Intermittent Fasting Transformation

Cynthia Thurlow

Yeah, it’s nice to be here. I think this is a really important discussion and certainly a very important topic for middle-aged women.

Dr. Sharon Stills

Yes, yes, so tell us just, I mean, a lot of people probably know who you are, and your bio is so impressive, but is there a story behind how you got into doing what you’re doing today, and would you be willing to share that with us before we jump into the details of everything?

Cynthia Thurlow

Of course, of course. So I’m a traditional allopathic trained nurse practitioner. My whole background’s in ER medicine and cardiology. And the real story about intermittent fasting was that I’m like so many women that I interact with every day on social media or in group programs or one on ones that find in their late 30s, early 40s, everything they ever thought or knew about nutrition and exercise and lifestyle gets flipped upside down once we transition into perimenopause. This is the 5 to 10 years preceding menopause, so late 30s, early 40s, those hormonal fluctuations are already starting. It was the first time in my adult life that I really struggled with weight loss resistance, and so it was very humbling. Everything I had taught my patients, everything I was talking to women about all of a sudden weren’t working. 

And so out of utter frustration, I started thinking, “Okay, I need to find a workable solution because this is not going to be my destiny.” And I had a presumably well-meaning GYN say to me, “Well, Cynthia, you are in your early 40s. Maybe this is just the way things need to be,” and that got me fired up. And so I came to intermittent fasting out of curiosity. I didn’t initially lose weight. What I did gain was a greater awareness of my hunger cues. I had so much more energy and just felt so much more mentally clear, and then my fascination with intermittent fasting really started to weave its way into all the work that I was doing both professionally and personally. But I came to intermittent fasting out of a desire to lose weight because I was in the throes of perimenopause and had some degree of weight loss resistance, wasn’t sleeping well. I thought I was eating a heart healthy diet, as I used to call it, but I found that women in middle age have to do things a little differently. It doesn’t mean we live a life of deprivation. It just means we need to exercise differently. We need to eat differently. We need to sleep differently. 

We need to manage our stress differently. And once you can manage the lifestyle piece, then things can fall into place, and then you can have a tremendous quality of life. So I’m all about reframing because for a lot of people, if they follow me on social media, they are always surprised, “Oh, you’re gluten free. You’re dairy free.” That’s what works for me. That’s what is a priority to me because it assumes that I reduce my inflammation in my body, and I feel better, along with eating less frequently have been several strategies that have really impacted my life in profoundly beneficial ways, and so that’s where it started from, not realizing that would eventually be what I was known for, but it started with just an N of 1, just a curiosity. And the other thing that I always like to add is there was a book that I read. I’m an avid reader and it was Jason Fung’s book “The Complete Guide to Fasting,” which gave me the confidence that this was not just woo woo, that there was actual solid science, although not enough on women, but when you think about it, fasting is not new or novel, but the media likes us to believe that it is.

Dr. Sharon Stills

Exactly. Wow, that’s a great story. I love when we’re inspired from our own, and then we go out and help others. And so I too am gluten and dairy free. I’ve been gluten free for about 30 years. I was a gluten-free pioneer.

Cynthia Thurlow

Wow.

Dr. Sharon Stills

It’s how I helped heal my own asthma. And I used to go to restaurants and I’d say, “I’d like a burger, but I’d like no bun,” and it would just blow up their brains. They didn’t know how, they couldn’t understand how I would want that. They’d have to get the chef. We’ve come such a long way, where now you go and it’s animal style. It’s gluten-free bun. It’s probably a wrap. And so I think also, I do a lot of food sensitivity testing on patients, and even when it comes back they’re not sensitive to gluten or dairy, which I don’t see that often, I’m still like, “You still should avoid it. You’re not a baby cow. You don’t need to be doing dairy products. Gluten is so inflammatory these days, unless you’re going over to Europe, and you wanna have a baguette or something.” And so I think it is so important that we look at those things. And there’s another thing that you said, that, before we jump into fasting, you mentioned hunger cues. I think that’s something that we don’t really talk about, hunger cues, and so I’d love for you to just talk a little bit about, for the ladies, what does that mean, and how do you kind of befriend your hunger cues?

Cynthia Thurlow

Right, and it’s a great way of starting this conversation. So if we abide by the traditional dogma that we need to be eating every two to three hours, we need to stoke our metabolism, I put that in air quotes, we need to have snacks throughout the day, what we’re really not allowing our bodies to do is ever get hungry, physiologically hungry. The best analogy I can provide is my father always likes to top off his gas tank. So think about it this way. If you only allow your gas tank to get to 3/4 of the way full, and you’re always filling it back up, the same thing happens in our bodies, and so you’re never burning off the fuel that is available. You just keep eating because you’re taught, you eat breakfast at 8:00, you eat lunch at 12:00, you eat dinner at 6:00, and in between you have to stoke your metabolism, have that granola bar, have that fatty, maybe not even fatty coffee, but like a Frappuccino. 

