In this episode of the Smarter Not Harder Podcast, Cynthia Thurlow gives us one-cent solutions to life’s $64,000 questions that include:
- Why do GLP-1 medications work for some people — and why can they backfire when hormones, nutrition, and muscle mass aren’t addressed?
- How should fasting, protein intake, and resistance training be adapted for women in perimenopause and menopause?
- What do most people misunderstand about insulin resistance, metabolic flexibility, and long-term fat loss?
- When are GLP-1s a useful tool versus a short-term crutch that masks deeper metabolic issues?
- How can you protect lean muscle, thyroid function, and hormonal health while pursuing weight loss?
Who is Cynthia Thurlow?
Cynthia Thurlow, NP, is a nurse practitioner, hormone expert, and leading authority on women’s metabolic health, with a clinical focus on perimenopause, menopause, and sustainable fat loss. With a background in ICU and clinical cardiology, she brings a systems-based, evidence-driven approach to health that bridges conventional medicine with lifestyle interventions. Her work centers on helping women understand how hormones, nutrition, stress, and muscle mass interact across different stages of life.
After navigating her own health challenges during perimenopause, Cynthia became deeply interested in intermittent fasting, insulin resistance, and metabolic flexibility — particularly how these strategies must be adapted for women. She has spent nearly a decade developing female-specific protocols that emphasize timing, hormonal context, and the concept of hormetic stress, while cautioning against extremes that can undermine thyroid health, adrenal function, and lean muscle mass.
Cynthia is also the bestselling author of Intermittent Fasting Transformation and Every Woman’s Guide to Intermittent Fasting, and the host of the Everyday Wellness podcast. Through her clinical work, writing, and speaking, she is known for challenging diet culture narratives, advocating for strength and longevity over scale weight, and helping women make informed decisions about fasting, hormone replacement therapy, and emerging tools like GLP-1 medications — always with the goal of long-term health, resilience, and independence.
What did Cynthia and Dr. Scott discuss?
00:00 Intro: Why Fasting Works — and When It Backfires for Women
02:20 Cynthia Thurlow’s Journey from Cardiology to Women’s Metabolic Health
05:10 What Intermittent Fasting Actually Means (Water, Fat & Dry Fasting Explained)
09:05 The Hidden Dangers of Over-Fasting and Extreme Diet Culture
12:45 Muscle Loss, Sarcopenia, and Why Preservation Matters More Than Weight
15:40 How Fasting Should Change Across the Female Hormonal Lifecycle
19:30 Perimenopause, Stress Resilience, and When Fasting Makes Things Worse
23:45 Menopause, HRT, and Using Fasting as a Strategic Tool
28:10 Thyroid Dysfunction, Cortisol, and Metabolic Red Flags to Watch For
33:20 Why Protein Timing and Breakfast Matter More Than Skipping Meals
38:45 The Case for Strength Training Over Chronic Calorie Restriction
43:30 GLP-1 Medications: Benefits, Risks, and Muscle-Sparing Strategies
49:10 Food Noise, Alcohol Cravings, and Unexpected GLP-1 Effects
54:40 Sustainability, Long-Term Health, and Doing Less for Better Results
Full Transcript:
Cynthia Thurlow: [00:00:00] I always tell men and women that menopausal women and men have a much easier time with fasting or have, and if we really think about fasting as this hormetic stressor, it's a beneficial stress in the right amount at the right time. Um, I, I think what we see on social media, what we see in terms of clinically with patients are people doing the extremes, of course.
Cynthia Thurlow: Like if a little bit of fasting is good, more is better. So I'm gonna fast, I'm like a 30 5-year-old woman that's metabolically healthy and I'm gonna fast oh, every single day, every time, every day of the month, and I'm gonna wonder why I lose my menstrual cycle or
Dr. Scott Sherr: right.
Cynthia Thurlow: I wonder why I am suddenly incredibly tired and depleted.
Cynthia Thurlow: And so, um, I feel like the amplification of voice is to help people understand when to fast, when not to fast, has really become a mainstay of a lot of the work that I do.
Dr. Scott Sherr: Cynthia, it's good to see [00:01:00] you.
Cynthia Thurlow: Absolutely. I've been looking forward to this conversation.
Dr. Scott Sherr: Well, you've had the pleasure of course, of having me on your podcast, I think now two times. That sounded very egotistical, but it was a lot of fun to be on your podcast talking about methylene blue and hyperbaric oxygen therapy and all the other things that I do.
Dr. Scott Sherr: And, but you have such a great platform and all the work that you do, and I know that you have your book that you've already published, and you have another one coming out in a little while. Um, and you're a clinician yourself. You have a background in, you know, the crazy worlds of ICU and clinical medicine like, like I do.
Dr. Scott Sherr: So, um, with all that sort of as preamble, I'm really happy to have you here and, and welcome.
Cynthia Thurlow: Thank you. Thank you. I think we have bonded over a shared experiences in Baltimore and, uh, you know, our, our trauma backgrounds, you know, medical trauma backgrounds and er medicine and ICU and sick acutely ill patients.
Cynthia Thurlow: So.
Dr. Scott Sherr: Well then thankfully there are good people that are still doing that work because it's not easy work, but it's [00:02:00] necessary work. But Anna know your world has, you know, transformed because of, you know, the fasting that you've described in your own personal life and how it kind of came around for you.
Dr. Scott Sherr: And so I wanted to start off with, you know, how did you first understand fasting and, and, and sort of the evolution of it, maybe like a short story, like, and how that worked, just to give people like a framework for you on how that affected you personally. And then, you know, from there I'd like to talk about, you know, like the major differences in men and women versus in fasting and how that really, um, how that really looks, you know, in real time.
Cynthia Thurlow: Yeah, I mean, I think my evolution towards fasting or my interest in fasting really came out of a personal desire to understand what was happening to my body in perimenopause, like so many women, so many clinicians,
Cynthia Thurlow: mm-hmm. All
Cynthia Thurlow: the information that we're dispensing to patients suddenly doesn't work for us.
Cynthia Thurlow: And we realize we need to do something different. And I always credit Jason Fun's work. Mm-hmm. Um, I came to his work and it really gave me the ability to understand that there's real science behind intermittent fasting. It's [00:03:00] not new or novel. And so about 10 years ago, I started intermittent fasting for myself just to lose stubborn weight that I suddenly was unable to get rid of in perimenopause.
Cynthia Thurlow: And then at that time I was working in clinical cardiology and I started to realize like. Most of my patients have lifestyle related issues. Mm-hmm. Because of the frequency with which they eat, what they choose to eat, how little they're physically active. And so I started integrating some of it into my work with those patients.
Cynthia Thurlow: I would say maybe about 20% of them were open to the idea of eating less often.
Cynthia Thurlow: Hmm.
Cynthia Thurlow: But it then kind of bled into this desire to really focus on lifestyle as medicine. And so nine years ago I left clinical cardiology, really started a practice solely focused on women in perimenopause and menopause. And then fasting at that time really became quite popular.
Cynthia Thurlow: And so we mm-hmm. Kind of springboarded from there to, um, you know, developing protocols for women, specifically because women are not small men. Um, and as we both know, there is a rhythm to most [00:04:00] women's lives mm-hmm. Until they go into perimenopause. I was able to kind of ascertain how to effectively utilize this strategy with women at different periods in their lives.
Cynthia Thurlow: Hmm.
Cynthia Thurlow: Um, and I always tell men and women that menopausal women and men have a much easier time with fasting or have, and if we really think about fasting as this hormetic stressor, it's a beneficial stress in the right amount at the right time. Um, I, I think what we see on social media, what we see in terms of clinically with patients are people doing the extremes.
Cynthia Thurlow: Like, of course, if a little bit of fasting is good, more is better. So I'm gonna fast, I'm like a 30 5-year-old woman that's metabolically healthy and I'm gonna fast Oh, every single day, every time, every day of the month, and I'm gonna wonder why I lose my menstrual cycle or
Dr. Scott Sherr: Right.
Cynthia Thurlow: I wonder why I am suddenly incredibly tired and depleted.
Cynthia Thurlow: And so, um, I, I feel like the amplification of voices to help people understand when to fast, when not to fast has really become a mainstay of a lot of the work that I do. Mm-hmm. And then also. [00:05:00] Quite frankly and transparently allowing people to utilize the strategy could be a right strategy at one point in your life and not in another.
Cynthia Thurlow: Mm-hmm. And helping people understand when to use this hormetic stressor and when to back off a bit. And unfortunately, as you know, um, we live in a pretty toxic diet culture and there's a lot of outside influences. So patients come into our offices or come into, um, you know, opportunities to work with us and they have wildly unrealistic expectations because what they see on social media is sometimes not entirely real or sustainable, most importantly.
Cynthia Thurlow: Mm-hmm. And so helping
Cynthia Thurlow: them find out like what are the things they can do for sustainable long-term health that are not going to, um, cause metabolic derangement, you know, thrash their adrenals, their thyroid gland. Yeah. You know, lead to losing their menstrual cycle, et cetera.
Dr. Scott Sherr: Yeah. Well that's a beautiful overview.
Dr. Scott Sherr: I think, and maybe before we get it too into it, uh, there's a lot of, I think. Nuances. [00:06:00] And when people define the word fasting and so there's water fast, there's there. I mean back in the early bulletproof days there was fat fasting, if you remember this. Um, and that was a big thing. You could have fat, but you couldn't have any other macronutrient or micronutrient, just fat.
