Realfoodology - Mastering Perimenopause + Intermittent Fasting | Cynthia Thurlow

Episode Date: July 9, 2024

EP. 202: Join me on the Realfoodology podcast as I sit down with Cynthia Thurlow, a seasoned nurse practitioner and intermittent fasting expert dedicated to empowering women to live healthy lives. With nearly two decades of experience in clinical medicine, Cynthia discusses all things perimenopause. Tune in as we explore insights on metabolism, insulin sensitivity, and effective ways to support your body during perimenopause. Plus, Cynthia shares her expertise on intermittent fasting, reproductive health, menopause signs, and treatments like HRT. This episode is a must-listen for anyone seeking to optimize their health journey with evidence-based nutrition and lifestyle tips! Topics Discussed 05:47 - Education surrounding perimenopause  12:41 - Preparing for perimenopause  15:17 - Aging with grace  18:14 - Exercise and the menstrual cycle  23:58 - Metabolism and insulin sensitivity  30:50 - Ways to support your body during perimenopause  38:16 - Intermittent fasting  49:08 - Reproductive health  53:02 - Signs of menopause & treatment  01:00:08 - HRT  01:03:54 - Cynthia’s health non negotiables Check Out Cynthia Website The Intermittent Fasting Transformation Sponsored By: Cured Nutrition www.curednutrition.com/realfoodology REALFOODOLOGY gets you 20% off Needed Use code REALFOODOLOGY at thisisneeded.com for 20% off Paleovalley Save at 15% at paleovalley.com/realfoodology and use code REALFOODOLOGY Organifi Go to www.organifi.com/realfoodology and use code REALFOODOLOGY for 20% Off Check Out Courtney:  LEAVE US A VOICE MESSAGE Check Out My new FREE Grocery Guide! @realfoodology www.realfoodology.com My Immune Supplement by 2x4 Air Dr Air Purifier AquaTru Water Filter EWG Tap Water Database  Produced By: Drake Peterson Edited By: Mike Frey

On today's episode of The Real Foodology Podcast. There's this protein leverage hypothesis. So if you don't eat enough protein, your body at some point is going to be looking to make up for the caloric deficit. And you generally are not craving more protein. What you're craving are carbs and fat and not the healthy kind. It's usually the processed stuff, the things that are the ultra processed foods. And as I know you talk about on this podcast, helping people build awareness about how ultra processed foods tease us into thinking that we aren't eating as much food as we are but people that eat ultra processed foods eat on average a minimum of an additional 500 calories a day and for a

middle-aged woman that can be catastrophic hello friends welcome back to my show the real foodology podcast i'm your host courtney swan and today's guest is Cynthia Thurlow. Cynthia Thurlow is an intermittent fasting expert and for women specifically, which is really cool. Nutrition educator and nurse practitioner, empowering women to live vibrant and healthy lives. What's very cool about her story, and I love when people do this, is that she worked in clinical medicine, both in the ER and cardiology for almost 20 years. And while she really respects the power of conventional medicine to treat disease and save lives, she began to think more about the root causes of the chronic health issue. So like many of her peers, she was seeing all these sick people come into the ER, into her office, and realizing that they weren't getting any better because we were just throwing pills at them. We're not actually in the modern allopathic conventional model. We're not trying to get to

the root cause. And this is really harming people. And many diseases and health issues are going unaddressed because we're not helping them get to the actual root cause. So she recognized the powerful relationship between food and her patient's health and wellness. And this led her to do advanced training in nutrition and functional testing so that she could help others enjoy optimal health before they needed emergency care. She was such a joy to talk to. We were so much in alignment and we had so much to go over. We talk about intermittent fasting from a women's health perspective, specifically how intermittent fasting could possibly be affecting women's hormones. And we talk about

low carb and low impact workouts and how chronic cardio could be affecting our hormones and women's health. And we also talk about a lot about perimenopause, which is the window of time between while you're still menstruating, but your body's kind of gearing up to go into menopause, which is the window of time between while you're still menstruating, but your body's kind of gearing up to go into menopause. And I think perimenopause is now starting to be talked about more, but it really was largely disregarded for a long time in the women's health space. And then we talk a little bit about menopause as well. We talk about side effects and things that women can do in order to support their bodies during perimenopause and menopause. So this really just is a jam-packed women's health episode all about our hormones and

how to take care of our health really throughout every stage of a woman's life. So I really hope that you enjoy this episode. And as always, if you are loving the podcast, if you could take a moment to rate and review, it means so much to me. It takes like two seconds out of your time and it really does help the show. And of course, if you want to post about Real Foodology on Instagram, if you want to tag at Real Foodology, I would love it. It would help the show so much. And I just really appreciate your support. So thank you guys so much for listening. I am very excited to announce that Cured Nutrition just came out with a new product.

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realfoodology. Cynthia, thank you so much for coming on today. I'm so excited to have you on. I feel like it's been a long time coming. And I really wanted to take the time today to talk to you about overall women's health from the perspective of hormones, because I feel like so many women are struggling unnecessarily, especially as they go into perimenopause and menopause, because we just really aren't educated enough about the changes that are happening in our bodies, what we can do about the hormonal changes. So I just want to dive into all that today. And thank you so much for coming on. Of course, I've been looking forward to our discussion. I think on so many levels, it's really starting from a place of education. I am very, very transparent about the fact that no one prepared me for perimenopause, not my mom,

not my GYN, none of my girlfriends. And I think that there has been so much shame and secrecy surrounding women and the aging process just in general. And for the benefit of listeners, explaining what perimenopause is, it's really anywhere from the five to 10 years preceding menopause. And if the average age of menopause in the United States is 51, ladies, if you're in your late 30s, early 40s, you're there. And this is oftentimes when women are dealing with young children, the combination of work, whether they work inside the home, outside the home, aging parents. And when we reflect on what perimenopause really starts with, it really is the hallmark of ovarian aging. So our ovaries are as old as we are. We are not like men where we replenish sperm every 72 hours.

