Ep. 263 AMA with Ben Azadi: How to Unlock Optimal Health

Today I am honored to connect with my good friend and multiple-time past guest, Ben Azadi!

Ben was most recently with me on Podcasts #149 and #101. He is a prolific social media star and a fasting and ketogenic dieting expert. He is known as “The Health Detective” because he investigates dysfunction and educates, not medicates, to return the body to normal function. Ben is the founder of Keto Kamp and the popular Keto Kamp podcast.

Today, Ben and I use an Ask Me Anything format and dive into listener questions. We talk about the nuances of macronutrients, fasting, and supplements. We discuss gut health and how changing your diet and intermittent fasting can help the body realign and be better balanced. We get into troubleshooting with fasting, including insomnia-related issues, and we also discuss the DUTCH test and how it can be beneficial in conjunction with other lab tests.

I love doing AMAs, and I hope you will enjoy listening to my conversation with Ben Azadi.

“When you’re doing everything right, and you are just not feeling well, you’ve got to think environmental toxicity.”

– Ben Azadi

IN THIS EPISODE YOU WILL LEARN:

• Serita asks how to keep her energy up while on a keto diet and fasting.
• Mary Julie wants to know what is happening inside her body when her ketones are 1.8, but her glucose is 115, 19 hours into a fast.
• How does losing sex hormones when approaching perimenopause and menopause make women less metabolically flexible?
• Why is it essential to stay hydrated and get enough good quality sleep every night?
• How circadian rhythm impacts our metabolic flexibility.
• How breathing exercises can help us get into the parasympathetic state.
• Janie would like to know how much protein her body can absorb at once and how much protein she should consume over a 24-hour period.
• Suzanne lives a clean lifestyle and wants to know if there is a way to shift the metabolism of estrogen away from the 4OH pathway. (She is referring to the DUTCH test.
• A listener asks how to use fasting to help with candida.
• Michaela was recently diagnosed with gallstones and has one blocked duct. She read that saturated fat is not good for her condition, so she wants to know what she can eat to stay on keto.
• Lena has been doing strict keto with OMAD for three months, but her GGT is very high. She asks if that could be due to fasting.
• Why we tend to experience insomnia while doing a ketogenic diet, and how to address chronic insomnia patterns.
• Mary Jo wants to know when to take my creatine supplement powder.
• Ben and I discuss the supplements we use.

Connect with Cynthia Thurlow

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Check out Cynthia’s website

Connect with Ben Azadi

On his website

On Instagram, Facebook, LinkedIn, YouTube, TikTok

The Keto Kamp Podcast

Ben Azadi Speaker Reel

Episode 149 – Keto Flex, Feasting and Fasting: Bringing the Body Back to Normal 

Episode 101 Keto and Fasting the RIGHT Way with Ben Azadi

Books mentioned:

The Circadian Diabetes Code by Dr. Satchin Panda

Wheat Belly by William Davis

Super Gut by William Davis

Breath by James Nestor

Transcript

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today, I had the honor of connecting with my good friend and past guest multiple times, most recently on Podcast 149 and also 101 my dear friend, Ben Azadi. He is the prolific social media star and both a fasting and ketogenic diet expert. He is known as The Health Detective because he investigates dysfunction and he educates not medicates, to bring the body back to normal function. He is the founder of Keto Kamp, as well as a very popular podcast. And today, we used a different format. We did an Ask Me Anything where Ben and I dove into listener questions. We had so much fun talking about the nuances of macronutrients, fasting, and supplements. As well as the role of gut health, and how changing your diet and intermittent fasting can be instrumental in realigning the body’s intrinsic desire to be better balanced. We spoke about troubleshooting with fasting, including insomnia-related issues and we also spoke at great length about one of our favorite tests, the DUTCH. And specifically, to this estrogen metabolism, and how this test can be incredibly beneficial in conjunction with other lab testing for yourself and your loved ones. I hope you will enjoy this conversation as much as I did recording it. I’m loving these AMAs and I know you are too. 

Cynthia Thurlow: Welcome back to the podcast.

Ben Azadi: Cynthia, I love that we’re doing this today. We’re going to have some fun. 

Cynthia Thurlow: Absolutely. For listeners, I think many of you probably know this, but Ben and I are genuinely really good close friends inside the podcast and outside and so it’s always a pleasure to have our communities come together and foster question and answer session. I was just telling you before we started recording that I think this has really become a favorite thing to do, is to record with people that have been on the podcast multiple times. There’s so much synergy, there’s so much alignment and I think we’re agreeing to agree on this. We’ll have to dive into all these amazing questions that people submitted. 

Ben Azadi: Some great questions. We reviewed them beforehand. I love that we got these different dynamics with the questions. And, yeah, it’s a great day when we could emerge the Everyday Wellness Podcast and the Keto Kamp Podcast all in one session. So, let’s dive right in Cynthia.