Dr. Scott Sherr: There's obviously no water fast. These are what are called dry fast. Mm-hmm. Maybe you can define some of these for people, it's just terminology. 'cause we talk about intermittent fasting that could be intermittently fasting for 20 hours a day or if it could be for less. So maybe, maybe defining some of those terms would be helpful before I wanna get more into like the sort of female centric aspects of this, but maybe that's a good place to start.
Cynthia Thurlow: Yeah. So when I think about water fasting, it's, it's helping people understand that when you are in an unfed state. You are consuming, you are hydrating your body with water, sometimes with electrolytes. I usually encourage that. Mm-hmm. And that is what I think is the safest way of intermittent fasting, because in a dehydrated state, there are a lot of, there are a lot of metabolic things that can happen.
Cynthia Thurlow: And in some instances, if [00:07:00] patients are on blood pressure medications Sure. Or diabetes medications that can be problematic. On the other hand is dry fasting, which I know that the extremists in this space really like to focus in on. And, and there are specific benefits to that. And if you're a purist, you won't even shower because your skin will l absorb water.
Cynthia Thurlow: I haven't heard that.
Dr. Scott Sherr: Interesting. Okay. Yes. Yeah. The, the
Cynthia Thurlow: purists, they, but, and then most others that are less of the purists, maybe they are just not consuming liquids of any kind during the period of time in which they're not eating.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: And you can get some upregulation and autophagy, but I don't. I, I'm not a fan of that.
Cynthia Thurlow: I think my background in cardiology has assured me that hydration's an important process in our body. Sure,
Cynthia Thurlow: sure.
Cynthia Thurlow: Um, and then, you know, yes, Dave Asprey very astutely, you know, bulletproof coffee, fat fast. I, I think when I have patients that are coming from a standard American diet who are eating six to eight, 10 times a day, the thought of eating less often is terrifying.
Cynthia Thurlow: Mm-hmm. And I always looked at fat fasting as a [00:08:00] bandaid approach to help them get to full water fasting. Mm. Okay. And so what might that look like? You know, they may have some. Coconut oil or MCT oil. Um, if you really wanna get nuanced, like there are a lot of people that will say, well, if you put butter in your coffee, it's insulin anemic because it's dairy.
Cynthia Thurlow: Um, so then you're encouraging people just to stick with ghee, which is clarified butter. Sure, sure. Um, but I think for some people who need a, it's almost like a set of training wheels while they're learning how to fast. I think fat fasting can be helpful. I think the challenge that I sometimes will see is patients go overboard.
Cynthia Thurlow: 'cause of course butter, ghee, MCT oil, delicious, right? Yep. Um, a lot of people go overboard and if they're trying to lose weight, they're not cognizant of the additional calories and fat we know is a much more caloric, um, macronutrients. So fat fasting has a place, I always say for some people it's like having a meal while they're fasting because they have so much fat in the coffee.
Cynthia Thurlow: Mm-hmm. Um, and I think that certainly can have a place, but I tend to be someone that thinks of [00:09:00] fasting as like, keep it simple, don't overthink it. Um, and that's where I think hydration and water fasting is a much better option. I've had much greater success when patients get to a point where they are solely water fasting and that could be for 15, 18, 20 hours.
Cynthia Thurlow: The challenge then becomes, you know, helping people understand like, what are you fasting for? Are you fasting so that you can get on social media and say, Hey, I haven't eaten for 48 hours. Or is there a specific purpose? Are you someone that's trying to heal from an autoimmune condition? Are you, um, you know, just trying to kind of dial in on some of the strategies that you're utilizing to utilize excess stored fat as a fuel source.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: Mm-hmm. There's a
Cynthia Thurlow: lot of different ways to look at it, but when I look at it as a whole, water fasting is generally what I'm speaking to. And those other two caveats, there are people that still embrace it, but, but I think you have to just be aware of the pros and cons of each. I, I think always with dry fasting, um, I, [00:10:00] I, I would end up in most instances, having people that had, you know, their HRV would tank, you know, they would be, you know, clinically dehydrated.
Cynthia Thurlow: Their heart rate was up, their HRV was down. So clearly their body's showing some signs of huge amount, amount of stress strain, right?
Cynthia Thurlow: Yeah. Yeah. And so
Cynthia Thurlow: again, goes back to that hormetic stressor, right amount, right time. Not at altitude. I probably wouldn't go to Denver and dry fast. That probably wouldn't be good for me,
Dr. Scott Sherr: especially if you're not used to being in the dry weather.
Dr. Scott Sherr: Not a good idea. Yeah. Yeah. The, it's funny, the, uh, the dry fasting, the, the other name for this group of people, if they're like spiritual is the Breatharian. Have you heard of this before? Oh, I have not. The Breatharian are people that they can get all that. They need nutrition from the air. Oh. So they get the prana, the energy from the air, and they don't need water.
Dr. Scott Sherr: They don't need food. So I, that's another group of pastors from like the spiritual side, if you wanna call it that. When you're talking about intermittent fasting, Cynthia, are you talking typically within a 24 hour period? I mean, and then what's your sense of just like broad strokes, we'll talk about this more when we get to more female-centric, but like, as far as [00:11:00] like longer, fast, is there a role for 3 5, 7, 14, 21 day fast?
Dr. Scott Sherr: Under, or is it more that you found that from a clinical perspective, people can get most of the benefit doing some realm of intermittent fasting in your experience?
Cynthia Thurlow: Yeah, I mean, I think it always comes back to like, what is the reason for why people are doing it. Um, I, I think that I, I would just say if someone is lean and metabolically healthy, when they start getting over the 24 and 48 hours, I start getting genuinely concerned about.
Cynthia Thurlow: The catabolism of muscle. You know, muscle is so precious. So there's that camp. But then if we look at 92 to 93% of Americans are not metabolically healthy. Yeah. Uh, most of us can benefit from a degree of not eating. And so that's where I like a two to three day fast. I know that there are people out there that, you know, they wanna, I wanna fast for five days 'cause I want to stimulate stem cell activation and I know that I need to fast that long for that to happen.
Cynthia Thurlow: Or I get someone who will say, I'm willing to do a medically [00:12:00] supervised longer fast. They wanna do 21 days, 14 days. And that really, in my estimation, really does need to be medically supervised.
Cynthia Thurlow: Right.
Cynthia Thurlow: Um, not meaning that you have to be in an inpatient, but that you do have to be seen and evaluated by your provider.
Cynthia Thurlow: And so I, I think when I think about fasting, I like to think about it more in the shorter experiences because I am just so conscientious and concerned about preserving muscle. Yeah. And we know after the age of 40, sarcopenia just really starts to kind of upregulate. And so from my perspective, I like the shorter fasts, especially for those that are already lean.
Cynthia Thurlow: Um, you and I should not be doing 7, 14, 21 day fasts. No. We would whittle into nothing. Yes. Um, but, but I do think that there is a time and a place for longer fasts, and specifically if someone is. You know how many patients I've seen who are post-cancer treatment and they really wanna dial in on I was thinking
Dr. Scott Sherr: cancer treatment.
Dr. Scott Sherr: Yeah, cancer. Yeah. I've seen that a number of times of conjunction, right. With their oncology
Cynthia Thurlow: team. Right. Um, I think there's [00:13:00] very specific circumstances, but again, I'm so myopically concerned about maintaining muscle that, um, I try to be very cautious and. Judicious about the length of the fast for the patient.
Dr. Scott Sherr: Yeah, I mean, you said a couple things that just ring true for me. One is like the extreme part of it, right? So people like the commoditization of all different, these dietary fads or the non eating fad, as it were. Mm-hmm. Right? That you get sort of the fads around that, um, which can be dangerous, right?
Dr. Scott Sherr: Mm-hmm. I remember like in the keto movement, going to a metabolic health conference, you know, Dom Dino, he is a friend, he is a good guy, but I was like, keto pizza, keto ice cream. It's like four or five years ago. We, I mean that's what kind of like the heyday of like keto and fasting. But I had a lot of concerns as you do now, and I did then with muscle mass and people that were on the lower end of the spectrum of weight doing these longer fasts or even doing intermittent fasting, just getting, not not getting enough calories in on a day-to-day basis.
Dr. Scott Sherr: Um, did you see a lot of that happening initially and like, and has there been [00:14:00] an evolution now? Or what, what is your sense of that? Because I mean, I certainly don't recommend as much fasting as I did initially. Oh. When this first came out.
Cynthia Thurlow: Yeah. And I mean, I very transparently last year, um, I lost my dad.
Cynthia Thurlow: And, and one of the things that contributed to his death was this profound, significant sarcopenic, um, frailty mm-hmm. That led to falls, which led to a couple head bleeds.
Cynthia Thurlow: Sure, sure. Yeah. Um, and,
Cynthia Thurlow: and so that made such an indelible impression on me. Over the last several years, I've been doing much less fasting, but now I speak very openly that for me personally, I do a lot less fasting and I eat an additional, like, I was eating two meals, two good meals, but now it's three.
Cynthia Thurlow: Mm-hmm. And I'm really, I, I probably take more women off of fasting than I I have before. And definitely over the last two to three years explain to them like, this is still a strategy you can use. Yeah. You know, if you go on vacation and you overdo it, you come home, you wanna kind of get back on track or, um, you know, maybe you fast one or two days a week.