And so as the ovaries are getting older, and yes, our ovaries do get older, if they start producing a little less and less progesterone, and this is a very important hormone, and how this can show up, typically I see it with sleep issues. Women will notice right before their menstrual cycles, they suddenly aren't sleeping quite as well. They're waking up. Maybe they feel anxious. Maybe there's more depression. And one of the more common things

that I also see is very heavy menstrual cycles. And for anyone who has experienced what I affectionately refer to as the crime scene period, they know exactly what I'm talking about. It's no fun whatsoever. You are feeling like you don't want to leave your house or have to leave where you are for fear that you're going to have an accident. So perimenopause is really this preparatory, it's like reverse puberty. And the joke is that as I was going into perimenopause, my teenagers are going into puberty. And so their hormones are ramping up and mine are ramping down. But if you look at the research on these five to 10 years, you're really understanding that it's a form of hormonal chaos. So not only

is progesterone waxing and waning, estrogen, which is designed to be balanced with progesterone, kind of like a seesaw, all of a sudden you have less circulating progesterone, you have relative estrogen dominance, and you can sometimes see the highest levels of estrogen of a woman's entire lifetime in the chaos of perimenopause. And so again, this shows up breast tenderness, heavy menstrual cycles, weight loss resistance, these sleep issues.

And so I think the more that we can educate women about their bodies and what's happening, it makes so much sense. For a lot of women, it can be as simple as oral progesterone, bioidentical progesterone, the week preceding their menstrual cycle for many years. And that in and of itself can be of huge and incredible benefit. It also has a nice sedating effect. So if you're struggling with sleep, progesterone is wonderful for that. And then the farther that women get into perimenopause, they may need some estrogen support. They could need testosterone support.

But I think the biggest change for many women is understanding our lifestyle needs to change. We become a little less stress resilient, and yet we have to manage and buffer quite a bit of stress. We may be more established in our professional lives, our kids may be older, our parents are aging. And so finding ways to address stress proactively, prioritizing sleep, eating anti-inflammatory nutrition. So I oftentimes will say to women, the way you ate in your teens, 20s and 30s is not the way you navigate perimenopause successfully. And that could look like being gluten-free or dairy-free. Alcohol becomes a big hot topic because for a lot of women, it will erode the quality of their sleep, not just deep,

but also REM sleep. That was the only time I would get hot flashes. And so for me, leaving alcohol behind was an easy decision because I disliked having hot flashes. And then also reflecting on strength training, because after the age of 40, the whole role of sarcopenia, muscle loss and strength loss with aging is not an if, but when, if we are not actively working against it. And so encouraging women to lift weights, to weight train, to not just do chronic cardio. Again, the things that we got away with in our 20s and 30s more often than not don't serve us as well. So that's kind of in a nutshell what perimenopause is. And then to kind of further clarify, menopause is 12 months without a

menstrual cycle. And so once you have gone 12 months without a menstrual cycle. And so once you have gone 12 months without a menstrual cycle, you are then in menopause. And I always say it's a pause for a reason. I think for a lot of women, they reflect on it as being a negative thing. There are a lot of benefits to no longer getting a cycle. You know, things as simple as not having to worry about, you know, if you're wearing white pants and you suddenly get your cycle or having to worry about, you know, if you're wearing white pants and you suddenly get your cycle or having to worry about the degree of fluctuations of hormones throughout the month. I think for a lot of women, they deal with less migraines. They may have less bloating. And for a lot of individuals, I think that, you know, when I trained as a nurse practitioner, it was preceding the Women's Health

Initiative. So we're talking late 90s, early 2000s. And when I graduated about a year later, that's when the Women's Health Initiative came out. And a lot of women that were on hormone replacement therapy were taken off. And a whole generation of clinicians were trained with the understanding that hormones were bad, hormones cause cancer. And yet now life is coming full circle,

realizing that that wasn't necessarily a great study, not particularly healthy participants. And so I feel like my generation is starting to speak very openly, very loudly, helping women understand you have options, you don't have to suffer. And so aging is inevitable. Suffering is not. I like to think of it from that reframe that helping women understand that you have options, finding providers that can help you navigate those changes. But I think that for a lot of people, perimenopause is a time of chaos. And for most of us, as we make that transition into menopause, things kind of quiet down and stabilize. And I feel like now that I'm on the other side,

I can stay that without reservation. But perimenopause for myself was a time of utter chaos. I did everything wrong. And this is why I think it's so important to have platforms like you do to help educate women about what to expect and what to do so that you mitigate and don't have to have quite so many hiccups like so many of us do. Yeah. So what were some of the things that you would have done differently knowing what you know now? Yeah. So at the time, I was in a very demanding cardiology practice in Washington, DC. And so I had a very stressful job. My husband traveled internationally. I had two young kids and a puppy. And so I wasn't getting enough sleep. I was doing too intense exercise. And I'm the first person to

say exercise is such an important aspect of my mental health and physical health. But I was doing really intense CrossFit type classes too many days a week, not enough recovery. And so when I reflect back, I was not eating enough, not because I was trying to be restrictive, but I'd started intermittent fasting and I didn't yet understand how much protein I needed in my meals, how much protein I needed to consume during a given day, probably too low carb. So I think the nutrition piece, the over-exercising though, although not intentionally, and then not properly managing my sleep. I think that having trained in the inner city of Baltimore and kind of an intense environment and being a bit of an adrenaline

junkie, I think a lot of your listeners probably can relate to that. I like intensity. I like being in the action. And so it was just the perfect brew for creating a bit of hormonal chaos. And it was interesting to me that once I changed the intensity of exercise, changed the way I was eating and managed my stress better, the rest of perimenopause was not that eventful. And yet no one talked about these things prior to going into perimenopause.

I still think that my generation is as much as we're doing a really good job of talking openly about our experiences, so many in my generation is as much as we're doing a really good job of talking openly about our experiences. So many in my generation really still have a tremendous amount of shame and secrecy around the aging process. And I always say like aging is a blessing. Like the opposite of aging is not something I want to entertain. And so if I've gotten to be this age, it is a blessing. And that's the way to kind of find that reframe is instead of thinking about less than like,

oh, I'm 45 instead of 25, I wouldn't want to go back to 25. And by that, I don't mean if there's anyone that's listening that's in that age group, I've learned lots of wonderful things throughout my lifetime, but I'm very happy being where I am at this stage of life. Yeah. Oh, I'm so happy to hear that. And you're right. It's such a great reminder that aging is a blessing because it means that we're still here. Yes. Yes. And there's always things that we can do to improve. This is one of my favorite things to talk about. And I love that we're talking about this right now because so many people just think like, oh, aging just comes with fatigue and you can't do all your

favorite things anymore and just list off all the symptoms, right? And I really don't subscribe to this notion. I believe that there are certain things that you can do to support your body in every stage of life that you're in. So for example, with perimenopause, just knowing what's actually happening in your body and knowing the hormonal changes that are happening, then working with a really good practitioner to mitigate those side effects and also maybe to supplement some things and maybe possibly get on some hormone replacement therapy just to really help your body through those changes. That way we don't have to be victims to just, you know, of like, oh, well, I'm getting older