Maybe you need a soda in the middle of the afternoon. And so I think that as we have become more and more dysregulated hormonally, as we’ve become more insulin resistant, as we’ve become more metabolically inflexible as a society, we are losing our ability to acknowledge what does true intrinsic hunger feel like. Like, you can have your stomach rumble, and it could be out of response to being dehydrated. It may not actually be that you are physiologically hungry and out of gas. And so I like women to understand that when you start eating less frequently, you’re gonna feel differently. Some of it could be scary. Some people tell me that they feel like they’re walking like a tight rope, that they feel like, oh, I’m outta balance. I don’t know what’s going on. But over time, people are then able to distinguish what does true physiologic I’ve run out of gas feel like, and that shouldn’t happen with fasting because your body becomes more efficient and utilizes different substrates for fuel. But I think for anyone that’s listening, and they’re probably aware of this, we as humans eat for different reasons. We eat out of hunger. 

We can eat out of emotional needs. We can eat out of craving desire. And what I like women to understand is that there are different reasons why we eat, but not all of them necessitate eating. It could be that you’re bored. It could be or dehydrated. It could be you need to take a walk. Maybe you need to distract yourself. I’m not an advocate for people depriving themselves of nutrient-dense whole food, but I am someone that takes a pretty hard stance and says we are a nation of snackers. We are grown-ass adults, and we need to stop the snacking. So getting back to your original question, the hunger piece, differentiating what true intrinsic hunger feels like. I think for me, I’ve had the opportunity to interview some really incredible psychologists on the podcast, talking about what physiologically is going on in our brains that convinces us sometimes that we need to eat, where we feel outta control. 

Has nothing to do with hunger. It has everything to do with, we have a part of our brain called the amygdala that can override our prefrontal cortex. Why this is relevant is that all of us have gone through more stress in the last years than we probably have in the last 10, and sometimes when our reptilian brain perceives out of fear that there’s food scarcity or that there’s some impending sense of lack of ability to eat, it can override that prefrontal cortex, which is our thinking part of our brain, and we can sometimes binge, not make good decisions. Then afterwards we’re like, “What just happened?” So a lot of the work I do is making women a little bit more aware of their choices, and then really thinking thoughtfully about how our thinking brain impacts our choices that we make day to day in terms of what we choose to eat and when.

Dr. Sharon Stills

Mm, I love that because I’m a big proponent of mindfulness and mindfulness medicine, and that goes so much along with it, that you really, when you are craving, it’s so powerful to just stop, take a deep breath, put on a dance song, go for a walk and just see and really get in touch and have that intimate conversation with yourself to really know when you are hungry. I don’t think we talk about that enough, and it’s such a powerful tool. It’s just empowering overall for your relationship with yourself, so thank you. Thank you for bringing that up. So fasting, where do we begin? Fasting 101. Tell us what is fasting? What are the options? What do these women need to know?

Cynthia Thurlow

Oh, it’s one of my favorite questions, to be honest with you. So fasting is as simple as eating less often. That can look differently for each one of us. What I love about fasting, for women in particular, is it’s flexible. And I remind women that women that are still cycling need to fast differently than a woman in perimenopause, need to fast differently than a woman who’s in menopause. So obviously menopause, 12 months without a menstrual cycle. Average age in the United States is 51. And if you’re part of that demographic, you have the benefit of not having as much hormonal flux day to day, week to week. So you may be able to fast on a daily basis. Now before I get to the fasting piece, I wanna make sure women understand, especially of this particular age group, middle-aged women, I’m one of them, you’re one of them, really understanding that lifestyle aspects are critically important. 

So if you can’t sleep through the night, and you’re a hot mess, and you’re having hot flashes, and you’re working with your healthcare provider to figure out why, don’t start fasting. One thing that’s important for us to understand is that fasting, like cold exposure, like heat exposure, like high intensity interval training, is a type of hormesis. This is beneficial stress in the right amount, at the right time. So if you can’t sleep, please don’t add fasting. Work on the sleep first. Sleep is the most important foundational aspect to middle-aged life. I tell everyone, “You gotta sleep, and if you can’t, if you’re not sleeping well, we need to figure out why, and then we can deal with this later.” So middle-aged aged women, sleep quality is super important. 

We know based on studies, if you’re getting less than six hours a night of sleep, we know that it impacts your blood sugar. We know it impacts key hunger and satiety hormones, like leptin and ghrelin. It impacts insulin sensitivity. So you gotta sleep. And the other thing is when you’re sleep deprived, you don’t crave broccoli. You’re gonna crave hyper-palatable processed foods. Number two, you have to eat the right kind of nutrition. Everything starts with food, every single thing. I find most middle-aged women do not tolerate the super inflammatory foods, whether it’s gluten, grains, dairy, sugar, alcohol, alcohol in particular because we know it impacts REM sleep, deep sleep, which are critically important. Your relationship with these types of foods may need to change, and for each one of us, it might be different. I feel like each decade, I keep ticking something else off the list that I don’t tolerate. Alcohol was the big one for me, and I wasn’t much of a drinker. Number three, the right types of exercise. So if you were doing CrossFit five days a week in your 30s, guess what? When you enter into middle age, you can’t tolerate that degree of stress. You can push your body, but you need more recovery. You need more things that are tapping into the parasympathetic, which is the side of the autonomic nervous system that is designed to be nourishing, bring our heart rate down, allow us to digest our food, have an orgasm, et cetera. 

