would go contrary to the fact that it is what is allowed us to exist as a species for as long as we have. So when I hear the fear mongering, I always say what’s the context, if it’s someone who’s going through a divorce, just got fired, just had a big move is already really thin, then I’m going to say that’s probably not the time to do it. But for the other individuals, there’s probably some play that you can have 35 and under maybe you’re doing it once a month, maybe you’re doing it once a week, but the the insulin resistant individuals, I do believe there’s a lot of value, again, with the caveat of where are you in your cycle? Are you trying to conceive because I see a lot of that people are trying to get pregnant or they’re pregnant or breastfeeding. Those are not the times I feel that women should be restricting their food intake when you’re trying to grow a human or feed a human on fat and I think a lot of women will relate to this. When I was breastfeeding my kids. I was never more hungry. I was voraciously hungry. It is not the time to restrict the amount of food you’re consuming. But outside those contexts, I think in many ways, housing can be beneficial but I Think unfortunately, there are people who don’t understand the physiology of women enough to be able to make that determination. I see these blanket statements. And I always remind people, each individual is their own individual, there are men who should not pass. There are women who should not pass but to give a blanket statement and say that it’s harmful, or detrimental to women is really doing a tremendous disservice.
Dr Gundry 40:21
Let’s talk about the other elephant in the room on the internet. It’s full of horror stories of women suppressing their thyroid function because of fasting and time controlled eating, as someone who writes about her own low thyroid, what’s a you?
Cynthia Thurlow 40:37
Yeah, well, let’s look at what intermittent fasting does in terms of mitochondrial health. And so I think on a lot of different levels that many people benefit from intermittent fasting if done properly, because it’s improving mitochondrial efficiency. I didn’t talk about a toffee G as a benefit, but mitochondrial efficiency, these are the powerhouses of ourselves. And so again, if that context, Are you a woman with an underactive thyroid, that doesn’t sleep, that doesn’t manage their stress and over exercise, and it restricts their food? Yes, fasting is not going to help you under those circumstances. But most women that I speak to and that I interact with, they’re sleeping, they’re eating a nutrient dense diet, they’re managing their stress, they’re not over exercising, and fasting for them can be that one strategy that may improve the quality of their thyroid health. And I think for so many people, it’s like half the conversation with your health care practitioner. Am I at a point when I’m ready to do this? And it’s interesting, I’ve asked a lot of thyroid experts, what are your thoughts on fasting and it without exception, they all say the same thing. We know that it’s beneficial for the mitochondria, we know it can help with ATP production, we know that it can help with metabolic flexibility. And so I think it’s all in the context of what is the amount of stress in your life, you know, this is one of many types of stressors. So for me, this is neither it’s generally good. But if you have too much stress in your life, that may not be the time to push that lever.
Dr Gundry 42:05
Alright, let’s talk about other stressors. You and I are both right about how it’s important to exercise on an empty stomach, which goes against the prevailing wisdom that I better get this giant smoothie in my belly or my energy bar before I go work out. How come that’s a dumb idea?
Cynthia Thurlow 42:29
Well, you know, it’s interesting, because I used to be of the belief system when I didn’t know better that I wanted to have that protein shake before I went to the gym, and I wanted to have another one as I was driving to the hospital. And I’d be the first person to say if you want to utilize stored fat as a fuel source, go to the gym and workout fasted. But it’s always in the context of, you know, where are you in your menstrual cycle. So if you’re in the luteal phase, it’s a week before your menstrual cycle, you may not feel good. But I think for most people, they feel so much better. They don’t want to be working out and having their blood shunted to their gut to help digest a meal. They want their body to be able to free up stored fatty acids and to fuel their body and fuel their workout and they’ll worry about eating later. This is not a question of not fueling your body properly. I do think there are certain types of activities where people do need to bring food with them. If you’re an endurance athlete, I mean that as a good example. But you don’t have to eat the carbs before your workout, you can actually have some fats as a fuel source. But I think for a lot of people, it’s helping them understand that you can power through a workout when you become fat adapted when you become metabolically flexible. And it makes things so much easier. When I go to the gym. I just have water with me that is the one thing I think about. And other than that the food can wait until later.
Dr Gundry 43:43
Now you write a lot about sleep and you actually write the time before thinking about this transformation. Get your sleep in order. Now what ways do you find help you prioritize sleep you got a fun gadgets that you like to use, or use other techniques?
