Ep. 188 – Troubleshooting Your Fasting Method with Megan Ramos

The amazing Megan Ramos was on the show with me in Episode 116, and I am delighted to have her join me again today! Megan is a Canadian clinical educator and expert on therapeutic fasting and low carbohydrate diets, having guided more than 14,000 people worldwide. She is the co-author of the New York Times Bestseller Life in the Fasting Lane and co-founded The Fasting Method with her colleague, Dr. Jason Fung.

Modern agriculture and the processed food industry have led to the mass production of hyper-palatable, highly salted, and sugared foods designed to be addictive. That has resulted in millions of people becoming obese and developing inflammatory and metabolic disorders. Fasting is an effective method for overcoming those problems. Megan and I both feel that it is vital for women to know that and to understand that fasting is a sustainable lifelong strategy for maintaining optimum health.

In this episode, we debunk the myths and misconceptions around women and intermittent fasting. We talk about the evolution of the agricultural processed food industry and the impact it has had on people’s health. We also discuss leptin resistance, how stress impacts hormones, different types of body fat, fasting in women who are still cycling versus those in menopause, PCOS, the impact of fasting on thyroid health, weight loss plateaus, and troubleshooting while fasting. Stay tuned for more!

“We need to remember that the body is a whole system and if there is one hormonal imbalance, it is likely to trigger others.”

Megan Ramos

IN THIS EPISODE YOU WILL LEARN:

• Megan unpacks and busts the myths and misconceptions around women and intermittent fasting and explains how fasting enhanced every aspect of her health and the health of thousands of other women.
• How modern processed food was designed to be addictive.
• Why do we need to cut out snacking and start eating less?
• What leptin resistance is, and how to overcome it with fasting.
• Megan explains why the fear-mongering around fasting is unfounded.
• The body is a whole system. So if there is one hormonal imbalance, that will probably trigger others.
• Megan talks about the success she has seen in women with PCOS who fast.
• The body composition of a tophi individual and the difference between visceral fat and subcutaneous fat.
• Why should healthy women fast?
• Megan explains why postmenopausal women find fasting easier than other women do.
• What are the benefits of using the DUTCH dried urine hormone test?
• What can women do to deal with weight-loss plateaus?
• Megan shares some tips for avoiding having diarrhea when breaking your fast.

Connect with Megan Ramos

The Fasting Method website

The Fasting Method Podcast@ the fasting method on all social media

Books mentioned:

Salt Sugar Fat: How the Food Giants Hooked Us by Michael Moss

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.

 

TRANSCRIPT

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health, and wellness goals, and provide practical strategies that you can use in your real life. And now, here’s your host, Nurse Practitioner Cynthia Thurlow.

Cynthia: Today, I had the opportunity to record with the amazing, Megan Ramos. We recorded previously on Episode 116 and today, we really dove into a lot of the myths and fearmongering around women in intermittent fasting. We talked about the evolution of the agricultural and processed food industry, the role of food addiction, and hyperpalatable, highly salted, and sugared foods, the role of the pandemic, and stress, and cortisol, and its negative impact on hormones. We talked about different types of fats, specifically, visceral or subcutaneous fat and the role of TOFI, which is ‘thin on the outside fat on the inside,’ hidden sources of inflammation. Specifically, how to address different types of fasting in women both those that are still cycling versus menopause, the role of PCOS, the impact of fasting on thyroid health, the beauty of the DUTCH dried urine test, how to debunk plateaus and troubleshooting while fasting. I hope we’ll enjoy this conversation obviously. Megan and I are very aligned and very much believe that it’s important that women understand that fasting is a sustainable, lifelong strategy.

Megan, it’s so nice to reconnect with you. For listeners, Megan and I connected on Episode 116. It’s hard to believe we’re close to 200 published episodes. Welcome back.

Megan: Thanks for having me back, Cynthia. That’s awesome. Congratulations on all the amazing episodes.

Cynthia: Yeah, yeah. The thing I’ve come to find about podcasting, it’s probably one of my top one or two favorite things I do in my business because it gives me opportunities to connect with so many amazing people in health and wellness space. I really feel very, very grateful. But I’d love to kind of start our discussion today. Obviously, we’re two women, clinicians and obviously you’re also a researcher, but in this fasting space, helping women to find a strategy that’s effective that they can do throughout their lifetime, and one thing that troubles me and one of the reasons why I wrote a book on this is that, there’s so much fearmongering about women in fasting and I know this is something that you probably also, you find from a source of frustration. So, let’s start the conversation there about the fact that this is an amazing strategy for women to embrace, and obviously, we have to tweak things a little bit when we’re women. But let’s start the conversation there.

Megan: There are so many myths and misconceptions out there when it comes to females. I just feel so bad for a woman out there that are trying to navigate all of this and that’s why I now love doing interviews with women like yourself to really help bust all of these myths. So, there’s just so many. From fasting is going to like, say, you are woman in menstruating, thinking about potentially fertility, or you’re in that fertility journey that fasting, it is going to screw up your menstrual cycle, fasting, it is going to lead to infertility, or fasting just isn’t safe for female hormones in general with really no rhyme or reason, or it’s not an effective strategy for menopausal, postmenopausal women for weight loss. It’s going to kill your thyroid function, it’s like never ending when it comes to women in fasting. I was 27 when I first started fasting. I was so sick from type 2 diabetes, I gained a bunch of weight, I couldn’t figure out why, had PCOS, had fatty liver, the whole kit in caboodle of metabolic symptoms and diseases, and I have literally had nothing left to lose. So, you hear all of this stuff and I just jumped in.

If anything, it’s just enhanced every aspect of my health and my “female health” too. And we’ve seen it with thousands and thousands of women over the years in the clinic like, we’re monitoring their blood work in line, we’re working with their physicians, and looking at all of their labs, and how well they’re doing. Every day, there’s a new baby, every day there’re reduced symptoms, the PMS, and regular menstrual cycles. Every day, there’s a woman that is 60 years old and it’s just losing so much body fat, and seeing a decrease in appetite, and feeling so good. So, it’s just so bizarre all these myths and misconceptions.

And then, just in general, those that affect women and men like reduction in metabolic rate, which we have so many great RCTs out now to show that that’s just such garbage. And the same with lean mass. Like, fasting is just going to eat away your muscle mass and we have all of the stored food energy in our fat cells. It literally makes no sense. Fortunately, too, in the last several years, there’s been some really great randomized control trials, which are the gold standard of medical research. Not that they don’t have their own clause, but it is what we consider the gold standard, just totally debunking that myth, and how fasting is not just great for maintaining your lean mass and maintaining your resting metabolic rate, but that is far superior to traditional calorie restriction diets, too.

