Sync Your Fasting with Your Cycle

Kashif Khan

Welcome back, everybody. We have an important discussion here. Why do I say important? Because the health care system fails women. Let us just say that straight out. And why? Because all the research is done on men who do not have menstrual cycles. Why? Because it is much easier to build a drug that way. And Amy Shah is here. First of all, thank you for joining us.

Amy Shah, MD

Thank you.

Kashif Khan

You are here to join us to discuss how to think about fasting and maybe even some other general female health concerns in the context of the cycle. Which is the context has been removed from solving all female health problems which is why they are so prolific. Thank you for doing that because it is so important. And it is not a discussion that happens at your typical allopathic doctor, right?

Amy Shah, MD

Absolutely.

Kashif Khan

Starting there we are going to look at a bunch of stuff, the various weeks and the portion of the cycle, what to do and when to do, and how to do. But let me perhaps maybe break down the cycle a little bit like why is it so important to even consider that there is variability in the month.

Amy Shah, MD

I think most people get it wrong on the Internet. Everybody talks about the period as the time that you are really miserable, and yes, the first day or two of the period you are very miserable, but it is really the week before that, what we call the late luteal phase. In the luteal phase of your menstrual cycle you get a lot of the symptoms of fatigue and stress and cravings, difficulty sleeping, and mood issues. I think if you understand that when your late luteal phase is going on, you might not want to do things like longer fasting, you might not want to do very stressful activities, you might want to get a little extra sleep, and you might want to eat foods that satisfy the cravings in the right way. Understanding that there are even these phases and which phase you should plan for helps women in so many ways. I know for me, when I got this information out, I thought to myself, Why did I learn how to manage my fasting, my food, and my exercise in medical school? Nobody ever told us. We knew about the menstrual phases, but almost just in the context of pregnancy and puberty, not really in the realm of how we optimize our bodies. The two main phases are the luteal phase that I just referred to and then the follicular phase, and the third phase, of course, is menstruation, which happens after the luteal phase. The follicular phase is when the follicle is growing. From day one of your period to day 14, day 14 is when you ovulate, and then day 15 to day 28 for most women is the luteal phase, and the luteal phase is the area that we need to talk about adjusting fasting and changing the way you eat.

Kashif Khan

We are going to drill into some of this stuff. But just so people have some context, is it important, you describe these three phases? There are some nuances within the phases; are those impactful? Are we talking about three separate sets of habits?

Amy Shah, MD

You hit the nail on the head. We do not know the nuances because we just have clinical data; we do not have research data. We do have some good research data that says luteal phases X, Y, and Z happen, and follicular phases X, Y, and Z happen, but we really do not have the very detailed research that we need, like, okay, how long can I fast in my follicular phase? How long can I fast in my luteal phase? That is based on some of the things we infer from how insulin-resistant you are, how stressed you are, etc. Within the phases, there are many nuances, especially the late luteal phase. Because what you see is at the end of the luteal phase, you start to see a drop in all the hormones, estrogen and progesterone, and that is when you start to get symptoms. When you lose your estrogen, you feel tired; when you lose your progesterone, you cannot sleep and you feel more anxious. Really at the end is when you really get to see the symptoms.

Kashif Khan

Both symptomatically. Here is this innate map: There is a circadian rhythm of hormone flow for the month. You are seeing it. But women are also complaining at that time. Things are lining up kind of clinically. Right now, forget about everything you know. What you are going to teach us today is what is being done right now prior to that: is it more like too bad you are a woman, or are there pills being prescribed, or what is the answer allopathically?

Amy Shah, MD

Yes, that is a great question. That is why birth control is so widely prescribed because sometimes people will say, Oh, my late neutral phase is really severe, or my cycle. They have a question about their cycle, and almost always it is answered by, Hey, take this pill; regulate your cycles. We used to think it was harmless, and now we know that is not the case. Now everybody is a little more careful about who gets oral contraceptives and make sure it is appropriate, it is not just for acne or it is not just for period cramps, or something.

Kashif Khan

Yes. Okay. Makes sense. We heard the same thing, and the challenge there becomes, then there is variability in the hormone profile; some women are more estrogen-dominant, some women make estrogen-toxic metabolites, and you are fueling that by adding birth control and a few more hormone metabolisms into toxicants. Anyway, I am sure you see a lot of this clinically. But let us take it back then. Now, scrap that. No pill. What are you seeing that is working in terms of, let’s start with fasting, let us look at that luteal phase, we will separate out for a second, what does that look like ideally in that third week?