And then the other piece is stress management, and that’s not five minutes of meditation three days a week. That is actually working and endeavoring every day to integrate things into our lifestyle that bring down our cortisol levels. I think about oxytocin as this poorly understood, poorly talked about hormone. Think about when you were breastfeeding your baby years ago. That amazing bonding hormone is oxytocin. When you hug your spouse or significant other or your dog or your kids. I have teenagers. They don’t love hugging anymore, but that’s okay. I still get little hugs from them. But each time we have a little bit of oxytocin boost, it lowers our cortisol. So I remind people that those four things are super important. When they’re dialed in, then adding in fasting can be super helpful. I encourage women to start, this is my mindset, start with removing the snacks. We shouldn’t be snacking anyway. 

It’s dysregulating your blood sugar. It’s keeping your insulin elevated. When insulin’s elevated, you’re not gonna be able to tap into fat stores as a fuel source, and that’s a problem. And I always like the analogy that Jason Fung uses. You think about, you have a refrigerator. The carbohydrates are in the fridge. You have to work through all the carbs sources and stored sugar before you can get to the fat in the freezer, and that’s an important way, if you’re an analogy-type person, that’s a great way to think about it. But I remind women that when we are starting baby steps, dial in on those lifestyle things that I mentioned to the next level, is removing snacking, because that’s gonna force you to adjust your macros. Your macros are protein, fat, and carbs. That would make the argument that everyone listening` is probably not eating enough protein. Protein is critically important for satiety. It’s important for maintaining muscle mass as we get older. We start losing muscle mass in our early 40s, so it’s significantly we have peak bone and muscle mass in our 20s and 30s, and then it starts to kind of drop off. At each decade, it’s a significant reduction. I want everyone to understand that muscle is the organ of longevity. 

It is where insulin resistance starts. So if there’s no other encouragement to maintain lean muscle mass, understand that you wanna eat enough protein to be able to stimulate muscle protein synthesis. You want to do weight bearing, if not strength training, several days a week, and you need to get that quite good high quality sleep because it’s critically important. So that’s the next level: snacking, adjusting your macros. The macros are as follows: protein focus first, then healthy fats, and then non-starchy carbohydrates. That doesn’t mean I’m anti carb, but women, we become more insulin resistant as we are getting closer to menopause. Part of this is a byproduct of that loss of muscle mass. Remember, we talked about muscle’s the organ of longevity. As we lose muscle mass, we lose insulin sensitivity. It’s also a byproduct of a loss of estradiol, which is our predominant form of estrogen, as well as some petering amounts of testosterone, so understanding that there are hormonal things that are happening that are impacting our insulin sensitivity, and so carbohydrates are not bad, but this means your relationship with carbohydrates will change. So non-starchy carbs are great. 

I encourage everyone, salad, raw vegetables, cooked vegetables are great. When we’re talking about starchy vegetables, squash, sweet potato, root vegetables, those are fine too, but it may be that your threshold is 1/3 of a cup, or 1/4 cup, or 1/2 a cup, depending on your insulin sensitivity. Gone are the days that you can sit down and blow through a piece of cake or a piece of pie or ice cream with no detriment to your blood sugar. In fact, this is also a time I recommend women understand their carbohydrate threshold, so getting a glucometer or continuous glucose monitor is absolutely, positively one of the best things that you can do to figure out for you, what is your threshold? As an example, I can eat all the tropical fruit I want. I don’t eat a lot of fruit, but if I were to eat tropical fruit, my blood sugar response would be pretty negligible. My body doesn’t like grains. My body really doesn’t like plantains. And so when I eat carbohydrates, I pick low-glycemic berries. I pick some sweet potato. I pick some squash. That’s what my body does well with at this stage of life that I’m in. Most women are undereating protein. They’re eating the wrong types of fats, and by that I mean vegetable oils and adulterated seed oils, and they’re eating too many carbohydrates. So really it’s flipping that model, and this is sometimes the hardest thing for women to do because you’re undereating protein so significantly, you don’t understand that’s why you’re craving carbohydrates. 

And so let me give you an example. If you were to have a piece of ribeye or a piece of salmon, your fats are already in that meat. You don’t need to add more fats to your meal. Versus if you have a piece of lean chicken breasts or piece of cod, maybe that’s the time to add some salted macadamia nuts to your salad, or maybe you have some avocado, really being cognizant of flipping that switch and that methodology. And a good gauge for protein intake should be 100 grams a day as a starting point. Now if you’re currently eating 40 or 50 grams total during the day, it will take time to get there, but I can almost always assure you, if you’re eating enough protein, you will not be hungry in between your meals. So next is looking at fasting, going from dinner the night before and not eating until breakfast the next day. For most people, that’s probably 14 hours, most of which you spend, excuse me, most of the time you spend sleeping, so it’s not nearly as arduous of an option as people think it is. And then as you are getting to a point, as you are able to, you can open up that window, ideally kind of shooting initially for 16 hours with an 8-hour feeding window. That’s a good starting point. And once you’ve gone to a point where you feel good, you’re fat adapted, your body’s able to use both carbohydrates and fat as a fuel source, then you can get creative with options. 

Now you mentioned, what are some of the schedules? There’s lots of variety that’s out there. I myself just am very attuned to my body, and so I might do 20 hours fast the one day. I might do 14 the next. It really depends on my schedule, what’s going on. But I think it’s important for women to understand, if you are menopausal, you have the opportunity to be more consistent with your regimen, meaning you don’t have to stop fasting the week before your menstrual cycle, which is what I typically recommend for most women. And the cool thing about fasting is you can do it around a vacation. You can do it around special events. As an example, OMAD is a fairly popular, it’s one meal a day. I don’t like that as a sustained strategy because you can’t get enough protein in during a short feeding window. 