Cynthia: Well, I think it’s really important for us to unpack a lot of these myths and misconceptions, and to do it in a very loving way which I know that you and Jason do really understanding that there’s some fear-based methodology behind all this fearmongering that people are so fearful that they’ll lose something as opposed to gaining like, gaining your health. Obviously, as we know fasting is aligned with the ancestral health patterns. Food scarcity was a real thing before refrigeration and certainly way before the advent of the processed food industry. So, I remind women all the time that eating less often, however, you want to define eating less often, time-restricted eating, intermittent fasting is really the way that our bodies are designed to thrive. So, we aren’t designed to be having mini-meals, and snacks, and meals all day long.

In fact, I cringe, I’ve very athletic teenage boys now, but when they were younger, we would pack snacks because inevitably they just couldn’t eat enough food in a meal. That’s a very different process. But we kind of take that same methodology and we apply it to when they become preteens, and teenagers, and young adults and yet we don’t realize that that onslaught of calories is really making us very metabolically sick. There’s one study from UNC from 2018 and I’m sure the data is actually worse now, during the course of the pandemic, but really looking at metabolic health and why we need to be talking to all of our patients about this, it should not just be, a few enlightened individuals that are out there that are talking about it that really should be a platform that all clinicians are standing on with their patients. It shouldn’t be that fasting is considered to be trendy, or invoke, or popular.

The common misnomer is that people think low carb or keto is trendy and I have to remind people that this is very aligned with the way that our bodies are ideally supposed to be running. If we want to talk about efficiency, this is a superefficient way to live our lives to not be focused on food. I would much rather get my To-Do list done, my work day done, and not be thinking, “Oh my gosh, I’m so hangry. I have to grab something fast.”

Megan: A few years ago, when I was living in Toronto. So, I live in sunny California, although today is like the one rainy day this quarter of the year. But I hail from Toronto, Canada. So, we are wimpy Canadians. We truly are. Our summers are 100 degrees Fahrenheit, but our winters, we do have a couple of months where it hits minus 40 Fahrenheit, which is the same in Celsius. So, one February, I was giving this interview to this news outlet in Dallas, Texas. So, Dallas’ climate, well, it can get chilly much nicer than Toronto. And I’m looking at the window while I’m on the phone with this woman and she’s just trying to rail me on about how fasting is this fad. I just said to her, “Yes. Human history, we did develop these means of food preservation before modern agriculture. But that’s still a relatively recent human history.”

Now, I would argue that for a large part of human history, we’ve thrived. We’ve gotten to this point. Now, I would not say we’re thriving as a species now, because we’re sorry to see our life expectancy decline at this day and time. But till like the 1970s, we were really kind of thriving as a species, how did we get there to the point where we’re thriving, and I said, “I’m in Toronto right now. It is minus 45 outside and it is not going to be nice.” There’s nothing growing. Animals are in hibernation. Years and years ago, I wouldn’t be eating until April or May. Like, I would have had to come up with this mechanism where I would store food energy and be able to retrieve it as I needed it during this time, kind of like an animal in hibernation almost. And obviously, we did it. We’re still here. We are here and while our health is declining right at this present time, we feel through human history I have thrived to this point and she paused for a second.

I said, “Listen, there’s snow, there’s [unintelligible [00:09:52] outside my window. There are many people all over the world in this particular climate. Not everybody’s living in what is presently the Bay Area weather where it’s quite steady all year long.” So, there’s just wasn’t food available. So, it really isn’t a trendy diet. We’ve gone through these periods of time, well, there’s days, weeks, or even months through our human history where we just haven’t had access to these food resources and we’ve had to find mechanisms of storage and being able to retrieve that energy for when we needed it until food became available. Caveman didn’t wake up and go to their cavemen refrigerators and pull out some eggs or their caveman cupboards and get their cereal.

A friend of mine, Nick Mailer, another researcher in the low carb community, a great guy, we’re at dinner, pre-pandemic in London when people could gather, and we were talking to some professional rugby players about fasting, and low carb, different types of low carb approaches like ketogenic diet, and he made this great point. “Throughout human history, water has also been scarce.” But you don’t see people seeing a faucet, and turning it on, and just sitting there for hours just guzzling, guzzling water. We drink when we’re thirsty and we don’t drink when we’re not thirsty, and now we’ve got some mix up signals with that, but that’s just generally, you rarely see someone be able to have the capacity to binge on water.

But with food, I mean, food throughout modern agriculture and food processing has been so designed to be addictive through the addition of sugar, and then, just copious quantities of salt, just all of this, refined and processed fats and just made to be super addictive. So, people think that, it’s this instinct and yes, it is. For many years, our whole job was to hunt and gather, and as a species, but we’re not binging on water. It’s not happening. So, the food that we eat today is nothing like the food that we ate through our human history. So, they’re saying, “You need to have all of snacks, and all of this garbage, and all of this processed stuff to help we get through the day,” and none of it really makes any sense. It’s all designed to be highly addictive, have this really strong or chemical results, or impact that makes us just want to see it every time we have it.

Now, 10 years, reversed my type 2 diabetes. There’s still I’m having a bad day. You walk by that bakery and you can smell or you can see something, and I just have to take a deep breath, and be like, “Megan, that doesn’t serve you.” But that’s just that whole neurochemical response of knowing I’m going to get that dopamine happy hit that’s going to make me feel better in the short-term and not binging on water. So, the food industry, the whole system is just so out of sync. What we’re doing now is new. It’s not what we’ve done throughout human history is eat all these times throughout the day. I always tell people like, “You want to reduce obesity rates by about 50%, or diabetes, just cut out snacking. Absolutely just cut it out.”

All of a sudden, we’re going to see huge reductions in cardiovascular disease, and diabetes, and infertility, and thyroid disorders, and autoimmune disease. We just need to stop eating as much. You pointed out, sort of the freedom that you have and I’m in the middle of moving again, and oh, launching stuff for January, and getting programs all sorted out, and so busy, and I feel so liberated that, “Oh, I don’t have to force myself to cook and make all of these meals or experience guilt for not being able to. I can go about my day do what I need to do. When my day is over, make a meal and not be rushed or pressured. I can make the food that I want to have and have a proper meal at that time.” So, it just gives you so much freedom, too.

Cynthia: Well, that’s a really important distinction that people come from this place of lack and so many ways are so focused on what they’re going to “miss” as opposed to what they gain. I feel in many, many ways, the one thing that women will consistently say is that, all of a sudden, their focus isn’t on food and their next meal. Their focus is connection, or being productive, or efficient. And much to your point about the changes that have happened in the last 50 years, which let’s be really clear. I was privy to see Vinnie Tortorich’s upcoming documentary preemptively, because we did a podcast together recently, and he had a photo from the 1970s. And then, he had a photo from the 1990s, and it’s actually late 1960s, but it was looking at the first Woodstock versus the 1990s version. You can’t imagine how different the bodies looked. 1960s looked neat and healthy, 1990s looked completely the opposite. So, you think about the trajectory of the things that have changed and whether it’s been high fructose corn syrup or the addition of seed oils. But these highly processed, hyperpalatable foods that are essentially eroding all of our health.