Amy Shah, MD

Yes. Ideally, if you are a woman right now listening and you are like, Okay, what does this all mean? The basic thing is that the day of your period is considered day one. When we are talking about all these days, just so you know, day one is the day of your period, and day 14 is when you ovulate, and we are talking about the phase after ovulation all the way to your period, the last kind of half of the month. Okay. If you started your period on June 1st, then we are talking about June 15th to June 28th, and that is the luteal phase. As you get to the end of that luteal phase, especially when you get to days 24, 25, 26, 27, and 28, that is when you pull back on your fasting, on your stressful exercise. That is when you want to get a little more sleep. What happens is as estrogen and progesterone drop, your ability to process carbohydrates goes down, your ability to counteract stress goes down, and your ability to withstand a lot of biological stressors goes down. What is happening is that you are biologically basically saying, the body is basically saying, Nothing was fertilized; the egg was not fertilized; it is time to shed the lining, and it drops all the hormones for your body to do that. During that time, you are going to feel a little moody, and you will feel low energy, you will have poor sleep, and often you have trouble doing the fasting that you usually do.

And again, like you said, there are nuances between individuals. Some women are like, I fast all month; I have no issues at all. That is great. But if you are someone who notices that during that five- to seven-day period you feel exhausted and it is difficult to fast, then that is the time to pull it back and maybe just do 12 hours, maybe do 13, 14, or something that is easy for you. If you are used to doing 16, 18, maybe you pull back to 14, 12. If you are someone who does 24-hour fasts every few weeks, maybe that is not the time to do that. Maybe if you are just wondering, Hey, should I be fasting at all? That is the time to take a break if you want to. That is how I think of it biologically.

Kashif Khan

And we see that in today’s time. Everyone wants to be that biohacker and that superhuman that loses 250, we will see who gets there first.There is this culture around, No, I can do it; I am going to try. But rest and recovery are part of progression, and perhaps that is the time we have needed them most. It appears that way anyway.

Amy Shah, MD

I think for me, when I am coaching anyone on nutrition, on exercise, on fasting, I am always cycling it anyway. We always want to be cycling: pushing your body, then letting it recover and rest, and then pushing your body. This is kind of the way you can do it in accordance with your natural rhythms.

Kashif Khan

Now that we have talked about that phase, does the rest of the month matter? Is it just to do what you want, or is it only this way to think about?

Amy Shah, MD

Yes. That is a great question. Once you get your period, and usually by day two or three, you feel pretty good, and your hormones are rising again. That is when you hit the fasting. You hit the gym; you do the things that, your sleep is improved, your mood, and your energy levels. At the end of that phase, around days 12 to 14, around ovulation, your testosterone is at its highest. That is also when you might want to incorporate more strength training. That is when you want to maybe do more in your life or work, maybe the tasks that require more courage and strength. Because testosterone is going to give you that bravado, it is going to give you confidence, and it is going to give you those muscle-building capabilities, that is when you want to really utilize that and use that to your advantage if you can. Then, that is around day 12 to day 15, that is your prime spot to build muscle to do the tasks that maybe require a little more strength and confidence.

Kashif Khan

We had this. You are just talking about fitness. Everything we read and hear, and listen to, and I am not a woman trying to navigate this or trying to respect the challenges, Well,  even what I see, it is all kind of based on this 25-year-old man fitness regimen, which is what I do today or this week, as opposed to you got to have a one-month plan. Because what is happening to your body in week one versus week two, versus week three, versus week four is very different, and then the nuances of different hormonal profiles may even pull that in more exaggerated directions. It sounds like the big lesson is most of what you hear out there is not designed for the cycle.

Amy Shah, MD

Yes. I mean, we always talk about the circadian rhythms; we have learned so much about the Nobel Prize in medicine that went to the discoveries around circadian rhythms a few years ago, and this is a rhythm also. It is the infradian rhythm. There are a few infradian rhythms, but this is the most dominant. When we are working with our female clients or if you are personally looking to improve your health, taking this into account can change the way you feel, you look, you train, you fast, all of that.

Kashif Khan

Now, when it comes to, I heard you mention insulin resistance and then you dropped it in there a little bit. What do people have to think about there?