and now like X, Y and Z is happening. Like, no, that doesn't have to happen. Yeah, it doesn't have to be your destiny. And I speak from like personal and professional experience that I have more energy at 52, almost 53 than I probably did 15 years ago, but I know so much more. And so I think that helping people understand that many of the people that I'm friends with in health and wellness space would say the same thing, irrespective of what age they are. They're like, I know so much more now. And that allows me to enjoy what I'm doing. I mean, some things get prioritized over others, like sleep is a huge priority and nutrition. But I think that the limiting beliefs around aging as a general,

a generalization, like people will say to me, oh, you can't possibly be, insert whatever age you are, because you are X, Y, or Z. And I said, but that's a contrived perception of what it's like to be this age. And so I think for most of the people that I know in the health and wellness space, everyone is, we're not trying to biohack ourselves. We are trying to live to our fullest potential

and to be able to wake up with energy, feel refreshed, be able to engage in the things that we want to be able to do. When someone comes to me and they talk about, as an example, brain fog, I've never experienced that. So I can't imagine how frustrating that would be. But understanding that there are so many things at play that feed into that, and that can happen to men too. It's not unique to women. But I agree with you, knowledge is power. And the more that we know, the more we can anticipate, and then we can be advocating for ourselves. And as an example, women don't have to wait until they're fully in menopause to start HRT. I find a lot of women do well, like I

mentioned earlier, with a little bit of oral progesterone at a time in their menstrual cycle. And then as they are getting older, they may need it more frequently. They may need to add some estrogen. They may need testosterone. And in some instances, there are other types of hormones that can interplay. It's not uncommon to see hypothyroidism in perimenopause. And so just reminding women that there's no one size fits all. And definitely, as you stated, working with a practitioner who knows exactly how to support women at that stage of life is critically important.

So important. So you briefly dropped this about doing a lot of intensive cardio exercises. And I'm curious to dive a little bit more into this because I have a personal experience with this. A couple of years ago, I was doing really intense cardio every single day. There were days where I would do two soul cycle classes in one day, which is absolutely insane to me now. Like I can't even believe. And what I started noticing is that I was coming out of these workouts being really fatigued. And it was alternatively before I remember coming out of classes and being like, oh my gosh, I have so much energy because of the endorphins and just starting to realize

that my anxiety was ramping up. My hormones were all over the place. And I started to realize like, wow, I feel like these cardio workouts are actually having a really bad impact on my hormones. So what are things that I can do alternatively? And I will say that one of the most impactful changes that I've made in my life in the last couple of years is doing low impact cardio and doing more strength training. So doing more Pilates, doing more hikes and walks and just less impact cardio and more strength training has completely changed everything for me between my hormones and my sleep and my stress levels, all of it. What are your thoughts on that? No, I think that the power of the N of one. So you realize that a little bit of intensity was good and too much was not. One of the big pearls

that I think is important to share with women is that when we're doing too much intense exercise, not enough recovery, our menstrual cycle is oftentimes a barometer of our body's perception of stress. So hormesis is beneficial stress in the right amount at the right time. And so helping women understand that if you work out and you feel energized, great. That's what we're looking for. If you work out and you're depleted, exhausted, you need to take a nap, It is probably a sign that it's too much intensity. And it could also be where you are in your menstrual cycle. So we know from the day of when bleeding starts up into ovulation, this is when estrogen predominates.

And it's this hormone that is designed for us to be a little more insulin sensitive. We can handle more intense exercise. I always say it's our superpower hormone versus after ovulation. And again, we're just going to think of this as an ideal 28 to 30 day menstrual cycle. When progesterone predominates, it's kind of our mellow hormone. It's the hormone where we become a little less insulin sensitive. Our body may be more tired. It may gravitate towards less intense things like yoga or bar class or zone two or gentle hikes. And I think so much of the human experience is the power of figuring out what works well for us.

So when I was doing all those intense classes and I was doing cycling and CrossFit type classes, and I was doing them back to back to back with no recovery, which was not very smart on my part, but I didn't know any better. But then when I transitioned, I did a whole year of just walking because my adrenals were so thrashed. And so our adrenal glands are designed to be an emergency backup system, but in perimenopause, they kind of are a backup quarterback as the ovaries are producing less progesterone, our adrenal glands step in to offer up some progesterone as a backup system. So they're already put at a little bit of a disadvantage in terms of stress. So that's when I talk about hormetic stress, it's right amount, right time, doesn't leave you exhausted. And for me, like gentle exercise was part of that healing journey back to getting to

a point where I could, you know, exercise more intensely, but exercising intensely, but being smart about it. So the strength training, zone two training, which is one of my favorite things to do. And, you know, Pilates, which is another thing I enjoy to do, but does not substitute for strength training. Like when I go to Pilates, I'm oftentimes surprised because I'm always going to be a clinician. Like I view the eye, I view the world from a very curious perspective, not judgmental, but just curious how many women are in that class who are very small, you know, they're tiny, but they have no muscle mass. And I think for everyone to understand that, you know, north of 40, as that acceleration of muscle loss begins, this is when, as you

appropriately stated, I have noticed such changes when I started strength training. And for a lot of women understanding that it's a use it or lose it, you have to use it to be able to maintain it and grow it. Otherwise you lose it. And with the loss of muscle, this is very important. You lose insulin sensitivity. And why is that so important? Because muscle is this organ of longevity. My very good friend, Dr. Gabrielle Lyon, I always give her credit for helping to kind of educate me about this whole process, but helping women understand that maintaining muscle mass

should be one of the things we're critically focused on throughout our lifetime, but especially in perimenopause and beyond, because it gets a little more challenging. You need more protein, like a 25 or a 30-year-old female needs less protein to trigger muscle protein synthesis versus someone at 50 or 55 or 60 is going to need more. And for many of your listeners, they may notice that on days when they don't eat enough protein, there's this protein leverage hypothesis. So if you don't eat enough protein,

your body at some point is going to be looking to make up for the caloric deficit. And you generally are not craving more protein. What you're craving are carbs and fat and not the healthy kind. It's usually the processed stuff, the things that are, you know, the ultra processed foods. And as I know you talk about on this podcast, helping people build awareness about how ultra processed foods tease us into thinking that we aren't eating as much food as we are. But people that eat ultra-processed foods eat on average a minimum of an additional 500 calories a day. And for a middle-aged woman, that can be catastrophic. Yeah. Yeah. Well, that's a big concern for women as they're going

into perimenopause and menopause. Is their metabolisms slow down or that's what they say? Is that actually what's happening or is it more that their hormones are changing? Yeah, I think most of the research... But that is a big concern. Yeah, yeah. No, you're absolutely right. Most of the research suggests our metabolisms really don't change until 60. So what is actually happening is we're getting changes in insulin sensitivity, changes in fluctuations in estrogen and testosterone can have a big impact. I mentioned that a lot of women develop thyroid problems. I certainly did. And I can recall when I was diagnosed with hypothyroidism, I was like, I don't want the medication. I'm going to fix this. Six months later, I was exhausted. And I was like, I want the medication.

