Ditch the Diet Mentality: Intermittent Fasting Ideas for Weight Loss & Brain Fog

About Cynthia Thurlow

Cynthia Thurlow is a nurse practitioner, intermittent fasting and nutrition expert, two-time TEDx speaker, author and podcaster. She leads numerous specialty fasting programs, has been featured on many well-known podcasts and her book, Intermittent Fasting Transformation: IF45, launched in March 2022.

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[00:01:21] Dr. Sarah Milken: In this episode, I have what I call a bucket list guest. She's a nurse practitioner, CEO and Founder of the Everyday Wellness Project and an international speaker with over ten million views for her second TED Talk, Intermittent Fasting: Transformational Technique. She was on the Lewis Howes podcast and Megyn Kelly.

She developed her intermittent fasting platform after hitting the fucking wall at 43 and realizing it was perimenopause and her doctors telling her to deal with it. With a curious mind and unrelenting dedication, she quickly became known for her work in intermittent fasting and wellness. She says 99% of what she learned in nursing school on nutrition is not true and helpful.

Breakfast is not the most important meal of the day. Starting intermittent fasting can be hard but no harder than anything else we want to do in life that promotes self-growth, healing and change. As Glennon Doyle says, “We can do hard things.” With her intermittent fasting and health plan, she lost weight, had more energy, fewer cravings and had lower blood glucose levels.

She has helped thousands of women get their midlife health together. She has worked with thousands of women in her private practice to make her unique program of intermittent fasting work for them too. She has a huge podcast called Everyday Wellness, which I'm a huge fan of, covering all the things women and health. I love her book, Intermittent Fasting Transformation. This book is meaty with a strong action plan and very digestible with all the information broken down. It has an amazing author voice of true relatability. Her name is Cynthia Thurlow.

[00:03:01] Dr. Sarah Milken: Hi, Cynthia.

[00:03:03] Cynthia Thurlow: I've been so looking forward to this discussion. Thanks for having me.

[00:03:07] Dr. Sarah Milken: I'm so excited you're here. My intentions for this episode, as it is for all of my episodes of the show, is for us to dig deep with our golden shit shovels in a deep-dive conversation on how intermittent fasting can help with hormone balancing, lifting brain fog, weight loss, detoxification and the midlife shit list that goes on and on. As Cynthia tells us in her TED Talk, in 1900, the average female lifespan was 47. She was 47 at the time of giving that TED Talk. I'm 48 and this is crazy information.

Based on what I know about you and being an avid follower of your content, this episode could be six segments at least. There is so much I want to cover about your expertise in intermittent fasting and women's health and your personal journey and career pivot or as I call it, the midlife remix. I read that two of your TED Talks were born out of the desire to teach women to be hopeful and reduce shame about the midlife and menopausal narrative. Tell us about that.

[00:04:19] Cynthia Thurlow: Thank you for that wonderful introduction. I never sought to be known in this space in this way. I was like most of us, fumbling and bumbling through having kiddos and managing a household, dogs and a husband traveling. I also had a very stressful job as a nurse practitioner in cardiology. For me, in 2018, because I'm an introvert, which always surprises people, I said to my husband, “I want to do a TED Talk.” Honest to God, his first reaction was, “Is this about an ego thing?” I said, “No. It's because I'm an introvert.” It was a scary thing to do. I said, “This is a scary yet very safe challenge.” That's where it stemmed from.

When I was working with my coach, I had not even acknowledged that what I should be talking about is how life imitates art and how someone like myself who went to a big school and one of the best research institutions in the United States, if not the world and no one ever prepared me. Not my mom, girlfriends, aunts or grandmothers. No one taught me what was going to happen when I started to go through reverse puberty. It was very much a journey of explaining, “This is what I went through. Here's what I now know.” This brain fog, weight loss resistance, exhaustion all the time and no libido, we don't need to let that be our narrative. We don't have to let that be our reality.

For me, doing that first TED Talk when I got on stage, I remember thinking, “God, this is the most embarrassing thing in the world.” I'm very much an empath so when I'm on stage, I'm looking at people like, “Is it resonating?” It was all these women that were shaking their heads like, “I get it.” Let's take the shame away from the aging process. Let's change that narrative. Let's flip it around and make it a positive.

We're so conditioned in our society that we want to be anti-aging or extend longevity. We want to be 50 but look 20. It couldn't be farther from the truth. Most of us endeavor to have high-quality existences. We want to sleep well, interact with our loved ones and have fun. We want our brains stimulated. We still want to feel like we're sexual beings with our partners or significant others. What we don't want is people making us feel bad about the fact that we're no longer twenty. We don't want to feel like we can't talk about the fact that we're at the end of our fertility. We're no longer capable of having children unless we use extraordinary means.

On so many levels, my experience has been the same experience, if not worse, for most of the patients and clients that I interact with. There are women who have lived for ten years with chronic insomnia. There are people who have such bad hot flashes that they have to walk around in a change of clothes. They have to bring changes of clothes of them everywhere they go or they no longer feel cognitively intact because their brains are so starved for nutrients. It’s not just from food but if HRT is appropriate for them, even having those options. For me, clinically and professionally, I acknowledge my life's work is to help women understand, not fear aging, embrace it, do it from a place of empowerment and education and teach.

To me, the gift of my platform and being able to connect with other women and their families is to say, “If I can do it, you can do it too.” I have three beautiful nieces. I want my nieces to grow up with a different mindset about the aging process. My mother, for as long as I can remember, never liked to talk about her age. She was like, “You don't ask women their age.” I was like, “Why not?” What I realized is that generationally, talking about your age was acknowledging you're getting older. Whereas I feel I'm comfortable saying, “This year, I'm going to be 52 and I'm proud of it. I'm proud of where I am.”

[00:08:26] Dr. Sarah Milken: That's how I feel too. I'm like, “I'm 40-fucking-8 and I look pretty damn good. I feel pretty damn good aside from a few things that we all have.”

[00:08:37] Cynthia Thurlow: It’s coming from a place of people feeling that they don't have to fear the changes that are going to happen. It's wonderful to not have a menstrual cycle anymore. I don't miss it at all ever. It’s never a question. I was having to have tampons everywhere I go for 5 or 6 years.

[00:08:56] Dr. Sarah Milken: It’s also sending your husband and being like, “Those are the wrong fucking ones. Why didn't you read the picture?” There are so many things. What I love about your message is it's not just, “Here are the things you need to do.” It's also saying this shit is hard work. It's not easy. It's not like there's this magic pill and suddenly, everything changes. It's all of the intentional steps that we're taking every day. Your tools like intermittent fasting, strength training and all of these things are not easy. Things that are amazing for us and worth doing usually require hard work.

[00:09:43] Cynthia Thurlow: Also, the reframe is that once it becomes part of your normal, it isn't hard work. When you make those lifestyle changes, it's a conscientious effort to change your mindset and methodology. Maybe you wake up a little bit differently. I have this beautiful way that I approach my day and the way that I interact with my team and family. Occasionally, my snarky fifteen-year-old may throw a wrench in things but I'm like, “That's fine.”

When you make those lifestyle changes, it's a conscientious effort to change your mindset and methodology

[00:10:12] Dr. Sarah Milken: You don't have a girl. I have a girl. You have two boys.

[00:10:15] Cynthia Thurlow: Years ago, I had this wonderful woman who helped us with the boys when they were young. She said, “You'd get one angel baby,” and that was my first. I didn't understand what that meant. We had our second and he made it very clear there would be no others after him. He has been a force from day one. There's nothing about Liam Thurlow that is ever without a degree of drama. I love him dearly but there's nothing about this child that does not have some degree of drama interwoven into it.

I do not have girls. However, this second child is so willful and determined. I always say, “I hope he does great things in the world,” because from the first day he was born, he came out of the C-section screaming like he was on fire and grabbed the OBs arm. The OB was like, “Twice in twenty years of clinical practice has that happened. This is the second time.” He is a willful child. Parenting him reaffirms that you get one angel baby and then maybe you get a typical kiddo. He's our typical kiddo.

[00:11:36] Dr. Sarah Milken: My first is a boy and then my second is a daughter. They're both amazing but he's my angel baby. He was annoying at fourteen when he wanted to ride the electric scooters around town with his friends with no helmet. My daughter is different. She's obsessed with me and she hates me all at the same time. It's like, “I hate you. When are you coming home?” I have that going on. It's about having your ass handed to you. My husband always says, “Good luck to you. You birthed yourself.”

[00:12:11] Cynthia Thurlow: What's interesting is we finally broke down and bought a third family car because we don't want the seventeen-year-old to think it is his car, which it is not. We own the car. The irony is this child and my husband, their first cars are the same car. They're carbon copies of one another. The second child is willful and determined. That's me. My husband says all the time, “I don't know who's like that.” He said, “You are an entrepreneur because you’re willful. Once you get direction, you run off in the left field.” I always say, “I'm not as difficult as he is.” He goes, “You are.”

[00:12:46] Dr. Sarah Milken: I went to dinner and my husband goes, “How are the new women that you met or whatever?” I was like, “I’m a fucking lightly.” He said, “Sarah, you’re not a lightly in any version of any time against anyone.” I was like, “Okay. I’ll take that.” I totally get that. Going back to this idea, I love your messaging about how we have to take self-responsibility and take care of our health. You have created this platform for women to become more proactive in their health. All of this shit is happening to us, like hormone changes, feeling disgusting and all of the things but you're here to say, “We can do something about it.” I love that message.

[00:13:30] Cynthia Thurlow: It's so important. If I had listened to the GYN years ago, I would've been put on synthetic hormones or an IUD. I was offered an ablation. It was then like, “Since you've told me you're done having kids, we can pull out your uterus.” I was like, “No. There has to be a better way.” I'm not picking on traditional allopathic medicine because that's how we're trained but it does speak to the fact that there's a limited amount of tools that most providers are given.

For me, it was all about, “I'm looking at my patients floundering. They're getting on more medication. They're having more procedures. This can't be the way. Why aren't we looking at what their sleep's like? Why aren't we talking to them about exercise? Why aren't we talking to them about their food? Why aren't we not talking about this?” It's like, “There's not enough time.”

[00:14:25] Dr. Sarah Milken: At 43, you hit the wall and your doctor was like, “Eat it.” You said, “I'm not going to do this,” and went on this path of discovery. You ended up doing two TED Talks. You were hospitalized in 2019, which we could talk about briefly because I know that was a thirteen-day nightmare for you. It brought you to this point of where you're at. You are helping yourself and other women rediscover how to live the second half of life in the fullest way we can.

[00:15:00] Cynthia Thurlow: 1) Being a provider, there is nothing more humbling than being a patient. 2) There's a degree of surrender that you have to embrace when you're in that situation. I was grateful that I had good care. 3) All I thought about was I wanted to get home to my family because I was quite sick. Things could have gone in a very different direction.

Being a provider, there is nothing more humbling than being a patient. There's a degree of surrender that you have to embrace when you're in that situation.

On the flip side of that, it was like, “I want to go home because I want to be with my kids and my husband but I feel compelled to do this talk.” I fervently believe that there are no coincidences. That was the time in my life when I was expected to rise from otherwise a pretty unpleasant experience. I did that talk with the sole intention of showing my kids I was okay so I did show my kids I was okay. That's as much as I thought about it. I was like, “I got on stage and did the talk. I checked that box. I'm going to enjoy the rest of the day.”

In Greenville, South Carolina, they were so wonderful. I didn't think about it again. I was like, “It will come out in May and then we'll move on. We'll have a low-key summer.” That wasn't the case. It goes to show everyone that through great adversity comes opportunity. That's always the message. Irrespective of what we're going through, we can walk through fire and still come out okay.

[00:16:16] Dr. Sarah Milken: We’re not doing things for the outcome. It's not like you did the TED Talk to become an instant star. You did the TED Talk to heal a part of you and show your kids that you were okay. By showing up for yourself and putting yourself out there not knowing the outcome, you created this beautiful new swirl of energy for the second half of life.

[00:16:39] Cynthia Thurlow: Thank you for seeing that. It's amazing, retrospectively. I can look back and I'm like, “Now it makes sense,” but at the time, I was stumbling and bumbling forward. I did that talk and then have my appendix out ten days later. I always tell people when I finally went to have my appendix out, then things started to hit me. I had a panic attack because they relocated me from an outpatient procedure to the main OR. They were like, “If you have a problem, we want you to be in the main hospital.” I broke down and told my husband, “My greatest fear is I'm going to be hospitalized again.”