Amy Shah, MD

For example, if you have higher cravings, it is kind of a conundrum; your cravings are higher during that time, but you are also more insulin resistant, and you want to incorporate more protein and more fat into your meals so that you feel more satiated. You are not reaching for the typical thing people always think of when they are PMS, the ice cream, and the chocolate, and those pretzels and it is because it is a real phenomenon, your cravings go up. But you can counteract that by introducing more protein and fat, healthy fat to your diet, and also some complex carbs like sweet potatoes, which are a great thing to eat at that time. These things are carbohydrates but also have a lot of fiber with them, like fruit that can help you battle the cravings but also slow down that blood sugar rise.

Kashif Khan

Yes. I know there are some women that are listening who are probably thinking this all sounds great, but I have not had a cycle in ten years, and that is where things get tricky. Because from what I have heard and told me, almost two-thirds of this still has this rhythm that is happening, but it becomes hard to track because the key measure or key start point of the cycle is not there. What does a woman do when she is postmenopausal?

Amy Shah, MD

Yes. Postmenopausal women are like men. You have to make your own cycle because at that point there are no eggs being fertilized, there is no rise and fall of estrogen, and everything is kind of stable and low. You can still cycle, but on your own schedule. I am sure you cycle on your fasting or your workouts or your eating, and I do too, but for postmenopausal women or women who do not have a period at all, you basically can create your own cycle. Now, women who had ovaries but have had a hysterectomy, though still have cycling hormones. Even though you are not getting a period, you probably noticed that there are ebbs and flows in your cycle, and there are other ways to figure out where you are in the cycle. But in general, post-menopausal, your hormone levels are low unless you are on hormone replacement, which means that your hormone levels are higher but they are still at stable ranges; they are not going to be cycling like they do when you are premenopausal.

Kashif Khan

That makes a lot of sense. It becomes a little bit easier to manage. You can go with your intuitive feedback, like how you feel, and this highly structured map becomes less important.

Amy Shah, MD

Yes.

Kashif Khan

Which is some sense of freedom. Something to look forward to in menopause.

Amy Shah, MD

I do not think most women are looking forward to menopause, it is because, even though you can fast longer and easier you lose a lot of the benefits of estrogen and progesterone with your skin, your moisture, and your hair, and the whole thing of aging that we think of is really that menopause that happens where you lose the hormones that were helping you do that. I think it is a difficult time, but from the fasting front, it could be easier.

Kashif Khan

It could be easier, okay? There are some women that we hear, and I am just giving you the feedback that I have heard to ask you what you think. There are some women that say that, I fast every day and I may actually gain weight; I fast a couple of days a week and I feel good; there are some women that say I need to do a 36-hour fast; it is good if I do it consistently every day; but then there are some that say, yes, every day, no problem. There is this variability we kind of see in terms of frequency, and how does somebody know what is right in terms of frequency?

Amy Shah, MD

Yes. Women, in general, have a very finely tuned HPA axis, our hypothalamic pituitary adrenal axis. Meaning our stress is very finely tuned because the body is seeing that you are in a lot of stress, it is not going to let you ovulate and procreate like that; it is a guard. If you are in a famine or war, your body shuts down its reproduction. When women say they have not gotten their period in months or whatever, I would say that is a vital sign. It is a bad sign if your body, or your HPA axis, has decided to shut that down. That means that there is some kind of threat, there is a famine, and there is something going on in the body that is telling our hormonal axis to turn that off. Everybody is different, though. For some people, we can say in general, women’s HPA axis is more finely tuned to stress, but there is a lot of variability in that. Some women, I will tell you, they are not sleeping enough; they have a job and maybe they have kids, and they have home responsibilities, and then they are waking up at 5 AM to work out, and then they are kind of fast, and then they are just doing all these things that are telling the body that it is in danger, and all of the benefits that you are trying to get from it you are not going to get those benefits because your body is hypersensitive to all the stressors that are going on. That happened to me. I used to think, I cannot sleep; sleeping is for lazy people, and then I was doing these crazy fasts too because I read about fasting and thought, Well, 14 hours is good; 16 hours is good; what about 18, 20? I would try all these fasts, and I was seeing the opposite of what I wanted: my health, my cravings were worse, my energy levels were worse, I was not looking more muscular or stronger. It was going the opposite direction because I was just piling on the stressors, and my body was detecting that.