Cynthia Thurlow: But helping them understand that. The greater good is that they [00:15:00] really, again, have to be myopically focused on maintaining, preserving, and building muscle. And the only way to do that is you've gotta strength train and then you also have to eat adequate amount of protein. And so,
Dr. Scott Sherr: mm-hmm. I
Cynthia Thurlow: find for a lot of women there's this duality.
Cynthia Thurlow: We've been conditioned to believe that we wanna be skinny. You know, I grew up in the eighties and um, yeah, that was certainly is the fat phobia. Yep. Of course. You know, fat, free cheese, all sorts of disgusting things that we ate because we were so fearful of fat. And it, and the realization that we were condition believe like small is better, skinny is better, and having to kind of reacquaint.
Cynthia Thurlow: Patients and clients with the understanding that what we really wanna ultimately be is strong. And the only way to be strong is we have to feed those muscles and we need to lift and we need to stop being so restrictive. Because one of the things that I saw quite honestly, Scott, was there's definitely this minority of women that would hide their eating disorder behavior in the guise of fasting.
Cynthia Thurlow: There's some of that. Yes. Sure. Um, [00:16:00] and so kind of whittling that out when I was working with people. Um, and, and, and then now we also have the concomitant use of GLP ones. And so we see this overlap where there's still this emphasis on, you know, being thinner, being smaller, but helping people understand like in order to remain as independent as possible for as long as possible.
Cynthia Thurlow: You have to maintain your muscle,
Dr. Scott Sherr: you have to be strong. Yeah. And, and that's the thing. And you have to be strong. Yeah. Yeah. I mean, our ancestors, yeah. Like they had to carry things for long periods of time. They were skinny, but that's because they were getting just enough nutrients to be able to do the things that they needed to do.
Dr. Scott Sherr: Like carry water from a river that was three miles away or Yeah. Or something like that. And, and I appreciate that you have, I know you've had this evolution. You and I have spoken about it on your podcast when I was chatting with you about how that's changed over the years. Now when you're thinking about fasting in these various stages of a woman's life specifically mm-hmm.
Dr. Scott Sherr: Whether they're, they're, uh, they're, they're having their normal periods, they're, or they're perimenopausal. This is kind of when you came into it versus [00:17:00] menopause. Yeah. Maybe you can kind of go through how you approach, what's your framework as a clinician when somebody comes in, and I know this probably has to do with their goals on to some degree for sure, but there's also probably some general frameworks that you use here, uh, to really kind of help people along.
Dr. Scott Sherr: So maybe you can go through what those are a little bit, uh, parade, different age groups and, and, yeah. That'd be interesting.
Cynthia Thurlow: So I kind of divide women into 35 and under, so still peak fertility, age range, you know? Mm-hmm. If they're metabolically healthy, I'm not gonna be encouraging them to do a lot of fasting, like 12 to 13 hours of digestive rest is great.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: If they're metabolically healthy and lean, only a little bit of fasting, if they choose to in their follicular phase when estrogen predominates. Okay. Versus if someone is 30 years old, 25 years old, they're PCOS, pre-diabetic or even type two diabetic. Then again, just in that follicular phase, helping them understand that a little bit of.
Cynthia Thurlow: Intermittent fasting a few days a week would have tremendous gains, even if it's two to three. And helping them understand like what that looks [00:18:00] like. It doesn't mean that they binge on the other days. It means that they're kind of drawing in and getting very purposeful, very, um, focused on those two or or three meals that they can fit into a feeding window and then not fasting during their luteal phase when progesterone predominates.
Cynthia Thurlow: Mm-hmm. And it's interesting, if you look at the research the week preceding a woman's menstrual cycle, she might need an additional 125 to a hundred fifty, a hundred seventy five calories. So that's not the time. That's actually when women will say yes.
Cynthia Thurlow: Yeah.
Cynthia Thurlow: They'll actually say, oh my gosh, I, I feel like I eat everything in anything.
Cynthia Thurlow: And it's like, or your body is thinking that it may actually be producing a human or creating a human. So it's looking for a little bit more, um, food source. Mm-hmm. So that's women under the age of 35. I always look at the guise of are they metabolically healthy or not, because that. Allows me to kind of determine how aggressive do I wanna be now perimenopause 35 to 50 for a lot of women, some people on the earlier side, some on the later side.
Cynthia Thurlow: Again, it goes [00:19:00] back to where are they in their menstrual cycle? How are they doing in terms of metabolic health? Are they starting to become insulin resistant? Are they suddenly, have they gained 15, 20 pounds and this is something we need to look a little more closely at.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: It also ties in with women become less stress resilient as they are navigating into perimenopause.
Cynthia Thurlow: You know, sadly, as our progesterone is decreasing, our cortisol is, is one of the few hormones that goes up, and so mm-hmm,
Cynthia Thurlow: mm-hmm.
Cynthia Thurlow: Probably wanna understand, like we have to really think about the hormetic stressors in our lives. I find a lot of women, if they latch onto fasting, they're probably someone that also wants to do infrared sauna.
Cynthia Thurlow: They wanna do cold plunges, they wanna do high intensity interval training. They wanna do
Dr. Scott Sherr: it all. Yeah. They wanna
Cynthia Thurlow: do it all. And I respect that. 'cause I, I love all the technology, I love all the wearables, I love all the things, but it has to be the right strategy at the right time. And so if they're not sleeping through the night, I don't want them fasting.
Dr. Scott Sherr: Totally.
Cynthia Thurlow: And they do 12 to 13 hours of digestive rest. Absolutely. In fact, my teenagers can do that and they're, you know, six feet tall and a hundred seventy five, a hundred ninety [00:20:00] pounds so they can not eat for 12 hours, which says a lot. So it always kinds of go back to if you're foundationally not managing your stress, not sleeping through the night, adding and fasting is not helping you.
Cynthia Thurlow: I love that. Yeah. But they can certainly benefit, um, they can certainly benefit from mm-hmm 12 to 13 hours of digestive rest. And then as we're kind of working through things, you know, it's always the lifestyle as medicine piece first, before we even talk about HRT, before we even add in a GLP one or anything like that.
Cynthia Thurlow: Again, focused on that follicular phase. If they wanna take advantage of intermittent fasting, not in the luteal phase. And then women in menopause, there's so much more flexibility because their hormones, for the most part, unless they're on HRT, are relatively flat. It's like a little bit of a flat line as we navigate menopause.
Cynthia Thurlow: Right. And so it goes back to the same thing though. If you're not sleeping through the night, if you're going through a divorce, you just lost a job, you're doing a cross country move, it is not the time to add in like 18, 24 hours worth of fasting. And I think that's a message that more women need [00:21:00] to hear because many women come to fasting thinking that that is the be all, end all that is going to fix all of their problems.
Cynthia Thurlow: Mm-hmm. And
Cynthia Thurlow: what
Cynthia Thurlow: they actually need to do is less. And that is very, very hard for high functioning women like myself. Mm-hmm. I had to learn that the hard way sometimes doing less is actually going to be better for you than doing more.
Dr. Scott Sherr: I love that. Yeah. In fact, I just, uh, I was just on a podcast and they asked me, uh, about anxiety, right?
Dr. Scott Sherr: And people trying to work with anxiety, and I said the exact same thing. And it's kind of a similar frame, which is that it's not like you need to do more to become less anxious, you to become less, you do less to become less anxious. And the same thing goes here because one thing, a couple of things kind of came to mind as you were, you were talking.
Dr. Scott Sherr: One thing is, is this stress component, right? You're talking about if somebody's not sleeping well, if they're, if they're like lots of stress already. I, and this is, this is where I would, I'm, that's interesting your navigation, right? Because. Bringing in intermittent fasting is stressful, right? Yes. [00:22:00] But if you have somebody that has metabolically unhealthy, um, and they're, you know, they have PCOS and they're 25 years old, that you wanted them to start intermittent fasting three days a week.
Dr. Scott Sherr: How do you navigate that? Is it, is it, I mean, because you just start off with really small window, like a, like a big window and then you kind of increase you slowly in Yeah. You know, sort of decrease the window from there or how do you think about it? And
Cynthia Thurlow: sometimes it's like training wheels on Yeah. You know, for some people it's okay, we're gonna not eat for 12 hours and that blows them their mind.
Cynthia Thurlow: Okay, well we're gonna have,
Cynthia Thurlow: yeah,
Cynthia Thurlow: some mc a tablespoon of mc t oil in your coffee 'cause you love coffee and you're gonna go to the gym. Let's add that. And, and we literally will do a 30 minute increment. Like we go from 12 hours to 12 hours and 30 minutes to 13 hours. And then, you know, I'll say like, let's try to get up to 15, 16 hours.
Cynthia Thurlow: Got it. And sometimes that's where I think the fat fasting can be helpful. But if I know, and we know what the basis like three quarters of the women with PCOS. Are of the phenotype that they genuinely are either o obese or overweight. And so doing just about anything is gonna be more beneficial than doing nothing.
Cynthia Thurlow: [00:23:00] I think, you know, it's the number one endocrine disorder in the world, and yet it is so poorly diagnosed, understood, and addressed. And so at the basis is inflammation, oxidative stress, and insulin resistance. And so, right. For me, it, it starts off with low lying fruit. Like what can I get them to do? They, maybe they're not gonna change their diet much,
Cynthia Thurlow: right.