Cynthia Thurlow: Exactly. So, we’re going to start with Serita. She asked how to keep your energy up. I’m on keto and fasting, but still tired after a month of ketosis. 

Ben Azadi: Yeah, this could happen. The body is still going through an adaptation period Serita, and for most people that adaptation period is about seven to fourteen days. For others, it could be a little bit longer, it sounds like you’re in the latter category. Serita, is actually a student in my academy. So, I would recommend to just keep working on that metabolic flexibility, keep incorporating those healthy fats, those saturated fats, monounsaturated fats, and then eventually pair it with intermittent fasting when your body’s ready. As you know Cynthia, the intermittent fasting part would be a great way to give your body some energy, because when you’re in a fasted state, the body wants to survive. It’s going to raise those counter regulatory hormones. So, you go out there and hunt and kill, but what can you do in the meantime until you get that switch. I would recommend a few things. This is where I would strategically use something like exogenous ketones. In general, I’m not a huge fan of exogenous ketones because people just like to drink them and not actually do the work. But Serita, you’re doing the work. So, just supplement with exogenous ketones, like the one from Kenetik or H.V.M.N are two of my go-to could just be a good way to flood the body, the blood, the brain with some ketones, and you might feel better. 

There’re also some things you can do with MCT oil, which is kind of an exogenous ketone, although it’s not. But a C8 caprylic acid is the one that’s most researched when it comes to energy production and ketone production. The cool thing about these medium chain fats is that there’s no bile required to break it down, no stomach enzymes. It goes right into the mitochondria for energy. I would just caveat this and say go very slow and low with MCT oil. A lot of people hear about the benefits and I’m sure you see this all the time, Cynthia. They will take two tablespoons and then they’re running to the bathroom like stomach distress disaster pants as Dave Asprey calls it. So, start with maybe one teaspoon and then if you feel good the next day, two teaspoons and work your way up to one to two tablespoons eventually. The last thing I’ll add here is L-carnitine. This could be a great time to add in L-carnitine. The way that I use it is, it’s kind of like a mechanism for shuttling some fat to your mitochondria, which also helps with ketone production. Then, of course, looking at the fundamentals, like sleep and stress, and all that good stuff, which I’m sure you’ll touch upon in a second. But those are my initial thoughts Serita, your body’s adapting, you might want to throw in those supplements to see if it does the trick short term until you fully achieve that metabolic flexibility. But Cynthia, what would you add to this conversation here? 

Cynthia Thurlow: Great responses. Ironically, some of the things you talked about, I was like, oh, L-carnitine in particular a definitely favorite supplement. Serita, I would say as you are transitioning to becoming more metabolically flexible, you know for some people it does take longer, sometimes it’s four to six weeks or even longer to be able to effectively utilize stored fats as a fuel source. I think about leaning into the lifestyle. Ben’s done a really nice job of identifying some things that you could do in terms of supplementation. I would make sure you’re getting high quality sleep. I would ensure you’re properly hydrated with electrolytes. I feel like so many individuals, when they go lower carb or even ketogenic, they don’t realize that electrolyte loss can actually contribute to what we sometimes call keto flu. It’s this loss of electrolytes that will actually mimic some of the fatigue, nausea, malaise, just not feeling great. High quality options like LMNT or Redmond’s are really nice ways to support your body. There are unflavored electrolytes for when you’re in a fasted state and you can use the other ones in your feeding window. I also think about where are you in your menstrual cycle? I don’t know your age. The threshold of the average age of menopause is 51. If you’re still in perimenopause or peak cycling years, understanding that there are going to be times in your menstrual cycle when it’s going to be easier to effectively utilize a low carb or a ketogenic diet and fast. 

Understanding from the day you start menstruating up until roughly around ovulation, that’s your superpower estrogen predominates and you certainly have more metabolic flexibility, and the ability to fast and go lower carbohydrate, push your workouts, etc., is optimized. And then kind of backing off on the fasting piece and adjusting your carbohydrate intake as you’re heading into the luteal phase when progesterone predominates. The other thing that I would think about is if you’re having significant fatigue and this is persistent, is to consider touching base with your internist or primary care provider to get some labs drawn, especially in women that are still in their peak fertile years. Iron loss, thyroid issues can all exacerbate these things and really looking at your sex hormones, I think that’s always the last recommendation. If you’re still having debilitating fatigue is really what else could be contributing to it. Certainly, touching base with your primary care provider if you find that it’s persistent. But as Ben said, a lot of times this is this acclimatization process where you are getting your body primed and ready to be able to effectively utilize carbohydrates and fats as a fuel source. That can be a little bumpy and rocky, but I know you’ve got great support, certainly with Ben’s program, and therefore, I think just giving yourself a little bit more time and then revisiting this if this persists with your doctor.