Cynthia Thurlow 44:04
No, no, I do a lot of different things. I do love my aura. So I like to track my sleep that’s really important. And I’m a data person, probably not surprisingly, I mean, I like data. I would say that in terms of technology. I have a bunch of things. I’ve Apollo neuro, which is a device that was designed for PTSD patients, but they now understand that it’s very helpful for kind of evoking the autonomic nervous system, parasympathetic, getting us out of the fight or flight mode. I have something called some knocks this was gifted to me, I didn’t buy it. And it’s a device that you actually hug while you’re sleeping. And it actually like calibrates, your breathing, and so it’s a way of again, getting you into the parasympathetic and that it looks like a beam. That’s a Danish company that actually gifted that to me, and I have no affiliation with them. I just I think it’s a really nice, nice gadget. I also have a PEMF mat and this is probably one of my favorite things that I will lay on that. I’ll lay in it afterwards. Workout Alana before bed, it’s just very, very relaxing. And that’s also, you know, improving communication between the mitochondria. It’s very relaxing, there’s different settings. I don’t think gadget wise, those are the things but the big things that I think about during my day, I start thinking about sleep quality. When I get up in the morning, I start thinking about how important it is to get light exposure in my retinas. I think about that physical activity piece. Obviously, not at too close to bedtime, I think is really important. In fact, my aura will scream at me if I eat too close to bedtime. And that doesn’t happen very often. But if I’m traveling or a business events and you’re having a late dinner, sometimes you don’t get the option to close your feeding window at five o’clock at night like I normally do. But I think those are the things I lean into. And obviously there are supplements that I think can be very helpful if people perceive they’re experiencing an extra amount of stress. I am a firm believer in progesterone for women that that needed. Obviously I’m in a stage of life where I’m in this ovarian, you know, reserve failure piece of my life. So progesterone I think is incredibly beneficial. And then up regulates a neurotransmitter called GABA, which is very common in the brain. And I see a tremendous amount of benefit from that.
Dr Gundry 46:11
Now at least in California, progesterone is a prescription drug, and I assume it is in Virginia. So and I’m a big fan of progesterone, particularly in postmenopausal women, and I am convinced it’s helped my patients sleep among other things. So who should ask their practitioner to prescribe it?
Cynthia Thurlow 46:34
Well, I would say if you have a diagnosis of polycystic ovarian syndrome, you may very well benefit from progesterone during the luteal phase of your cycle. So number one, I think about that. And that would be someone taking that every day that would just be during the luteal phase and some practitioners like 14 days and practitioners like seven really depends on the clinician, women in perimenopause, we know that the kind of transitional point that starts to happen is the ovaries. Our ovaries are sold as we are. So unlike firm they get through generated every three days, or reserves oldest we are so late 30s, early 40s. We’re already in early ovarian failure. And so as there’s less progesterone produced I do find for many women, especially if they’re experiencing sleep issues, anxiety, depression, progesterone can be hugely impactful in perimenopause and menopause is Well, oftentimes in perimenopause, it may just be cycled around that the last, you know, seven days of the menstrual cycle. It’s interesting, I’m starting to see more emerging research about women cycling, progesterone, even in menopause. I think that’s probably highly dependent on the clinician and what’s going on with the patient. But I think I think that progesterone is being a pretty benign form of hormonal support in the body. I like compounded progesterone, because it’s more consistent, but the regular progesterone that’s that’s made in a pharmaceutical industry is very inexpensive. So this is not a super expensive product. If it’s compounded, it will be more expensive. I’ve just found that works better for me personally, and some of my patients. But I’m a huge proponent of progesterone, I think it makes a big difference in sleep quality.
Dr Gundry 48:14
Before I let you go, you mentioned the importance of listening to your body. And I think that’s incredibly important as well, how do people practice listening to their body? And can you learn how to do that? I’ve found simply when people follow my program, when they deviate, for whatever reason, they know it, and they’re their body tells them Hey, well, you What are you doing this for? Have you found that to be true as well?
Cynthia Thurlow 48:47
I have and I think a lot of listening to your body really speaks to slowing down? You know, I think we’re in this Harry culture where it’s Go, go, go, go go all the time. And I will encourage women to slow down and to just be mindful. You know, how do you feel when you wake up in the morning? Do you feel refreshed? How do you feel after a meal? Do you want to take a nap? How do you feel after exercising? Do you feel like you have to take a nap two hours later, that’s certainly a sign that things aren’t working well for you. So I think it’s the slowing down and the awareness. But I think it’s also just being cognizant of the variables that we have in our life. You know, do you feel good when you hang out with this individual? Do you feel that they you know, do you do activities that bring you joy? I think just getting very attuned to your lifestyle piece and how that works for you or against you. I think that’s certainly a first step but I would say from the perspective of metabolic flexibility and people being able to intuitively eat I think a great deal of that is a byproduct of, you know, just paying attention to like how do you feel when you have more curtsy and how do you feel when you have a little more fat? How do you feel when you have too much carbohydrate and then you can adjust your your macros or your food intake pretty readily
Dr Gundry 50:00
All right, I warned you that we’re going to have some audience questions. And these are perfect. So it’s time for our audience questions. This is from my Instagram post about shortening your window of eating from iCarly dashed TA. Does lemon in my water break the fast? What are you?
Cynthia Thurlow 50:26
Yeah, so technically it’s burritos. Technically, it will break a clean fast however, it is not. You know, it’s a pretty benign thing to do. I think for many people, they get caught up in minutia and get very granular. And so sometimes my team and I will have to decide like, does it break clean? Technically, but I don’t want that to be the reason why you don’t enjoy some lemon because I think lemon water is one of my favorite things that I do. And I’d like to squeeze lemon in my water. So I think on a scale from zero to 10, it’s like a 0.5.