I was grateful I ended up in the main OR because I ended up having a lot of trouble waking up. They had given me too much narcotics. I’m not a big person and they gave me way too much so it took me a while to wake up.” When I got home, I was like, “Check the box. The appendix has been removed. I've lost an organ but I've gained my health. Let's look forward.”

[00:17:38] Dr. Sarah Milken: I've had so many guests on my show. We've talked about longevity strategies and research. Everyone is saying a lot of the same things. The main thing that I'm pulling from all this is muscle mass. I call it doing the dumb fucking weights. I refer to it as the dumb weights. It’s not because the weights are dumb but it's like, “I got it. We have to do the weights.” You are saying that sarcopenia, which is also the fancy name for muscle loss, is not an if, it’s a when. Along with this muscle-building journey that we should be on is the intermittent fasting party.

[00:18:23] Cynthia Thurlow: It's both validating for some of us and also not sexy. It's things as simple as lifting heavy things that are the impetus for continuing to maintain and grow muscle. The intermittent fasting interjection is great, provided that you eat enough food in your feeding window. Hopefully, I'm not going to make anyone angry that reads your show. Women that want to die on the sword of OMAD every day are like, “I'm not hungry for a second meal.”

[00:18:54] Dr. Sarah Milken: Tell everyone what OMAD is so everyone knows.

[00:18:57] Cynthia Thurlow: It is One Meal A Day. It’s that easy. If you're eating one meal a day, you're not eating enough protein. You’ve got to be lifting heavy things and eating enough protein. You've got to be eating at least 30 to 40 grams of protein with each meal to stimulate muscle protein synthesis. If you're not eating more than one meal a day, you're losing out on opportunities to help support your muscle growth and then that sleep piece.

If you're not eating more than one meal a day, you're missing out on opportunities to help support your muscle growth.

Let's be clear. I'm a fan of hormone replacement therapy because it does make such a big difference. We know that about 25% to 50% of women so that's a large nebulous number, still continue to maintain a sufficient amount of testosterone in middle age. I'm not one of those people. My testosterone went down the toilet.

[00:19:43] Dr. Sarah Milken: Mine’s zero.

[00:19:45] Cynthia Thurlow: Unless I'm taking testosterone, my free testosterone is very low. You may need to take some testosterone. There's no supplement or food that is going to replace it if you don't make enough anymore. I could also tie in that if you're insulin-resistant, that's not going to help. If you're exposed to too many estrogen-mimicking chemicals, that's not going to help your testosterone. For the average person, eating enough food in your feeding window, lifting heavy things, getting high-quality sleep and plus or minus testosterone can be very supportive for maintaining insulin sensitivity.

[00:20:26] Dr. Sarah Milken: We all think that we know what intermittent fasting is because of social media but I want you to tell us what intermittent fasting really is and what it's not.

[00:20:37] Cynthia Thurlow: Intermittent fasting is eating less often. That is the most simplistic way to state it. It is not starvation. It is not restrictive eating. It is eating less often. It means I still eat as much food as I did when I had a 12-hour feeding window but I have 2 larger meals instead of 3. This means that there is a time during the day when you choose not to eat and there is a time during the day when you do eat.

Intermittent fasting means eating less often. It's not starvation or restrictive eating. It's eating less often.

It is so important to emphasize that this is not an eating disorder behavior. This is choosing to eat within a prescribed time. That could be 8 hours or 6 hours. I need an 8-hour window to get 2 large bolus of food in. There are people on social media that get triggered by the concept of intermittent fasting because it triggers their eating disorder behavior.

[00:21:27] Dr. Sarah Milken: You're also sleeping supposedly for eight hours of it. It's not like you're expected to run your whole day with no food.

[00:21:35] Cynthia Thurlow: I don't advocate for that. I tell people, “If you get hungry, eat.” I'll be transparent and say the benefit of the pandemic was that it demonstrated to me I do better eating earlier in the day than I do eating at night. I have plenty of metrics I track, whether it's my blood sugar or Oura Ring. If you look at the science of chronobiology, the science of mechanisms related to circadian clocks in our bodies, we do better eating earlier and closing our feeding window earlier. For a variety of reasons, people may not be able to do that. It's on a case-by-case basis. It's very important to emphasize we do not support eating disorder behavior. I'm not orthorexic. I don't recommend people to deal with any of that.

[00:22:19] Dr. Sarah Milken: You eat a shit ton. I see it on your Instagram. I'm like, “She’s eating a bison burger and this and that.” It's not like you're not eating. It’s that you're giving your body a break from the eating and the insulin party that is brought on by eating the wrong foods.

[00:22:38] Cynthia Thurlow: I'm fortunate that I like what I eat. When I sit down, I don't go, “I feel like I don't like what I'm eating.” I genuinely have always been a healthy food eater. That's what makes my body feel good. My husband tells me I would've died off many years ago. He's like, “You would've been the person that if you had to eat junk food, you wouldn't have functioned well.” My husband's like a garbage can. He could eat anything. His digestive system runs optimally. Whereas mine is if I eat healthily and I eat meat, poultry, fish and veggies, I'm great. If you give me greasy, fatty, fried food, it's not pleasant.

[00:23:18] Dr. Sarah Milken: There are a million fasts out there but the window that you're mostly advocating in your program is a 16:8 timeframe. It's 16 hours of not eating and 8 hours of eating in that window.

[00:23:33] Cynthia Thurlow: Throughout the book, I talk about different types of fasting, like longer fasts and different low-protein fasts, for variety. I say all the time that we don't do the same workout when we go to the gym. Our body is a little bit varied. Interestingly enough, I was listening to an interview with Satchin Panda. He's this chronobiology sleep researcher. He was saying, “We should eat at the same time every single day.” I was like, “No. I don't know if I necessarily agree with that.” Our bodies thrive on variety. We don't eat the same foods every day. We don't do the same exercise every day. Adjusting that fasting window, even if by 30 minutes, can keep our bodies guessing as to when food is coming.

For so many of us, it's an all-or-nothing phenomenon. We get very rigid and dogmatic. I encourage women to not be rigid and dogmatic. We're hard enough on ourselves. If I get hungry, I eat. I had meetings starting at 10:00 AM. I was very hungry. At 9:45, I ate a small meal. I was like, “When I'm done with all my meetings, then I will eat a good size meal. I'll probably have another meal before I go to bed.” The point of what I'm saying is we have to give ourselves grace. We have to stop being so rigidly dogmatic. We have to be so rules-oriented.

We have to give ourselves grace. We have to stop being so rigidly dogmatic.

Another thing that I've noticed as I've been interviewed for talking about the book and talking about fasting is how rigidly dogmatic many people are. They don't even realize they're doing it. They're like, “I can't eat before 11:00 AM.” I'm like, “If you're hungry at 10:30, eat.” I'm an advocate of people pushing themselves out of ketosis.

If someone's low carb or ketogenic, every once in a while, it's good to push yourself out of being so structured and conditioned all the time. It's important for people to understand. It then makes intermittent fasting a more viable option for a lot of women when they understand. They're like, “Cynthia said if I get hungry, I eat earlier and if I need a little bit more protein, to eat it and not feel like, ‘My feeding window is closed. I can't eat.’”

[00:25:39] Dr. Sarah Milken: You talk about that in the book about wanting women to lean into those intuitive feelings of, “This is what my body needs now.” Sometimes, I feel like, “I need to eat a fucking steak,” and then sometimes, if you offered me a steak, I would throw up. It’s knowing and feeling what your body needs and going easy on yourself sometimes. I'm sure when you're traveling, it's not so easy to stick to the 16:8 rule. Things are going to have to be a little bit flexible. There are time changes, airplanes, and all sorts of things.

[00:26:17] Cynthia Thurlow: I was ironically out in LA. I got into my hotel. I was able to get into my room early. I was like, “I'm so hungry.” I ordered room service because I wanted exactly what I wanted. I got a double burger with bacon and a salad. They brought it up to me and it was perfect. I agree with you. Certainly, for me, I did a longer fast. It was longer than I wanted to. I ate a big meal and then I ate another meal. I'm not a fan of snacking but sometimes, when I travel, that's a good example. I was so hungry by the time I got to my hotel that I was like, “I should have eaten.”

[00:26:52] Dr. Sarah Milken: You weren't looking at your watch going, “I'm not in the eight-hour window.” Sometimes, it's like, “Fuck it. Let's move on here.” That's how I feel about it and I'm not even doing what you're doing. You've said in the book too, you can't do the workout. Your body's like, “I’m sorry. I can't do it today.” It doesn't mean all the time but once in a while, you had a shitty sleep and you can't do it.

[00:27:19] Cynthia Thurlow: You have to learn, especially in middle age, that you are less stress resilient. That doesn't mean you're incapable. I know that if I have a terrible night of sleep or I'm stressed about something, 1) I'm not going to make good food choices. 2) That's not the day to go to the gym and try to push a personal record. As an example, I had a good night of sleep, went to the gym and did a very heavy leg day.

I could tell by mid-day that not only did I need more food in my feeding window but I might need a nap at some point. I was like, “I pushed it so hard.” My husband came home and said, “I saw you upstairs. Are you sick?” I was like, “I'm not sick. I got all my work got done. I pushed my workout so hard that my body was like, ‘We need a cat nap.’” I probably took a twenty-minute nap where I felt amazing when I woke up. We have to lean into those.

My mom has done some amazing things. She's an incredible role model in many ways. She was one of these female CIOs so my mom didn't sleep for twenty years. Since she has retired, it took her five years to gear down to relax enough to not do anything. She's this master gardener. I was laughing. My stepfather said, “She's outside gardening.” She has a big hat on. She wears all this sunscreen. She's loving the fact she's in the dirt. I said, “That poor woman was so on the go and not resting enough for so many years. Her body needed a break.” She's out in nature and having fun. It's important to reinforce that there's no shame in taking a nap and going to bed earlier. My whole family makes fun of me because I go to bed before everyone else. I have teenagers and they love staying up late.

[00:29:10] Dr. Sarah Milken: I do too. I'll say to my husband, “Please stay up and make sure everyone gets home.” He's like, “No. Could you do it tonight?” Neither of us wants to stay up late. It's like a kid's scavenger hunt like, “Where are the teenage children tonight?” I'm texting my kids, “Where are you?” They're like, “You have Life360.” I'm like, “I don't want to look at Life360. I want you to tell me where you fucking are.”

[00:29:39] Cynthia Thurlow: My oldest has this first serious girlfriend. She's lovely. I was explaining to him, “Your curfew is your curfew. If you show up at 11:05, that is not abiding by your curfew.” He's like, “You should give me a grace period.” I was like, “No. You should get in your car earlier and get your butt home. That five minutes makes a big difference.”

[00:30:01] Dr. Sarah Milken: I know, everything’s a negotiation. It’s crazy. Going back to fasting for a second, let’s talk about fasting basics. Why do we want to be metabolically flexible? What does that even mean? What's the quick and dirty on that?

[00:30:14] Cynthia Thurlow: Metabolic flexibility is as simple as saying that your body can effectively use carbohydrates or fats as a fuel source. To be metabolically flexible means your body is able to use either/or. It's not that it's a one or nothing. Unfortunately, it's only about 7% to 8% of our population here in the United States that is metabolically flexible. We're outliers.

Most people, because they eat too frequently and they eat the wrong types of foods, their bodies are not effectively able to tap into fat storage to use as energy. It's almost like you've loaded your car up with gas. You've only used a quarter of a tank and you keep topping it off. Your body never has the ability to work through the gas to get to empty, which is where we need to be. It ends up setting up this communication between different hormones in the body such as cortisol, insulin and glucose.

Over time, your cells can become less receptive to the chemical messenger or hormone messenger of insulin which is trying desperately to lower your blood sugar and move glucose into the cells. Over time, it's almost like you're knocking on a door and you can't hear that insulin's there to move blood sugar into the cells. On a lot of different levels, when we talk about metabolic flexibility, it's as simple as saying allowing our bodies to effectively use different types of fuel substrates.

[00:31:38] Dr. Sarah Milken: How do we measure that?