However, if you go on vacation, you’ve overindulged. The next day you wake up, you’re just not hungry, maybe you have one meal that day, and you get back on your normal schedule the following day. So there’s a lot of variety. There’s certainly longer fasts. You’ll see some people that are doing 24, 36, 72 or longer fasts. There are people that do shorter fasts. It’s really finding what works for you, your lifestyle, et cetera. Now certainly when I was rounding on patients in the hospital, I would not be able to be as flexible as I am now. Now I predominantly work online and I work from home, so if I wanna eat at 10:30 in the morning, I can, whereas before I was lucky if I got to eat at all during a workday because the patient load was so heavy. So kinda getting back to the original question, there’s a lot of flexibility. 

However, what I think is most important for women to understand at this stage of life is that it’s critically important that you dial in on those lifestyle pieces. I see far too many people that don’t sleep enough. They overexercise, they over-restrict their calories, and their stress levels, out of control. They’re so sympathetic dominant. Their body is in fight or flight all the time. And when you think about it this way, when your body is under chronic stress, generally speaking, you’re gonna get this elevation in cortisol, which I’m sure some of your other speakers have talked about. What follows elevated cortisol? Follows elevated insulin. Guess what happens when insulin is high? You’re in fat storage mode. You will not be able to burn those stored fat stores. So I think it’s important for people to understand that it’s really, really important to us as women at this very important stage in our lives, we spend 40% of our lives in menopause, really important, it is time to listen intuitively to our bodies, even if that is something new and you’ve never had to embrace before.

Dr. Sharon Stills

Exactly. Exactly. And in real estate, they say, “Location, location, location,” and in medicine, I say, “Lifestyle, lifestyle, lifestyle.” Those are the foundation of the house that you build. So I just wanna go back and ask a couple of questions about the timing. So for women who are still cycling, you said you don’t have them fast the week before their period. What about when they’re bleeding? Are they fasting then, or what do you have them do that time?

Cynthia Thurlow

So if we’re talking about women that are in perimenopause, so this is, again, the 5 to 10 years preceding menopause, and I’ve actually seen some research that’s even saying it might be 15 years before menopause, so now I feel like I have to widen that gap. So if you’re in perimenopause, all the lifestyle stuff that I just discussed is still very important for you as well. What I typically recommend is from the day of bleeding up until ovulation, so this is the predominant follicular phase when estrogen predominates, you can push your workouts, you can push your fasting schedule. You’re more insulin sensitive, so this might be a time that if you decide to have an indulgence, your body is going to be able to buffer it a bit better. However, the luteal phase, which is when progesterone predominates, you can’t push those workouts, you have to adjust your macros, and your body doesn’t handle or weather the stress as much with fasting. 

So the five to seven days preceding your menstrual cycle, 12 to 13 hours, I call it digestive rest. 12 to 13 hours is about the longest you wanna go. And, actually, I would make the argument that every single human being, maybe except for kids that are growing and teenagers, should all be not eating for 12 hours a day because it really does allow our bodies to kind of get back online. It allows our digestive system to be better optimized. But to answer your question, five to seven days preceding menstrual cycle when progesterone levels are starting to falter. This can be when women are experiencing some anxiety, depression. Their sleep may be impacted from degree of progesterone levels that they’re experiencing. Not the time to push their fasting.

Dr. Sharon Stills

Great, and then for women who are already postmenopausal, who just listening and just getting started, is it something you can dip your toes in the water? Can you do it one day and then not do it the next day? Or is it something you have to commit to and be fasting every day from then on in?

Cynthia Thurlow

Well, I mean, this goes back to me talking about being intuitively attuned to what their body is telling them. I think that for most people, once they start fasting, whether they do it five days a week or seven days a week, they feel so much better. They’re like, “I don’t have energy slumps. I am so cognitively clear.” I would encourage women to experiment, and this is a departure from the traditional rhetoric where we put every patient in a bucket, like, “Okay, you’re a middle-aged woman, so everyone needs the same kind of methodology.” Some people wanna be able to sit in with their families on Saturday and Sunday mornings, or maybe they eat a later dinner, and I would say the one thing, that you can come back to this at any point in time. If you’re insulin resistant, and we know based on a study from 2018, this is preceding the pandemic, that 88.2% at that time were metabolically inflexible. 

So what I would say is more often than not, we need more, or, well, I should put it this way, more often than not, women need to be more attuned to the fact they are not insulin sensitive, and they need to work towards strategies, whether it’s you walk after a meal, whether it’s lifting weights, whether it’s prioritizing protein, whether it’s eating less often. You have a responsibility to want to ensure that your 40% of your lifetime that you spend in menopause is spent in a way that you can still interact with your family, be able to exercise, travel, et cetera, wherever your values are. So what I would say is you really have to check in with yourself, like know your numbers. What’s your fasting insulin? What’s your leptin? what’s your A1C, your fasting glucose? If you’re on hormone replacement therapy, we know that oftentimes helps buffer some of the insulin sensitivity. But really being honest with yourself because when I say to women, even in a one-on-one relationship, “What do you think’s going on?” generally women know. 