For many people, they assume when they go to the grocery store everything is healthy. They assume that if it’s in a box, a bag, or a can then it had to have met some type of nutritional guidelines to be able to be processed, and it couldn’t be farther from the truth. So, I think it really starts with understanding it all starts with food and nutrition, and what we choose to put in our bodies. And I love that you make the point of saying like, “If we just stopped snacking, that could be the first step to embracing metabolic health,” because our bodies never get an opportunity to use up the fuel. It’s almost as if we think about our bodies as a car, we’re not waiting till the gas tank gets low or 90% full tank and we’re filling it up again and it’s just falling out of the gas tank over the side of the car, but we don’t even see it as being a problem. We don’t see the inflammation.

We’re not recognizing the signs that we’re seeing where we don’t even associate hunger with eating. We’ve gotten so uncomfortable feeling hungry and I remind my kids like, “Being hungry is a good thing. It’s a privilege, it’s a good thing that we get hungry,” because it’s a sign that our body is getting closer to needing more food, but it doesn’t mean we have to eat immediately or what I do find is a lot of people are so accustomed to eating so frequently that there’s a whole this whole emotional component, psychological component to eating less often that for them, it can be very triggering on many levels. I’m sure you probably see that with your own patients.

Megan: Yeah, we see that all the time that people just don’t know anymore, and their hormones are so screwed up. The more body fat you store and the more body fat you have, the more you’re at risk for developing something called leptin resistance, where your body just doesn’t recognize that you are satiated. Your brain is not experiencing, so, in our hypothalamus is where we primarily have these leptin receptors. So, when we eat our body produces this hormone, this protein signaling hormone called leptin. Its job is to cross into the blood-brain barrier until the hypothalamus engage with leptin receptors, which then tells our body, “Hey, you’re full. You’ve got enough stored fuel. ” So, it’s like, checking your bank account balance. It’s like, “Oh, this is good.”

So, when you’ve got enough stored fuel, your body turns off your appetite because it means you have money to do fun metabolic things like, exercise or pregnancy, these things like renovating your kitchen if you got a big enough balance in your bank account, you’re like, “Oh, okay, I can stop saving.” Now, I’ve saved the x number of thousands of dollars that is going need to buy all new kitchen appliances. But what happens is eventually, the lessons I’m able to engage with those leptin receptors or we’re still trying to understand why and there’s different philosophies. Even just the fact that more fat produces more inflammation, and that inflammation produces C-reactive protein, and the C-reactive protein binds the leptin even preventing it from going into the brain. So, when our brain thinks that we’re low in leptin, because it’s not engaging with any, it’s going to cause our appetite to go up. And also, we know that it actually affects our tastebuds. So, when leptins levels are low, we are craving for sweet foods as well.

So, hormonally, as we gain weight, we don’t even know and our bodies are almost tricked into thinking that if we need to eat, right? Your leptin is not able– You’ve got this leptin resistance, you are not able to engage with your own leptin, so you’re just chronically hungry all of the time. This is where strategies like fasting, and lower carb diets, and even just like not snacking, not eating before bed have a huge impact at reregulating your appetite. One of the most rewarding things is, you always meet a patient and someone new to fasting and you tell them, “Okay, this is what you’re going to do and we’re going to start working on this in terms of your diet.” They look at you like a deer in the headlights like, “There’s no way.” They haven’t gone more than like two hours of not eating while they’re awake for the last 10 years. But as soon as you do it, it has such a profound impact that suddenly people are offering you food but you can’t eat it. Or, you’re no longer attracted to that particular food.

I remember the first time I tried dark chocolate, I thought it tasted like dirt. Now, I find like 100% dark chocolate actually being pretty sweet and certain non-starchy vegetables I can even taste the sweetness of them now, 10 years ago, Megan would have just thought that I was crazy. So, at a certain point, our bodies are so out of control. We never really know if we’re hungry, if we’re satiated, what’s really going on, it’s a hot mess. Like this whole modern industrialization of agriculture and processed and refined foods, it’s just been such a disaster. I really harp on snacking, because so many snack foods are processed and refined sugars, processed and refined fats. So, they’re just loaded with seed oils and high fructose corn syrup. There are healthier options. Sure, but you’re going to get a lot of that garbage in most of the snack foods that are out there.

Cynthia: Well, I agree with you. I think leptin resistance is poorly understood and I remind people that oftentimes that goes along with insulin resistance. So, insulin is up, you’re going to struggle to lose weight. If leptin is dysregulated, you’re going to struggle to lose weight. Another hormone that I really think about in the context of the pandemic is cortisol. The amount of people who’ve just been stressed at home, stressed eating and cortisol is up, you’re not going to make good food choices. More often than not, I’m seeing stressed women making poor food choices, not feeling satiated. If you’re not satiated, you’re going to continue to eat, you’re probably going to crave hyperpalatable sugary foods, which are going to further drive up that insulin and exacerbate the leptin resistance. So, it becomes this very circuitous conversation and understanding that all these hormones, it really is a hormone issue.

Anytime, anyone struggling to lose weight, I remind them please stop counting calories. I’m not suggesting in any way that you need to be conscientious. However, it’s a hormonal imbalance that drives one’s decision-making process and it can be so sophisticated that it can override all these other mechanisms in our bodies that are designed to let us know, “You are full, stop eating.” They all just regulate this. More often than not, when I start talking about the hormone piece, I think people are reassured because they’ve been shamed for so long that there’s something intrinsically wrong with them, because they don’t, or they’re incapable, or struggling to limit what they’re eating or to not overeat certain foods.

I always remind them like, the binge-worthy foods are designed to be that way. They’re designed to override every mechanism in our bodies and it is not a willpower issue. It’s really as you mentioned this is neither a chemical nor endocrine issue in their bodies, that they’re this bliss point. There’s a great book called Salt Sugar Fat, and I always use this as a reference point. It’s disgusting when you think about the processed food industry is that they design testing, so they bring in children, adults, and they try out like, “Where’s the bliss point, where is the most sugar in this item?” I’m using that as a good example, or the highest fat content that people can’t stop eating it. And that’s how they develop these products. They design them to be as addictive and seductive as possible.