[00:31:41] Cynthia Thurlow: It's interesting. When people talk about labs, one that's certainly very popular is glucose. You can check your fasting glucose. You can check an A1C, which is a snapshot of 90 days’ worth of blood sugar control. However, the most important one that I reflect on is fasting insulin. It's an inexpensive test. Your MD, NP, PA or whatever initials are after your provider's name should be able to order it. It's covered by insurance and is inexpensive.

Fasting insulin is usually the very first marker that will dysregulate as you are becoming less insulin sensitive. When I talk about measuring metabolic flexibility, we're starting with some lab work but we're also talking about the signs that your body is metabolically flexible. You can go for longer periods without eating. You don't have energy slumps. You are able to lose weight more readily or easily. You have sustained blood sugar. There's no hangry in your life versus those that are using carbohydrates as a fuel source, they can only go 1 hour or 2 before meals. They are symptomatic when their blood sugar gets low. They struggle to lose weight. They don't have the same degree of cognition.

We want to be able to use fats and glucose or carbohydrates as a fuel source. When our body uses fats, certain types of fatty acids can be diffused across the blood-brain barrier in the form of ketones. These are very helpful for brain health and cognition. It allows for tremendous mental clarity. If someone says to me, “I ate a meal and I want to take a nap,” that's not a good thing. If someone says, “I eat a meal and I have so much energy and mental clarity for five hours afterward,” then you know that your body, very likely, is using fats as a fuel source. We want both based on our physical activity and how active we are. Those are some of the clues that can let people know.

[00:33:38] Dr. Sarah Milken: Every lab is different. There is going to be a little difference in the normal range. In your practice, what are you looking for that number to be?

[00:33:50] Cynthia Thurlow: It is usually 2 to 5. If you're eight, it means you have some work to do. If you're ten, you have work to do. These are the people that will say, “I've been trying to lose weight for two years. I can't budge,” and then their fasting insulin is 20. For fasting blood sugar, 75 to 90 is where I like it to be. When I finished my NP program many years ago, we were looking at higher numbers as being acceptable. I always say, “You don't want to be low and symptomatic.” If at 75 you are shaky, sweaty and you feel crummy, that's different than, “I wake up in the morning. I wear a continuous glucose monitor. I use a glucometer. My blood sugar is 78. I feel great.” It's important to understand there's a narrow therapeutic window of blood sugar in a fasted state.

If you eat after a meal, you do expect your blood sugar to go up. Fats are going to have the most negligible impact on blood sugar than protein and carbohydrates. They are going to have the most exaggerated response. If you're monitoring your blood sugar, you can trend, “Did I have too much carbohydrate? Did I get my macros dialed in?” I don't like to see blood sugar going up by more than 25 points. If it goes up much higher than that, it could be a sign that the quantity or the quality of carbohydrates was the wrong choice.

[00:35:04] Dr. Sarah Milken: Some people that are laymen like me and some of the readers, I'm sure, interchangeably use insulin levels and blood sugar but they're different things.

[00:35:18] Cynthia Thurlow: They're different hormones. Insulin works to regulate blood sugar. If you eat a meal, in response to your meal, your blood sugar will rise. That’s normal. I've seen some physicians online who are like, “We shouldn't see any changes in your continuous glucose monitor.” I'm like, “That’s a bunch of BS.”

[00:35:38] Dr. Sarah Milken: If you wake up and it's 70 and you eat your first meal, I don't know what your eating window is, then what would you expect your number to be after 30 minutes or 1 hour?

[00:35:53] Cynthia Thurlow: Let's say I wake up and I'm 75 and then at the time I sit down and eat a meal, it's 90. I don't want to see my blood sugar go up by more than 25 points. If I go from 90 to 150, I'm like, “Did I have dessert? Did I have a bunch of pasta? Did I have too much bread?” Glucose Goddess who is amazing, I interviewed her. She's an incredible human being. She talks about the order of operations for food and how that can help mitigate your blood sugar.

Most people are sitting down and having a bowl of chips or something that's very carbohydrate-dense and then are having protein. She talks a lot about food orders. For me, when I sit down and eat a meal, I don't want to see more than 20 points, more than 25 at most. People need to understand when your blood sugar's above 140, you're creating damage in the endothelial wall. That is the internal wall of that blood vessel. It's not benign. People that walk around and say, “It's not a big deal. I ate this cake and my blood sugar went to 200,” that's not good. That's not good glycemic control.

When your blood sugar is above 140, you're actually creating damage in the endothelial wall, or internal wall, of that blood vessel.

What I like to see is if we're checking it 30 or 60 minutes afterward, I don't want to see those wild fluctuations. I would expect within two hours, your blood sugar's back down to baseline. An easy thing you can do that everyone can do is walk after a meal. I used to make fun of couples that did this in my neighborhood. We are that couple that walks in the morning. We walk in the evening. We walk with the dog.

[00:37:20] Dr. Sarah Milken: We're the couple that has the weighted vests too. It’s extremely awkward.

[00:37:26] Cynthia Thurlow: The LA peeps are overachievers. It's interesting. I live in a very hilly part of my state. There's nothing flat in my neighborhood. We're up and down hills all the time. I'll say to my husband, “I feel like that meal is sitting in my stomach.” We went out to dinner. If you can believe it, there's this restaurant in Richmond, Virginia that has a four-month wait. We finally got in on a Thursday at 5:30. That was the only reservation we could get. We went to L’Opossum.

[00:37:54] Dr. Sarah Milken: Did that fit in your window? It’s a little late for you.

[00:38:00] Cynthia Thurlow: It is a little late. I can't believe I'm going to admit this out loud. Every time we tried to get reservations at this restaurant, something came up. We were both traveling on Valentine's Day and then we had all these other things that happened. My husband's like, “Our Valentine's Day reservation is in April at 5:30.” That’s why we went.

The point of what I'm saying is when we got home, I was like, “I had a steak. I had a delicious meal.” We didn't even eat dessert because they had nothing that fit within my gluten-free boundaries. We went for a walk and I was like, “I love the fact that we walk. Every night, we walk. We have become the people we used to make fun of that would walk at night.”

[00:38:41] Dr. Sarah Milken: My husband and I have mastered that apparently according to my teen children. Let's talk about the fasting benefits. There are a million and your book goes so beautifully into all of them. I'm going to read the list and let's pick a couple that you think are the most salient for our conversation. It burns fat, promotes gut health, creates metabolic flexibility, enhances mitochondrial health, helps hormones like insulin and cortisol, cleans defective cells, boosts brain health and cleans out the garbage, strengthens immunity, reduces inflammation and slows the aging process.

[00:39:17] Cynthia Thurlow: Let's talk about autophagy. This is this waste and recycling process that goes on in our bodies in an unfed state. It's not as if autophagy gets turned on and off. That's a common misconception. I do like to let people know that this is one of my favorite things. We talk about how disease-disordered cells have the potential to go on and create pre-cancerous cells. It's helpful to understand when you've been around for at least 40-plus years, you got some cells that we could recycle or get rid of.

It's like, “I've been exposed to a lot of things I want to get rid of.” I love the concept of autophagy. It understanding that in an unfed state, you get upregulation of this process and your body is able to effectively get rid of diseased organelles or mitochondria. These are things that are contained intracellularly. I also think about this reduction in inflammation. It is something as simple as eating less often.

People will say to me, “I have so much less joint pain.” People assume it's because they're getting older. Estrogen is a major anti-inflammatory player. People are like, “It must be because I'm getting older.” No. It's because you're eating these highly inflammatory foods. You're allowing your body to have a degree of digestive rest that helps reduce inflammation patterns in the body. That's another one that is probably not spoken about enough. There is also the whole concept of the migrating motor complex, which is this nerdy bit of physiology that goes on in the body.

Estrogen is a major anti-inflammatory player.

I love talking about it. My team's always like, “Here she goes.” It's like a janitor. It's pushing things forward, not just debris but potentially microorganisms that don't belong there like parasites. We ingest bugs, bacteria and parasites. It happens. We want our gut to be healthy enough that it can kill these things off with hydrochloric acid and otherwise.

The MMC is like a janitor. Think about the janitor that works in the building you used to work in or the school. It’s like a sweet sweeper. They’re pushing things forward, trying to move them through the gut. It takes about 4 to 5 hours in between meals for that MMC to be optimized. This is why I don't recommend eating big meals and then eating two hours later. You can take out Thanksgiving and Christmas.

[00:41:33] Dr. Sarah Milken: I've heard you say that you can either do 3 meals within an 8-hour window or sometimes, you do 2 meals and then some protein powder or bone broth. Since it's a smaller window of time, when does the third meal become a snack? How much time do you need in between? How do you organize that?

[00:41:53] Cynthia Thurlow: It depends on the day. Some days, if it's cold outside, I may heat up a warm bone broth and I'll have that to break my fast with. Maybe an hour later, I'll have a real meal. It's never that I'm eating a big meal and then having another big meal two hours later. I remember around probably 43, I intrinsically wasn't as hungry so for me, I have to be super disciplined about making sure I'm getting that other protein hit.

Do you know when you’ve got that stomach rumble and you’re getting there? It’s like, “It’s that time that I've got to prep to eat.” For a lot of people and I'm certainly one of these people, I have the flexibility and the privilege of being able to work from home so I can generally eat when I want to. I work it into my schedule. I acknowledge if I were still working in a hospital, I'd be lucky if I was eating much at all. That's certainly a circumstance where maybe someone is breaking their fast with a protein bar or a shake because that's as much as they can get on board before they can have a real meal. It's always dependent on what your lifestyle is going to allow you to do.

Certainly, there are days when my feeding window is longer because quite frankly, I need it to be. I don't have the ability to sit down and eat a real meal. I tried to avoid eating in airports and airlines as much as possible. I'm always saying I'm lucky. When I was on this last Delta flight, they handed out roasted pistachios. I was like, “There's nothing junky in here.” It was a pistachio and some sea salt. I'm like, “That's a nice change,” as opposed to Cheez-Its and goldfish crackers.

[00:43:27] Dr. Sarah Milken: Is that considered a snack for you even though you're supposed to only eat meals?

[00:43:32] Cynthia Thurlow: If I'm hungry, I'm going to eat but I generally don't. I took it with me to say, “The next time I'm on a business trip and I need a healthy fat added to a meal, I'll use this small serving of pistachios.”

[00:43:44] Dr. Sarah Milken: In terms of women in menopause and perimenopause, in your book, you go into crazy depth about hormones. For the purpose of this conversation, what's a quick overview of how intermittent fasting can help us with the fire hose of hormones?

[00:44:02] Cynthia Thurlow: It comes down to understanding that in perimenopause and menopause, lifestyle becomes very important. You're sleeping well and you wake up well-rested. You're managing your stress and that's not five minutes of meditation once a week. You are eating an anti-inflammatory diet, which means you're mindful of the quality of the food that you eat. You purchase what your budget allows you to.

Understanding that protein, non-starchy carbohydrates and high-quality fats like olive oil, coconut oil, salted macadamia nuts, lard, tallow, towel or duck fat, if you tolerate those things, they are going to be better choices than going to Chick-fil-A and eating that five days out of the week. Those are not just inflammatory foods but the way the foods are prepared and the oils they're cooked in can be problematic.

The other piece that I always say is the exercise piece. I usually get a lot of hate when I say this but I'll pick Orangetheory Fitness as a good example. If you're doing that six days a week with no rest days, in perimenopause and menopause, it can be problematic. Think about the impact of that stress. Chronic stress on your body can raise your cortisol, and that can be problematic.

[00:45:14] Dr. Sarah Milken: I also find that it makes you hungrier. Some of my friends who used to spin all the time are starving.

[00:45:21] Cynthia Thurlow: It's all in the context of understanding we have to do things a little differently. In that setting, if you're doing the lifestyle piece right, adding intermittent fasting can be impactful. I have women every day that will send me messages. They'll say, “I was ten years into menopause and I thought I was never going to lose the menopause weight. All I did was I followed your program and then, all of a sudden, I've lost weight.” Someone is 45 years old and they’re like, “I've been carrying 20 extra pounds for 5 years. I never thought I could get rid of it.” It has to be creating this hospitable environment to add in this one strategy, intermittent fasting and then adjusting your macros and seeing the magic that happens with that.