Kashif Khan

What does your personal fasting schedule look like right now?

Amy Shah, MD

I like to really follow circadian rhythms. I am a huge fan of circadian fasting, which basically means that instead of fasting late into the day, I start with an early dinner. Stop eating two to three hours before bed as early as I can and then fast through the evening, the night, and then break it not to maybe one or two hours after waking up. Between a 12- and 16-hour fast, I usually average around 13 to 14 hours. But again, when I ovulate during my late luteal phase, I will do more like 12 or 13 hours. In my follicular phase, I will do more like a 16, sometimes even an 18, sometimes a 14. I can push it during that time depending on how I am feeling, what my exercise is like, etc. But that is what works for me. I have found that some women, and especially my male clients, often can go much longer without having any negative side effects. For me, I find that if I go too aggressive on my fasting that I start to see these HPA axis changes, and maybe it has to do with the lower body fat you have, the harder it is to do longer fasting without having the hormonal effects, and then all the other stressors in my life, I have so many other stressors. I think my fasting tends to be shorter than someone who may not have the same stressors, or, like I said, often my male clients can do a longer fast without a problem.

Kashif Khan

Yes. I think your point about the eating schedule is so important to not consider. Because almost everybody you talk to about fasting is like, Wake up and do not eat, and the longer I can go, the better. Every day is unique and a challenge depending on what time I go to the gym and how long I work, and how much food I need, but really, the benefit of stopping eating early? Now another new challenge pops up, and we hear this from a lot of women, which is emotional eating, the environment-based eating, and that I do not know how to not eat at night. You are at home, it is comfortable, it is your time off, the kids are asleep. How do you do that? Because I understand it is a lot easier to go during the day and just skip food because you are busy and then be at home like that is the time where you want that soul food, how do you personally do that?

Amy Shah, MD

Yes, 30% of Americans’ calories come after eight p.m., and those are not salads and protein; that is usually junk. That itself is a feat. It is much easier to fast during the day, right in the morning, in the daytime, because it is often everybody is busy or working out, or going to work. It is much harder to do it in the evening. Even if you can get two hours before bed or one hour before, that is how I would start. The biggest thing I found that helped me through this and helps a lot of people is changing your diet in general. If you are eating a very highly processed, refined carbohydrate diet, it is going to be very difficult for you to fast in the evenings; your blood sugar is going to drop, and you are going to feel like crap. The first thing I had to do, I mean, it is so crazy that I went to nutrition school and medical school, all these things, and my diet was full of sugar and processed foods, and I was on that roller coaster, and for me, the first time I tried to not eat after six p.m., I was dying because that blood sugar, when you are on a roller coaster, you are going to crash and you are going to feel like I was feeling dizzy and light. The whole thing that people talk about when they first start fasting, you feel all those effects because my baseline diet was so poor. Once I started to change that, fasting became easier. Then I tell people all the time the biggest advantage of learning how to fast is that when you are in a social situation where there are no good food options or you are at the airport where there are no good food options, you do not need to eat. I think so many people think, well, I got to get something at the airport; where else will I be hungry, or I have to eat at the party because what am I going to do? What fasting teaches you is that your metabolism is flexible and strong, and you do not need to be eating every two hours. You can go for hours and hours, you can go 14 hours, 24 hours without food, without damaging anything, and in fact, it is good for you. I think that gives you a lot of power.

Kashif Khan

For someone who is doing what you are doing, which most people are not, you are not eating at night, the metabolic fitness and how it affects your sleep, I am assuming, probably supports you there.