Cynthia Thurlow: But we're just going to compress their feeding window and I'll, I'll see if I can get them to eat a little more protein. Yeah.
Dr. Scott Sherr: Like baby steps. I love that. Yeah. With Dr. Tad, one of our, our founders, he always that, that's kind of something that he, I think, pioneered a long time ago, even like 10 years ago or so, where he would just shorten somebody's eating window or feeding window, whatever you want to call it, um, instead of having them change anything.
Dr. Scott Sherr: Yep. Like, you're not gonna change your diet. Yep. You don't have to change anything you're doing, just eat for less amount of hours and then slowly, incrementally decrease the amount of time that they're eating. And then when they're ready, start changing their diet too.
Cynthia Thurlow: And it's amazing to me that we as clinicians, like we walk into a patient's room or they're sitting in our office Yeah.
Cynthia Thurlow: And we're like, there's 95 things I want you to do. [00:24:00]
Cynthia Thurlow: Yeah. And
Cynthia Thurlow: when I kind of struck out on my own nine years ago, I would put down the 95 things I wanted them to do. And I slowly started to realize maybe 10% of my patients could actually do that. And so now I'm like, here are three things I need you to do.
Cynthia Thurlow: And it's like simple, straightforward, like don't focus on all the other. It's very easy to get distracted and overwhelmed, especially when, you know, there's influencers and, and people on social media that are spouting nonsense as you and I both know Indeed. And so, um, now I get very nuanced. It's like, I want you to eat, I want you to track your macros and ha eat 30 grams of protein at each meal.
Cynthia Thurlow: And then they're like, that's a lot of protein. I'm like, well, you need more protein or, you know, 12 hours of digestive rest and I want you to go to bed 30 minutes earlier. Sometimes it's that. Small
Dr. Scott Sherr: but granular. Right. So giving them like actionable things, but in a small way that can make a huge difference.
Dr. Scott Sherr: Right? Like I always liked the example of Cornerstone Habits that was created. [00:25:00] I, Charles Duhig, I think wrote a book on this a while ago and like a corner cornerstone habit he described there as exercise. Once you start exercising, everything else gets easier. Like once you start seeing something happening from a metabolic side, and then these patients, right, you just have them go to bed 30 minutes earlier and all of a sudden they feel so much better.
Dr. Scott Sherr: Like that gives you the, the window to do more, right?
Cynthia Thurlow: Yeah. And I, I think it's really important because we have to meet our patients where they are. That's ultimately what it comes down to. Yeah. Like when I think about the patients I've worked with where we've had tremendous success over the years, it's because they're ready and we capitalize on the fact that they're ready to make those changes as opposed to.
Cynthia Thurlow: Generationally, I'm sure you've seen this, you had patients that, uh, were of a different generation and you could literally just spoonfeed whatever needed to happen.
Dr. Scott Sherr: Yep.
Cynthia Thurlow: Younger generations are not that way, and so, you know, they, they want a much more kind of interactive discussion, which I think is great.
Cynthia Thurlow: Um, but they don't wanna be spoonfed. They're like, I wanna understand, help me understand, help me how to get from point A to point B and how [00:26:00] to do it successfully so that I can sustain this. Because ultimately, isn't that what we all want? We want sustainability as opposed to like a quick win so that they then, you know, they peter out in a couple months 'cause they're like, I can't do this forever.
Dr. Scott Sherr: Yeah. I have a question for you. It's kind of a side question, but it's, it's related. Do you have your patients or clients coming in after they've consulted with Chad GPT for like seven to 10 hours on an issue and then saying, this is what Chad GPT needs me to do or thinks I should do? What do you think?
Dr. Scott Sherr: This is happening to me all the time now.
Cynthia Thurlow: Yes. In fact, I had a woman today who is prescribed a GLP one by someone else who said to her, I don't know how to prescribe this drug.
Dr. Scott Sherr: Okay.
Cynthia Thurlow: To the patient then read that to be, oh, I get to decide how I take this medication. So she went to Cha GPT.
Cynthia Thurlow: Yeah.
Cynthia Thurlow: And so when I had a conversation with her, I said, you wanna lose 40 pounds?
Cynthia Thurlow: You are not gonna lose 40 pounds dosing tirzepatide at one 10th of the initial dose. Okay? I was like, it's not going to happen. And she's like, but cha GPT. And I was like, [00:27:00] cha, GPT is not a medical professional, and I'm telling you, you are not going to get what you want at that small of a dose.
Dr. Scott Sherr: Yeah, I've just been seeing, I mean, I know that, that there's a new model just came out, but the, the sycophantic aspect of catt BT is very, very, very, you have to be very careful, at least previously, right?
Dr. Scott Sherr: Because it would just tell you what you want to hear and that's dangerous. And so I have a couple of my patients that will email me these, like list of things that they, they put all their supplements and all their data and everything in chat, BT, and this is what they wanted and, and this is what they're doing.
Dr. Scott Sherr: And I'm like, dude, we, this is not the way we practice. We gotta this. But I mean, I think it's good on some level because you do have a lot of empowerment for people, but then like, there's so much more data for people to go through. Um, it's not like gonna Dr. Google back in the day and like, I have a hangnail.
Dr. Scott Sherr: Oh, that means you're going to die. That's typically what the, the final conclusion bet anybody was gonna be. But, um, before I get to G Ps, 'cause I, I want, I wanna ask you about those one thing that you did mention earlier on, on uh, menopausal Women and HRT. So [00:28:00] if you said, you know, obviously during menopause the hormones are flat, but if you're gonna put somebody on HRT, how does that change your.
Dr. Scott Sherr: Your calculations as far as you, how your perspective would be, Cynthia, I know there's not a lot of people on HRT, but more people are getting on it. So just interested in your, your framework there as well. Yeah,
Cynthia Thurlow: it's a great question. So 5% right now is what we believe to be in the United States on hormone replacement therapy.
Cynthia Thurlow: So you're correct. It's a very small subset of the population. What's interesting is when I do intake paperwork, I know who's on HRT 'cause they sleep better. Like that's a given. Yeah, sure. Like they sleep better, they manage their stress, they generally are having less libido issues. Um, so, so to answer your question, I, I think that if a woman comes to me and she is on progesterone and estrogen and testosterone and maybe she's on pregnant and DHEA and a few other things mm-hmm.
Cynthia Thurlow: And feels great and she's sleeping through the night, then I'm like. I mean, and you're managing your stress. Do you feel good? Then yes. You can add, you can add this hormetic stressor,
Cynthia Thurlow: right?
Cynthia Thurlow: More often than not, it's the opposite. It's someone who [00:29:00] hasn't slept well in five years, they've gained 50 pounds, they're now insulin, uh, resistant.
Cynthia Thurlow: Um, they've got fatty liver. Uh, you know, they haven't slept well. So they don't eat well, they don't exercise 'cause they're too tired. And so I, I think that, um, you know, when I'm looking at that subsect of the population, it really is viewing it from like a bio individual approach. How is that person perceiving?
Cynthia Thurlow: Like people can say they don't feel well, but then everything el all of their, all the other metrics that we look at look pretty good. And I think that on a lot of different levels, it's viewing each one of them as an individual. But the consistent patterns that I see are people that are on HRT are generally doing better.
Cynthia Thurlow: Yeah.
Cynthia Thurlow: The the funny thing is, um, every time my team and I post anything around HRT. 99.9% of the comments are positive, but we always get the, I'm 56 and I am the same weight I was when I was 16 and I feel great and I sleep well, and I have a great sex life and you know, this whole thing, but I'm not on HRT and [00:30:00] why, why are you gonna make me get on HRT?
Cynthia Thurlow: And I'm like, well, first of all, you're not my patient. Um, and second of all, if you understand physiologically what's happening beneath the surface, I said, I hope that you and your clinician sit down together and they talk to you about shared consent. Mm-hmm. Mm-hmm. About what the possibilities are if you are not on.
Cynthia Thurlow: HRT for bone, brain, heart benefits. Right. All those things. Yeah. Metabolic health, I said, and after you've had that conversation, if you still choose to not be on HRT, that's obviously your choice. But what I imagine is happening is your clinician doesn't wanna talk about HRT and the only information you're getting is from social media.
Cynthia Thurlow: So you're getting in some instances, like a very biased perspective. Mm-hmm. Because I look, again, it goes back to those quality life metrics. Who wants to remain as independent as possible? And certainly from my perspective, when I look at family members, now, my mother's generation were all taken off of their HRT Post, WHI Women's Health Initiative.
Cynthia Thurlow: Yep. Yep. And
Cynthia Thurlow: so when I look at all of them, and I have permission to talk about this [00:31:00] publicly, the neurocognitive effects of being off hormones for the length of time that they have been off of them doesn't sit well with me. Hmm. And so that's the stuff that I think about is maybe in 56 you don't see those effects, but it's 70 and 80.
Cynthia Thurlow: If you live long enough, you know, older than that, you'll, right,
Dr. Scott Sherr: right. And we know that women live longer, but they have higher risk, quality of life. They have a higher chance of having poorer quality of life in those later years. Right. Yeah. And they have a higher chance of dementia as well if they do live to a certain age compared to men.
Dr. Scott Sherr: Um, so I think that there's a lot going on there that, and I, and I appreciate your perspective and I've, I've had a number of, I know you speak to a lot of experts in this, these kinds of fields too. And my wife's and my wife's 47. So like, we, we think about these things a lot in my house too. Mm-hmm. Um, so it's, it's all very, it hits home.