That's not to suggest. There are people out there that will say there's a season and a time. Certainly, the pandemic added a lot more stress to our plates. I say to people “Be kind to yourself.” I have stopped fasting certainly when I lost 15 pounds and was in the hospital for 13 days. I didn't fast for probably 4 or 5 months because I didn't have the bandwidth to do it. It is understanding you can take a break. It doesn't have to be something that you do 7 days a week or 31 days out of the month. Maybe you do it five days a week. Maybe you find a system that works well for you. It is understanding that there's a degree of flexibility in fasting.

[00:46:42] Dr. Sarah Milken: If you're in the perimenopausal years, is there any research that shows the minimum you can do to get these janitorial inflammation effects?

[00:46:54] Cynthia Thurlow: Specific to perimenopause, not that I'm, per se, aware of. I forgot to mention this. If you're still having a menstrual cycle, there's a time to utilize fasting as a strategy and then there's a time to back off a bit. In the follicular phase, the first day of bleeding up until ovulation, estrogen is your superpower. It allows you to push your workouts. You can be low-carb or ketogenic if you choose to be. You can get away with more fasting. After ovulation, when you have these fluctuations in progesterone during the gluteal phase, the closer you're getting to your menstrual cycle, the less you want to be fasting. It could be 12 to 13 hours of digestive rest.

To your point, when we're talking about benefits to the migrating motor complex and reduction in inflammation, 12 to 13 hours of not eating is still beneficial. I want to be very clear. That should be the gold standard for everyone but maybe not for our teenagers because they're always hungry. They're in this massive anabolic phase in their lives.

There's a lot of solid research on obese menopausal females. There's a lot of research on men and lab animals but not as much on women during their peak fertile and perimenopausal years. That is because a lot of male scientists think of it as a variable they don't want to account for. Our menstrual cycle is considered to be something that they have to account for and it makes it less convenient.

[00:48:19] Dr. Sarah Milken: In terms of who intermittent fasting is for, let’s break it down into life cycles. If you're a 35 or younger female who's in their “fertile” years, what is ideal for them?

[00:48:35] Cynthia Thurlow: It depends on if you are lean and fit, you should not be doing a lot of fasting. Twelve hours of digestive rest is perfectly fine. If you want to fast 1 day a week or 2 days a week, that's fine. You don't have a lot of reserves. Even if you're choosing not to become pregnant at that stage in your life, your body's taking a lot of information around you. If it is perceived you're not eating enough and over-exercising or over-restricting, that could impact your fertility and menstrual cycle.

If you are an obese, PCOS, Polycystic Ovarian Syndrome patient or diabetic, then a little bit of fasting is going to be beneficial in the context of that follicular phase. Some of the people that have PCOS have very long cycles. You may want to do this in conjunction with your MD, NP or PA so that they are hooked not only to monitor your blood sugars but also your progress because you may need less medication.

You transition into perimenopause at 10 to 15 years preceding menopause. This is when the lifestyle piece is important. If you don't sleep enough and you’re doing seven days a week of Orangetheory Fitness or CrossFit with no rest days, you’re restrictive with your diet, maybe you’re too low carb for you, which is very bio-individual or you’re not managing your stress, adding in fasting can be like adding gasoline to a fire.

It's important that people understand that if you're not sleeping, don't add intermittent fasting. It's another type of beneficial stress or hormonic stressor. It is understanding that that can be a variable you need to think about. Men and menopausal women, women who haven't had a menstrual cycle in greater than twelve months, the average age in the United States is 51, sometimes, they can have the easiest time with fasting provided that they are looking out for those metrics around the lifestyle that I talk about.

[00:50:29] Dr. Sarah Milken: It’s because they’re not on the hormonal roller coaster anymore.

[00:50:32] Cynthia Thurlow: That’s correct. How many menopausal women tell me they haven't slept well in ten years? I'm like, “Fix the sleep piece first.”

[00:50:41] Dr. Sarah Milken: I'm glad you said that because that's what I was going to say. In this journey of discovery for yourself and creating this platform, did you get the HRT piece in motion before you were able to do all these other things?

[00:50:55] Cynthia Thurlow: No. When I was hospitalized in 2019, I was still getting a regular menstrual cycle. My last cycle was in January 2019. That was my very last one. I had no idea when I was hospitalized that that fifteen-pound weight loss was going to push me over the cliff. My GYN said, “Women that have bad divorces go through a major illness. It's not at all surprising.” I was technically 48 because I went one whole calendar year. I was still sleeping well and eating right. I was doing the right things. By then, I had figured out what needed to happen.

Initially, before I even came to fasting, I didn't realize I was doing all the wrong things. I was doing very intense conditioning classes early in the morning. I was probably too low carb. I had a stressful job. I wasn't sleeping as well or as much as I needed to. It took me a solid year to get back on course. For a solid year, all I did was walk and do yoga.

We talked about how our bodies go through the adrenal pause. Our adrenals take a big hit when our ovaries are making less progesterone. The ovaries start doing less and the adrenal glands have to pick up the slack. For me, I realized that the stress resiliency piece was something I needed to work on. I can be an intense Type A person so I have to diligently work at that piece every single day.

[00:52:30] Dr. Sarah Milken: I don't want women to walk away from this conversation going, “I feel like shit.” I'm going to intermittent fast and not do HRT. Where do those things intersect? Where in that journey do those things lie? I don't want anything to be misconstrued.

[00:52:44] Cynthia Thurlow: I do take HRT. I'm going to be very transparent about that. I didn't initially because there are so many other pieces. Women sometimes get put on HRT before they fix the lifestyle stuff. Lifestyle is first in every single circumstance. Once you've dialed in on sleep, stress, exercise and nutrition and you ensure those detox pathways are properly primed and in a position where you can add these things in, it's understanding that not every woman in perimenopause needs estrogen yet. We can have these wild fluctuations in estrogen.

Women sometimes get put on HRT before they fix the lifestyle stuff. Lifestyle is first in every single circumstance.

Most women do well with progesterone. That's sometimes the low-lying fruit. You start with oral progesterone. I take oral compounded progesterone. That's what I started with. I have been on both estrogen and testosterone. I see a lot of women that start with testosterone. I always say, “You don't start with testosterone because you have these estrogen receptors that have to be optimized before you add testosterone.” That's based on research and from the teachers that I have learned from who are clinicians and MDs.

It is helping people understand there's a continuum. Most women benefit from oral progesterone. If they're at the tail-end of perimenopause and estrogen patch, compounded estradiol may be of benefit. Once that's optimized, it is then adding on that testosterone piece. There are a lot of other things that can get added there. It's dependent on the woman, their symptoms and how they feel. I feel like for a lot of women, progesterone helps them fall asleep and estrogen helps them stay asleep.

I sleep blissfully and effortlessly but it's taken me time to figure out what I need in what I call my sleep stack. It is figuring out what works for me in my sleep stack and what can I share with women that would be a benefit. No one should have to put up with crappy sleep. If I have a one-off crappy night of sleep, I'm like, “I can deal with that.” If it's a couple of nights in a row, I’m like, “What is going on?”

[00:54:48] Dr. Sarah Milken: That was my question. Isn't the estrogen going to help us get that hormonal baseline down so that we can get off the fucking couch to go work out and set up the pieces to help lift the brain fog so that we can get our asses to the gym? That's why I see the order of it.

[00:55:09] Cynthia Thurlow: Testosterone is oftentimes that hormone that is the motivation hormone. I can honestly tell you I generally know if mine is not optimized because I'm like, “I know I need to go to the gym but I have no motivation to go to the gym.” I can feel that.

[00:55:26] Dr. Sarah Milken: Do you use the inner thigh cream or whatever it is?

[00:55:29] Cynthia Thurlow: I use compounded testosterone. It's created for me. There are no FDA-approved testosterones for women, which is a crime. For progesterone, you can get regular pharmaceutical-grade progesterone, which has about a 20% variance. For me, that was enough that sometimes I would sleep well and sometimes, I wouldn't. That means you could have a pill of progesterone that you could buy from your pharmacy. About every third or fourth night, I would take the progesterone that didn't have as much in it and it would impact my sleep quality.

It's important to take a break one day a week. Sunday night is my break day. I don't take any hormones. I've come to find that starting with progesterone and then adding estrogen can be helpful. Not everyone that is in perimenopause or menopause needs, per se, to be on testosterone but a lot of people are prescribed. It's usually compounded. It can be done legally. Let me be very clear with that. There is no black market testosterone.

I see women that have differing protocols based on their clinicians. It's all about finding someone that is willing to invest the time to hear about your symptoms and find a custom-tailored prescription for you. I can honestly say that I'm so grateful that I work with someone. It’s both a blessing and a curse that everything is compounded because it's more expensive. Jokingly, every time I put in an order for thyroid medicine or any of these things, I'm like, “I better save a lot of money for when I retire one day so that I can pay for all my compounded stuff.”

[00:57:10] Dr. Sarah Milken: There are also a lot of doctors who say, “You don't have to have compounded. It's okay to not have compounded. It's covered by insurance,” and all of that too.

[00:57:20] Cynthia Thurlow: It's been my experience. The compounding is where a lot of people end up.

[00:57:23] Dr. Sarah Milken: They want it customized.

[00:57:27] Cynthia Thurlow: I get that. I'm fortunate and privileged that that is an option I can go with. You can get very inexpensive progesterone at the pharmacy with a prescription. You can get estradiol patches that are covered by insurance. Testosterone's not covered. I take five medications and none of them are covered by insurance because they're all compounded. It was because I got to a point where the normal thyroid stuff wasn't working anymore. It was ridiculous. We throw our hands up. You're then like, “This has become my new normal.” I usually recommend NAMS or the North American Menopause Society as being good resources. Those are clinicians that are trained on the new guidelines for HRT as a good resource for women that are looking for a provider.

[00:58:16] Dr. Sarah Milken: For women who are like, “I want to do Cynthia's plan. I need someone to teach me how to intermittent fast for 45 days,” I want to do a quick overview of your plan and the three phases of the plan. This is for the audience who are like, “Sign my ass up.”

[00:58:34] Cynthia Thurlow: First of all, the book is a great resource. We also have classes that we teach quarterly. Depending on when this episode comes out, we usually teach them in January, April, July and usually October timeframe. That's an in-person class where we expand beyond what's in the book. The first phase of the book is helping prep you for success.

It's important for people to clean out their pantries and wrap their heads around the changes in macros. Quite honestly, most women do eat not enough protein, too much carbohydrate and the wrong types of fat. We're helping people understand how to set themselves up for success. When you're getting to a point where you're no longer snacking, then move to adjust your macros. Protein is the most satiating macronutrient.

Most women eat too little protein, too much carbohydrate, and the wrong types of fat.

If you go from snacking twice a day to no longer snacking, you're going to structure your meals in such a way that you'll be able to get from breakfast to lunch, lunch to dinner and hopefully, from dinner until you eat breakfast again without being miserably hungry. You start opening up that fasting window. Maybe you're going from dinner to breakfast. Maybe that's fourteen hours. We then start training you. Everyone is a little different. Some people do it in fifteen-minute increments. Others do it in 30 or 1-hour increments. We do that until we get to a point where you're having the sixteen hours of fasting.

[00:59:55] Dr. Sarah Milken: Are there accountability coaches? How does the program work?

[00:59:59] Cynthia Thurlow: It's myself and my team. I have 45 coaches. Some of them teach within the program with me. My program has 3 calls with me and then 3 with my coaches. There's a call every week so a ton of accountability. We then have a private Facebook group where people can ask questions. There's a metric ton of support in between. Typically, what people do is they buy the book and then are like, “I want to learn more.” That's a great first start.

There are challenges in the book and also in the virtual program that allow people to ask questions. We have customized guides. It’s taking it to another level. I am teaching so it's me and the group. People always say, “Is this Cynthia?” I am physically in the group. Over 45 days, I'm checking in along with my team because we're all in different time zones.

[01:00:55] Dr. Sarah Milken: I want to come to you and take your in-person class so I can meet you in person. It would be so much fun. Let's talk about self-limiting beliefs. You talk about them in the book. All midlife women have these crazy self-limiting beliefs of, “I'm too old. I can't do that.” With intermittent fasting, it's very triggering. Tell me. From your clinical experience, what are the main self-limiting beliefs that are preventing women from either starting or staying consistent with intermittent fasting?