So there's no shame if you need medication for your thyroid. But I think for a lot of women, it's multiple things. They're not sleeping enough. And I tell women very directly, if you are not sleeping enough, which means seven to eight hours of good quality sleep every night, I can't get you to lose weight. It is that foundational, that important. They're not managing their stress. Their macros are not properly balanced. And what does that mean? That means that you are eating no less than 30 to 50 grams of protein with each meal. That's number one. Number two is eating the right types of carbohydrates. I am not anti-carb. I think because many people know me in the intermittent fasting space, they assume I'm

always ketogenic or always low carb. And I think my thought process around carbohydrates have evolved quite a bit. And I think that for women, depending on where you are, depending on how metabolically healthy you are, I am insulin sensitive, I am metabolically healthy. So I can get away with a bit more fruit or starchy carbs. I don't eat pasta, I don't eat bread. I don't eat rice. It

just doesn't agree with me. And I'm better off because of that. And for everyone listening, it might look a little bit different. But I think helping women understand that there's multiple things that contribute to weight loss resistance, it is never just one thing. I do personally think that underlying food sensitivities drive quite a bit of inflammation in the body. And so sometimes elimination diets can be very, very beneficial. But to answer your question, I wish I could just say it's related to a slowed metabolism. The research doesn't support that, but I do think that there's multiple reasons that contribute to the frustration of being weight loss resistant in middle age. 2024 is the year of fertility for me. I'm just naming that right now.

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use the code realfoodology, and you're going to save some money. Well, and everything that you just said is probably what people are confusing with a slowed metabolism, right? Because if they're dealing with a little bit more insulin resistance, they're going to have more cravings for sugar and high carbohydrate foods. And if you're eating more of those, obviously it's going to have an impact on your weight. I wanted to clarify that for people because there is this conversation that happens publicly where they say, oh, just watch out when you turn 40, your metabolism really goes downhill.

And again, back to what I said earlier, I just don't believe that that's what's happening. I think that there's hormonal changes happening, affecting the diet, possibly affecting your energy levels and exercise. And two, if we're not paying attention to muscle mass and making sure that we're really keeping on lean muscle mass, it's also going to have an effect on the body as well. So knowing all of this and knowing that this is happening, you know, we had already mentioned getting a really good practitioner for women. But what are other ways that they can support their bodies from, you know, maybe to lessen the impact of all of these things that we've just talked about with like the insulin resistance and all of that?

Yeah, I mean, I think that it really starts with what are you willing to do? Because I acknowledge that not every female that I work with, you know, patient or client is in a position where they can change a bunch of things all at once. So I think we really start foundationally like sleep. And sometimes it's saying to a woman, let's get in bed 30 minutes earlier. And it can be as nuanced as let's turn the thermostat down. Let's buy a sleep mask. I mean, you don't have to spend a lot of money. Let's get into bed before 10 o'clock at night. Let's not sit and watch TV or sit on your iPad, like read a real book or listen to music, like low-lying fruit with sleep.

And then thinking about, there's lots of supportive supplements for sleep. I'm very much of a nutrition-based first, but let's be transparent. This is a society where we love supplements. I think that people are always curious. much of a nutrition-based first, but let's be transparent. This is a society where we love supplements. I think that people are always curious. They want to try things. I start to think about the supplements

that seem to help the most. And so I think about things like myo-inositol, which is yes, naturally occurring, but helps with blood sugar, helps with sleep architecture. That can be a game changer for a lot of people. I think about adaptogenic herbs. So things like ashwagandha, which has both tonifying and can be stimulating,

but that I think about other adaptogens like Rallura, which is magnolia bark, can be very helpful. So kind of managing and buffering stress. So don't get in an argument and try to go to bed. Don't run 10 miles and then take a shower and think you're going to be able to gear your body down. Not eating two to three hours before bed because melatonin is an important hormone for many things. It is not just a sleep hormone. It's also a master antioxidant. We make less of it after 40. But for a lot of people

helping them understand, when you eat a big bolus of food at nine o'clock at night and try to go to bed at 10, your body, all of those circadian clocks, which are not just in the brain, you have them throughout your digestive tract. They're saying timeout on secreting melatonin. We need to secrete cortisol,

get this bolus of food processed. So helping people understand that we want to eat when it's light outside and we don't want to eat when it's dark outside. So things that simple can be very, very helpful. And then working on other things like, you know, Whole30 is not a forever, you know, kind of nutritional paradigm. But for a lot of women, I'll say for a month, let's cut out the most inflammatory foods. I find that dairy seems to be the most challenging and alcohol in particular.

I think the pandemic didn't do most of us any favors in terms of our propensity for drinking because it became the stress stop gate. I start to think about gluten and grains and dairy and alcohol and processed sugars. And so for every one of us, there's probably a kryptonite. I really like dark chocolate. And if someone told me I had to give that up,

I probably would be pretty unhappy. Most of the other things, not such a big deal. But I think about these lifestyle pieces too, before I start thinking about heading on the medication route. Now, obviously if someone is getting lab work done and it shows that you have an underactive thyroid, most women diagnosed with hypothyroidism at this stage of life have an autoimmune condition called Hashimoto's thyroiditis. You can have that

without having abnormal antibodies. I mean, that was certainly my case. And women that are prone to autoimmune conditions are more likely to have more than one. So I'll just put that out there. Lupus, rheumatoid arthritis, psoriasis, hypothyroidism. So if you have a reason to be on medication, there's no shame in that. So maybe it's adding in thyroid replacement. Maybe it's adding in some progesterone. Depending on where you are in perimenopause, you may benefit from estrogen therapy. And more and more providers and researchers are suggesting that that five-year window preceding and as you transition to menopause is the time to optimize adding an HRT. So I think of it as, you know, it's the sleep, it's the stress management, it's the right types

of exercise, anti-inflammatory nutrition. Those are non-negotiables. But for some women, they'll say to me, it's easier for me to change my diet than it is to prioritize sleep. And so I always say sleep should be number one. And then from there, you can kind of navigate the rest. But I think a lot of it is really driven by what is reasonable and feasible.