Dr. Scott Sherr: I'm, you know, for me too, you know. Um, and so, you know, one thing that I think that gets talked about a lot during the, the, when you're doing intermittent fasting and you're, and you are as a [00:32:00] clinician, kind of working with patients, is, is looking at various metrics, biometrics, uh, data laboratory values. And, you know, some of the things are, will be kind of obvious, but like.
Dr. Scott Sherr: Would be interesting in your take is, you know, you have to watch, make sure people don't like drop out their blood sugar if they start losing weight fast. But there's other things like. The one that I always think about that was one of the first ones on the women's side, is like, if you fast too much, you are gonna screw up your thyroid and you're gonna mess up your thyroid hormones and you're gonna fuck up your metabolism.
Dr. Scott Sherr: So, so maybe you can just maybe address that piece and then, you know, because of your experience and then, and you can talk about the different walks of life when women's different stages maybe through that and then maybe some of the other biometrics that you're thinking of that, that are kind of ones that you found to be most important as people are kind of going and, you know, starting to do more intermittent fasting.
Cynthia Thurlow: Yeah, I mean, I always think about thyroid as, you know, is it the chicken or the egg? Because yeah, yeah. Mm-hmm. It's so common to see latent hypothyroidism or subclinical hypothyroidism in middle aged women. That my question is always, was it there before or did fasting [00:33:00] just bring it about because I, I don't have a patient right now that is not on thyroid replacement.
Cynthia Thurlow: Really not one. Now granted, I mean, I, I work with a very specific population, whether I've started it or another clinician has started it. But I, I think in many, many ways, it's what I would say to anyone, if you have newly diagnosed hypothyroidism or Hashimoto's and you still are exhausted and you, you know, your hair is falling out and you're constipated and you feel bad, then it's not the time to add another hormetic stress.
Cynthia Thurlow: Now, if you're stable on thyroid medication, your labs look fine. Um, that's different. But when I'm looking at lab metrics to see what have I seen clinically from over fasting high reverse T three, and I know many clinicians don't necessarily draw that or believe in it, um, you know, I will see depressed T three, T three.
Cynthia Thurlow: Mm-hmm. Mm-hmm. Um, I will definitely see, you know, beyond the, the, the, or even elevated antibodies. Um, beyond that, you know, cortisol [00:34:00] issues, you know, you'll see a serum cortisol, and I know a serum cortisol is not a 24 hour circadian distribution. Right. Um, you know, you can see blood sugar liability. I definitely, um, have seen a lot of like.
Cynthia Thurlow: Well, and it's probably also concurrently going on with like heavy menses and so they've got low ferritin and you know, their percent sat is low and their iron levels may or may not be problematic. But I'm usually looking at the other metabolic markers, like, what's their fasting insulin? Like I had a woman recently, her fasting insulin was one, and I said, you know, that's, that's not like, that's like a little bit off.
Cynthia Thurlow: Mm-hmm. You know, it's not even like it's high, but, you know, looking at fasting insulin, um, looking at other metabolic, metabolic health markers like C peptides. Mm-hmm. Um, you know, A1C I don't always see that being particularly helpful, looking at a two hour postprandial glucose, um, to see how well they're doing.
Cynthia Thurlow: Looking at CG M data, looking at oaring or whoop band metrics like HRV to me is really important [00:35:00] and I help people understand like, this is a good sense of. Sympathetic to parasympathetic. Right, right. Um, balancing the autonomic nervous system. I mean, those are the things that I'm generally looking at, but I also listen as I know you do, I really listen to what they're telling me.
Cynthia Thurlow: Like, can you get up in the morning and not feel like you need five cups of coffee? If someone's telling me they're drinking a lot of coffee, they're, you know, drinking a lot of alcohol at night to wind, to wind down, um, more often than not, there's some degree of dysregulation of multiple factors. But latent hypothyroidism, subclinical hypothyroidism is such a huge problem.
Cynthia Thurlow: I rarely see graves, but I, I feel like, and I know there's been a lot of talk about, um, the FDA recalling a lot of these desiccated thyroid products, which has got the whole thyroid community in an uproar. Um, yeah, because that would impact a lot of people. I, I just think there's a lot here that I didn't know before I left clinical cardiology.
Cynthia Thurlow: How many women were impacted by. You know, subclinical hypothyroidism. And when I say that [00:36:00] these are people that are slowly brewing, um, developing a, a hypothyroid state and, and many instances feel a whole lot better on medication, even at low doses. But I think in many, many instances it comes down to like just being a good detective, like taking a good history and then adding in the labs to be able to say to the patient, Hey, you know, your cortisol's very low.
Cynthia Thurlow: Um, and you know, we're ruling out other things that could be going on. Let's get a circadian distribution of, um, salivary cortisol so we can see what you're doing throughout the day. I think that can be helpful. But those are typically kind of broad strokes. Some of the things that I'm looking at clinically.
Dr. Scott Sherr: Yeah. There's a big uproar, you know, maybe five, seven years ago now regarding women fasting and causing thyroid dysregulation. So, but it seems like your take on this is that it's, there's a time and a place like everything else, right? Like if you're right. I mean,
Cynthia Thurlow: it can be helpful for mitochondrial function.
Cynthia Thurlow: Yeah. I mean, that's the big thing is that I remind people if you're thyroid function is stable and you don't have symptoms, that's an, an [00:37:00] opportunity where you could utilize, um, intermittent fasting as a strategy. But the opposite is also true, right? Like, if you are very symptomatic, you're not stable on medication, that is not the time to add more stressors to your body.
Cynthia Thurlow: Mm-hmm. And I think for a lot of people that are so desperate to lose weight, again, we go back to this weight piece.
Cynthia Thurlow: Mm-hmm. Mm-hmm. They're,
Cynthia Thurlow: they're so desperate to lose weight. They're willing to do just about anything and they'll just fast longer. And I'm like, that's actually making it harder, harder for your body.
Cynthia Thurlow: Yeah. Um, to be able to do the things it needs to do. And, and when we talk about a broken metabolism, yeah. I don't feel like that's so much. Specific to intermittent fasting. I think that's part of the diet culture where people have chronically calorically restricted for years and years and years and they've gotten themselves down to eating 600 calories a day.
Cynthia Thurlow: That's where I think food diaries and chronometer, or chronometer, depending on who you talk to, I think are really invaluable. 'cause sometimes I literally have to say to people, um, you are eating 600 calories a day, you're telling me you're not hungry. [00:38:00] I'm telling you that is not sustainable. Your body thinks you're starving.
Cynthia Thurlow: Starving mode.
Dr. Scott Sherr: Yeah. There we go. And then
Cynthia Thurlow: we have to go through the process of slowly adding food back in and doing it in a way that doesn't trigger. Again, like latent eating disorders, in many instances, you know, they freak out about the scale. And also a massive
Dr. Scott Sherr: weight gain too. Right? Yeah. 'cause if you're under sort of that starvation mode, your body's trying to keep every calorie it can.
Dr. Scott Sherr: I had a friend of mine, good friend of mine, who did a long fast, uh, like a 14 or 15 day fast. Um, he's kind of a person that doesn't have a problem fasting. And, but, but after that, he had a really hard time losing weight. Uh, yeah. 'cause his body just went through like survival mode and then everything that he tried to eat afterwards, like, didn't matter what it was, it's just he would gain more weight.
Cynthia Thurlow: Yeah. And I think it's, you know, it's, it's something I'm incredibly sensitive to. I feel a tremendous responsibility because, you know, God, the universe gave me this opportunity to talk about fasting. Um, yeah. But I, I feel like it's really important, uh, as a clinician and as a middle aged person to make sure that I'm.
Cynthia Thurlow: Saying to patients, [00:39:00] like, I think we're getting it to a point where you're chronically under nourishing your body. Right. And that's a problem.
Dr. Scott Sherr: Yeah. And I saw this like time and time again, number of years ago, people doing too much. But one thing that came to mind as you were talking is, um, do you have a preference in general if people have breakfast and no dinner versus having lunch?
Dr. Scott Sherr: Because I can just say personally, like, I do much better not eating throughout the day and having a bigger breakfast as opposed to having, uh, no breakfast or no nothing to eat until one or two o'clock in the afternoon. And then I just want to gorge because I'm starving. Yeah. Um, so I, I don't know what your, what your sense is here, but I, I've talked to Dom Dino about this actually too.
Dr. Scott Sherr: And, and, uh, Dom, for those that that don't know, is a, a keto researcher for years and years, he's been fully ketogenic for like over a decade, or at least he was one of the first guys. Talking about this from a non-medical perspective. Mm-hmm. Uh, back in, uh, I guess 2000, I wanna say 14, 15, that timeframe. And so do you have, I mean, any, what he'll tell me is he'll have like a big breakfast, but then he won't eat the rest of the day.
Dr. Scott Sherr: Yeah. And then I'll [00:40:00] maybe have like, maybe he'll have like a light dinner or something like that, but his biggest meal is typically breakfast. So just interested in your thoughts on meal timing and circadian biology and things like that.
Cynthia Thurlow: Yeah, no, I, I'm a big believer in eating earlier in the day, so I, I think that that's much more in alignment with our insulin sensitivity as well.