Ben Azadi: Yeah. That’s a great addition to the conversation. Let’s say Serita, you are doing all of these things. You got the electrolytes up, you’re taking L-carnitine, you’ve experimented with exogenous ketones, your sleep is pretty good, and you’re still not feeling well, then I do agree with Cynthia. It’s probably a good time to maybe get a full thyroid panel, maybe do something like a DUTCH test and maybe even explore, like, an environmental issue. It could be potentially I’m not saying it is, but we might want to explore this. It might be a mold situation where there’s black mold or some sort of mold in your environment, or even more of like a heavy metal toxicity issue. I’m not saying that’s what you need to focus on right now, but if you’re doing all the things right, and you’re still not getting to the point where you feel good, because you should really feel great with keto and fasting, then you might want to explore those other avenues. 

Cynthia Thurlow: That’s such a good point and it’s interesting because I did a podcast with Dr. Aaron Hartman last year and 25% of the population is more susceptible to mycotoxins and mold and that was something I didn’t actually realize. I happen to be one of those people.

Ben Azadi: Yeah.

Cynthia Thurlow: You can get cumulative mold exposure, and for some people they may never really persist with symptoms, but others can. It could be like, over time, cumulatively, that could be a problem. Definitely something to kind of think about in the future if your symptoms persist, but you bring up a great, great addition with the heavy metals and mold or mycotoxins. 

Ben Azadi: It’s always important to explore that. When you’re doing everything right and you’re just not feeling well, you got to think environmental toxicity. I know that it takes time and it takes money to do all that, but just focus one thing, check it off, and then get to the next thing. So, start with the low hanging fruit here, the salt, the electrolytes. I don’t know where you’re at with your menstrual cycle either, but fine tuning that, and then you could explore the other avenues and go upstream if you need to. 

Cynthia Thurlow: Absolutely. Mary Dooley submitted a question. What is going on inside my body when my ketones are 1.8, but my glucose is 115, 19 hours into a fast? 

Ben Azadi: Yes, Mary, this is a common question I see. So, a couple of things. Number one, your ketones are in a really good range at 1.8 and I know that you’re testing blood, so that’s going to be your finger prick millimole or so, 1.8 is terrific. It’s showing that your body is using fat for fuel. Now, the glucose is a little bit elevated, and my question would be this, is it trending up or is that glucose at 115 and trending back down? Because you said 19 hours into a fast, it’s at 115. But I’m curious to know, what was it 14 hours into a fast? 12 hours into it just was the trend going up? Was it staying at 115 or is it going down from a higher level? If you see the trend going up, because what we want to see during a fast is we want to see a gradual increase in ketones, which means your body’s burning fat, which is what you want to do and then you want to see a gradual decrease in your blood glucose.

If you’re seeing your ketones maybe staying the same or going up, the glucoses are going up too can mean a couple of things. Number one, it could be that you might have a really stressful day. It could be mental stress and glucose is following the cortisol and that might be what’s happening there. Number two, you could be going into gluconeogenesis and breaking down some protein maybe you’re not as metabolically flexible yet. So, you might want to just decrease the fasting window, and work more on getting more fat adapted and then bring back the fasting window. But I would need more specific numbers so I would recommend doing that test where you test right when you wake up in the morning and then maybe 3 hours into your fast, and then right before you break the fast and see where it’s trending and do it three days in a row to get an average.

I wouldn’t put too much value and too much emphasis on just one day. There are so many variables as Cynthia teaches us, hormones are fluctuating, different emotional stressors are going on. So, I would do three days in a row, get an average, but track it throughout the fast and see where it’s trending. If you do see it continuously trend up the glucose, then you might want to have a smaller fasting window, maybe clean up your stress and your sleep little bit, work a little bit more on fat adaptation and then give it another shot. That would be my recommendation. What about you, Cynthia? 

Cynthia Thurlow: Yeah. I totally agree with you. I would tell my own patients this, one metric does not give me the full clinical picture. And so, my first question would be getting a better representation of what your blood sugar is doing over the course of a day. Where are you in your menstrual cycle if you’re still menstruating? What other lifestyle variables could have contributed? So, did you go through a day where you had higher carbs and this is afterwards? Were you not as physically active, which we know we really have to think about our muscles as a glucose disposal unit. And so, understanding that that can play a role, physical activity is one of the biggest predictors of insulin sensitivity. Also thinking about stress management, we know when cortisol goes up, blood sugar goes up, insulin goes up as a counter regulatory response. And then the other piece of it is really looking collaboratively what other lifestyle factors could be impacting? Have you had high quality sleep? Are you getting seven to eight hours a night of sleep? What else is going on in your personal history? Are you going through a move, a divorce, other variables that can impact things?