Megan: It kind of makes me laugh a little bit. So, a couple of years ago, I was at this conference talking about healthcare solutions, and there’s this one massive dessert manufacturer, popular all throughout North America. They were there because they were experiencing an EHR crisis. They could no longer afford their insurance premiums for their employees. Diabetes, cardiovascular disease, all of it was running rampant, and they just cannot afford their health insurance premiums. So, they were looking for out-of-the-box solutions and I was chatting with them a bit, and I found out that they do mandatory taste testing of their dessert products [laughs] with their employees. “Just stop that, like, just stop that.”

But they’re causing their own gamut of problems there. But it’s really just that we’re so backwards in the mentality here and to go to your point, there’s so much fearmongering when it comes to fasting, and just none of it is really unfounded. I feel especially bad for women in particular. I don’t know men are under a lot of stress but we’ve got women right now that in COVID, so many of them sacrifice their careers or they’re trying to work from home and also do homeschooling. It’s just absolutely mind blowing the amount of stress that has happened, and they’re already pre-pandemic have been blamed for their weight, lack of willpower, lack of effort, not being strict enough, not doing well enough.

I mean, when you think about it, they’ve only ever done calorie restriction diets, whether it’s packed with smoothies, shakes, soups, fish, whatever it is, is like different types of toilet paper, it’s still toilet paper and might be Costco brand versus a grocery store brand, but it’s still toilet paper. So, there’s all these diets we’ve tried, but they’ve all been founded on calories in, calories out, calorie reduction as a primary. So, women have been doing the same thing over and over again expecting different results. We know that’s the definition of insanity. But this is what their doctors are telling them to do. This is what society or governments here in Canada and the US are telling them to do. It’s not working. It’s getting worse. And then we have got clobbered by this COVID pandemic and the stress and it’s just further adding fuel to the fire. Women are blaming themselves now more than ever for where their health is at. I hear it every single day.

I think we’re so used to medicine just to be isolating everything like I think we’ve gone down this extreme specialization pitfall in Western medicine, where you’ll go to like, “I’ll be quite blunt, my background is in nephrology, kidneys.” So, you go there, and we look at your kidneys, and your blood pressure a bit because they’re controlled by our kidneys. You got a cardiac issue, you get a cramp somewhere, that’s not our problem, like, “Go somewhere else.” And then, you go to your cardiologist, and you’re having flank pain, that’s not their issue. You can go to somebody else. Everybody is so isolated. So, I think society has this pre-conception now that like, everything is so isolated. So, their stress has nothing to do with their weight gain, their stress has nothing to do with their blood sugar levels. But we need to remember that the body is a whole system. If there’s one hormonal imbalance, it’s likely to trigger others. So, like you mentioned, the stress triggering high glucose, which triggers high insulin, which triggers high appetite hormone, which decreases satiation signaling, like, it is all one big system.

I saw this meme on Instagram. I don’t even know that stress really undoes all of our great efforts with our diet. The last two years and I think we’re going into another year of weirdness with this COVID pandemic and we spend so much time trying to educate people that, “No, it is a whole encompassing system and we’ve got to work on all of it because it all works together, either very harmoniously or it’s just going to cause chaos amongst the whole system together.”

Cynthia: I couldn’t agree more. My background is ER Medicine in cardiology, and we very much in cardiology would decide you’re in a cardiology bucket or no, I got to send you back to your primary, I’ve to send you to another specialist. We really have to take ownership of the recognition that, if metabolic disease is really going to be met head on, we have to look at it globally as we all work together to make a society, a group of people, a group of patients healthier and the communication piece has to be better. I know that and this is not a criticism, because at the time, I didn’t recognize it any differently.

But I recognize that at some point in my career, I contributed to that problem. [crosstalk] there’re some patients back, you’ve got a thyroid problem, well, you’re not in myxedema coma and you’re not in thyroid storm. So, I technically in the hospital don’t have to deal with this. We would call it the [crosstalk] in which we do with their thyroid medications. But I think there needs to be more ownership and I agree with you that, the way the medicine is started going defaulting towards specialization is because quite frankly your physicians graduating from medical school that have such massive burdens from their student loan debt that they have to do specialization because they can’t afford even if they want to do primary care unless they’re independently wealthy. Someone gifted them a bunch of money or they end up in the military, at least here in the United States. So, I know a lot of my colleagues ended up in expensive specialties because they have a lot of student loan debt and burden.

But one of the things I really want to make sure we touch on is really digging into the women in fasting piece. Now, I seem to have quite a few women that have PCOS. So, for those that are listening, this is polycystic ovarian syndrome. And not every person with PCOS is obese. This is this common misnomer, there can be this thin phenotype, meaning, thinner women can also be insulin resistant. These are people that are typically struggling with fertility and they may not be able to conceive, they may have a luteal phase defect, maybe their progesterone levels are too low in the second half their menstrual cycle.

Let’s start there. Because we’ve had Nadia on, this is her area of expertise, let’s talk about the research that’s being done and the success that you and your staff have seen with women and PCOS. Because I think this is a great starting point because it does impact such young women. When you’re beyond the age, you want to have children, it’s probably less of an issue, but it’s still speaking of insulin resistance. So, fasting can be particularly helpful with this disorder.

Megan: Yeah, absolutely. I was actually 14 and I was diagnosed with PCOS, and I was stick thin. My BMI was 17. So, I was classified as sort of that just borderline underweight. I remember I was at the Hospital for Sick Children in Toronto, which is like one of the best pediatric hospitals in the world. And I just remember the specialist looking at my appearance, and I was having a lot of like little cyst rupture and abdominal pain because of it, or pelvic pain. As they said, “It doesn’t make any sense.” She’ll grow out of it. She’s so skinny and luckily, she didn’t get your genes, so it’s their attitude. Hopefully, she stays that way. I never grew out of it. In hindsight, I actually did do quite a lot of fasting. I didn’t eat very well and that’s why I had PCOS in the first place. But I did do a lot of fasting. It didn’t better, it didn’t get worse very much throughout my lifespan.

But the whole point is that, like, insulin in general promotes growth. Growth, when you’re younger is the appropriate amount of growth directed at the right things is good. You want to grow to be a healthy height and have muscle mass that supports your joints and your organs. But then, there’s a thing such as too much growth that can occur. So, too much insulin can result in this unwanted growth. No, eventually, once we have a good amount of muscle mass and we’re good size, we really as humans don’t want to be experiencing any extra growth unless it’s in the time of pregnancy. That is sort of the one acceptable time of growth in adult life if you are growing life within your body. So, having this excess insulin, it can lead to growths like cysts, multiple cysts on your ovaries, which then can disrupt your ovaries produce a lot of your sex hormones, and they can disrupt how much or when and all of your sex hormones pretty much, and it can lead to conditions like infertility, it can lead to obesity, it can lead to unwanted things like facial hair and thyroid disorder. So, it can happen and it doesn’t need to be a disease of obesity necessarily. It is a disease of excess insulin. It’s also important to really understand obesity.