And it's meeting people where they are because I can sit in an ivory tower and say, these are the things that you must do. Well, that's probably not realistic for most people. And I've learned that if you are not open to the possibility that everyone's on their own trajectory, you're really going to isolate people from the potentiality of being able to navigate these choices. And I'll just dovetail and say meal frequency is also important. So I mentioned chronobiology supports eating earlier in the day and not eating when it's dark outside.

It's easy to say that in summer. When it's winter, most of us are eating when it's dark outside because winter starts, we start having darkness at 4.30 or five o'clock in the afternoon. But I also think a great deal about meal frequency, how frequently people eat, the whole concept of snacks and mini meals, which is complete bullshit. Nothing frustrates me more than, you know, when I'm traveling with my kids and I'm like,

you just ate, you don't need, you don't need, I have teenagers, they think they always need to eat. But having said that, I'll suggest sometimes like it's actually not a bad thing to go 12 hours without eating. And really that should be the bare minimum for adults. I think that we've been conditioned to believe that if we go more than two to three hours without food, we're going to starve. There's many wonderful processes that go on in the body that allow us to go longer than two to three hours without food. And I would actually argue that if we ate less frequently, we would probably have less metabolic disease than we do now.

But whether it's digestive rest of 12 hours, which is much less offensive than saying intermittent fasting, I do think a lot of individuals, especially women, can benefit from some degree of intermittent fasting, but fasting for their menstrual cycle, which is critically important, or understanding that if you're in perimenopause or menopause,

the lifestyle stuff really has to be dialed in. I think that goes without saying that that's very, very important. Yeah. Well, let's use this opportunity to go into intermittent fasting a little bit. It was really big. I feel like it had its really big wave. And I'm wondering now if people are still doing it as much because there was a lot of conversation about how there wasn't a lot of studies done on women, or I don't think there was any studies done on women. And then they were all done on men as far as regarding intermittent fasting. And then there was a lot of conversations saying that it's harming to the hormones and for women's bodies and for cycles, it's not the best. Before you get into it, I do want to talk a little bit about my philosophy with it and the way that I've kind of done it that has really worked for me is I practice something

that I call intuitive fasting for myself, which is I really lean into what feels best for my body. There are some days where I wake up and I am starving and I'll eat at like 8am. There's other days I wake up, I could care less about food and I don't really want to eat until, you know, maybe 11 or noon. I'll have my water first thing in the morning with a little bit of sea salt to support my adrenals. And then I'll have a little bit of coffee. I do really, really low caffeine coffee. So I don't think that it's affecting my adrenals that much. And for me, that has really worked great. It's helped me to maintain my weight for the last, like, I mean, I've been the same weight for probably the last like eight years since I've been doing it.

And I don't have to think about it. I don't think about it. I don't stress about it. I don't find myself trying to like stay in these windows. Like I, for me personally, where I feel like it becomes harmful is if somebody is waiting and looking at the clock and they're going, Oh me personally, where I feel like it becomes harmful is if somebody's waiting and looking at the clock and they're going, oh my God, I can't eat until noon. I'm starving. I'm freaking out. And then they're going crazy in their brain. But for me, like I said, I'm not sitting looking by the clock. I find that when I'm closer to my period, I'm a little bit hungrier in the morning. I need more calories because my body's ramping up to do ovulation and then obviously having my period. And so that is what I practice. And that is what I have found to be really helpful.

And I'm curious to know from your perspective, what you think about intermittent fasting for women and how it affects our hormones. Yeah. I mean, first I want to congratulate you for leaning into what intrinsically felt right for you. Because there are so many women that are outwardly focused on what everyone else is doing instead of trusting what their body is intrinsically trying to share with them. So obviously, I'm known for intermittent fasting. So I want to first acknowledge that I came to intermittent fasting, like many people do out of a desire to lose weight. I was the typical perimenopausal woman. I was doing everything right. I still wasn't losing

weight. Let me be clear. When I started intermittent fasting, I didn't instantly lose that 10 pounds that I wanted to lose. It took a bit of time. It actually took getting rid of dairy in my diet that got rid of the weight loss resistance, which I found interesting. And obviously, my perspectives have shifted. Five years ago is when my TED Talk went viral. And so that was like this explosion of information. That was the year where that was the most searched nutritional paradigm of all, or strategy. And so I do think that it kind of rode a wave.

And I think many people still intermittent fast. If you were to ask me what my philosophy is now, personally, I would tell you that I do less fasting and more digestive rest because I have found that I need more protein, not less. I feel better. I sleep better. I've liberalized my carbohydrates. And by that, I'm not eating a high carb diet, but I am someone that does better with leaner proteins, more carbohydrates and less fat. And that's just what works for me. Do I still intermittent fast? Of course. But I find that as a menopausal female, when I get up in the morning, I am thinking about, is today a strength

training day or is this a day I'm going to do zone two training or walk outside with my dogs and my husband? And depending on what that answer is, I may actually eat earlier. I eat much earlier on days that I strength train. And I think that for women, if we've been catabolic all night long, where we are potentially breaking down muscle, and especially at the stage of life I'm in, I'm very cognizant of when I break my fast. And when I say breaking your fast, it is all of us break fast when we eat after being asleep. I'm much more conscientious. I do not do long fasts. I don't fervently believe in them for thin fit people. I am too concerned about losing weight and frankly, losing muscle mass. And just to kind of give everyone some perspective, in 2019,

preceding that talk, I was hospitalized for 13 days. I had a ruptured appendix and a whole slew of complications, more than I could have ever imagined. But after 13 days of being hospitalized, I lost 15 pounds. I'm not someone that needed to lose 15 pounds. So it has taken a long time to put that muscle back on. And so my concern about long fasts and lean thin people is predominantly around that loss of muscle. We've talked about how important that is. But I think, you know, when I have patients as an example who are not metabolically healthy, obese or overweight, they do really well with intermittent fasting and having a compressed feeding window. So I still think that there's a great deal of therapeutic benefit. I think the power of the N of one is very important. And to your point, most of the research that's been done