Amy Shah, MD

Yes. Your sleep quality improves. Our blood sugar metabolism drastically changes at night. When melatonin is released, not only does it go to the brain, but it also goes to your pancreas and tells it to turn down the insulin. It also goes to your stomach and says, Turn off those digestive juices. It is going to go around the entire body, telling all the organs, Hey, it is time to sleep; it is time to get ready for bed, so that they can focus on repair and renewal instead of constantly needing to digest. That is why you hear all about people who eat very late at night, huge meals; they get all kinds of issues with gastric reflux, with IBS, with all these issues because you are waking your body up when it is already in sleep mode to try to digest this huge meal. It is not going to do a good job. I found that my digestion was better, my sleep was better, and I was able to fast according to my natural circadian rhythms, kind of time-restricted feeding, is how they call it in the literature that has so many benefits and is good for your skin. People do not realize that you have circadian clocks in your skin, in your liver, and in your muscles. Everybody needs to know in your body what time of day it is because it can optimize. Your brain is optimized in the morning, and your skin is optimized when it does not see a lot of bright light and food in the evening. The same with your digestion. If you are trying to optimize your eating, your body, and your aging pathways, you really want to switch to that early evening fast all the way to late morning. When you wake up, you might not eat for an hour or two, and that is actually natural because, thousands of years ago, you did not go out of bed and eat and drink your coffee, and have your Pop-Tart; you would have gotten up food for your family, gathered something, and then maybe two hours after you wake up, that is when you would eat food. That is what our body is accustomed to; your body wakes up, and the melatonin clears out the daily function starts.

Kashif Khan

Another question we have had, and I do not know if there is really even a need to address this or not, is: for women that are striving to get pregnant, is there a different consideration, is there even something they should be thinking about?

Amy Shah, MD

Yes. I always tell women that your period is a vital time for you; it is the health of your organs and your hormones. Your HPA axis will not let you have a period if it is feeling danger or stress. If you are someone who is trying to get pregnant, you want to make sure that you address this. If you are not getting a period, or it comes every five to six months, or it is irregular, that is a sign that you have to get fast because often you can change your lifestyle and do things to improve that. But besides that, I think that optimizing your fertility is really about optimizing your hormonal axis, like that hypothalamic pituitary adrenal axis, by really watching: how much stress are you getting? Are you having regular cycles? Because if you are, then you are optimized for getting pregnant.

Kashif Khan

It does not matter if you are condensing your eating window while you are trying to get pregnant, the effect on hormones, etc.

Amy Shah, MD

As long as you are still getting a period, your energy levels, your cravings, and your mood all of that is unaffected. There should be no issues at all. I mean, I think the only issue is that once you do get pregnant, you really do not want to do extended fasting or fasting that is outside your comfort zone. That is when you stay within the easy boundaries of easy fasting or no fasting at all.

Kashif Khan

A lot of people that are listening have probably experimented a little bit or maybe even regularly fasted. There are some people that we know who are listening who have never done a lick of it, never even tried. For that person who is scared to even get going, like, Well, I am not going to eat the way I eat, where do you start? What is that thing that you have learned from having gone through this journey, the hacks that you wish you knew at the beginning, what are some of those jewels that people need to know?

Amy Shah, MD

The number one hack is that you do not run a marathon on your first day. I think I did it wrong. The first time I tried fasting, I just read all these studies, and I was like, How cool! I am going to start fasting. You do not just get up and run ten miles on your first day; there are going to be negative effects if you do that. That happened to me. I fasted for I think 16 to 18 hours every day for the first three, five, and seven but at the end of the week, I felt exhausted, my cravings were out of control, my sleep was disturbed, and I already knew something was not going right. I tell everyone to just start simple: eight PM to eight AM, just super simple; it could be seven to seven, eight to eight, whatever it is for you, just do a 12-hour fasting. I mean, most Americans are not even doing a 12-hour fast, they are doing, they are eating until the minute they go. Sometimes they are eating in bed and waking up and then thinking that they need to jumpstart the metabolism, and they are eating right away, and you are getting maybe an eight-hour break, at most that is if you sleep eight hours.

Kashif Khan

Yes. Now that makes sense: starting small and building that habit, and then stretching it out. Because you can kind of scale those habits once you start to learn and you go down this path of reward and you start feeling better, and you automatically will do more, and eventually, like you said, you get that metabolic flexibility. If you are in the airport and you want to skip that nonsense food that is available, it is not difficult to do. Day one might be difficult. Day one, it may be more about replacing as opposed to skipping. Let us purge the pantry and bring in some healthy options so that if you get stuck or these are something healthy to lean on, and you slowly, incrementally, get better and better, which is awesome. I know that you practice clinically. The people that are coming to you, is it more like, I have a health problem, and what could I do? You are like, Well, maybe fasting is a tool, or is it like, No, teach me how to fast? I am just wondering if you are using this as a therapeutic tool.