In general, I’ve noted that I was young and I was classified as underweight, but it’s not really about weight. It’s about body composition. In hindsight, I was a little sack of fat. I sure, I didn’t weigh very much, but I was a little sack of fat. I never had energy, I love playing sports, probably, because anytime I feel like, I broke something. I had brittle bones. So, well, the number on the scale didn’t say very much, the majority of what that came from was from fat. I didn’t have a lot of muscle, I didn’t have a lot of bones, and the scale just tells us the total amount of weight. It doesn’t tell us how much fat you have or how much fat you don’t. I am 120 pounds to date and I wear a size two. But I’ve been 97 pounds, and I’ve worn a size five. So, at 120 pounds, I have more muscle mass and I have less fat mass than I did at 97 pounds.

So, it’s really about a body composition. You mentioned Nadia, Nadia has been a stick her whole life, but she was what we call a TOFI, thin on the outside and fat on the inside. And what we see with a lot of these particular individuals too is, there’re different types of body fat, just very generally speaking. So, we’ve got visceral fat, which penetrates in our organs and around our organs. And then, we’ve got subcutaneous fat. Subcutaneous fat, it’s underneath the skin layering our belly, but above our cavity wall. So, our organs, glands, everything are protected by this cavity wall, this abdominal cavity we call it like a shield almost. A lot of subcutaneous fat will sit on top of that shield, but below the skin, when we look at that and when we see fat accumulated there, we know it’s probably not going to be healthy if we keep accumulating it and it is not necessarily one want to show off on a bathing suit on the beach. But it’s really that fat that hides in and around the organs, that’s causing a lot of complications. It’s preventing the organs and glands from interacting with each other, signaling each other properly, preventing them from functioning properly.

This summer, we lost a family member. She was 33 years old. She had kids. We’re not quite sure how because she’s super PCOS, but she had a six-year-old and a one-year-old, but she died from fatty liver disease. She was 5’8″ and 103 pounds soaking wet. Her whole life had been a total [unintelligible [00:34:52], but she was very fat on the inside. Her liver was extremely fat and it got to the point where it started to harden and prevent the liver from functioning properly. So, it’s actually these skinnier individuals with metabolic disease that are at this extreme risk for very serious complications, because the type of fat that they have is really causing a lot of metabolic damage, a lot of damage to the whole-body systems. So, in terms of the PCOS and women with PCOS, you don’t have to be overweight, yet PCOS can eventually lead to obesity if you’re not overweight, but it’s just a disease of too much insulin and that insulin causing excess growth, and that growth causing disease, and further hormonal chaos, and unwanted complications like infertility, for example.

Cynthia: Oh, I’m so sorry to hear about the loss of your family member. I think it just really redefines the need for people to understand the difference between subcutaneous versus visceral fat and how that can change the way that our organs in our body communicates with one another. Now, when we’re thinking about someone that doesn’t have PCOS, women that are getting a regular menstrual cycle, we’re assuming you’re ovulating, do you have any restrictions, recommendations around their type of fasting, because this is where I think I see the most fearmongering going on. Now, obviously, a very lean athletic woman like an athlete, which is a very small percentage of the population probably needs to have more food intake given her training than the average person.

So, this is always the place I come from that the average woman is not an athlete, and is not heading to the Olympics. I think that’s a very different subset to the population. But the average woman who’s still getting a menstrual cycle, still in her fertile years, I would imagine much like I do, I have no problems. In fact, I think, in many ways can keep their hormones better balanced, it can allow them to have more metabolic flexibility, being able to switch between using fat as a fuel source and carbohydrates as a fuel source. Where’s your starting point or how do you start the conversation with your female patients that fall into that age range?

Megan: Yeah, so, if someone was healthy and just looking to optimize their health and focus on longevity, unless they are in that very, very small category of high-performance athletes with extremely little amount of body fat. I mean, we can absolutely fast them to keep their immunity up for anti-aging and disease prevention. We know that fasting induces autophagy at a very efficient rate, autophagy is a great cellular recycling, physiological phenomenon, it can be induced by very intense exercise through very low carb diets like ketogenic diets. But it’s turned on or fasting activates autophagy in a very significant powerful way and in a short period of time without a whole bunch of work for the individual to perform. You’re literally just not doing anything when you’re fasting in that sense and you’re getting all of those benefits.

So, when you’re in autophagy, your body gets this process going where it’s able to identify damaged, broken, or old proteins and take them apart and put together new and healthy ones from its parts. This is so great for disease prevention and just sort of maintaining good overall health. People ask me all the time, “Why do you still fast?” So, COVID has been unique, but before that we’d travel, go on vacations, speaking at conferences, my circadian rhythm never knew where I was coming or going, we enjoyed eating out at restaurants when we could find something good, but you never know. You could be eating grass-fed steak but it’s cooked on a grill doused in vegetable oils. So, there’s always these inflammatory things popping up. So, for a healthy woman that’s like me talking about these sources of inflammation, these other hormonal disruptors like traveling, traveling the world is wonderful, but it does throw off your system quite a bit. Or, you’ve got these periods of time in the year like Christmas, where there’s just more indulgence or a vacation.

I went to Hawaii this summer and there was definitely eating a little bit more fructose than I normally would because there were things I’d never really seen before. And then, just eating a little bit more and days of lot of activity and not a whole lot of activity, so, fasting and just for that hormonal reset. And with a healthy woman, you only talk about doing something like 24 hours a few times a week or even on a daily basis, especially, Monday through Friday for those who are still working being a perfectly safe hands of great way to maintain your good health and continue to fight any sort of these micro instances of inflammation or hormonal disruption that you might have in your system.

And then, we typically too discuss the benefits of occasionally doing an extended fast anywhere from one to three or four times a year just for immune boosting, and just sort of a bigger hormonal cleaning, or bigger cellular cleaning. So, I, myself around our home, we do seasonal cleaning. So, while I’m doing my seasonal cleaning in the house, I’ll do seasonal cleaning in my body. So, I’ll have plenty of work to do around the house to keep me distracted, to keep me active, and I’ll do an extended fast during that time, and it just helps tidy up all of these things in my system.

Cynthia: Well, I love that you have such a kind of proactive stance, and certainly, one that’s very aligned with me, and talking about those sources of inflammation. So, even for young, healthy cycling women, being mindful of the quality of your food, being mindful of your sleep patterns, you’ve mentioned the travel piece, and we just started to get back to traveling. When I say traveling, traveling outside the US in September, we went to Africa.

Megan: oh, wow.