[01:01:26] Cynthia Thurlow: It stems from a lack of self-confidence. It is women that will say, “This lifestyle change has never worked before for me so this won't work this time.” I'm all about reframing our thoughts because that can be so powerful. It's helping people understand. As an example, when I hear that, which I do hear often, it is like, “This time, we're going to have all this consistency point. We're going to have accountability. We're going to be in a group. We're going to be able to lean on one another.”

I'm going to use their words because it's not my words. “When I feel like I'm weak and I'm going to binge, not make good food choices or have this wild feeding window,” it's helping them understand that it’s all possible. Just because it didn't work before doesn’t mean it’s not going to work now. This is a new time and place. This is not the same as before. We're ahead of where we were before.

The other most common thing I hear is, “I've tried everything else to lose weight. This won't work.” I always tell people, “If you're saying that out loud, what are you saying internally to yourself?” It's helping women understand that weight loss resistance is a symptom of an imbalance in the body. Where is that imbalance coming from? Is it because your sleep quality is terrible? Is it because you don't manage your stress and your body is in sympathetic overdrive? I use their terms. Is it because you sneak candy at night because you are unhappy and unfulfilled in your life and purpose? Are you over-exercising?

In my old neighborhood, there was this group of women that were big runners. They would run 8 to 10 miles every day. They looked haggard. They were so haggard because they were raising their cortisol. I was helping them understand that instead of taking 2 hours to run every day, maybe what they need to do is invest 30 minutes in strength training. I was helping them understand, “The biggest bang for your buck is Zone 2 training, strength training and a little bit of mindfulness work, whether or not it's yoga or tai chi.”

Lastly, it's helping you understand that this is not an inevitability of age and that you shouldn't accept poor-quality sleep, feeling like you're inflamed or your clothes don't fit. Those are all things we don't have to accept but we have to understand what is contributing to that. A lot of people are so disconnected from their bodies. It's helping them understand like, “Don't take my advice because I'm saying it. Take it because intrinsically, you are trusting the process.” There's a degree of surrender when we are trusting in someone to help navigate these changes and do it in a way that's healthy.

I'm a big proponent of if the external dialogue is negative, imagine what the internal dialogue is. One of our IF:45 coaches is a mindset guru. She teaches in that group to help with those limiting beliefs. To me, there are all these extra resources that help women navigate these changes and do it in a way that honors them as individuals but also allows them to reframe those negative thoughts.

As I always say, if you're saying something negative outwardly, imagine what your internal dialogue is like. I'm also guilty of it. I'm not perfect by any stretch of the imagination but I will catch myself when I'm doing it. I'm like, “Reframe that thought. What's a different way energetically to look at that and reframe that?”

[01:04:54] Dr. Sarah Milken: Instead of, “I have to do the dumb weights,” it's, “I get to do the dumb weights.”

[01:04:58] Cynthia Thurlow: “I'm fortunate. I'm blessed. I'm grateful.”

[01:05:04] Dr. Sarah Milken: In terms of perceived obstacles, I'm sure you have women who are like, “I did intermittent fasting for 1 month and didn't lose 12 pounds.” How do you address that situation? Fasting isn't just for losing weight and changing body composition. There are women who fast that may not be as thin as they want to be. How do you respond to that?

[01:05:27] Cynthia Thurlow: I used to say this to my patients in clinical cardiology as well. If you're losing more than 1 pound or 2 a week, that's not sustainable. I was like, “Let's set the expectation. If you lose 4 to 6 pounds over 45 days, I'm happy with that because that is sustainable weight.” It's helping them understand that CICO, this Calories In, Calories Out model, is a bunch of BS. We're not that simplistic. It's helping them reframe conceptually that there are many factors that influence weight loss resistance. There are many things that impact that.

I want them to focus on non-scale victories. There are some people that I tell, “I don't want you stepping on the scale again until the end of 45 days. Go by how your pants feel. Go by how much energy you have. Go by how clear cognitively you are. Those are the metrics that I want you to focus on.” I recognize that that may be different than what these women have ever heard before because they've been so conditioned to believe it's about that number on the scale.

There are many factors that influence weight loss resistance. There are many things that impact that. You need to focus on non-scale victories.

[01:06:29] Dr. Sarah Milken: That number on the scale is fucked too because it’s more about the muscle-to-fat ratio. I've talked about this before because I did another episode on metabolic health with an endocrinologist. I've been very guilty of being the skinny-fat person.

[01:06:44] Cynthia Thurlow: Things like BOD PODS, I don't know if you know that.

[01:06:46] Dr. Sarah Milken: I don’t know what that is.

[01:06:48] Cynthia Thurlow: It looks like an egg. You get inside it and sucks all the air out. It is a more accurate reflection of your body fat index, so that's humbling.

[01:06:58] Dr. Sarah Milken: Is that different than using an InBody machine?

[01:07:02] Cynthia Thurlow: Yes. I'm going to date myself, Mork from Ork. It looks like that kind of egg. That's what my trainer recommends. She said that's how she keeps herself honest. She was like, “Calipers are very subjective. You can lie in a bed of water but that's not always as accurate.” BOD POD sucks all the air out so it can measure your body fat mass.

We have a very toxic diet culture. Many women have grown up with yo-yo dieting and the concept of gaining and losing a certain amount of weight over their lifetime. It is helping them understand that there's a healthier way to reflect on the benefits of intermittent fasting that aren't solely focused on the metric on a scale or changes in body composition. I'll say to people, “Monitor how your pants fit.”

[01:08:00] Dr. Sarah Milken: Monitor how you don't feel like an ass every day and that you don't feel like a ton of bricks came down on you. It's interesting. I was listening to you. I don't know if it was another podcast but it was saying, “The same shit you were doing before in your 20s and 30s is not working.”

[01:08:21] Cynthia Thurlow: People don't like to hear that though. I always say, “I wouldn't want to go back to my 20s and 30s.” My thirties were amazing because I met my husband and that's when I had kids but I'm so much wiser, self-confident and self-assured. There's something wonderful when you have less estrogen circulating in your body. You lose a lot of those people-pleasing tendencies.

[01:08:46] Dr. Sarah Milken: We have the window and the structure. We understand the benefits. What are we eating in that window? Protein is the $50 million tool here. Let’s get into a little bit of the details. You said that it's 30 to 50 grams per meal. It depends on if you're having 2 or 3 meals in that window. Are you in the hundreds zone for you?

[01:09:11] Cynthia Thurlow: I eat anywhere from 50 to 60 grams of protein with each meal. I'm very cognizant.

[01:09:19] Dr. Sarah Milken: What's your day total? Does it depend on your 2 or 3-meal version?

[01:09:26] Cynthia Thurlow: It's 1 gram per pound of ideal body weight. I weigh anywhere from 115 to 120 pounds. If I hit 100 grams of protein, I'm happy with that. Do I hit that every single day? Some days, I'm over and some days, I'm under. I try to be consistent. I like a variety of vegetables. I really like vegetables.

[01:09:47] Dr. Sarah Milken: I'm not a huge vegetable fan. I have to be honest. If somebody said that Athletic Greens could solve all of my vegetable-eating issues, I would only do that.

[01:09:56] Cynthia Thurlow: I probably have 4 or 5 veggies that I eat consistently. It's warmer here so I've been eating more salads. If I have a bison burger, I'm probably going to have a big salad with it. I throw whatever needs to be eaten. It might be beets or a cucumber.

[01:10:12] Dr. Sarah Milken: I know you're gluten-free. Do you eat gluten-free bread or do you stay away from bread?

[01:10:16] Cynthia Thurlow: Bread, for me, is a slippery slope so I don't eat it. If I'm on vacation and someone gives me gluten-free bread, I'm going to enjoy every single bite. When I go home, I'm like, “I need to decompress from that.”

[01:10:27] Dr. Sarah Milken: If you took away all of those carbs from me, all the alarms in my body would go off. I'd be like, “Goodbye.”

[01:10:35] Cynthia Thurlow: It has to be what's consistent. I don't do gluten-free pasta or bread because I don't enjoy it. I'll eat rich vegetables or a sweet potato. It depends on how physically active I am. On days when I'm lifting heavy legs and I do two leg days a week, that's usually a day I'll have more carbohydrates. If I have more carbs, I lower my fat threshold. I tend to like leaner meat, fish and poultry anyway so that's not an issue. Whatever you're doing, you want it to be sustainable. If you could never have a piece of bread again and it would be too restrictive, then it's good to know that about yourself.

[01:11:10] Dr. Sarah Milken: Once I tell my brain, “I'm not eating sugar anymore,” it's self-sabotage for me. I have to pretend to myself that I'm going to be somewhere in the middle. I'm like, “I'm going to fast for twelve hours today,” and then it hits twelve hours and I'm like, “Maybe I can go to thirteen.” I have to pretend to myself.

[01:11:29] Cynthia Thurlow: That's fine. This is why sometimes when people want to know exactly what I eat, it makes me a little uncomfortable. For me, I genuinely like the way I eat. I eat plenty of food and a healthy amount of food. To someone else, it is like, “I couldn't get by without eating ice cream or these things.” I say, “I put several autoimmune conditions into remission by going gluten-free so that, to me, is non-negotiable.” I don't do well with dairy but I love dark chocolate. That's my one big vice. I tell people that all the time. I’m like, “I have a little bit of dark chocolate every day because I can.” If you told me I couldn't eat dark chocolate, I would probably cry.

[01:12:06] Dr. Sarah Milken: Me too but also regular chocolate. Let's talk about protein powder. I feel like protein powder is super stressful. You go on Instagram and it has whey protein, collagen, bone, or pea. It’s like, “Does your body know the difference between animal protein and protein powder?”

[01:12:28] Cynthia Thurlow: I always want to come from a place of realism. If your choice is to eat a steak or drink a whey protein shake, I'm going to tell people to eat the steak. I acknowledge there are people that are on-the-go. My kids like whey protein. We have a lot of whey protein in my house. You buy the best quality of whey protein you can afford. That's number one.

[01:12:47] Dr. Sarah Milken: Is there a brand that you like that is a Cynthia-approved brand?

[01:12:50] Cynthia Thurlow: There are two. MariGold and Paleovalley make two clean options. For me, I use bone broth protein and then add in branched-chain amino acids. Bone broth protein, although derived from beef, because it's not whey, is missing some of those amino acids so I add in some amino acids. With a lot of plant-based options, you have to be careful. We don't have a lot of long-term data on pea protein. What does it do to you long-term? Do I think it's okay every once in a while? Probably. You want to pick a well-sourced low ingredient list and low-sugar option. I have no affiliation with Truvani but I know Food Babe has a protein powder. I don't love the way it tastes. I don't like plant-based protein powders. They tend to be chalky and are tough to mix.

[01:13:39] Dr. Sarah Milken: Is Truvani a plant-based protein powder?

[01:13:41] Cynthia Thurlow: It is.

[01:13:42] Dr. Sarah Milken: Will that not process the same in terms of muscle building as a whey protein?

[01:13:48] Cynthia Thurlow: Always, animal-based protein will trump plant-based protein. It's a different amino acid composition. It comes down to trying to meet people where they are. As an example, in my programs, we'll have people that are plant-based. We’re helping them navigate choices of getting enough protein and not overeating carbohydrates. We’re finding what works for them. It can be a challenge. It's not to suggest it's impossible.

Animal-based protein always trumps plant-based protein. It has a different amino acid composition.

At least one of my coaches is plant-based predominantly. She does eat some animal-based protein and eggs. It's always trying to find, “How can we get more high-quality protein in your diet?” If you do dairy, that’s great. If you do eggs, that’s great. Overall, animal-based protein is always going to be a superior choice.

[01:14:33] Dr. Sarah Milken: For me sometimes, if I make a smoothie, I'll take one scoop of Truvani and one scoop of, I don't remember the exact brand because I have 100 of them, another protein that is meat-based powder. In my mind, I'm like, “I nailed it. This is 50 grams of protein.” Depending on what my milk source is, whether it's almond milk or I cheat and use the fairlife dairy milk, which says complete protein and has 42 grams of protein, then I'm like, “At least I've gotten half my protein for the day.”

[01:15:09] Cynthia Thurlow: It's all about meeting people where they are. One of the things that I believe is becoming problematic is people get so rigidly dogmatic. They're like, “You should not have that prepared shake.” I'm like, “My teenagers love that thing.”