Dr Gundry 50:59
Yeah, I agree. It’s such a tiny amount. And you know, and Valter Longo, my friend at USC is actually shown in humans, that having a basically a nut based bar does not change ketosis. So that’s the purpose of the fast which it is don’t worry about this minutia. All right. And from Greer Gomez, do you think intermittent fasting leads to disordered eating? Please give tips on how to avoid this? Yeah, that’s the other elephant in the room. So what do you say?
Cynthia Thurlow 51:40
Well, I can tell you that I back in the good old days, during my training, I actually interned at one of the leading eating disorder units on the East Coast. And so I have experience working with patients that have disordered relationships with food. Do I think that there are people who are more susceptible to disordered reading and that intermittent fasting is not a good idea for them? I absolutely agree. I think if you have a history of anorexia or bulimia or binge eating, you have to be very careful. And this is in conjunction with your therapist or your physician that you’re working with, you need to make a determination if you are healthy to participate. For most other individuals, I think it’s always in the context of these strategies are not designed so that you don’t eat, the strategies are so that you eat within a certain feeding window. So if you are eating a healthy amount of food, protein, fat, and carbohydrates, I don’t think that will lead to disordered eating. However, I do think that there are people on social media who I see all the time that I think hide their disordered eating in the guise of intermittent fasting. So I think that you have to be honest with yourself. I’ve had several women who had been very honest, and it was said, I did really well initially, but then I felt like I started to binge. And I thought, and I just then timeout, and maybe this is not a strategy for you. So I think it’s getting really honest with yourself, asking for help or support if you need it. And then being observant of your behaviors, your cues. And I think that’s the best way I would say, Have I seen it happen? Absolutely. It’s thankfully the minority, but it’s also the people who are also a little bit aware of their behavior, and they’ll they’ll come for help. They’re looking for help. How do I do that? And to answer her second question, how do I navigate this? Number one, don’t over fast. There are a lot of people who are like a little bit of fasting is good, then more is better. I don’t like to see women as an example, with a very tight feeding window. I don’t want to see omad as a sustained strategy, you’re not going to be able to get enough food in and those are the people that I sometimes see consumers be at greatest risk for binging because their body is just looking for more fuel. Number two, it’s like where are you in your menstrual cycle? Because if you’re white knuckling it, and you’re in the luteal phase, okay, back off. Remember, 12 hours of digestive rest is great. And then number three, like if you’ve got some extraneous stressors going on in your personal life, and you feel like you’re having more cravings, your needs aren’t being met. Back off on fasting like this is something that is not designed to be rigid. It’s designed to be flexible. It’s designed to kind of work around our lifestyles and not be a huge detractor from having successful that
Dr Gundry 54:20
perfectly put. All right, Cynthia, oh, this has been great. Where can our listeners find out more about your work? Thank
Cynthia Thurlow 54:27
you so much. This has been a pleasure. So probably easiest off my website. So it’s www dot Cynthia thurlow.com You can get access to everyday wellness podcast or which Dr. Gundry has been a wonderful podcast guests in the past. You also get access to my Instagram account Twitter before warned I can be a little snarky. I have a free Facebook group called the intermittent fasting lifestyle, backslash, my name and you can get access to my book, which is there as well.
Dr Gundry 54:55
All right. Well, thanks for joining us and hopefully we’ll talk Knock again soon and good luck with your teenagers.
Cynthia Thurlow 55:03
Thank you. Thanks so much.
Dr Gundry 55:07
All right, it’s time for our review of the week from at GP weed. I read the plant paradox five years ago now and I’ve kept 50 pounds off since this stuff is real and part of my daily life. I tell people to replace the no foods with the yes foods and a miracle will happen fast. Sad that most of the people I know still make fun of me on how I eat even though I take no medicine. bloodwork is perfect. I am physically fit at age 60. While they struggle with heart disease, diabetes, cholesterol and inflammation. Plus, they always complain about fatigue. I can do 50 Push ups, one hundreds of ab workout 50 knee bends, ride a bike 25 Miles hike in Colorado mountain trails, 10 hours to the top play golf, play tennis basketball. So thank you. Boy, I couldn’t have said that better. Did I write this? No, thank you GP weed. This is why I do this is why I get up every morning. This is why I do these podcasts to get feedback from you that it’s been worth it. Get rid of the no list and follow the yes list. And you’re right. When people actually do this a, a miracle happens. And that’s what’s so exciting. You know your body has repaired itself and look what you can do at 60. And so thanks for writing in again. If you got a comment, please send it in wherever you get your podcast. And who knows I might be reading you on the next episode of The Dr. Gundry podcast because this is Dr. Gundry. And I’m always looking out for you. We’ll see you next week. I hope you enjoyed this episode of The Dr. Gundry podcast. If you did, please share this with family and friends. You never know how one of these health hacks can completely transform someone’s life when you take the time to share it with them. There’s also the Dr. Gundry podcast YouTube channel where we have 10s of 1000s of hours of free health insights that can help you and your loved ones live a long vital life. Let’s do this together. Because I’m Dr. Gundry. And I’m always looking out for you
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