Cynthia: So, it was one of those things where it was very easy for me to jump ahead six, seven hours. It’s always more brutal coming back the opposite direction, but I always use it as an opportunity to fast longer, because 99.9% of the time, I can’t find anything decent an airport and the running joke is, I carry meat sticks and salted macadamia nuts in pre-portion bags in case I need something, but otherwise, I just fast longer. Also, really the importance of giving yourself grace and the recognition that sometimes, our busy lifestyles, we have to adjust and I love that you incorporate spring cleaning in your house and giving yourself a longer fast, which is always a great thing to do. And especially, given the fact we’re still in this evolving pandemic situation, for many people, one of the things that isn’t spoken about on social media much at all is the role of metabolic health and susceptibility to long-term outcomes related to the pandemic.

Certainly, something I always say, this is what we need to be focused on is talking to people about eating less often, trying to fast for a period of time, choosing less inflammatory foods. Now, do you find that your menopausal patients have an easier time with fasting? That has certainly been my experience I think for many of them that have really struggled and said, since I hit 42, everything I used to work no longer works, and now, all of a sudden at 54 they’ve been in menopause for a couple of years, they happen to lose the weight and all of a sudden it starts dropping effortlessly even if they do nothing other than just cut out snacking. I’m sure you probably are seeing the same circumstances with your women as well.

One last thing that I want to tie into that is, for a lot of women that are really symptomatic in perimenopause, the 5 to 10 years preceding menopause, in the menopause with hot flashes, lot of vasomotor symptoms, there’s a lot of good research really related to insulin resistance, being prediabetic. So, I remind women to really be mindful like, know what your fasting insulin levels are, be really mindful and attentive to those, and certainly fasting can be at many levels a gateway to garnishing or embracing metabolic health at a level that perhaps you were less familiar to that before.

Megan: Yeah. Fasting is such a gift to women of all ages, but definitely not postmenopausal group like you’re saying. I tend to find it a little bit just more stable across whereas a menstruating woman, we have these two cycles that define us every month. So, the first phase of our cycle estrogen is dominant and estrogen makes us feel good, it suppresses our appetite, it gives us energy, it makes us feel sexy, like all these wonderful things. So, we joke with the ladies that are menstruating for the first two weeks of your cycle you’re like a unicorn like [laughs] nothing can touch you, you are fabulous, and you can fast like a machine, and you feel so good.

And then in the second half of your cycle, this luteal phase of our cycle, estrogen levels go way down. And then, progesterone and testosterone become more dominant, especially, progesterone. They are appetite stimulating hormones. They tend to maybe not make us feel as sexy or as delightful. It might make us a little bit more moody, and irritable, and sad, and even second guessing ourselves. So, we’re emotionally, a little bit less than secure and then we’re just hungry all of the time. There’re so many younger women that are just wanting to rip up their hair, “What’s wrong with me, why am I broken?” And we don’t really understand. So, we spent a lot of time with women in that particular age group educating them, those first couple of weeks of your cycle, this is when we can go hard with the longer intermittent fast. So, this is when we’re going to experiment with some extended fasting in the second half of your cycle. This is what you expect. So, it’s not your fault.

Women are so told, “It’s your fault, it’s your fault, it’s your fault.” It is not your fault. These are hormones. Because during this part of your cycle, your body wants to be producing progesterone. So, it can grow life. So, it can attach that fertilized egg to your uterine lining and start the whole process of conceiving a baby. So, this is supposed to happen, like, this is a really good and exciting thing. So, we try to explain the whole evolutionary perspective to them. So, this is what you can focus on in terms of fasting or time restricted eating, or even sometimes, that week four of the cycle we’ll just focus on fat fasting and poor quality more so than any type of other fasting structure. Whereas sort of postmenopausal, you don’t necessarily have these ebbs and flows of these very hormones. It’s easier to stick with more of a consistent fasting plan. It’s not always just trying to plan everything around a monthly cycle. So, it works out pretty well.

We see so many women that are going through that transition with menopause, and they’re saying, “I’m not having hot flashes anymore. My body temperature is nice and stable. I’m feeling good all of the time. I’m losing weight, too.” I don’t think many women realize that. We have different types of estrogen in our body. You got estradiol and that’s what makes us feel sexy, and lovely, and delightful, and suppresses our appetite. But as we get older and we accumulate body fat, our body fat actually produces the evil estrogen, estrone. And that, unlike the wonderful best friend, estradiol, estrone like I say [laughs] [unintelligible [00:46:51] can lead to unwanted cancers but it also has a lot of all kinds of unwanted side effects, too, and that’s our fat cells are producing that which can cause a lot of unwanted symptoms, especially, as we’re going through transition in life.

But when you lose body fat, you’re actually lowering the amount of “evil estrogen” that is being produced. So, you’re even further feeling good, and feeling optimistic, and feeling like you’re young, sexy self again, and so many women say, “Hey, I’m 60 and I feel better than I did when I was 30 and such a different outlook on life.” So, fasting, especially as you get older at any age, there’re so many benefits. I think it gets easier as you get older too, because of the lack of flows with your menstrual cycle, and it’s just efficient, it’s consistent if you fast, you’re going to lose weight, and you’re going to feel great, and there’re so many great hormonal benefits of doing it.

Cynthia: Yeah, no, I think you just did such a beautiful job and the acknowledgement that the first half of the menstrual cycle from the day we bleed until right before ovulation when estrogen predominates. And you’re right. Women do feel good. This is when they can generally push their workouts, they have more energy, and then we’re simplifying it. But the latter part of the menstrual cycle, when progesterone predominates and this is oftentimes, when I’ll tell women, the five to seven days preceding their cycle kind of back off on the stringent fasting, increase your consumption of good quality carbohydrates. Let’s not pig out fast on like pizza and ice cream. But whether it’s sweet potato, or squash, or some type of root vegetables, something that’s going to help nourish your body and the recognition that you can’t push your fasting, you’re going to be more hungry. It’s a byproduct of progesterone and decreased insulin sensitivity.

I mean your body is conditioned to want to consume a bit more macros and certainly that way. And I love tying in the types of estrogen and I talk a lot about the DUTCH hormone test, which I’m sure you probably are familiar with and I use it in several of my group programs, because it really allows women to determine where are they in their fertility or non-fertility years, how are they metabolizing their estrogen? We talk about estradiol is kind of a sexy, estrogen form, and then, estrone is the predominant form of estrogen our body makes unfortunately fat tissue as we get older. But looking at how our body breaks down and metabolizes, estrogen is so important to eat more, support with detoxification processes, how do we mentally– There’s so much there, I think it’s such a valuable test, are you using that in your groups as well?