They just don’t want to know. Like, they don’t wanna say it out loud. They are contributing to ways that are contributing to why they’re no longer insulin sensitive. They ate too many carbs. They don’t eat enough protein. They’re not exercising at all. They don’t go to bed on time. They stay up. They get a second wind and they go to bed at two. I always say, “Time out, you’re missing out on so much benefit from prioritizing sleep,” just from a foundational perspective. If you do nothing else, even if you watch this, and you decide for yourself, “Okay, I’m not ready to fast, but I need to work on my sleep,” you’re still doing benefits to your body. So I think it’s important for people to understand, what I love about flex, what I love about fasting is it’s flexible. It is not rigid, although, I do have methodologies around fasting that I always say are like non-negotiables. I think they’re very important, but you have to do what works best for you. 

We want it to be sustainable, and I find for a lot of my patients, if they make too many changes all at once, they can’t sustain it. So make one change at a time, master it. And lifestyle changes are not meant to be easy. This is the problem, because we have conditioned our patients to ask for a pill, and that is perceived as easier than doing the hard work, but the hard work is the stuff that helps us stay healthy and helps with longevity and helps with quality of life. I’m sure you know. Both you and I have been in healthcare for a long time. I’ve had the opportunity to see people from teenagers all the way up to people that are over 100 years old, and the people that age well and still have a high quality of life are the ones who are putting in the lifestyle changes. They’re the ones that are prioritizing movement and flexibility, and they’re not overeating. They’re making better food choices. And, no, those things are not easy to do up front, but you’re going to yield so many benefits down the road.

Dr. Sharon Stills

Exactly, every time I talk, I sound like you and I always have to remind people, no, I still really love taking my bioidentical hormones, and trust me, I have a cabinet full of supplements, and I love my supplements, but they are supplemental to all the things you are talking about. They’re important, and we do. We have been conditioned. We want a pill. So many patients come to me and they’re, “Dr. Stills, what’s the pill I can take? But I don’t wanna take pharmaceuticals. I wanna take a vitamin or a homeopathic.” It’s still, it’s changing that mindset, that we have the power with our lifestyle choices, and then the natural pills are just the strawberry on top. So for someone who’s listening, do you recommend fast and then have your eating window from 10:00 to 6:00? Are there any times you’ve seen better? Because I know some people will do 12:00 to 8:00, but I’m always of the mindset, you don’t wanna be eating three hours before you go to sleep. So do you have any thoughts on that for the people, the women who are listening?

Cynthia Thurlow

I do. I do. The more I understand about circadian biology and chronobiology in our bodies, which is really just the natural hormone fluctuations that occur throughout the day, we really should be eating when it’s light outside and not eating when it’s dark outside. And we know we lose insulin sensitivity as the day goes on, so, to me, I personally eat earlier. It doesn’t mean I get up and eat. I will eat earlier. Like, I may break my fast at 10:00, and I may eat something at 2:00, and then I may have, maybe I have bone broth or something small at dinnertime with my family. But I find for a lot of women, not eating three to four hours before bedtime is critically important for sleeping well, and it has a lot to do… People always think melatonin’s a sleep hormone, it’s a master antioxidant, but we actually have melatonin clocks in our gut. So guess what happens when you eat two hours before bedtime? Your body says, stop the melatonin, increase cortisol. We’ve got a food bolus. We have to digest. 

I wear an Oura Ring, and I tell everyone my Oura Ring is so smart, and it knows me so well. It squawks at me when it wants me to go to bed, and it’s right. If I’m in bed by 9:30, my whole next day is better, but it also, my HRV, so my heart rate variability, my pulse rate, all get impacted if I eat later in the evening, and so it’s a constant challenge when I travel with my family ’cause they like to eat later and I don’t. We always have to find a compromise. But if someone’s watching, and they’re trying to determine where they feel best, experiment. This is not something I used to tell my patients. Experiment. Maybe you do better eating breakfast at 9:00, and you eat another meal at 3:00, and maybe you eat something small right before 6:00 at night, and that’s where you, but your biggest meal of the day, I generally recommend, is your first meal. It’s gonna help with insulin sensitivity. If you’re gonna have a starchy carb or a piece of fruit or this is a discretionary day, maybe you’re having a… 

Maybe there’s a celebration. You have something, dessert. Eat it earlier in the day. The other thing that I would say is if you have a processed carb, which I don’t recommend people do binge days or cheat meals. I don’t even like the word cheat. I always say you’re gonna have a discretionary carb period, end of story, go take a walk. We know something as simple as taking a 10 or 15 minute walk. Remember we talked about muscles being the organ of longevity, and they’re helping with insulin sensitivity? Go take a walk because it’ll help buffer your blood sugar. Last night I ate a little later than I did normally. I took a one mile walk after I ate, and my blood sugar came down 20 points. My blood sugar was already well controlled. So I think it’s important for people to know that experimentation isn’t a bad thing. Figure out what works best for you. Don’t stress over it. What did we talk about earlier? Our bodies are constantly taking in information throughout the day. 