Cynthia Thurlow: So I'll say to patients. Have a good sized breakfast, you know, nine, 10 o'clock in the morning, and then, you know, maybe you're eating a second or third meal later in the day. Um, I, I feel like when patients eat a bigger meal earlier in the day, they tend to eat less food the rest of the day.
Cynthia Thurlow: Yes.
Cynthia Thurlow: Um, it also sets up better blood sugar regulation.
Cynthia Thurlow: Um, in many instances, they're not binging. I think many patients for a long time, were doing the opposite. They were, um, you know, going to the gym at five o'clock in the morning, they were doing something intenses. They'd go to work, they'd drink a couple cups of coffee. They would like squeak through till lunchtime.
Cynthia Thurlow: Then they would eat a, you know, a decent sized lunch and then they'd binge in the afternoon. They'd have candy bar, they'd have soda. Yeah,
Cynthia Thurlow: yeah.
Cynthia Thurlow: Then they would get home and it would just continue all throughout the evening. So what I have come to find [00:41:00] personally and professionally is I think women in particular do much better having a bolus of protein in the morning.
Cynthia Thurlow: And then kind of going about their day now, how people decide to make it, you know, if they decide to have a protein shake and some other thing. That's one thing. I mean, I like to have a real meal in the morning, but mm-hmm. I, I think that protein bolus is really critically important, and it's also kind of setting you up for muscle protein synthesis and everything else that comes from that.
Cynthia Thurlow: It also ensures, I find for a lot of people that if they get a good sized meal in that the rest of the day, it's less important what else they eat. But that first meal is the most important meal of the day.
Dr. Scott Sherr: Yeah. Protein intake, a big part of it. And you're mentioning already in various ways of protein, and you mentioned the word bolus, which I, I love from our, from our hospital days, we call it about bolusing fluids, bolusing food, Boling just means like having your meal at, like having a, a, a substantial part of something at that time.
Dr. Scott Sherr: Right? Yeah. So bolus for those that don't know what that means, but like from, like, from a protein perspective, it sounds like you're, you know, you're, uh, you've [00:42:00] evolved here significantly. What is your sense for women and protein now and, and how that evolves through the life cycle too?
Cynthia Thurlow: Yeah, I mean, I, I think that.
Cynthia Thurlow: Protein is the way, um, protein helps the satiety. I mean, there's so many mechanisms that get triggered in our bodies when we consume adequate protein and, and I probably have no less than 50 to 60 grams in a meal. Like I've worked my way up to that. But when I'm looking at food diaries or chronometer, what I find is women are eating like 50 grams a day, and really what I want them to be focused on is.
Cynthia Thurlow: A hundred grams a day minimum.
Cynthia Thurlow: Yeah.
Cynthia Thurlow: Um, you know, even making the argument one gram per pound, if I did a body weight, so I'm consuming a hundred, 120 grams a day, that's ideally what I'm trying to aim for.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: Now, when patients weigh more than that, they're like, that sounds insurmountable. And I said, well, it doesn't mean you go from 50 a day to a hundred, it means Yeah.
Cynthia Thurlow: It down and eat. It's an additional ounce. Like, you need to understand what four to six ounces of protein looks like. Yep. And adjust accordingly. You know, there's no shame if you're in a restaurant, like, I went to a restaurant this [00:43:00] past weekend and I was like, I want the eight ounce filet. And even though it's what it's, that's how much it weighs before it's cooked.
Cynthia Thurlow: But still, I'm like, I want the bigger steak. I, I definitely want to be pushing the envelope because more often than not. When you're pushing those protein metrics, it means you know, you're having some vegetable with that, or maybe you're having some healthy fat depending on what the meat or fish or poultry is.
Cynthia Thurlow: Yeah. Uh, but I find that people tend to do a whole lot better. It's when we don't eat enough protein and there's this protein leverage hypothesis, which I'm sure you're familiar as with, but for women in particular, as we are navigating perimenopause and a menopause as our follicular stimulating hormones going up and our estrogen's going down, it really triggers this.
Cynthia Thurlow: If you're not getting enough protein, guess what happens? Your body's looking to make up for the lack of calories. That's why you end up in your pantry at 7, 8, 9 o'clock at night looking for more food. You're hungry. You're genuinely hungry.
Cynthia Thurlow: Mm-hmm. And
Cynthia Thurlow: a lot of it has to do with that. You haven't triggered that threshold of protein intake over the course of the day.
Cynthia Thurlow: And you're probably eating chips and ice cream and, you know, [00:44:00] cookies and things that are not ultimately gonna be the macronutrients that allow you to build and maintain healthy muscles. They're going to contribute to, um, more subcutaneous or even visceral fat. And it's helping women understand like there's a way to eat that's going to help facilitate maintaining as much muscle as we can for as long as we can.
Dr. Scott Sherr: Yeah. And that's really the key, right? Is, is kind of balancing these metabolic metrics that we have and understanding also that sarcopenia. Kills people. And unfortunately it does. It sounds like you know your dad, right? Yeah. And uh, I, I, I listened. I was actually had a researcher on her a long time. Her name is Lucia.
Dr. Scott Sherr: Veronica. She'd be good for your show. Yeah. As well. She's an epigenetic researcher. She did a, this this study called the Fit Fat Study and looked at various dietary changes and epigene changes and, and like, but in the end, like looking at epigenetic, these new clocks that we talked about, right? And how you can gain one of the clocks by going completely vegan for six months.
Dr. Scott Sherr: Your epigene age is going to increase, but then your muscle mass grows down like 20%. And she talked about her, her mom, who was in her eighties. She's like, I would never [00:45:00] want my mom to do this, even if it extended her lifespan because, you know, what about her health span? Right. So, I mean, I think that's really what this comes down to when it, when it comes down to your evolution with this, especially this emphasis on protein.
Cynthia Thurlow: No, I, I think what's interesting to me is when I reflect back on different stages of my life, even when I was, you know, in working in the ER or doing, still doing a lot of hospital medicine, what do healthcare providers do? They're oftentimes never able to let alone empty their bladder, let alone eat. So, what did I sustain myself on when I rounded?
Cynthia Thurlow: I would have like crappy protein bars and like, you know, bottled water, and that's what I would be drinking all day long. And I always say like, ultimately we have to mimic the kind of lifestyle that we're recommending to our patients. We actually have to live it ourselves. Mm-hmm. Mm-hmm. I kind of cringe when I think back to those days where you'd sit in the doctor's lounge and be, you know, jamming food down your throat as you're getting fatigued.
Cynthia Thurlow: As fast as
Dr. Scott Sherr: you can. As fast as you can. Yeah. Yeah. Um, but let's, let's change gears a little bit 'cause I wanted to also get into GLP ones a little bit. 'cause I know this has been a big hot topic now, but I, I know you've been [00:46:00] speaking about it more. So, I guess, what do you think about this whole realm of glp?
Dr. Scott Sherr: How are you using 'em in clinical practice? Which ones are you using for which types of people? You know, maybe like, maybe go into some of that and we can kind of explore some questions.
Cynthia Thurlow: Yeah. I mean, I would say right now exclusively tirzepatide because I, okay. I found that. It is. Um, there's less side effects.
Cynthia Thurlow: You know, with Ozempic Semaglutide there was a lot more nausea and then I would get so much pushback about the nausea, and I'm like, I get it. You don't want that. No one wants that. Um, but tirzepatide for women in perimenopause and menopause that are looking to shift body composition when we're already working on foundational elements, let me be really clear.
Cynthia Thurlow: Sure. Um, you know, most of them are wanting to shift body composition, and I'm a hundred percent supportive of that in conjunction with, you know, HRT and, and other modalities. Um, then there's another group of women who are, maybe they're almost at their ideal body composition and they've either got autoimmune conditions, maybe they've got inflammatory conditions, like rheumatoid [00:47:00] arthritis is one that
Cynthia Thurlow: Yeah.
Cynthia Thurlow: Really stands out. Yeah. Some research on that. Yeah. Um, they deal
Cynthia Thurlow: with chronic pain and this is where. I think I find GLP one to even be more interesting, um, people that are trying to reduce cardiovascular risk. Maybe they have terrible heart disease in their family. They themselves have no evidence of heart disease.
Cynthia Thurlow: Their lipid markers are all dialed in and they're just trying to lessen the likelihood of developing atherosclerotic cardiovascular disease. And so, mm-hmm. This microdosing concept, what is microdosing? I think it probably depends on whomever you speak to. Maybe it's 25%, maybe it's a 10th of a starting dose.
Cynthia Thurlow: It's well tolerated. They're not looking to lose weight. And so this is where, you know, this nuance related to GLP ones that I find so fascinating. I, I think that what I find, kind of looking at how other people are practicing or things that I'm seeing in the, um, on social media in particular. Mm-hmm. It's like the wild, wild west.
Cynthia Thurlow: So I try to be really, uh, really specific if I'm choosing to prescribe this, number one, you have to [00:48:00] promise me you're gonna strength train. Mm-hmm. And number two, you have to be really conscientious about your protein intake,
Dr. Scott Sherr: right?
Cynthia Thurlow: Because. So the GLP one is useless if you end up losing significant amount of muscle mass.
Cynthia Thurlow: And, and that is kind of, that's why we do pre and pre and post bio impedance readings. So we can look at like your fat-free mass. Sure. Your muscle mass. And then they also can objectively look at them themselves. And it allows us to kind of track for transparency purposes, what are we actually losing? If we're losing body fat, great.