[01:15:22] Dr. Sarah Milken: Do they drink the fairlife one too?

[01:15:24] Cynthia Thurlow: They do when my husband goes shopping. It's accumulatively over time. If five days out of the week you hit your protein macros and do a great job, that's great. That's better than what most people are doing. If two days out of the week, you don't hit your protein macros and drink a prepared shake, that's okay. That's the message I want to make sure I speak about.

[01:15:47] Dr. Sarah Milken: It says complete. That's in opposition or in contrast to the bone broth powder or the collagen powder because those are not complete proteins.

[01:15:58] Cynthia Thurlow: Correct, that is why when I have bone broth protein, I add essential amino acids so that it will round that out.

[01:16:05] Dr. Sarah Milken: When you're saying you're adding in essential amino acids, is that a powder? What is that?

[01:16:09] Cynthia Thurlow: It is a powder. Protein is broken down into amino acids, nine of which are essential. The bone broth protein doesn't have all of the essential amino acids so I add in, as an additional supplement, BCAA.

[01:16:24] Dr. Sarah Milken: That's the one I see on Instagram that's called PerfectAmino or something. I don't know which brand you use.

[01:16:31] Cynthia Thurlow: It’s similar to that. Collagen is different than bone broth protein and whey protein. It's great for hair, skin and nails. If you're taking that, it's with the understanding it's going to help your hair, skin and nails. I take collagen every day because I'm at the stage of life where my hair, skin and nails are pretty important. I've got very long hair. I don't have extensions. Someone asked me, “Did you get extensions?” I was like, “No. My hair's gotten long.” I don't need one more high-maintenance thing.

[01:16:58] Dr. Sarah Milken: What collagen do you like?

[01:17:00] Cynthia Thurlow: I've got a couple. I have Designs for Health, MD Logic, which has marine collagen, and Primal Kitchen because my kids like the chocolate one. Sometimes, they'll add it to their shakes. You want limited ingredients. There are different types of collagen. Someone said to me, “When I need to add in more protein, I do a scoop of collagen.” I said, “Collagen is great for hair, skin, and nails.”

[01:17:29] Dr. Sarah Milken: That's why I'm asking because there's a big misconception out there. Why do you do the art project of mixing the essential amino acids in the bone versus going for the whey?

[01:17:41] Cynthia Thurlow: It’s because I don't tolerate dairy.

[01:17:43] Dr. Sarah Milken: Whey has dairy. I see.

[01:17:46] Cynthia Thurlow: I've tried it several times because with my functional medicine provider, we did a bunch of genetic testing and he said, “You would tolerate whey.” I was like, “I'm telling you. When I cut dairy out of my diet years ago, it was what allowed me to lose the last 5 perimenopausal weight pounds that I had not been able to get rid of.” For me, it was non-negotiable. It was such a big difference. In me, even though I was eating very little of it, it was enough that it created enough inflammation that I was like, “I’m not going back to that.” For me, with having a couple of autoimmune things that are in remission, anything I can do to keep those in remission and not reactivate them is the goal.

[01:18:28] Dr. Sarah Milken: In an ideal world, we aim for complete. Complete would be potentially the pea protein but we don't have enough long-term research on it.

[01:18:41] Cynthia Thurlow: I'm not a huge fan of processed pea. If you're going to have plant-based protein like legumes, beans and things like that, that's a whole food source. Ideally, that's what we're aiming for but I'm also a realist. If someone says, “I don't do any animal-based protein,” I would then say, “Pick a plant-based protein that does not have a bunch of junky fillers and an ingredient list with 30 things in it.” I'm always suspicious of long ingredient lists in general.

[01:19:13] Dr. Sarah Milken: You talk about quality protein. I feel like I've been wanting to ask someone like you this question for a long time. Is it better to have, let's say, a powdered meat-based protein versus eating a bunch of chicken from Chipotle? What does quality protein mean? Does it have to be an organic grass-fed steak? Can you tell us?

[01:19:38] Cynthia Thurlow: First and foremost, quality protein is dependent on your budget. Robb Wolf put out a great book. He did a combined book titled Sacred Cow. He talked about how the only real difference between pastured meat, let's say beef and conventional food lot meat was a difference between omega-3s and omega-6 ratios. For the audience, if they're not familiar with that, omega-3s tend to be anti-inflammatory. Omega-6 tends to be pro-inflammatory.

Sacred Cow: The Case for (Better) Meat: Why Well-Raised Meat Is Good for You and Good for the Planet

Most Americans eat too little omega-3 fatty acids and too much omega-6 generally coming from seed oils. To answer your question, I would rather be someone eat a plain hamburger from McDonald's than eat a bunch of processed crap. I would rather that you eat the whole food source protein. We do have the ability to buy grass-fed, pastured meat, fish or well-caught stuff. That's a personal choice.

[01:20:42] Dr. Sarah Milken: It is also not a convenient choice. You have to make it.

[01:20:46] Cynthia Thurlow: We've gotten to the point that my teenagers eat so much food. It's obscene. We go to the regular grocery store and then we have meat shipments to maintain our sanity.

[01:21:01] Dr. Sarah Milken: ButcherBox is also another one too.

[01:21:03] Cynthia Thurlow: We have Wild Pastures. That’s who I like. They're affiliated with Paleovalley. They do a nice job. We do it that way. You can go to your grocery store. You can get chicken, eggs, fish, pork and even bison. I'm seeing it in a lot of grocery stores. Those are perfectly acceptable. Those are whole food sources. People perseverate and stress about, “The chickens ate soy.” It’s like, “I would rather you eat the real thing.”

[01:21:30] Dr. Sarah Milken: You'd rather be someone who eats chicken bowls from Chipotle than have whey protein powder.

[01:21:37] Cynthia Thurlow: If we want to split hairs, we can talk about what rancid seed oils Chipotle uses. That's why I was saying, “Go to the grocery store and get your chicken.” I'm a fan of batch cooking and cooking ahead of time. We avoid seed oils at home. Do I go to a restaurant and probably get some seed oils? Yes. Do I stress about it? No, because I don't eat out a lot. Do I think everyone reading should then add that to their list of stressors? No. Be conscientious. When you're bringing things into your house, avoid seed oils. Don't cook with seed oils but when you go to a restaurant, enjoy your meal.

[01:22:11] Dr. Sarah Milken: What about sliced turkey and all of that?

[01:22:14] Cynthia Thurlow: I would probably recommend getting the organic pastured options.

[01:22:18] Dr. Sarah Milken: Otherwise, it's super-processed.

[01:22:22] Cynthia Thurlow: We have a grocery store where they'll put a hunk of roasted turkey on their slicer and slice it for you. I'm a realist. You have to work within your budget and what makes sense. My kids have gotten away from eating any type of sliced anything, which is both frustrating and humorous. They go through stages. Probably your kids too. They love something for two months, you buy a bunch of it and then they're like, “I don't want that anymore.” I'm like, “I'm stuck with a bunch of this stuff.”

[01:22:48] Dr. Sarah Milken: Believe me, I have 47,000 things like that. My husband says I do that too. Let's talk about carbs for a second. You talked about the Glucose Goddess. The idea is to generally manage carbs in your day. You're gluten-free and you don't eat a lot of bread-ish type things. For the average person wanting to do this, what would okay carbs in a day look like?

[01:23:15] Cynthia Thurlow: The conversation has to start with are you metabolically flexible? Are you insulin sensitive? If you are, you can get away with a lot more discretionary carbohydrate intake. I always encourage people to look at low-glycemic berries. Lemons, lime, citrus fruits and tart apples are going to be great choices. If you are insulin sensitive and metabolically flexible and you want to have a banana, go enjoy a banana. Have a piece of pineapple. Have a cantaloupe.

It comes down to low glycemic fruits. Those are the things I first talked about. It is integrating more carbohydrates on days you are more active. If you're at the gym and you lift heavy, that's maybe the day to have those root vegetables, maybe some sweet potato or squash or if you tolerate grains. Not everyone does. It's more or less representative of what is done to the grains.

Was it sprayed with herbicides and pesticides like glyphosate and Roundup? That can be why some people don't tolerate those things. Even potatoes. Cooked cooled potatoes have a form of resistant starch, which can be very helpful. It comes down to whether you are insulin sensitive. If yes, great. If not, then you probably need to eat less carbohydrates.

Most perimenopausal and menopausal women are not metabolically flexible, not insulin sensitive and want to lose weight. More protein, less carbohydrates, what does that mean? Sometimes, it's 1/4 of a cup, 1/3 of a cup or 1/2 of a cup. It's not sexy to measure these things but until you know what that portion size looks like, that can be very helpful. I had some raspberries and some blueberries in a shake because it was one of those days. It was a busy day. I knew that I would eventually get to stop again and eat.

Most perimenopausal and menopausal women are not metabolically flexible, are not insulin-sensitive, and want to lose weight.

A lot of it is dependent on your physical activity. How's your sleep? Some people are sensitive to low carbs in terms of sleep quality. If you see your sleep quality erode when you start eating lower carbohydrates, what is that in terms of numbers? For the average American, it is 200 to 300 grams of carbs a day. I usually encourage women to get under 100 as a starting point. For a lot of people, that's a big change. They don't realize how much carbohydrate they're eating throughout the day and even some vegetables have carbohydrates in them. People don't understand all of that discretionarily adds up over time.

[01:25:34] Dr. Sarah Milken: How do you get all your fiber in with all the protein?

[01:25:38] Cynthia Thurlow: It depends on the person. I don't, per se, think everyone needs a ton of fiber. I love Brussels sprouts. It is one of my favorite vegetables. It's very dosage dependent. I could eat a ton of Brussels sprouts. I love them. If I ate two cups of Brussels sprouts, my stomach would let me know. It was way too much fiber. For me, it's more about the quantity of fiber that I consume than it is about doing it every day. I'm always eating vegetables. I enjoy vegetables so I get a good amount of fiber in my diet. Do I have a resistant starch powder that I use? Occasionally, yes but I have to be careful because even small amounts will give me a lot of gas and bloating.

[01:26:23] Dr. Sarah Milken: Give me an example of a resistant starch powder.

[01:26:26] Cynthia Thurlow: It's a product by Designs for Health. It's called PaleoFiber®. It's a mix of green banana, flour and potato starch. Cooked cool potatoes have a good amount of resistant starch in them. It’s feeding the good bacteria in the gut microbiome. For me, with six weeks of antibiotics and antifungals, it was not overnight that my gut reset itself. I still have to be conscientious. It probably makes me sound neurotic but I know my gut well enough that I can push the lever a little bit on here and then I have to back off.

[01:27:00] Dr. Sarah Milken: What are the things that we can do for our gut if we have been on antibiotics excessively?

[01:27:07] Cynthia Thurlow: Fermented foods. We want to start with food-based sources. Kombucha but not going overboard. There are a lot of people that drink way too much kombucha-fermented tea.

[01:27:15] Dr. Sarah Milken: I know. My daughter loves it. I haven't tried it. It sounds disgusting to me.

[01:27:20] Cynthia Thurlow: It’s so good.

[01:27:22] Dr. Sarah Milken: Is it full of sugar? What's in it? Those $9 bottles from Whole Foods, I'm like, “Did you drink that?”

[01:27:29] Cynthia Thurlow: Those $9 bottles, that’s 3 or 4 servings. When I have a bottle of kombucha, it's like using half a cup at a time. I don't drink the whole bottle but a lot of people do. That's why they go overboard. If a little bit of something is good, more is better. It evolves into looking at fermented foods, like kefir and yogurt. Fermented vegetables are one of my favorite things.

You can walk into Whole Foods. My favorite brand is HEX Ferments. They're in a glass bottle. They have amazing flavor profiles. That's probably my favorite brand. That's usually where I start. You can also add things like a beneficial yeast called Sacc boulardii. That can be very helpful. You can maybe cycle in some probiotics. We're a culture that wants a supplement over a food source. I always say, “Start with the food.”

[01:28:16] Dr. Sarah Milken: I want a bowl of magic pills.

[01:28:22] Cynthia Thurlow: That's how most people think.