We don’t want more stress. Just experiment. For me, I know eating after 7:00 at night is a disaster for me, but my body likes to be in bed at 9:30, so I generally, during the pandemic, what I found out is my body really likes to have its last bit of food at 5:00, and so that’s what I’ve found works best for me. But there might be people listening that will say, “I like to open up my feeding window at 12:00 and I wanna eat at 8:00.” Well, if you have a WHOOP band or an Oura Ring and you can track the metrics, it may encourage you to make some adjustments, maybe 11:00 to 7:00, maybe 10:00 to 6:00, but I encourage women to always experiment a little bit to find what works best for them.

Dr. Sharon Stills

I love that. We would make good roommates ’cause I’m on that same schedule. I have dinner plans tonight and I’m working, and so they’re at 7:00, and it’s already like, “Ugh, I’m gonna just eat something light. I just wanna go and enjoy my friend who’s needing company.” And sometimes you can’t avoid it, but if it’s up to me, I’m like, “Let’s go to dinner at five. Let’s go to the .”

Cynthia Thurlow

No, my kids call me. They’re like, “You like to go to dinner early like the grandparents.” I said, “You know what’s interesting for me? My body does better finishing a meal earlier in the day.” Now I’m getting ready to go on vacation with my family next month, and I know we’re gonna be in Europe, and Europeans generally tend to eat later, so it may be that I adjust a bit to accommodate where we’re going. But it’s vacation. It’s not the rest of my life.

Dr. Sharon Stills

Exactly, so for someone who’s listening and they’re intrigued about fasting, but they’re maybe not ready to jump into the CGM and really looking at more healthy foods, but they just like, “Well, I could do the feeding window, but I’m not really ready to change my diet yet,” for someone who’s thinking that, what would you say to them? Is their benefit in just doing a feeding window without changing anything else, or do you have to really be all in?

Cynthia Thurlow

No, I think we have to meet our patients where they are. That’s what I would always say. In fact, I was arguing with someone on social media about this the other day. They were offended that I brought up protein powder. I said, Listen, there are people…” I mean, I use protein powder on occasion. I think that if that’s the starting point, that they say to themselves, “I’m not gonna snack after dinner,” that’s great. You’re still doing good things for your body. I would encourage you to buy the book because I have a lot of strategies of how to kind of slowly dip your toe in the pond, but we’re still doing beneficial things. Remember what I said earlier, that everyone should be not eating for 12 hours of their day. So, to me, eating less often is still going to be beneficial, and for many people, that’s how they start. And then they feel so good. Then they’re like, “Okay, well maybe I’m gonna eliminate this particular food from my diet.” And then they feel good. 

They get another one. And then they’re ready to do another thing. I have a wonderful family member, who I’m not gonna say too much about her ’cause she’ll know that I’m speaking about her, but it has taken her about a year to fully just get enmeshed in intermittent fasting. And I know her well enough that I knew she kinda had to do it on her own pace. Now she’s fully in, but it took a period of time. And so I think there are probably people watching or listening that maybe they’ve had a chronic health issue, and they’re just so tired of pulling things out of their lifestyle or their lives or not being able to be as physically active as they would like to be or something has happened to them. 

And so I think being really sensitive and not being really rigid. I just know that it’s much easier. My Southern grandmother used to say, “You can get a lot farther with sugar than you can with vinegar,” and so that’s my methodology with my patients, that being kind and saying, “Let’s celebrate the one big change you just made, and then when you’re ready to do the next one, I’ll be there for you.” And so I think what we really, we really lose opportunities to help serve women when we get really rigid with them. I mean, if someone were using drugs or smoking, I mean, I might be a little more firm, but in most instances, if it’s like slowly making lifestyle choices that are gonna ultimately be sustainable, I’m 100% behind that.

Dr. Sharon Stills

Yeah, and ultimately it’s really this introspection of looking at, what am I gaining from this and how is it harming me? And I remember when I was giving up dairy, I would eat it. I had this thing for creme brulee, and I would eat it, and then I would suffer, and I would have issues, and I would be bloated, and I would know what it was from. And as, like, I’m a big girl. It took me a while, but finally I would be able to just look at the creme brulee and say, “You know what? As delicious as this is gonna taste, it’s not gonna be worth two weeks of snot in my nose.” And so we have to really start asking ourselves sometimes difficult questions that we don’t wanna answer, but when we can really start to get in conversation and look at what we’re doing. And sometimes I say to patients, I’m like, “If you are gonna get so much joy out of eating that creme brulee, and you’re gonna be fine making your body struggle for the next two weeks, and it’s a once in a while thing, go for it. You’re a big girl. You can make your own decisions.” But we have to really be looking at the cause and effect of what our choices are.

Cynthia Thurlow

I think that’s an important distinction.

Dr. Sharon Stills

So I also wanna ask another practical question, and then I wanna just see if you’ll give us a few tidbits from the book. For women who are listening who are fasting, I think there’s sometimes confusion about, can I have coffee? Can I have electrolytes? What can they do in the morning that still doesn’t actually break their fast, but they can put into their mouths?

Cynthia Thurlow

That’s an important question. So I’m an advocate of clean fasting, which means I want patients to avoid things that’ll evoke an insulin response. So cream in your coffee, butter in your coffee, they’re insulinemic. I do like bitter teas, I do like plain coffee, and I tell people, “Bitter is better.” Bitter means that it has high polyphenol content. These are plant-based compounds that can increase fat oxidation. And so I always remind people, like if you were acclimating to the taste of plain coffee, you can add cinnamon, which will boost insulin sensitivity. You can add high quality sea salt like Redmond’s. I mean, they’re produced here in the United States. Bitter tea are like green and black tea. It’s not Celestial Seasonings Apple Spice. We don’t even know what’s in that. When it says natural flavors, I don’t even know what that means. And, yes, you can have electrolytes, but it needs to be electrolytes that don’t have flavorings in them. So this is not the time to have a Stevia-sweetened electrolyte. 