Cynthia Thurlow: If we're losing a significant amount of muscle mass, then that's concerning. Yeah. And then that tells me you're probably not doing the first two things that I asked you to do. So that has become part of every discussion that we have with patients, just helping them understand, um, how important it is to maintain that muscle mass.
Cynthia Thurlow: And I feel like I, I harp about this.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: But I've been able to see this from the inside out, both with my patients and then also personally with a family member. I think that's a very slippery slope of Sarcopenic royalty that we don't think about [00:49:00] until, you know, grandma goes into the hospital and can't get off the bedside commode.
Cynthia Thurlow: Yeah, but I've seen 50 year olds with that same issue, and so if you wanna remain independent and you're choosing to take a GLP one, those are the two things I require my patients to do. Now what I find is most of my patients don't necessarily have to get to therapeutic doses. They're getting.
Cynthia Thurlow: Improvement in some instances, you know, they're, they're on a, you know, 2.5 or five milligrams and they're doing really, really well and they don't ever need to get 10 or even larger doses, um, that I know other colleagues have had to use with some of their patients. So I, I think that it's, it's encouraging.
Cynthia Thurlow: Mm-hmm. Mm-hmm. And I think, you know, to me, I feel like I can't think of another drug in the trajectory of my experience working in the medical field that has had the kind of impact that this has the potential to have. And I'm also not of the belief system that patients should be shamed. Um, I see a lot of that on social media.
Cynthia Thurlow: And it's not a cop out. I don't look at it, you know, when a patient says to me, this is the first time in [00:50:00] my life I don't have food noise. I'm not thinking about the pantry, I'm not thinking about the chocolate, I'm not thinking about alcohol. Or any other, you know, food that they is their kryptonite.
Cynthia Thurlow: They're like, I just don't think about it anymore. And this has been like, if, but nothing else. This has been the greatest achievement I've ever had in my entire life when I have been burdened by food noise my entire life. And I think that that is, you know, that is what I think is really fascinating about the drugs themselves.
Cynthia Thurlow: And even, you know, we know that the second generation GLP ones have that GIP as well as the GLP one. Yeah. Agonist. So I think it's really interesting when we, the more we understand and the more applicability that we'll be able to utilize, I think it, you know, it's like, we used to joke about this in cardiology, and I'm embarrassed, I'm gonna admit this out loud.
Cynthia Thurlow: We used to say that we needed to have benzodiazepines and statin in the water supply. 'cause everyone, we can make a justification that everyone needed one. I cringe when I say that now, but I think we will get to a point where there will be, if people choose [00:51:00] to take a GLP one, there's probably going to be an indication that will help them.
Dr. Scott Sherr: Well, I think we would've been better putting LSD in the water supply than, than statins and benzos, but I could see that terrible from a cardio terrible from a cardiology perspective, right? Like every, everybody thinks, I mean, I, you mentioned some really interesting things there. I think one of 'em was related to alcohol, you know, and, and I, I know that we're seeing a lot of potential with these microdosing protocols.
Dr. Scott Sherr: Again, there's a lot of variability, what that number is, or how much of the percentage that you're taking, but for actually for addictive behavior too, right? Mm-hmm. So, and have you seen that in clinical practice too?
Cynthia Thurlow: Yeah, and I think that's what I find fascinating. Like people have said to me, 'cause we do talk about alcohol and I, I speak very openly that I think, um, you know, alcohol is one of these things that we don't speak enough about, about the potential harm of alcohol use.
Cynthia Thurlow: And I see a lot of women that depend on alcohol to like unwind and they're stressed and they don't sleep well, and then they wake up with the alcohol. And so that's, that's part of the educational process is just making them aware. I'm like, I'm not here to judge. I just want to make you aware. And they'll say, [00:52:00] oh my gosh, you know what?
Cynthia Thurlow: I don't need those three glasses of wine at night anymore. Yeah. Beautiful. And that to me is incredibly encouraging. It's like this untoward side effect that they didn't expect, but they're thrilled. They didn't realize they actually were drinking too much until they started a GLP one. And then those kind of addictive behaviors are just.
Cynthia Thurlow: Blunted.
Dr. Scott Sherr: Yeah. I mean, what, what's your sense here? You know, there is some feelings that it's very similar to the Sackler family kind of deal. Oh, right, oh yeah. Is once you get somebody on these drugs, it's
Cynthia Thurlow: hard to get 'em off. You got
Dr. Scott Sherr: on, you got them for life. And that's exactly what pharmaceutical companies want.
Dr. Scott Sherr: Yeah. Right. Yeah. Which is a drug that you love that's blockbuster as it is with the GLP ones, but you can't get off of. And what's your sense of that? Like do you, and how do you, how do you, because I haven't done this a lot in my personal clinical practice. I'm not prescribing them typically. Mm-hmm. Yet a couple people, but not very many.
Dr. Scott Sherr: So how do you, how do you feel about that in general?
Cynthia Thurlow: Um, I mean, I think we have to explore that with the [00:53:00] patient. You know, ultimately, I, I think what I'm hearing, and I'm hearing this from clinicians too, that are taking GLP ones, lot of are, yeah, I'll take this till the day I died because they feel like I'm in a micro doses.
Cynthia Thurlow: 'cause I feel so good. Whether it's pain or blunting, their hunger response or. You know, allowing them to maintain whatever body composition they want. Right. I think it's meeting people where they are and it's asking them, you know, we could titrate. We could titrate up and we can titrate down and see where you are.
Cynthia Thurlow: I think there are technologies that are kind of evolving. There's a, a company, um, that I'm, I'm interviewing the, the CEO this week. Um, and, and it's a company that actually has a bitter melon extract that apparently does the same thing very, if you look at the research is very effective. I, I, myself am, am just learning about the technology, but you know, are there things we can do to help patients successfully come off these drugs if they don't want to be on them long term?
Cynthia Thurlow: Mm-hmm. I get the sense that most people don't want to be on them long term. That's my [00:54:00] sense too. And most people,
Dr. Scott Sherr: most people do, do actually stop taking them. Right. Yeah. That's the, the natural history of these things that people do, stop them. And I know that there's these new evolution of supplements and drugs that are coming out that are oral.
Dr. Scott Sherr: That's my sense too, is there's gonna be this transition from people taking the subq and then finding these oral alternatives that may not be as strong, but then have a similar effect. Yeah. And I can maintain using some oral GLP. Peptides or OGOP, bitter melon or whatever it might be.
Cynthia Thurlow: Yeah. And I, I think, you know, the other thing is I, I feel like for a long time, especially on platforms like x where it could be, you know, it's like the wild, wild west.
Cynthia Thurlow: People have very strong opinions and I'm like, listen, if you were on the ground listening to what patients and clients are telling you, you will understand that this is not, I don't, I do not perceive GLP ones as a crutch. I really see them as, in many instances, miracle opportunities for patients who have not been metabolically healthy.
Cynthia Thurlow: Right,
Dr. Scott Sherr: right, right. Suddenly
Cynthia Thurlow: start reversing disease and then, you know, to be in a position where they're [00:55:00] able to be more active and sleep better and engage with their family. And so I look at it as a win-win as opposed to, you know, I've, I've heard clinicians, I've heard people talk about how, you know, it's, it's a, it's a cop out, it's a shortcut.
Cynthia Thurlow: I'm like, I don't feel that way. Maybe because I'm more pragmatic. I'm like, listen, and the greater good if, if we look at how our population's health is as a whole right now. Something needs to change. Yeah. You know, I mean, and,
Dr. Scott Sherr: and I don't think it's, it's not our fault. I mean, the people's fault, right?
Dr. Scott Sherr: Mm-hmm. In the sense of just the type of culture, the food culture, the big agro big farm. Like everything is sort of against you in some ways of making you try to eat more calories than you need of hyper palatable foods. Yep. And so it's been kind of like a interesting wake up for some of these other companies, right.
Dr. Scott Sherr: That have to like, have you heard of these new, the companies are trying to make GLP one friendly foods and friendly snacks Yeah. To get people to start snacking again too.
Cynthia Thurlow: I know. And I think, I mean it's, I understand there's, there's a marketing piece, there's a desire to generate revenue, but I also think we've [00:56:00] never held these companies really accountable.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: And you know, we have a whole generation of people that is it, 70% of people, they eat ultra processed food all the time, and it's like they don't know what real food tastes like. And so I, you know, I think that. I don't know. I mean, there's no quick fix. I mean, that's not what I'm saying. There's not one or two things that are gonna change the way that, that we choose to feed ourselves.
Cynthia Thurlow: But I, I also think that there could be no greater thing that could occur if suddenly these processed food industries, if they started losing money. 'cause people suddenly were just not hungry to snack. Well, that's what's happening. Right? And that's what's
Dr. Scott Sherr: actually, and that's, that's one of these, the impetus is or the why they're trying to come out with these GLP one snacks, you know, that you can have.
Dr. Scott Sherr: And that's kind of, it's no. It's called. It's called, no, it's called Please. No, but that's, that's the nature of our, uh, that's the nature of our, our, our just how, our system, our capitalism. Right. Um, [00:57:00] well, Cynthia, so I want to transition a little bit. I wanna ask you some rapid fire questions. Okay. As we're re reaching the end of the podcast today.
Dr. Scott Sherr: This should be fun. You can take, you know, 10, 30 seconds or a minute if you want. Um, and, um, yeah, let's, you ready? Yep. You excited? Okay, here we go. Okay. I'm excited. I'm definitely okay. Okay. It's gonna, alright. So first question. Uh, number one, one health myth. One health myth you'd wish would disappear forever.