[01:28:27] Dr. Sarah Milken: We touched on healthy fats. You're saying that veggies are okay but try to pick the less starchy ones. We haven't talked about hydration. In this show, we've talked about hydration before but I like the way that you frame it. You say you should be drinking half your body weight and that intermittent fasting requires that you do hydration properly. As we get older and I loved how you said this, our sensor decreases. We're like, “We didn't even know we were thirsty. Now, we're exhausted and dehydrated.” I'm constantly yelling at my parents who are 80 and 74. I'm like, “Are you fucking camels? Can you please drink some water?”

[01:29:20] Cynthia Thurlow: They don't want to go to the bathroom. It's interesting, physiologically. I have a journal article because I was talking about with my coaches about hormonal changes during menopause and the impact on fluid regulations. What it says here is that when women go into menopause, the changes in alterations in estrogen drive down these thirst centers. You don't realize you're thirsty. There is also clinical dehydration. By the time you're thirsty, you're already dehydrated.

When women go into menopause, the changes and alterations in estrogen drive down these thirst centers, so you don't realize you're thirsty. By the time you're thirsty, you're already dehydrated.

For myself, I drink electrolytes and water all day long. It's important for me for sleep quality and how I feel. People that are weight loss resistant, more often than not, are dehydrated on top of everything else. It is helping people understand how valuable electrolytes are. Remember, my whole background is in ER medicine and cardiology. That's a lot of what we did. We were constantly replacing electrolytes. It's not just one packet of LMNT once a day. You likely need more than that.

[01:30:18] Dr. Sarah Milken: That's what I was going to ask you. I drink LMNT. They have flavored ones and unflavored ones. I know Cynthia likes them because they have sodium and potassium. They don't have fillers and junk and gunk in them. Before you're breaking your fast, you should only be drinking the one that's unflavored.

[01:30:40] Cynthia Thurlow: That’s right if we're talking about a clean fast. It's very important when people are new to fasting or they’re weight loss resistant that they clean up their diet. Technically, if you look at research on stevia, will you get a massive insulin response? No, but you have something called a cephalic phase insulin response. In response to sweet things in your mouth, your body is signaling that something is coming. I always remind people of that. If you're weight loss resistant, you want to change body composition or lose weight, you have to clean up your diet. It's helpful and also important for people to understand that if you're doing a clean fast, then you don't want to be ingesting things that are sweet.

[01:31:23] Dr. Sarah Milken: You can get the unflavored one. You down it and you're done. How many of those LMNT packets could you drink in a day? They have sodium and potassium. How much can you have of that?

[01:31:35] Cynthia Thurlow: I do at least 2 to 3 and then I'm having electrolytes throughout the day. I am someone that does very well with using electrolytes throughout the day. I could give you five different things I do, but it helps me sleep and meditate well.

[01:31:51] Dr. Sarah Milken: What are the five things? You can't just say that and not tell us.

[01:31:54] Cynthia Thurlow: There's something called Quinton ampoules. It's isotonic water that I put in mine.

[01:31:58] Dr. Sarah Milken: I have them. They're in glass bottles. I got them but I haven't started using them yet.

[01:32:03] Cynthia Thurlow: I use those. I use a product by Teri Cochrane that's called Wild-Lytes. It's salt, watermelon and cilantro. It's super refreshing. I have trace minerals that I use. I have something called dysautonomia. There's this imbalance in the autonomic nervous system. It's very mild. I want to be clear. I don't have POTS. I do well with a lot of electrolytes and I salt my food.

[01:32:29] Dr. Sarah Milken: Can you over-electrolyte yourself?

[01:32:32] Cynthia Thurlow: Sure, people can.

[01:32:33] Dr. Sarah Milken: What would a day look like for you with the perfect balance of the little glass tubes or the LMNT packets? I'm trying to get a sense.

[01:32:42] Cynthia Thurlow: For me, and I'm not saying that this is what everyone else needs to do, it is probably 3 packets of LMNT and 3 ampoules of the Quenton ampoules. I use 2 to 3 scoops of Teri Cochrane's product, and I might do some trace minerals. It depends. If I'm sweating a lot, that can impact it.

[01:33:01] Dr. Sarah Milken: You don't get too salted up.

[01:33:03] Cynthia Thurlow: No.

[01:33:06] Dr. Sarah Milken: Would that be equivalent to getting an IV?

[01:33:08] Cynthia Thurlow: No, because I'm not getting a liter of fluid all at once. There's a company called Restore. They're in my area. Sometimes, before I fly, I'll do some hydration. I can get a liter of fluid and not pee. I know my body well enough to know that I probably need more than the average person. We know clinically that women lose some of this thirst center. That's why you see little old ladies and little old men in the hospital who are so clinically dehydrated. They fall and hit their head. They have urosepsis because they're not urinating enough. They think it's an inconvenience. That can happen.

[01:33:48] Dr. Sarah Milken: Have you seen any research in your work on those places you go to that you're talking about for IVs and if there's any harm in doing them once a week or twice a month?

[01:33:59] Cynthia Thurlow: It's always in the context of whether you need them. That's number one. I do it very specifically for long-distance travel. I don't necessarily do it every single time because I don't have a lot of extra time in my schedule. A lot of those centers prey upon people. They’re like, “You need this and this.” It’s because of my training that I can tell when I need a little bit more hydration. It's so easy to do it that way. I don't, per se, think that everyone needs to be spending a couple of hundred dollars.

[01:34:28] Dr. Sarah Milken: I was curious if there were any downsides to it.

[01:34:31] Cynthia Thurlow: Some of those places are also doling out semaglutide.

[01:34:38] Dr. Sarah Milken: I'm talking about the everyday Myers Cocktail.

[01:34:44] Cynthia Thurlow: Myers is fine. They're usually electrolytes and maybe you're getting some extra B vitamins. Those are pretty benign. I've seen on the menu some of that and I'm like, “I don't think you need a NAD injection.”

[01:35:02] Dr. Sarah Milken: What about putting salt and lemon in your water?

[01:35:06] Cynthia Thurlow: I love lemon in my water. I have a product that I created called Creatine Monohydrate. I love my creatine. I'll put that in my water with lemon in my feeding window.

[01:35:19] Dr. Sarah Milken: What if you put the Celtic salt? It’s not the same as using an LMNT.

[01:35:26] Cynthia Thurlow: It's fine. I like Redmond salt. Like a crazy person, I travel with it. I've taken photos of me on vacation where I'm like, “I got my salt.”

[01:35:37] Dr. Sarah Milken: We all have the crazy shit that we do, believe me. In terms of breaking the fast, you say you can have teas and black coffee but nothing mixed into them. No stevias, none of that.

[01:35:49] Cynthia Thurlow: Not for a clean fast. I'm always a proponent of the clean fast. Learn good habits.

[01:35:55] Dr. Sarah Milken: If you're going to do it, you got to do it right.

[01:35:58] Cynthia Thurlow: Sometimes, that triggers people because they're like, “I like what I like and I don't want to change it.” I'm like, “More power to you.”

[01:36:04] Dr. Sarah Milken: Have you found any tricks for drinking black coffee?

[01:36:07] Cynthia Thurlow: Yes.

[01:36:08] Dr. Sarah Milken: I love my coffee in the morning, I had to drink black coffee the day of my colonoscopy and I almost died. I was like, “What the fuck is this? I hate this. This is terrible.”

[01:36:18] Cynthia Thurlow: There are two things. You can add salt. It will change the flavor profile.

[01:36:21] Dr. Sarah Milken: What kind of salt?

[01:36:22] Cynthia Thurlow: Redmond salt.

[01:36:24] Dr. Sarah Milken: How much?

[01:36:25] Cynthia Thurlow: I would start with 1/4 teaspoon because that will probably do a lot. Maybe 1/8 of a teaspoon. You can also add cinnamon. Cinnamon helps with insulin sensitivity.

[01:36:33] Dr. Sarah Milken: I'm glad you can put that. I put that in my espresso coffee that has all my shit in it. That's so good to know. I'm going to try that. Everyone's talking about strength training. I have 8-pound dumbbells and all that stuff but you guys are talking about heavy weights. They’re not heavy but moving the needle. How do we know that we're doing what we need to be doing?

[01:37:01] Cynthia Thurlow: It's hard. It should not be easy. It's not so that you hurt yourself. Let me be clear. People may go from weight-bearing exercise to moving to light weights to heavier weights. I had a particularly hard leg day. I went up on weights. I work with a trainer. She loads into my app what she wants me to do. What I did kicked my ass. I was like, “This is hard.”

[01:37:27] Dr. Sarah Milken: You don't see her in person?

[01:37:29] Cynthia Thurlow: No.

[01:37:31] Dr. Sarah Milken: I feel like I might have seen her on your Instagram. What's her name again?

[01:37:34] Cynthia Thurlow: It’s @Gunning4Fitness.

[01:37:37] Dr. Sarah Milken: She loads it into your app and then you go to the gym and do this all yourself?

[01:37:43] Cynthia Thurlow: Yes. Let me be clear. I've been exercising and lifting weights for a long time so I've got good form. If you're new to this, then you probably want to have an in-person trainer. It doesn't mean that I'm perfect all the time. I can tell when my form is suffering and then I'm like, “Stop.” I endeavor to always go up on my weight but sometimes, I don't. It depends on how I feel.

[01:38:05] Dr. Sarah Milken: It’s hard. You're like, “I'm doing this at-home fifteen-minute workout with these little weights,” but that's not what we're talking about here. That's what stops a lot of women from doing it because walking outside or walking on the treadmill is less mental gymnastics.

[01:38:21] Cynthia Thurlow: Here's the thing. We need to be challenged. I don't mean so that you want to vomit.

[01:38:27] Dr. Sarah Milken: It's the next level up.

[01:38:30] Cynthia Thurlow: I lift heavy things and do some Zone 2 training. I try to do Pilates once or twice a week. For me, flexibility is important. That pushes me. The reformer and my instructor are brutal in a good way.

[01:38:47] Dr. Sarah Milken: Fasted workout versus non-fasted workout, does it matter?

[01:38:51] Cynthia Thurlow: It depends on who you talk to. There are researchers out there that hate fasted exercise for women. It depends on where you are in your cycle. How was your sleep? How do you feel? I've always worked out fasted. I always feel good working out fasted. If you're new to fasting, it may take you a little bit of acclimating to be able to free up some of that stored fat to be able to use as an energy source. It depends on a lot of factors. Where are you in your cycle? What's your stress like? How's your sleep? How do you feel? If I had to exercise with food in my stomach, I’d feel like I was jostling around a bunch of food.

[01:39:27] Dr. Sarah Milken: What about the idea of protein right after the workout? Does that matter or not matter?

[01:39:31] Cynthia Thurlow: It's in a 24-hour period. I don't know if you've interviewed Dr. Gabrielle Lyon on your show.

[01:39:35] Dr. Sarah Milken: I haven't yet but I love her.

[01:39:38] Cynthia Thurlow: She's a good friend. Every day, I'm quoting something that I've learned from her. It's more about over the 24-hour period.

[01:39:48] Dr. Sarah Milken: This topic could be five hours but all the Ozempic, weight loss drugs and all of that stuff, I did a whole episode on it so we don't have to get into the details of it. What are you seeing in your practice? Are you finding that women who are taking these drugs have an easier time fasting because it's an appetite suppressant or is that a fallacy?

[01:40:09] Cynthia Thurlow: It is an appetite suppressant. It slows gut motility. I don't prescribe it because I don't want to. I let other people if they want to do it. I'm very curious. I'd rather work on lifestyle as medicine. I've done so much prescription writing over so many years. 1) Nausea. 2) They don't want to eat at all. That becomes a challenge for them to eat enough. Remember, we talked about muscle protein synthesis. The research is showing that they're losing muscle. It's not just fat. That's a concern of mine.

The other thing is I'm hearing self-reported people saying when they stop it, their appetite comes back and then they gain the weight back. We know that yo-yo dieting, in particular, is pretty detrimental. People have to go into it with the understanding that much like anything, it's not a perfect process. I have no judgment.

Yo-yo dieting, in particular, is pretty detrimental.

[01:41:00] Dr. Sarah Milken: It’s good for people to know and have the information. Creatine and myo-inositol, how do you incorporate these into your program?

[01:41:21] Cynthia Thurlow: These two supplements are the two game-changers that I use for an entire year before I even thought about creating them. Creatine monohydrate is one of the best research supplements or ergogenic aids on the market. A lot of people think about creatine in terms of the gym bros and they’re solid science. Women make 70% to 80% less in our bodies so endogenously, we make less. Supplementing is very important for muscle protein synthesis.