This is really the time to utilize products that are just elements, so magnesium chloride, potassium, sodium is really what you’re focused on, and then save the flavored electrolytes maybe with Stevia for your feeding window. So the best results come from being a clean faster, and so I have women that will come to me and they’ve been, we affectionately call it dirty fasting. They’ve been doing the fatty coffees. They’ve been doing fat bombs. I mean, there’s always fit pros on social media that convince people if the calories are under 50, it doesn’t matter. Yeah, it does. If you’re eating grapes, you are absolutely positively breaking your fast, and maybe I’ll back up for a second and say, of the macronutrients, fats have the most negligible impact on blood sugar response, then protein, then carbohydrates. 

So if you’re having collagen peptides in your coffee, you’re breaking your fast. If you are consuming grapes, you’re breaking your fast. If you’re having sugar-sweetened beverages, you are breaking your fast. And so I find for a lot of women, maybe if they’re saying they plateaued or they’re experiencing weight loss resistance, I always say like, “What are you eating in your fasting window?” and they’re like, “Well, I’m not eating.” I’m like, “Okay, great, but what are you drinking?” That’s the next level. I think it’s also important to kind of identify. People say, “Well, I drink a diet soda.” We know that artificial sweeteners like sucralose, like those kinds of, they have a negative net benefit on the gut microbiome, so much so that it would give me pause to even consider consuming things like that. So clean fasting is always going to be my methodology. Again, I talk about it in the book, but you’re going to get the best results when you clean up what you’re eating in your fasting window, or drinking rather.

Dr. Sharon Stills

Gotcha, and so during that fasting window, are you concerned with women counting calories, or what is your thoughts on that? Are they counting anything? Are they counting macronutrients?

Cynthia Thurlow

Yeah, I mean, that’s a great question. I don’t encourage counting calories. I think that’s too kind of reductionistic in terms of a methodology. Unfortunately the toxic dieting culture has encouraged women to hang on every calorie nutrient they consume. I encourage people to count macros, and specifically protein, protein and probably carbohydrates, at least initially. Protein to make sure they’re eating enough. Carbohydrates because people don’t even realize there’s carbohydrates in broccoli. There’s carbohydrates in things that are seemingly pretty benign. And it’s not net carbs. It’s total carbs. Net carbs is a trick by the processed food industry to trick you into believing you’re not eating as many carbs as you are. The average American is consuming 200 to 300 carbohydrate grams a day. 

So I like women to get it under 100. I actually like them to get it lower, but as a starting point, start counting your macros because I cannot tell you how many women will say, “I’m only eating 40 grams of protein a day. I’m eating 200 grams of carbohydrates.” They gotta flip it. And so it’s really important to build awareness. Do I think people need to track their macros forever? Absolutely not. But do I think it helps build awareness? Largely because we’re really reconditioning people, less carbs, more protein, the right types of fat. If and anything else, like go through your pantry and toss every bit of seed oils that are there, vegetables, canola oil, cotton seed, sunflower, safflower. They’re garbage. Don’t even let them, if you have processed foods in your house, don’t even bring them into your house. It will really clean up your pantry because there’ll be a lot less food there.

Dr. Sharon Stills

Bring your own oil when you go to the restaurant. 

Cynthia Thurlow

I’m one of those. It embarrasses my teenagers enormously. I either don’t use dressing in a restaurant or I bring something pre-made, and, generally speaking, people don’t care. My kids are embarrassed, but that’s okay. That’s my job.

Dr. Sharon Stills

Yeah, they’ll get over it. My kids got over it. And restaurants now, they’re really used to it. They’re used to it. They know people have food sensitivities, and they know people are conscious of these things, and so they’re willing to work with you. So I have so many questions. I know we’re almost done, but I’m gonna sneak one more in there. So sources of protein, do you have favorite sources? Do you have any words to women who are vegans or vegetarians? Any advice for them on their protein?

Cynthia Thurlow

Well, first I’m gonna address animal-based protein ’cause that is my favorite. I would admit it that I’m probably carnivore-ish. I eat a lot of protein and then a lot of vegetables. My favorite personal sources are bison, beef. I’m a huge fan. I actually just started eating elk in the past year. We definitely have a little bit of pork, but usually just from bacon. I do like chicken and turkey, but they’re not my favorites, but I would say tuna and salmon, sardines. So I make an amazing sardine pate. There’s so many options. I mean, wild-caught shrimp. I mean, I definitely try to vary what I eat. I always say monogamy is good, but food monogamy, we don’t want that. You wanna vary your protein sources. So for me personally, I think for lunch, I’m going to have bison steak leftover from last night and a big salad, and so that’s pretty much every day, is some variation of meat and and a vegetable. With that being said, my concern with women that are vegan, and I respect obviously everyone’s choices, you’re not gonna be able to get enough protein in, and you’re going to do it with a detriment of too many carbohydrates because you can only get so much protein from beans and legumes, and I’m not a fan of soy. I’m very outspoken about soy as one of the most genetically-modified foods here in the United States, especially when we are exposed to so many estrogen-mimicking chemicals in our environment or personal care products and our food. 