has been on menopausal obese women, men, and lab animals. Unfortunately, women of younger reproductive ages and even perimenopausal women have largely been left out of research. I hope that is changing. I think there's greater awareness. I think women are demanding that they be included in research studies. And the joke is always, well, a woman's menstrual cycle is something we don't want to have to account for. And I'm like, we are complex individuals, but that doesn't mean that we don't deserve to then also have research done on us to better understand female physiology. Do I think that, yes, do I think that there are younger women? And by that I'll define as 35 and under. Even if you're choosing not to have children, your body is exquisitely attuned to meal and nutrient sensing and timing. And I don't like to see younger women

who are otherwise healthy, metabolically healthy, doing a lot of fasting. If they were to say, I want to fast two days a week in my follicular phase when estrogen predominates, and I can do that and I'm still getting in enough protein, great. If you have polycystic ovarian syndrome, if you know you are not metabolically healthy, you likely will benefit, quite honestly, from a degree of intermittent fasting and a compressed feeding window. The same thing applies to women that are in perimenopause and menopause. I see a lot of emerging eating disorders. Maybe they've had a latent eating disorder, gets ramped up in perimenopause because weight loss resistance is not a fun thing to go through. And for a lot of

women, it reactivates that latent eating disorder. And so I'm starting to see more and more individuals that are in this space really speaking to the concerns that they have. So I think that you have to know yourself. Do I think that there are influencers on social media who hide their eating disorders and intermittent fasting? Absolutely. I don't ever name names, but I can see it so very clearly. So I think we have a responsibility to acknowledge that. I don't think that's the majority of what people are doing,

but I do think that there are latent eating disorders that can become problematic. And the most important thing I can share about women in general, if you start intermittent fasting and your period goes away, that is a sign that it is too much hormetic stress. Now, I'm not talking about like your period's two days late or your period's three days early. Like the first few cycles, that may change.

But if it completely goes away and primary amenorrhea, which is what we're talking about, this loss of your period, is as important to me as blood pressure, pulse, temperature, respiratory rate, pulse oximetry. It's a vital sign. Correct. And that is why I always make sure I talk about, I have a responsibility to identify if your period goes away, that is not benign. That is a sign it is too much stress for your body. And that's okay. Women will DM me all the time and they'll say, I'm 32, I'm 34. I had a baby. I want to lose baby weight. And I'm like, listen, 12 hours of digestive rest. If you can tolerate that, if you're breastfeeding,

when I was breastfeeding, I could eat like a linebacker. There's no way I could have had a 12-hour feeding window. I was hungry all the time. I've never experienced anything like that. It's fascinating. But I think for a lot of women, helping them understand that most of us can get away healthfully with 12 hours of digestive rest. And then the rest of the time, maybe you have a meal every three or four hours and that works for you.

And that's a good thing. I think if just because fasting works for your best friend or for you or for me, that doesn't mean it works for everyone. I've been consuming collagen for about six years now. I like to put it in my morning drink, whether that's coffee or matcha. I usually prefer coffee, but lately I've actually been doing coffee and then having a matcha a little bit later. I love to mix the collagen in with my nut milk that I put in my coffee. It's usually almond milk or coconut milk. And I'm so excited to announce that Organifi has their own collagen now. As with all Organifi

products, it's glyphosate residue free, really high quality. It has hydrolyzed bovine hide collagen peptides that are derived from pasture raised cows. It also has eggshell membrane collagen. It's taken from the thin layer between the egg and the shell. And this is collagen rich, and it may be beneficial for strong joint health. It also has hydrolyzed fish collagen peptides derived from wild caught fish. Because this collagen source is of a small particle size, it makes it easier to digest and more absorbable. And then there's also chicken bone broth protein concentrate in there. This collagen type is

actually found in your gut joints and cartilage, and it helps support greater health both inside and out. Collagen is really good for lubricating the joints. It's also great for healing and sealing the gut. Often now because of our diets, people are dealing with leaky gut syndrome and collagen actually goes in there and helps to seal the gut. So if you're having any sort of leaky gut syndrome symptoms, collagen may be your best bet. It's also great for just replenishing collagen stores that diminish as we age and may help with wrinkles and keeping supple skin because collagen also is what keeps our skin elastic. So this is why I consume collagen. I love Organifi. I love all of their products.

If you guys want to try any of the Organifi products for 20% off, you can use code realfoodology or go to Organifi.com slash realfoodology. That's O-R-G-A-N-I-F-I.com slash realfoodology. Yeah. Well, and I think giving an actual example of what 12 hours looks like helps a lot of people because I think, and myself included, I used to feel this way before I started doing intermittent fasting. I was like, oh my God, what do you mean I can't eat for this large window of time? That's crazy. I'll be starving. I'll be r this large window of time? Like, that's crazy. I'll be starving. I'll be ruminating about food the whole time, you know, the whole thing.

And I was freaked out about it. But then when you think about it, if you do a 12-window fasting, that basically means that you don't eat for two hours before you go to bed and you don't eat two hours after you wake up in the morning. That is so easy. Or you could even do it where you don't eat three hours before you go to bed and then you wait an hour before you wake up in the morning. And that's to say if you get eight hours of sleep, but if you think about it like that, if you're sleeping seven to eight hours, it's really

not a lot of time where you're not eating in the morning. And there's so much research, especially for at night, if you don't eat a couple hours before you go to bed, there's so much research about how amazing it is for brain health, because it allows your body to stop focusing on digesting your food and focus on, you know, recalibrating your memories, like placing your memories and cleaning out your brain and really ramping up autophagy, which helps get out really old dead cells out of your brain. And so there's a lot of really amazing research around that. And I think a 12 hour window is really easy for most people. I do want to say one more thing too. When you were talking about studies and how they're not done on women in a certain age bracket,

I will say I think a lot of women will be like, oh my God, that's so misogynistic, blah, blah, blah, blah. There is a certain level of that, but I do want to point out that there's also, for a very long time, they've been very concerned about women in the reproductive ages because they want to be really sensitive to our reproduction and our ability to have children. So it is at a

certain point a little bit more thoughtful than maybe we were originally taught to think because they were concerned about our childbearing ages. And so now I think that's starting to change as we're starting to realize that there is a little bit more leeway and like, you know, studies that we can do on women, but it was not all just misogynistic. And it felt important for me to say that. Yeah, no, I mean, I used to tell, I was an ER nurse in inner city Baltimore, and I would explain to women, unless they were in menopause, we did a pregnancy test on everyone. And why did we do that? Because we don't want to potentially cause harm to a developing fetus. And I can tell you as a clinician, as a nurse practitioner, nothing made us more nervous than taking care of pregnant women.