Megan: We don’t use it in the group, but we’re a big proponent of it. So just some technical logistics about where we’re at, but it’s something we recommend. I mean it’s important, you can check your hormones via your blood, and you probably should. But our urine status of our hormone’s so important. I should have a DUTCH test that I need to do in my cabinet. I did one but my urine is too dilute, so I have to redo it. But I love it. It tells you sort of–I think going back to what we talked a little bit about stress is that, I think, we know that we’re in stress, we’re are also trying to simultaneously in denial about our stress, and seeing it on paper can really make you realize you’ve got to get a grip on it. So, it really gives you a great cortisol profile, which can give you a lot of insight into your thyroid function, and so many of us are out there with hypothyroidism, suboptimal hypothyroidism, reverse T3 hypothyroid, Hashimoto’s hypothyroid. So, it can give you an impact or some idea into how you’re stressing your thyroid and adrenal glands, how all of those are in sync. Testosterone, DHEA, all of these other sex hormones are so important to know.

Then, estrogen, just because with estrogen too, you want to make sure that you are metabolizing it because then builds off especially, the unwanted kind like the estrone, you got to make sure that you’re clearing it out. Not being able to clear it out efficiently, it can lead to a condition called estrogen dominance. And that can undo everything good that you’re also trying to do with your lifestyle, and cause weight gain in your abdomen, in your lower half of your body, and can promote insulin resistance and just perpetuate the whole metabolic disease gamble. So, really huge fan of like the DUTCH complete plus [laughs] it is the worthwhile test to do for sure.

Cynthia: I agree and make sure if someone is ordering this test for you that they’ve looked at hundreds of them because in 20 plus years of being in a clinical environment, I think it is probably a test that took me a bit of time. I take a class and I have reference points that hundreds of DUTCH’s before I felt really proficient. And inevitably, people will come to me with a DUTCH and I’ll say, “What did your healthcare practitioner tell you?” They don’t get a lot of information. So, I think it’s important, if you’re going to make the financial investment that you make sure the person that’s interpreting it has looked at a lot and feels comfortable with them.

One last topic I want to definitely touch on before we get to listener questions, and I want to be super mindful of your time, what is your methodology when you have patients [unintelligible [00:52:14] plateaus? It’s a source of frustration, and especially with women oftentimes even based on research, they may not lose weight as quickly as men. So, if a couple is doing intermittent fasting inevitably, the woman is frustrated, because the man loses 10 pounds in a month, and she’s lost one or two. So, the recognition that we can have plateaus, and we may not lose weight as quickly as our significant other, especially, if they’re male, what are some of the things you look at when women are dealing specifically with plateaus that are of concern to them?

Megan: Yeah. So, we spend a lot of time educating on the ebbs and flows of men versus females fasting journeys, and that men are more rapid at the start, females are much more slower at the start. And then, eventually, things sort of stabilize to more of a consistent rate for men and things pick up for a woman and then start to stabilize the same rate. So, in the six-month span, people are losing more or less the same amount of body fat. Now, for plateaus in women, there’re a few things that we recognize here. We have something called fasting training wheels, where people will have a fatty tea or fatty coffee. This is just plain green tea, but they’ll add in some of that heavy whipping cream for example. And they’ll hear someone like myself or Jason say, “It’s okay.” But it’s okay like a crutch, right? Like, if I sprained my ankle and I want to move across my house, it’s okay for me to use crutches. But if my ankle is not sprained and I use crutches, it’s just going to slow me down and be counterproductive towards my goal of trying to move over across the house to get something in an efficient manner.

But it’s part in our human instinct to see how far we can get away with things that we enjoy, like how much heavy cream can I have and still get results. There’s a problem with just the overindulgence of these “fasting fluids or fasting training wheels,” and that can be really problematic. I’ll get people to measure out how much fat are you putting into your tea or coffee. Sometimes, they’re like, “Wow, like half a cup.” I’m just like, “That’s a lot.” If you’re fasting for 24-hour period, initially, you’re still burning off your last meal. And then, if you’re having half a cup of fat, that’s now another six hours of fuel that you’re giving your body for you even tapping in or even starting to lower your insulin significantly to even tap into your own fat source. So, we find that there’s this comfort creep that we’re getting with these certain fasting training wheels.

And then, also, two things like heavy cream or dairy in general the source does matter and especially, going back to those conversation about estrogen, I mean, a lot of the heavy cream that you would just buy at your regular grocery store off the shelves, I mean, those cattle, the cows, they’re being doped up on hormones, many of them are pregnant while they’re still giving out milk and like that their hormones are even further exacerbated. So, when we’re having certain things like that dairy more regularly, we’ve got to be concerned about how that perhaps is impacting our hormonal health and any potential slowdowns there. So, in general, in an ideal world most people have really tried to minimize the dairy, or at least be aware a little bit more of the dairy source or switch to something. Like I’ll occasionally have some like raw goat milk now that I’m in California or sort of more sheep dairy or water buffalo dairy instead of this traditional cow dairy, where I run the risk of all those hormones, and pregnancies, and all this crazy stuff happening. So, that’s one thing really eliminating any potential triggers on the fasting days.

And then on the eating days, too, getting back to the idea of having meals, and for all the ladies out there, I don’t want you to roll your eyes at me when I say this. It is tough. I only have me. I have two dogs and I have a very competent, self-sufficient partner, my husband, who’s fully capable of making his own dinner and doing all of this, or even cooking for us all and cleaning up. But we’re both busy. Life is busy. Having that time to always prepare meals is really difficult. So, this is where fasting comes in. It gives you more time. So, when you have time to doing that meal prep and getting back to having regular meals, stop grazing. So often than not, I’ll ask women who have hit this plateau and I’ll say please write out a food diary, I always get the annoyance sense that they think we’re eating all these carbs, ah. It’s just no.

I think that you’re probably just eating cheese and nuts, because you can grab those easily. I don’t think you’re eating real meals at all. And sure enough, there’s maybe some portion of animal protein, which is great. But if it’s cheese and nuts, like that is the bulk because you don’t have time to prep things like vegetables or additional side dishes. Nuts you grab, you literally have to do nothing other than buy them, and grab them, and consume them. Whereas you have to chop up vegetables, wash them, cook them, clean the pans, I get it. It is busy. Nuts and cheese cannot be side dish one, side dish two of every meal that you have.

So, almost 90% of the time if I’m asking for a food diary is because I would bet good money that that’s going to be the result, and we’ve got to talk about, what is going to fit into, your whether it’s just taking some greens and throwing them into some duck fat and sauté, like what is going to be a suitable solution for you, so you’re not always filling up on nuts and cheese, and they see this all the time with women. So, it will be to do a trial period trying to eliminate those foods and starting to focus on real structured notes again. So, cleaning up the fasting training meals, eliminating dairy, cutting out the snacks, and really making sure that you’re not always trying to fill up on nuts and berry.