If you look at research, there's research to demonstrate that depending on where women are in their menstrual cycle, they may need more or less. We know women in particular in perimenopause and menopause benefit from taking it. For women, it is 3 grams a day, taken once a day. I mix it into my water. It blends seamlessly and effortlessly. I use a little bit of lemon and to me, it's perfect. I can’t even tell if it’s in it.

[01:42:14] Dr. Sarah Milken: You have your product. You have an auto subscription too, which is great because I take creatine every single day. The creatine does break your fast.

[01:42:23] Cynthia Thurlow: It does break your fast because it's an amino acid. In your feeding window, if you are vegetarian, vegan or male, you can take 5 grams a day. That's standard dosing. Myo-inositol, for me, has been a total game-changer for sleep. Remember, I was alluding to that sleep stack. It’s a total game-changer. I love this product. It works in many ways. It helps the sleep architecture. It helps with sleep onset and duration. It helps with blood sugar so it helps with insulin sensitivity.

[01:42:52] Dr. Sarah Milken: Is it a powder?

[01:42:53] Cynthia Thurlow: Yes. Mine is a powder.

[01:42:55] Dr. Sarah Milken: When do you take it in the day?

[01:42:58] Cynthia Thurlow: I usually take it in the evening so the tail-end of my feeding window. It's not going to break your fast because it's going to help with insulin sensitivity.

[01:43:06] Dr. Sarah Milken: What have you found to be the most effective in terms of inducing sleep?

[01:43:09] Cynthia Thurlow: It’s to take it in the evening.

[01:43:11] Dr. Sarah Milken: Not right before you go to bed?

[01:43:13] Cynthia Thurlow: You could do it too. It’s fine. How are you going to remember to take it? That’s important. Also, it can be very helpful for mood. I have an expert coming on my podcast to talk about, as a clinical psychologist, how she uses inositol to help with depression, anxiety and OCD. There is solid research. Since I'm not a mental health expert, I'm like, “This is her area of expertise.” She has been using it for years. It’s Dr. Roseann Capanna-Hodge. She's amazing. She's got a very long hyphenated name.

[01:43:50] Dr. Sarah Milken: Also, with creatine, I did an episode and looked at some of the research nuggets on the cognitive benefits of it. It helps you build the muscle and pull your brain together.

[01:44:01] Cynthia Thurlow: It's helping at the mitochondrial level. We talk about these powerhouses of our cells. That's where it's super beneficial.

[01:44:11] Dr. Sarah Milken: From listening to your TED Talk, I heard you talk about taking maca for hot flashes and libido and adaptogenic herbs like ashwagandha. What was the second one? It was so long I didn't catch it.

[01:44:22] Cynthia Thurlow: Phosphoserine. It was probably Seriphos.

[01:44:24] Dr. Sarah Milken: It was rhodiola or something. When are you taking those in your day?

[01:44:29] Cynthia Thurlow: I don't take maca with any frequency. During that talk, I only wanted to talk about herbs that had a lot of solid research. Maca can be very helpful but ashwagandha is usually during the day. You can take rhodiola at night as well. What's interesting about ashwagandha is it's an adaptogenic herb but it has this tonifying. If you need stress reduction, it helps with that. If you need energy, it helps with that.

[01:44:54] Dr. Sarah Milken: Is there a brand that you like? Mine is Pure Encapsulations.

[01:44:57] Cynthia Thurlow: Gaia is pretty well-trusted. There are other companies that I've used but Gaia is a brand that's accessible to a lot of people.

[01:45:10] Dr. Sarah Milken: You said we need sleep in a cold, dark room. It was something about no light for 60, 90 minutes before bed.

[01:45:17] Cynthia Thurlow: Getting off your electronics 60 to 90 minutes before bed is super important.

[01:45:21] Dr. Sarah Milken: I can't do that but I like how you did mention your TED Talk about the glasses. You said they were Swannies in uvex that blunts the blue light. I'm getting those. It's going to be so sexy along with the Invisalign and the Rogaine. It's super hot. As we wrap up, I want to ask you if you have one piece of advice other than to intermittent fast, what would it be for midlife women trying to get their weight, menopause, and mindset in order?

[01:45:51] Cynthia Thurlow: It's important to do the work internally. As we are navigating physical, emotional and spiritual changes in our bodies, the most important thing we can do is to find a reframe. You have to laugh about it.

[01:46:07] Dr. Sarah Milken: That’s the premise of my whole show.

[01:46:11] Cynthia Thurlow: Sometimes, people are so serious. They're so angry or upset or they feel so much pressure to look or live a certain way. The greatest gift that I've given myself in the last few years is the acknowledgment that we have the ability to change. We picked up in the middle of the pandemic. We sold our house in one day and relocated. We were like, “We don't love living here.” Pick up and move.

The recognition that you have and the ability to change your circumstances are not all written in stone. You have the ability to evolve, shift and change throughout your lifetime. That realization is so powerful and needed because we are blasted by imagery all day long. We're inundated by imagery that can be both positive and negative. It’s helpful for women to have that concept and embrace it in a way that they understand it's not the end of their lives. We spend 40% of our lives in menopause. Why wouldn't we want it to be great?

[01:47:13] Dr. Sarah Milken: I love your message. It's the message that I too have for women. We can do the hard shit. If it's hard, it's probably worth doing. We can change. There is hope for midlifers and menopausers. We can feel good again. Lifestyle changes are hard but doable and worth it. I loved talking to you, picking your brain and asking all the questions that we midlife women have on our minds regarding midlife weight and feeling “normal again.” If the audience wants to find you or stalk you as I do, how can they do that?

Intermittent Fasting Transformation: The 45-Day Program for Women to Lose Stubborn Weight, Improve Hormonal Health, and Slow Aging

[01:47:47] Cynthia Thurlow: Start with my website. It is www.CynthiaThurlow.com. You can get access to my book, Intermittent Fasting Transformation and my podcast, the Everyday Wellness Podcast, which I'm very fortunate. It's one of my favorite things I do in my business, being able to pick the brains of health and wellness professionals. I'm snarky on Twitter, be forewarned. I'm active on Instagram. I do have a technical presence on TikTok, although my team handles all that. I am growing my YouTube channel. I do have a private Facebook group that's free for men and women called the Intermittent Fasting Lifestyle/Cynthia Thurlow. Come find me and say hello.

[01:48:25] Dr. Sarah Milken: What are you not doing? Cynthia, you're coming back and we're doing an episode on women showing up for themselves not just in health but in their lives and stepping into their energy. I want to thank you for saying yes and being a new friend of mine on the show.

[01:48:41] Cynthia Thurlow: Thank you so much for having me. I enjoyed it.

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[01:48:48] Dr. Sarah Milken: It's me again. I listened to this episode with Cynthia Thurlow, nurse practitioner, intermittent fasting and women's wellness expert, two times TEDx speaker, Founder of the Everyday Wellness Project, author and podcaster, so I could summarize the golden nuggets for you to have actionable items to start using today.

I know that when I listen to a long episode I'm like, “My God, I love that,” but then I can't even fucking remember the specifics. This is why I come back and do a golden nugget summary. In this episode, we discussed Cynthia's personal journey and career pivot, emphasizing the importance of acknowledging the aging process, and embracing it from a place of empowerment and education. The conversation covers topics such as hormone balancing, brain fog, weight loss, detoxification, and the midlife experience. Cynthia advocates for a balanced approach to health and wellness with a focus on individual needs and self-compassion.

The episode also touched on Cynthia's TED Talks, which aim to reduce shame and promote hope for women going through perimenopause and menopause. Golden nugget number one, you have the ability to change your circumstances. You have the ability to change your circumstances, midlife, menopause, all the things. They're workable. It's not written in stone. You have the ability to evolve, shift and change throughout your lifetime. I think that realization is really powerful. Cynthia and I really got into it.

We really need to think about this because we're blasted all day with imagery about things that are positive and negative, and we really need to focus more on the positive. I think it's really helpful for women to just have that concept of embracing it in the way that they should be understanding that it's not the end of our lives. It's sometimes it feels like it is, but we do have steps that we can take and things that we can do.

Golden nugget number two, we can do hard things as Glennon Doyle states, “We can do hard things.” With Cynthia's intermittent fasting and health plan, she lost weight, she had more energy, fewer cravings, and lower blood glucose levels. She has helped thousands of women get their midlife health together. She has worked with thousands of women in her private practice to make her unique program of intermittent fasting work for them too. She has a huge podcast called Everyday Wellness.

Golden Nugget number three, what is intermittent fasting from the expert, Cynthia? Intermittent fasting she says is eating less often. That is the most simplistic way to state it. It is not starvation, it is not restrictive eating. It is eating less often. It means I still eat as much food as I did when I had a twelve-hour feeding window, but I have 2 larger meals instead of 3. This means that there is time during the day when you choose not to eat, and there's a time during the day when you do eat.

Cynthia says it's important to emphasize that this is not eating disorder behavior. This is choosing to eat within a prescribed time period. That could be 8 hours, 6 hours the actual eating window. She says that she needs an eight-hour window to get two large chunks or meals of food in. She says that there are people on social media that get really triggered by it because it makes them think that this is disordered behavior and disordered eating, and she says it's not.

Golden nugget number four, metabolic flexibility is key. Cynthia says metabolic flexibility is as simple as saying that your body can effectively use carbs or fats as a fuel source to be metabolically flexible, which means your body is able to use either/or. It's not that it's one or nothing. Unfortunately, she says only about 7% to 8% of our population here in the US is metabolically flexible. We're outliers, most people, because they eat too frequently and they eat the wrong types of foods, their body is not effectively able to tap into fat stores to use as energy.

It's almost like you've loaded up your car with gas, you've only used a quarter of the tank and you keep topping it off so your body never has the ability to work through the gas to get to empty, which is where we need to be. It ends up setting up this communication between different hormones in the body, both cortisol, insulin, glucose, and over time, your cells can become less receptive to the chemical messenger hormone, the messenger of insulin, which is trying desperately to lower your blood sugar, move glucose into the cells.

Golden nugget number five, why should we care about our fasting insulin numbers? According to Cynthia, a fasting insulin is usually the very first marker that will dysregulate you as you are becoming less insulin sensitive. When she talks about measuring her metabolic flexibility, she's saying that we're starting with some lab, but we're also talking about what the signs are that our body is metabolically flexible or inflexible.

You can go longer periods of time without eating. You don't have energy slumps, you are able to lose weight more readily or more easily. You have a sustained blood sugar, so there's no hangry. There's no hangry in your life versus those that are just fueling on carbohydrates. They can only go an hour or two before meals. They are symptomatic. when their blood sugar gets low, they struggle to lose weight. They don't have the same degree of cognition because one thing that we don't talk about enough, Cynthia says, is that carbohydrates as a fuel source when our body uses fats, certain types of fatty acids can be diffused across the blood-brain barrier and they can form of ketones.

Golden nugget number six, protein. It's the key in midlife muscle creation and weight maintenance. Around 30 to 40 grams of protein per meal, Cynthia says, women should aim for about 100 grams a day. Cynthia prefers animal protein to plant protein, yet understands that she has to meet people where they're at. She does not drink whey protein. She just buys the best quality of whey protein for her home, for her two teenage sons and her husband. Cynthia gets very specific in this episode on how she uses both bone broth, but because it's missing some of the amino acids from beef, she adds branch amino acids. Go back and listen for those specifics.

Golden nugget number six, strength train. I call this the dumb weights, if you follow my Instagram. Sarcopenia is the fancy name for muscle loss. Cynthia says it's not if it will hit you, it's more when the sarcopenia is gonna hit you. We need weight training for muscle maintenance and creation and our cognitive health. Cynthia uses an online app that her trainer loads her workouts into.

Guys, there were so many golden nuggets in this episode. The gold is dripping off these nuggets. Grab it, use it. There are three things that you can do. First, subscribe to the show. Second, share it with some midlife friends who might like some midlife shit. Third, write an Apple review. Writing reviews is annoying, it's an extra step, but it really helps the show grow. You think your little review won't matter, but it does. If you went to a show and everyone said, “My clap doesn't matter,” there'd be no clapping. You all matter. DM me, you know I always respond. Of course, follow my Instagram, @TheFlexibleNeurotic. Love you. Talk soon.