I mean, nothing made us more nervous because we had two people to think about. And I can remember even in cardiology, that if we had a pregnant woman come in, and it's not that we didn't like pregnant women, just in cardiology, if you're seeing us, you generally, there was either something very benign or something very serious. And we used to jokingly talk about the fact, like, we were like, we're used to dealing with one patient, not two, like that is a whole other level of responsibility. So I agree with you that there was, there is some paternalism in being conscientious about it. And the other concern on the other side is teratogenic effects. So certain drugs, certain modalities have the potential to harm the fetus,

and no one wants to be responsible for that. So I think that the concerns around working around women in their peak fertile years or even perimenopause has a lot to do with no one wants to be at fault for harming a fetus. That's really what it comes down to. It really comes from a paternalistic place. And, you know, there was a long period of time when we were just left out of studies altogether purposely, unless you were in menopause. Then they're like menopause. Oh, we get a free, you know, it's like a, it's like a free for all because we're done having children. It's like, okay, we don't have to worry about that piece. But I do think it's important to clarify that. Yeah, for sure. Cause, cause that I came

online to that a couple of years ago in a podcast episode. And I was like, oh my gosh, I didn't even think about that. And so I just wanted to clarify that for people. Well, in the essence of time, I do want to talk a little bit about menopause because we haven't really talked about that. You know, we've kind of mentioned it because we've talked a lot about perimenopause. So how can we support women through the stages of moving from perimenopause into menopause? And what are some of the signs and symptoms if you're in that window to know, oh, I'm starting to go into menopause. Yeah. So I think the biggest thing is, you know, probably you're knowing that your menstrual cycle

is starting to change. So by the time you get to the point where you're getting 60 days in between cycles, you're there. You know, there's lab work that we can order. You know, you can look at anti-malarian hormone. You can look at FSH. As an example, if your FSH is greater than 25,

you're kind of like knocking on the door. And I'll have women tell me, oh, I'm still getting a cycle. I'm like, yeah, but you're not ovulating. They may not even be cognizant of that. So the things that I think about, number one, women may develop basal motor symptoms. So that's a fancy way of saying hot flashes. And we know women that have the worst hot flashes, the kind that are debilitating and awful and unrelenting are more likely to have more metabolic disease.

So hot flashes are not benign. I mentioned earlier that the only time I got them was when I drank alcohol. So that was the end of drinking alcohol. Not that I drank much at all, but I was like, my sleep is too important. So I think about that, you know, changes in your menstrual cycle. For a lot of women, they may notice that they have more fatigue. They may have weight loss resistance. Obviously these are symptoms that could ascribe to a lot of different things. They may find that they have very dry skin. They may have pain with intercourse. They may have a

lower libido. They may feel like they have brain fog or they just don't have that clarity of thought. So estrogen is a very interesting hormone. It's involved in a lot of processes. Estrogen, testosterone, and progesterone have receptors diffusely across the body. But when I think about the changes in estrogen, that's when women will say like, I'm having trouble word finding. I'm thinking of that word, but I can't recall what it is. I can see it, but I can't think of it. So word finding, brain fog, changes in skin, turgor, especially as we're losing estrogen,

we're losing elastin and collagen. So you'll see an acceleration, especially the first five years of menopause, which women will sometimes say to me, this is a photo of me six years ago, and I look like a different person. And that is a byproduct of this massive shift in estrogen signaling in the body. I also think about a lot of women become more susceptible to palpitation.

So sometimes they're benign, like premature ventricular contractions, but it could go all the way to atrial fibrillation, which is an ectopic foci. So the top chambers of the heart are called the atria. And atrial fibrillation is much more common in women as they're navigating that transition. I also just think about, you know, changes in hair growth. They may have more constipation. They may have, you know, they may have more bloating. That seems to be a really, really common, commonly reported symptom. But I think it's always in the constellation of what are you experiencing? I think the most common things that I see are related to those changes in estrogen.

So to help women understand, as your body is producing or making less estrogen, your brain is signaling to the ovaries like release an egg, release an egg. And so the brain, hypothalamic pituitary, ovarian axis, and that can sometimes precipitate the sensation of having a vasomotor hot flash. But the other thing that I find interesting is a certain degree of blood sugar dysregulation can also precipitate hot flashes. And so women will find that their blood sugar just isn't quite as good about their insulin sensitivity is changing so they may notice that on a glucometer or CGM their their average blood sugars are much higher than where they were before I'm working with someone new and she mentioned to me her blood sugars averaged at 120 and her healthcare

practitioner I won't mention what their theirs were, said, oh, that's fine. And I said, no, it's not. And so we're having that conversation to say, I wanna see a fasting blood sugar between 70 and 85, a fasting blood sugar for your community of 90 to 99. And I learned this through Robert Lustig, who's a preeminent pediatric endocrinologist who's now retired, but still an incredible resource.

He said, Cynthia, I think what people need to understand is that if you're fasting blood sugars between 90 and 99, you're at 30% greater likelihood of developing diabetes. It is not benign. So those are the kind of constellation. I can tell you that every woman will experience things at a different timeframe, but those are the most common complaints that I get from women, many of which improve with hormone replacement therapy and lifestyle changes. So it's not as if it's a either or, it can be all of the above. And I can always tell on an intake form if a woman's taking HRT, always. I don't even have to get halfway through a form. It's like her sleep quality is better. Her energy is better. And that's not to suggest that that's the right decision for everyone, but it really does make a big difference. Do you have any concerns with cancer or other

issues with HRT? Which is also for people listening, hormone replacement therapy. Yeah. And it's funny. Sometimes now they call it menopausal replacement therapy. And I'm like, why make it convoluted? I know. It's like, why make it convoluted? I know. It's like, why make it convoluted? No, I mean, there's a great book for anyone that's interested. It's written by an oncologist and a researcher. So it's Dr. Avram Blumming and Dr. Carol Tavris. I've had the honor of having them on the podcast.

And they wrote a book called Why Estrogen Matters. So it's been able to dispel a lot of the misinformation, the extrapolation of data from the Women's Health Initiative that caused an entire generation of women and clinicians to fear hormones. In fact, every day my team will hear, oh, if I take hormones, I'm going to have breast cancer. I'm like, no, actually, if you take HRT, you are less likely to develop cancer. If you are metabolically healthy, you are less likely to develop cancer. So I think for everyone listening, those are good resources, obviously written by an oncologist. Dr.