Amy Shah, MD

Yes, that is a great question. Okay. My situation is unique, well, not unique to traditionally trained doctors. But when I first started practicing medicine, I graduated residency, I went to fellowship and then I took a job, and I became a partner in my clinic, doing immunology and allergy medicine like traditional medicine. It was not until my second year of doing that, when I became a partner, that I was like, Oh my God, what about nutrition? What about fasting? What about exercise? We are not even touching any of these subjects in these visits. I mean, I would talk about it, but then it is time to go to the next patient. I started to write for fun, and I started to educate for fun. I would say, Hey, if you are interested in the nutrition side, check out my blog. Check out this book that I wrote. Now I have a hybrid practice where I have my traditional practice. But I also see my wellness patients who specifically come to say, Hey, can you help me fix my nutrition, my fasting, and my exercise? And those patients I can take from all over the world; that is a virtual slash online practice. That one is where I get to see all kinds of fasting protocols being used. That is when I realized, Wow, men can tolerate fasting often a lot easier than women can. I notice that post-menopausal women do a little bit better with longer fasting because of the hormonal things that we talked about. I realized that most women are not sticking to their cycles or circadian rhythms. Most men are not eaters, so I thought one of the things I really do with my wellness clients is, Hey, let’s sync to the rhythms of their day and the rhythms of the month so that you can really optimize your health. It is simple things like changing the timing of your eating and then changing a little bit of your fasting during that late luteal phase. It is personalizing the diet based on what their needs are, like, are you 45 and you want to build muscle, or are you 65 and you want to lose fat, or are you 25 and you want to do both, or whatever it is? That way, I can personalize it.

Kashif Khan

It is awesome. Because as you were just saying that, I could see you telling the story of, Oh, I started in my medical practice, and then when you started to talk with the nutrition and enthusiasm, you could not hold back the smile. Because I guess the fulfilling nature of seeing people actually get across the finish line and feel amazing and knowing that you did that for them because what you were doing before perhaps did not do that, right?

Amy Shah, MD

Yes. I mean, you know and I know, I think the medical system, I love seeing patients. But I really feel the medical system is broken in the way it emphasizes and what it rewards. There are very few doctors that I know personally who do not feel it is broken. It is really a broken system, unfortunately. I love doing the wellness stuff because it takes me outside of all of the things that I hate about the traditional system and takes those away. Whereas, the traditional medical system, I still love it because I get to be in the trenches. It is where you see patients. Sometimes I see patients and I say something, and they have never heard of fasting; they do not know about eating a diet with whole foods; it is a basic thing, and I realized, Okay, I am talking about all this nuanced fasting; we are talking about syncing to your cycle and circadian rhythms, and this person has never fasted or never even heard of it. It is a nice way to keep yourself grounded.

Kashif Khan

Yes, for sure. Whenever something of this nature becomes more of a phenomenon in the mainstream, which it kind of is now, it trickles down into populations that were not intended for us, for example, even younger people. Is this something that is beneficial for young women, like the puberty stage, or is it a problem?

Amy Shah, MD

Yes. The problem with fasting is that we live in a diet culture, and girls, especially, live in a diet culture. Some of this can be dangerous with a girl who is already self-conscious about their weight or having an eating disorder issue. That is my only caveat with the younger women population. I do not want my daughter to think of fasting as a way to restrict her food further. I think it has to come with a lot of understanding about why we are doing this. It is a longevity pathway for most of us, and I think it can be done. With my kids, you can do a very easy thing: you can close your kitchen after a certain time, and that is completely appropriate. That is a way to teach them, Hey, you do not need late-night snacks; you do not need to be relying on these things. Apparently, it gets a lot more difficult, in my experience, gets a lot more difficult as they get to teenager and adolescent age, because that is when the food culture in America is all about late-night eating and late-night everything. I think young women can do it, but there are additional concerns.

Kashif Khan

Yes, I agree with you there. Because it is like what is the intention? If the intention is correct, then you are probably going to do it correctly. If it is more like a hack to starve yourself, we have seen how problematic that is already given social media culture and the perfection that people are being driven towards. Just because you also work clinically, not that we are meant to talk about this, but I am just wondering your thoughts on all that and people trying to shortcut things, is there a long-term problem there?