Cynthia Thurlow: Oh. Um, I, I, one of my biggest pet peeves is that, uh, it, it's just calories and calories out. One, people think it's a, it's just about the calories. It, it makes me crazy 'cause it negates the fact there's so many other things that contribute to weight gain, including hormonal dysregulation.
Dr. Scott Sherr: Yeah, that's a great one.
Dr. Scott Sherr: I a hundred percent agree. Um, what is a health gadget you actually use every day?
Cynthia Thurlow: Oh, I love my aura ring. I, I'm a data nerd and I like quantification, so I like to look at my HRV and you know, how much deep sleep I got and how much REM [00:58:00] sleep I got. So yeah, I would say, without question that, or I really like my Apple watch 'cause I like to track how much steps I've taken during the day.
Cynthia Thurlow: It's no surprise. Like I'm very, you know, I'm very left-brained. I like to track things.
Dr. Scott Sherr: Cool. I love it. I have my aura ring too. Um, I, although I have a friend, some friends of mine that are telling me that I should get the whoop instead. I don't know. I haven't tried, I haven't tried it.
Cynthia Thurlow: I, I'm like, I'm reticent to make a change 'cause I like my ora ring.
Dr. Scott Sherr: I like it too. I like it too. Um, how long have you had the ora ring for?
Cynthia Thurlow: Oh, like four years. Like I probably have five. Like I've had every color, every finish. Yeah. And then as they start dying, I get another one. Yeah. It's um, it's crazy. I've had every finish you can imagine, like silver, gold. Yeah.
Cynthia Thurlow: Everything rose gold. Yep. I've had every one.
Dr. Scott Sherr: Nice. Nice. I dig it. Okay, next question. Uh, one what one hell. So try again. What one wellness habit you think is overrated.
Cynthia Thurlow: Uh, cold plunges.
Dr. Scott Sherr: Ah, I always thought you were [00:59:00] gonna say it. I know that. Why Cold
Cynthia Thurlow: plunges, cold plunges. And it's, it's not because I don't see the value in the hormetic stressor.
Cynthia Thurlow: I think that it's very bio individual, and I know there are people that, that being in a cold plunge will raise their cortisol more than they need. So it just puts you in a position where if we're already dealing with high cortisol issues, maybe you need 30 seconds of a cold shower and that's all you need.
Cynthia Thurlow: Um, so again, it goes back to that amount of hormetic stress. And I just see women that are white knuckling it through a cold plunge when I'm like, dude, go do cryo or go do 30 seconds, uh, you know, at the end of your shower, do 30 seconds of cold water. And I think you're still getting benefits, hormetic benefits.
Dr. Scott Sherr: I love that. I'm, I'm a big fan of not. Cold plunging the sense that Yeah, I'm,
Cynthia Thurlow: I think that would be my hell.
Dr. Scott Sherr: I, I, I don't mind it. I think it's good, but I think it, like everything else, like you mentioned early in the podcast, like people just overdo it, right? Like overdoing, yes, [01:00:00] one cold plunge is good, but why wouldn't seven be better?
Dr. Scott Sherr: Right? It's just the American way, right?
Cynthia Thurlow: Both women that say like, I wanna have 15% body fat, and you know, I'm like, you know, you're already lean, you're, I mean, like very clearly, very lean, very fit. You know, it's, I mean, how much benefit are you getting from it? You're probably causing more cortisol de derangement than need be.
Dr. Scott Sherr: Yeah. I'm a hundred percent with you. Okay. One more question, or maybe two. Um, if you could only give one piece of health advice to your younger self, let's say you're 20 years old, what would it be?
Cynthia Thurlow: Oh my gosh. I would've told myself to, uh, sleep more. I think I've got my twenties, like not sleeping much. And yeah, I was an ER nurse and um, I worked nights and we would work, you know, three or four night shifts in a row and I just, yeah.
Cynthia Thurlow: I would sleep more 'cause I probably probably needed more sleep.
Dr. Scott Sherr: Yeah. We had, I think maybe I mentioned this on your podcast, we had shirts in medical school as medical [01:01:00] students that said sleep is for quitters. Yeah. So it's not, it's not a good culture that we Yeah,
Cynthia Thurlow: no, it's like self-flagellation. Like, I don't sleep enough, so Yeah.
Cynthia Thurlow: I'll, I'll pick up that other 12 hour shift. I just wanna show
Dr. Scott Sherr: everybody how tough I am and how much sleep I don't need. Yep. Um, I guess on the other side of it, what's like what are your some non-negotiables when it comes to sleep now?
Cynthia Thurlow: Oh my gosh. Uh, in generally speaking in bed before nine 30 or 10, um, cold, dark room thermostats at 65, uh, that's cold.
Cynthia Thurlow: And I, and my whole family's used to it. Uh, they like to blame it on me, but I'm like, everyone sleeps better, which is what we found. You know? I would say, um, just being off electronics.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: Uh, if, if something is stressing me out, I like have a piece of paper, I'll write it down just so I don't perseverate over it.
Dr. Scott Sherr: I do the same. Yeah.
Cynthia Thurlow: I used to say no, you know, turning off wifi, but I can't do that now 'cause I have teenagers and it's like if someone needs to reach me, I need to be accessible, but Sure, sure. I would say those are probably the very boring things that I think are super sexy. I would [01:02:00] say the other thing is melatonin and acetol.
Cynthia Thurlow: Like what are the things I think help with, help me personally sleep. Yeah, yeah. Um, you know, melatonin and acetol, progesterone, progesterone forever, magnesium, you know, those things are super helpful.
Dr. Scott Sherr: I love it. Well, this has been great, Cynthia. I really appreciate you spending time with us here. I have one more question for you.
Dr. Scott Sherr: This is what we ask at the end of our podcast all the time. It's, you know, the podcast is called Smarter, not Harder. You given a lot of, a lot of great advice, a lot of great frameworks here, but what are the three ways that you'd recommend everybody can live smarter, not harder, given all of your experience for all the different walks of life, as, as a clinician, as a, as a parent, as a, as a wife, as, as whatever else.
Dr. Scott Sherr: Just what would you think would be some of the, the good kind of takeaways for people?
Cynthia Thurlow: Yeah. I would say number one, hydration is far more important. Um, I, I see so many people that chronic dehydration is driving.
Cynthia Thurlow: Mm-hmm.
Cynthia Thurlow: Their HRV problems, it's driving their energy problems. So hydration and [01:03:00] electrolytes, um, go a long way.
Cynthia Thurlow: I would say do something that brings you joy. Mm-hmm. That oxytocin release that we get from being around loved ones, pets, um, people that we enjoy spending time with a hug goes a long, long way to, to lower cortisol oxytocin's an underrated hormone. And I would say number no way.
Dr. Scott Sherr: I don't think it's underrated, is it people don't about it.
Dr. Scott Sherr: Maybe it doesn't, it
Cynthia Thurlow: doesn't get enough. Like it doesn't get enough respect.
Dr. Scott Sherr: Yeah, I agree. I agree. It needs more respect. It doesn't get enough respect.
Cynthia Thurlow: Yeah. And so we look like crazy people. We have three dogs in our house, so we're constantly hugging furry, furry animals. And that's a lot
Dr. Scott Sherr: of dogs.
Dr. Scott Sherr: Occasionally when
Cynthia Thurlow: my teenagers are willing to, to give hugs. Um, I would say number three is creating more boundaries. I think that one thing that I have really worked diligently on the last few years is. Getting very clear about what is acceptable and unacceptable in my life. And that includes people. So having healthy boundaries is another underrated thing that,
Dr. Scott Sherr: yeah,
Cynthia Thurlow: I think if more people had healthier boundaries, they probably would [01:04:00] live very differently.
Dr. Scott Sherr: I love it. Yeah. Dr. Ted, who I work with likes to talk about toxic stress being toxic people too, right? So gotta get those outta people. Get other people outta your life as well. So that's beautifully said Cynthia. So well thank you for being here. Tell us where we can learn more about you, your platform.
Dr. Scott Sherr: You have a great podcast, your books, gimme all this stuff.
Cynthia Thurlow: Thank you. Yeah. Um, probably easiest just to go to my website, so it's www.cynthiathurlow.com. You can access to Everyday Wellness, which is my podcast. That's, Scott's been a, a guest on twice and a very popular one as well. Mm-hmm. Um, I'm active across social media.
Cynthia Thurlow: I am most active probably on Instagram. A little bit on Facebook and a little bit on Twitter. Although be forewarned, I can be a little snarky. We also have a YouTube. Oh, okay. Good
Cynthia Thurlow: news.
Cynthia Thurlow: Yeah, we also, I grew up in New Jersey. It's, it's deep down, it's there. Oh yeah. We also have a YouTube channel that we're slowly growing, so we put our full length podcasts on there for everyone to see.
Cynthia Thurlow: But if you reach out, um, definitely let me know how that you listen to the podcast [01:05:00] and um, I'd love to connect.
Dr. Scott Sherr: Well, again, thanks so much for being here, Cynthia. I wish you the best rest of your day and good luck with the teenagers, the dogs, and uh, elevate that oxytocin. Right. I'll try to do the same over here.
Cynthia Thurlow: Absolutely. Thanks Scott. Take care.
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