Arvind Balmunga is an oncologist. I think that the fear mongering around HRT, I'm hoping we're coming full circle so that we can assess each woman's ability and their desire to take hormone replacement therapy. Someone said to me, I would rather navigate menopause naturally. And I said, great, I respect that. But what I can tell you is natural is not optimal. And I look at it as I sleep better, my brain works better, I have more muscle mass,

I feel sharp as a tack. And a lot of that has to do with the fact that my body is still not the same level that you have day-to-day, week-to- week as a woman who's still at her peak fertile years. But as someone that is able to maintain a healthy amount of hormones so that my body works optimally at this stage of life. Women spend a third of their lifetime in menopause. And I think that's important for people to understand. Like, it's not like it's just 10 years.

It is, for a lot of us, it's a long period of time. Wow, that is a long time. Is HRT something that once you start it, you'll kind of be on it for life? Or is it something that you use for a while to support your body and then eventually you go off of it? Well, there used to be a thinking that you're on HRT for only 10 years.

And we've come to find that most women benefit from being on it long term. Like as an example, some women, most women will develop something called genitourinary symptoms of menopause. So it's called GUSM. It's a terrible, they just call it senile vagina. So I mean, like talk about things that make you kind of go like, who gave that a name? It clearly was not a woman. It's men that are scared of women's body parts. Yes, yes. So most women, by the time they're at least 60, will have some degree of vaginal atrophy, pain with intercourse, et cetera.

And a lot of that has to do with the loss of estrogen. So vaginal estrogen, I think, should be like over the counter because there's so many benefits with very little risk and it's not systemically absorbed. So for people that are like, I'm worried, I'm concerned. I always say like, I interview all the experts. So I ask them all the questions, but I think vaginal estrogen is such a benign entity. So to answer your question, I think HRT is designed to be taken for as long as you want to be on it. It is not a like,

you get it for 10 years and then we're going to take it all away and let you kind of suffer. I think in a lot of ways, Avram Blooming said when I interviewed him, he said, Cynthia, if men went through as a dramatic change, and some men go through andropause too, but it's not as dramatic. He said, if men went through what women go through,

they would never tolerate no hormone replacement therapy. They would never tolerate it. And so if you think about, like I trained at the time when Viagra came a vogue and we could never keep samples in our office, even though we had a whole milieu of male cardiologists, mostly male cardiologists. I always say like, it's interesting what we prioritize as a society, but yet understanding that women's suffering should not be optional. It should not happen.

And so for everyone listening, finding the right practitioner, the right provider, so they can help you navigate those choices. And for those of you that are, this is many years in the future, knowing that you have options, you don't have to fear this time in your life. Yeah. Yeah. That's a great reminder. And it comes back to what we were saying earlier of, um, there's a lot of things that you can do. You don't just have to be a victim of your body and the changes in your body. There's a lot of things that you can do to support, you know, these changes. Absolutely. Cool. And I love that women like you were talking more openly about this because, you know, I feel like even 10 years ago, we, you wouldn't even hear publicly about menopause really. So it's cool.

And perimenopause too. Like I, I didn't even know what perimenopause was for the longest time. Like I didn't even know that it existed. Do you know what I mean? Like I feel like when I was younger, I had just heard, okay, you know, you go through, you have your years where you're cycling and then you go into menopause. And it wasn't until the last couple of years, thankfully, credit to women like yourself who have been really open about this and have helped a lot of women to navigate this time in their life. Because I mean, it can be

confusing. It can be scary. It can be anxiety inducing because there's so many changes happening in our body. And it's, yeah, it's just amazing to have women like you talking openly about this and helping women. Thank you. No, I think knowledge is power. And for everyone it's just amazing to have women like you talking openly about this and helping women. Thank you. No, I think knowledge is power. And for everyone that's listening, knowing that there's resources. And I mean, I certainly knew nothing about perimenopause. And if I didn't know, my patients weren't going to know.

And so we had to kind of break that shame and silence that a lot of women, certainly my mom's generation, they never talked about anything. So my hope is that this generation of women will be loud and proud so that subsequent generations get the care they deserve to have. Yeah, I love that so much. Well, I want to ask you a personal question before we go. What are your health non-negotiables? These are things that no matter how crazy your day is, you prioritize these for your own health? Well, I would say sleep quality is pretty darn important. Prioritizing protein, that's a non-negotiable. Electrolytes and water,

because for me, I didn't know this about myself when I worked in cardiology and obviously we got very savvy with electrolytes, but I've always been someone that needs more salt in my life. And when I realized that I had a mild form of dysautonomia, my functional medicine doc was like, "'High five, you must have intuitively known that.'" I just think exercise in general,

and then probably because that's so good for my mental health, not just my body, but I would say the other thing is just connection with loved ones. Because when we hug our loved ones, whether it's our cute little puppy or teens or significant other, whomever, friends, we release oxytocin. And I think that the more I understand about this hormone, the more I realize how critically important it is for managing stress. So I would say those are pretty consistent dialed in things

and things that are absolutely non-negotiables for me. I love that. Those are good ones. Well, please let everybody know where they can find you and where they can find your books. Just plug all of your stuff, please. Yeah. Thank you. Thank you for having me. So probably easiest to start with my website. So it's www.cynthiatherlo.com. You can get access to my podcast called Everyday Wellness, which is one of my favorite things to do is interview health experts. I have a book called The Intermittent Fasting Transformation. I am active across YouTube, Instagram, even X and Twitter, depending on how you know it. We have a free Facebook group called The Midlife Pause. And I do personally

answer questions in there a few times a week. And I would say, get on my newsletter. That's a really good way to stay connected. Amazing. Well, thank you so much for coming on. I loved this conversation. Absolutely. Absolutely. Thanks for having me. Thank you so much for listening to The Real Foodology Podcast. This is a Wellness Loud production produced by Drake Peterson and mixed by Mike Fry. Theme song is by Georgie. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can leave us a voicemail by clicking the link in our bio. And if you like this episode, please rate and review on your podcast app.

For more shows by my team, go to wellnessloud.com. See you next time. The content of this show is for educational and informational purposes only. It is not a substitute for individual medical and mental health advice and doesn't constitute a provider-patient relationship. I am a nutritionist, but I am not your nutritionist. As always, talk to your doctor or your health team first.