Cynthia: Well, I’m laughing because nuts and cheese are like the two areas that I always say this is where people, well-meaning people can’t self-regulate the consumption of these. It’s very easy to overeat. Cheese’s delicious, nuts are delicious. Unless you can portion out and walk away, it’s best not to have it. I actually stopped eating dairy three years ago because it just wasn’t working well for me. I remember, there was a whole withdrawal period. I mean I’m a pretty healthy eater, no gluten, no grains but getting rid of dairy was challenging. But once I did, I came to find out that I definitely, even though, I wasn’t eating it very often, it was very difficult to self-moderate. So, that’s super helpful. I know all those tips are going to be helpful.

A couple of questions. I have several women that when they break their fast, they get diarrhea. We have troubleshooted in 20 different directions. All of my ideas have worked except for one woman who continues and it doesn’t matter, I’m like, break your fast with bone broth. Break your fast with something like– no matter what she consumes, she has significant diarrhea. So, curious to know what your suggestions or what have been some of the things that have worked well for your ladies in particular.

Megan: Yeah, absolutely. The biggest triggers we found have been eggs and nuts. Those induce the most loose stools and the most nausea. So, cutting that out, some people really struggle with meats and so stick to poultry and fish. If they’re more carnivore or very more sort of beef centric carnivore, this would be more of a time to grind your beef. Even if you do it yourself at home because you’re nervous about bacteria and don’t want to buy it pre-ground or if you have a butcher you trust, and you go there and watch them grind it, but that can help because it’s partially digesting it for you. But remember, your tummy’s been asleep for a little bit so to speak when you’re fasting and you eat if it’s difficult to digest, it’s going to be like punching it in the face to wake up. So, a big hardy steak might be like a big punch in the face whereas something like a little bit of poultry is just more of a gentler way to wake things up.

We’ve found bone broth. It is not very greasy, then that can sometimes be really helpful. But if it is more on the greasy side that can trigger some discomfort. Tomato, cucumber salad with olive oil, a little bit of balsamic vinegar, and some chopped fresh parsley, parsley really helps bulk up the stool. The vinegar and the olive oil help gently nudge that digestive track awake, and the tomato and cucumber really easy to get going or get your system going. They’re very gentle on your system and you’re not going to have this crazy high glycemic response to them, especially, with the fat and the vinegar is going to help blunt that source or that sugar potential increase. And then, having some chia seeds or psyllium husk in water about 30 to 60 minutes before you break your fast, just adding in some of that fiber is going to help you sort of absorb some of the water that’s in your gut and help sort of bulk up some of the stools. So, that can be helpful.

Every now and then, all of those things fail terribly. So, we found that some people do respond very well to probiotics, making that be the first thing that they put in their guts. Some of our community has said, it’s just been the biggest savior. So, having some very full fat yogurt, like grass-fed yogurt with a little bit of chia seeds and some cinnamon back in help or if they’re more on the dairy free side of things like coconut cafe or coconut yogurt, that can also help. Every now and then, still, we have someone with Hashimoto thyroiditis or suddenly hyperactive thyroid which can happen often. So, if someone is hypothyroid and they’re on medication, as they fast, they’re going to do cellular [unintelligible [01:02:36] and get better, they might experience symptoms of hyperthyroidism.

A common symptom of hyperthyroidism is overactive battle. Sometimes to us, if nothing else is working, and this is a recurrent issue, and we’ll get them to start checking their body temperature, and start to see if there’s other symptoms there, hyperthyroidism, get them to check their thyroid function, and then of course take that along with their symptoms with their doctor and perhaps start to reduce their medication. Because we see medication for many instances having to be reduced. For me, I went from two thyroid medications to one to like a 10th of the dosage or what I used to take of the one. So, it can get better to a certain extent for these individuals. And then, sometimes too, selenium. What I found in women with Hashimoto’s thyroiditis, it might not necessarily be that they’re having like a bit of a hyperswing, but there’s more of a selenium deficiency, and that seems to regulate the digestive tract, active as dormant period or time of not needing.

When we go from having these variabilities in our food intake that can either cause our digestive system to move rather quickly and we find this to be more triggered in that Hashimoto’s thyroiditis population and selenium seems to help balance that out. We’ve done micronutrient testing and then there always seems to be some deficiency in women that are experiencing these chronic loose stools and the selenium does help it quite a bit.

Cynthia: That really makes a lot of sense because it’s a co-factor for thyroid production that really helps.

Megan: Oh, yeah.

Cynthia: Two other questions, and then, we’re going to call it a day because I want to be respectful of your time. It’s interesting, I have a group program that we do intermittent fasting, but it’s a small group, and we also do the DUTCH, and we do the GI map, and so we do diagnostic testing and this past time, when I was detoxing, some of these people who clearly based on their lab results needed support before we did anything else. I had several women, some are perimenopausal, some are menopausal that got joint pain. Like, they didn’t have before. So, I have an idea. I think it might have been related to the detox itself, but are you seeing that with your female clients as well?

Megan: Yeah. Like toxins in our environment are such a huge issue. I have crazy issues with it in Toronto myself and it was just terrible because I come out of the space and being nearly dead from metabolic disease, the thriving just to be thrown back in that position of nearly feeling dead, again. So, our environments are so important to us, and the products that we use, and the quality of foods that we put in our body because it can really kill you. It’s quite terrifying, I mean, environmental toxins but we do generally see some detoxing in general. They can come in the form of loose stools. We detox primarily through breast milk. Not all of us are breastfeeding. So, then, through sweat, and then through stools. So, we’ll see women with increased perspiration, and they’re not really understanding why when they’re fasting, and we’ll see the loose stools, we’ll see joint pain, especially, flank pain.

When someone is new to fasting, I find that, that tends to be a very common origin of where patients experience bizarre headaches that don’t seem to be tied to hydration and sodium magnesium levels. So, detoxing is fairly common. We’d usually encourage people to write it out if they can. I know a couple of our team members will encourage some activated charcoal. It’s not necessarily a binder, but it does help like a binder in terms of getting some of the toxins out and minimizing symptoms and side effects.

Cynthia: Well, this has just been an invaluable conversation. It’s always a pleasure to connect with you. How can listeners find you on social media all the valuable work that you’re doing as well as find your podcast? You and Nadia have started up a new podcast. I was listening to that earlier today.

Megan: Yeah, that was at a whim.

[laughter]

Megan: It’s called The Fasting Method Podcast, Cynthia. We definitely need to connect because we need more female practitioners talking, and sharing, and debunking these myths together. We’d love to hear about your new book, too. So, The Fasting Method Podcast, since, wherever you find podcasts, we’ve got a great team supporting us on that. And then, all of our social platforms are @fastingmethods or my personal ones are @meganjramos, and our website is thefastingmethod.com.

Cynthia: Oh, awesome. Thank you as always for your time today. I love our conversations. We’ll have to have you back again.

Megan: Thanks, Cynthia. I appreciate and happy fasting everyone.

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