That’s why I’m even more so not a fan of soy. It’s also the number one consumed fat in the United States, soybean oil, so we should really avoid that. So when I work with vegetarians, I try very hard to see if they’re open to consuming eggs. Are they open to consuming some dairy? Are they open to consuming leaner types of chicken or fish? I find that when I really start talking about physiologically what’s changing in their bodies, and I’m supportive. Like I always say, “You cannot eat enough quinoa to equate to the amount of amino acid profile in a steak, so you can’t make that argument to me,” and it’s, “Oh, actually that amount of quinoa to equate to eight ounces of steak is going to absolutely be detrimental to your blood sugar regulation.” And so once I start educating people that I’m coming from a place, it’s not a judgment, it’s just the amino acid profile from animal-based protein is superior to every form of plant-based protein.

Do I like people to use like hemp hearts on a salad? Absolutely. That’s a great way to get a, what I would say, a plant-based protein in there, but most other sources are so carbohydrate dense. It becomes nearly impossible to get their protein up and get their carbohydrates down. And I find a lot of vegetarians are actually very hungry because they never get enough protein in. So that is a very delicate dance I would say, just very admittedly and transparently. I respect people’s choices, but I do really try to educate them and give them research-based principles and refer them on to experts who are doing a lot of research in this area so they can better understand what’s happening to their bodies.

Dr. Sharon Stills

Great answer. Great answer. So that book, the cover is just so gorgeous. It’s like a .

Cynthia Thurlow

Thank you.

Dr. Sharon Stills

Is there anything, what can you tell us about the book? And I haven’t read it yet as of the time we’re talking now. I can’t wait to read it. I’m really excited.

Cynthia Thurlow

Yeah, thank you. Well, it talks a little bit about my personal journey. Editors always like when you share your pain-to-purpose story. I go into the science, but I make it very accessible so people understand there’s a lot of solid science. I do talk about the lack of research done on women. Most of it’s done on lab animals, men, and obese menopausal women. I hope that will start to change. There’s certainly a lot of researchers and clinicians out there that are doing really great work in this area. I spend a lot of time talking about food and nutrition and lifestyle medicine because that really is the crux to have success navigating our middle ages and beyond, but I do provide options for women at peak fertility, 35 and under. I talk about perimenopause, I talk about menopause, the unique needs of each stage of life and how we need to navigate things differently. 

And then I have over 50 recipes that were done by my amazing friend and Chef Beth Lipton that I think are just incredible. They’re delicious. They’re not designed to be labor intensive. And then I walk you through a 45-day program to be able to embrace intermittent fasting. I do find six weeks, it’s kind of a sweet spot. 30 days wasn’t enough. 60 days was too long. That’s really the timeframe I think it takes for women to successfully make those changes and be able to integrate it into their personal lives. So, yeah, I I’m really proud of the book. It’s done really well. It’s been really exciting to see and hear from so many women, and actually men. There are a lot of men that are buying it for their significant others, or they’re buying it to support their wife or their sister or their mom or whomever, and it’s been a really amazing journey.

Dr. Sharon Stills

All right, so when we’re all done listening to this, including me, we’re all gonna go buy the book, and we’re gonna get on our fasting journey with Cynthia. So just fantastic. I love all the work you do in the world. It’s so very important. And do you have a free gift for the ladies who are listening?

Cynthia Thurlow

Yes, I have kind of a Get Quick Intermittent Fasting Tips guide that my team pulled together that we will share with your community, and we’re really excited to be able to do that, to help support women. Maybe they’re really just starting to get curious about fasting. They wanna do it in a safe way. Really, that’s the platform that I know we both stand on, is making sure women have good information to formally consent to different strategies that they utilize at this stage of their lives, and to do it in a way that’s research based. I always say, I know there are well-meaning people that are out there, but I always say that, ultimately, you want to really be listening from individuals that have worked with thousands of patients and know what works and what doesn’t work.

Dr. Sharon Stills

Yeah, it’s great to have someone helping you on your journey so you’re not alone. So, well, this is just been fantastic. I know it’s been very beneficial for the audience because we answered a lot of important questions. Hopefully all of you listening, you feel inspired now either to, if you’ve already been doing intermittent fasting, to take it up a notch. Maybe you’ve been dirty fasting, and you’re gonna shower and clean it up now, or you’re gonna try, and you have a consciousness of the window. And circadian hygiene is so very important, and this is an important piece of it because, as Cynthia said in the beginning, our food is everything. And don’t forget about those lifestyle. I love that you said that it’s the platform I stand on. It’s why I’m doing this summit, because we need to expand what health is about and our lifestyle and our sleep. I’m really mean in my practice. I won’t even give patients their hormones unless they’re doing all these things, and they are sleeping, and they are committing to their lifestyle. Otherwise, they don’t get their hormones because then they’re just not really on a healing journey, and I’m all about the whole holistic journey it is. So thank you, thank you so much for being here. This was fantastic. And everyone, we’re gonna go get the book now, and we’re gonna get on our journey. So be well. We’ll be back with another interview, and take care.

Cynthia Thurlow

Thank you.