Amy Shah, MD

Here is my thought on this: Anything that comes becomes super trendy and a phenomenon, and more people start to use it. There is going to be more experiences beyond just the company that created the studies. The company funded these studies, and they saw a certain level of side effects or negative effects that they reported. But let us be honest: when it goes into the real population and real people in the levels that it is going now, we are going to see some worse stuff, and I anticipate that just like it had a huge rise, we are going to start to see problems. We have already started to see problems, but we will start to see problems that are going to level out. It would not go away, but it is not going to be this phenomenon. Because we do not know enough about it yet to say negative things about it, but as soon as it goes a couple of years and the general population after levels it is now, I think we are going to see some of the concerns that we might not have seen in the drug-funded studies.

Kashif Khan

Yes. I just saw an article recently about what is being referred to as the Ozempic face and Ozempic butt. Essentially, what we are saying is that there is this rapid fat loss, but there is no reset to metabolic health, and the skin is still sagging, and literally, the butt is just kind of hanging in there because of fat.

Amy Shah, MD

And you lose muscle mass.

Kashif Khan

And you lose muscle mass, yes. All of a sudden, there is sagging skin. It just seems like, yeah, you may have burned some fat, but did you achieve health? But maybe that was actually, to begin with. Maybe that needs to be taught along with, Do this, but you also have to do this. 

Amy Shah, MD

But a lot of people, I will tell you the good side and the bad side. The good side is that it gives people who have tried everything a tool. I mean, that is amazing. There are people who have struggled with obesity for their entire lives, and this has been life-changing. But on the flip side, there are people who just are using it as a way to get a quick fix, and all it is doing is suppressing their appetite. and they are not changing any of their habits, and that is just going to end up in a rebound or other negative side effects.

Kashif Khan

Yes. I think you are right there. Like you said, you work with patients. I just wanted to ask you, to anyone who is listening and saying, Wow, this sounds interesting; I need to know more. How do people find you? Where do they go?

Amy Shah, MD

Yes. I am at amymdwellness.com, that is my main website, and I am fastingmd on Instagram. And I am Amy Shah MD on other platforms, such as Twitter or Facebook, etc. And I wanted to tell you that I was at the biohacking conference, but I never got a chance to meet you. I cannot believe that we missed each other.

Kashif Khan

Oh man, that would have been amazing. Yes, that was literally just last week.

Amy Shah, MD

Yes. I was with my brother, who is a gastroenterologist and lives in Orlando also, so I was going back and forth from his house. I did a panel on Thursday, and then I stayed most of Thursday, but then I did not come back until Friday evening.

Kashif Khan

That would have been nice to see you in person. Now, here we are, we are just next to each other. Now we are on Zoom.

Amy Shah, MD

I know. That is what I was like, thinking to myself when I was there, I was like, Oh, it would have been nice to meet you but I did not. It was unfortunate, we did not get a chance to meet.

Kashif Khan

Yes, it will happen eventually. Your medical and your wellness are both on the same site you mentioned.

Amy Shah, MD

Yes, there is access to both. You can kind of get my clinical or my wellness practice.

Kashif Khan

And you mention your Instagram. I urge people to go there because you have a lot of daily wisdom drops. And people, especially in the context of female health and fasting and everything we have been just talking about, there is a lot of wisdom being dropped there.

Amy Shah, MD

Thanks. I like your videos too. I saw a video just recently because it was up my alley; it was about gut health, about the fat-burning bacteria video, and I thought that was a great way to phrase it to get people to watch it. You phrased it as like the bacteria that can help you become a fat-burning machine or something; I do not know if you remember that, but I thought, Oh my God, that is a good way to capture people’s attention.

Kashif Khan

Yes. That is the thing, is that there is so much noise. Listen to me; I have something of value and really get attention. The reason why we are doing this all is to help people, but it is hard to get someone’s ear once in a while. Thank you for joining us. It is an awesome discussion. I know it is going to help a lot of people. Again, I urge people to check out your Instagram because there is just amazing stuff coming out there, and I am learning from it. And anyone that wants to work with you, we will share the link that you discussed, and everybody can connect with you and overwhelm you with appointments. Thank you again for that. Thank you for today. Thank you for your time. Awesome discussion. And I am sure it will help a lot of people.

Amy Shah, MD

Thank you. And I want to get my DNA tested at some point.

Kashif Khan

Sure. Kit is on the way.

Amy Shah, MD

Alright. Awesome. Thank you so much. Have a great day.

Kashif Khan

Alright.