Lastly, I would say that as I say to all women, we start losing insulin sensitivity as we are getting closer to perimenopause and menopause. As we are losing estrogen or estradiol, which is our predominant form of estrogen prior to going through menopause, we become less insulin sensitive. We’re also losing muscle mass and so it is not at all uncommon for people to start seeing this loss of insulin sensitivity, which in many ways we’ll see this blood sugar variability. But I’m not per se suggesting this is the case. I’m just giving you this kind of full clinical picture of what could be precipitating what’s going on. So, I see a lot of women who are doing a lot of really good things, and then they’re not realizing that as we’re losing some of these sex hormones, it makes us less metabolically flexible.

Just to really be thinking again, to recap, what stage of life are you in? What stage are you in your menstrual cycle if you’re still getting a menstrual cycle? Thinking about even a continuous glucose monitor, which would give you really a good snapshot if that’s within your budget, if you are insulin resistant, that’s generally covered by insurance. I’m really a huge fan of NutriSense. I love their app for interpreting data from a continuous glucose monitor. They use the FreeStyle Libre, which oftentimes you can have prescribed for you by your physician or a nurse practitioner, treating provider if you are indeed insulin resistant or diabetic. Again, as Ben mentioned and I completely agree with one or two measurements, don’t give us a full clinical picture, so we definitely would want to see more data. I’m a data nerd. I’d love to see more data to be able to provide additional guidance. But thus far, your ketones look great. I would say your blood sugar could be a couple of different things that are impacting. It doesn’t necessarily mean it’s something that’s negative. 

Ben Azadi: Yeah. You touched upon it with the sleep thing. It could just be that. It could be a sleep issue right now because we know, I mean, I recorded an Instagram reel that I’m going to post shortly about this. The study showed that in healthy adult men after just seven days of getting 5 hours of sleep or less, they had blood sugar levels of somebody who is prediabetic and you know 115 or whatever the marker was. What was it? 115. Yeah. That’s prediabetic blood markers, so it could be that. It’s not really the total amount of sleep, it’s the quality. If you’re not tracking how much deep and REM you’re getting, and you’re just saying, but I get 7 hours or 8 hours sleep per night, you might be kind of missing if you’re getting the quality sleep. So, that’s where like an Oura Ring or a Whoop band or whatever kind of a sleep tracker would give you those totals. I would say and I’m curious to hear your thoughts. I would say, in general, for most people, it’s a good idea to get about 90 minutes to 2 hours of deep and about the same thing, 2 hours or so of REM sleep and if you’re hitting that, then that should help with those blood sugar numbers. If you’re not, then I would work on that sleep component. Would you say, Cynthia, those are like good numbers to hit for REM. 

Cynthia Thurlow: I have a smirk on my face, Ben, because I get asked this question so often. I usually say 90 minutes of both at a minimum and for those watching both have Oura Rings on, and I’m the first person to say I’m not using the beta data. [ Ben laughs] There’s this new beta test and I’m like that’s messing up my deep and my REM sleep numbers. I’m just going to stay with the old school. But I think it’s very, very important to understand what impacts REM and deep sleep and understanding that one really is for the brain, one is for the body. But if you’re not getting 90 minutes whether it’s a Whoop band or an Oura, really working diligently. For me, I find that a lot of my women need to tap more into the parasympathetic, so more into the rest and repose side. We’re so sympathetic dominant, we’re go, go, go, go, we’re those big taskmasters and so for me connection with nature in the morning is very helpful for this.

I have a PEMF mat, which Mindy actually recommended and I completely love it. And everyone I talk to, I’m like, it’s one of my favorite things I do every day to honor my body. You don’t necessarily have to have a PEMF map, but finding things that slow you down are going to be very, very helpful for helping your body get into that parasympathetic, so that you’re going to get high quality sleep. One other thing that I find really can impact my sleep is hydration. I was just back from a trip and it was amazing to see. I can tell when I’m well hydrated because my HRV is better and my sleep scores are better. So, hydration is something that’s pretty benign that we don’t even think about. I just wanted to kind of add that into the sleep piece. If you have those metrics, if you can look at those metrics, they keep me honest. They really, really do. I think they do for a lot of us. 

Ben Azadi: Yeah, they do. Also like a data nerd like you Cynthia, so I like looking at that. It inspires me to want to improve those. It’s like a game that I play with myself. There’s one thing to put value on those numbers, but there’s also another thing to actually put value on your intuition and how you feel. So, I don’t want to let my Oura Ring tell me how I should feel today, but I also use it as a gauge and it’s a pretty good gauge. I like the Oura Ring, so I love that you mentioned the parasympathetic nervous system because that is so important, not just for women, but for men. People out there in this day and age, we’re just so sympathetic dominant. That PEMF mat is a great idea. I have two of them myself from HigherDOSE. That who you have them from too? 

Cynthia Thurlow: I do. The embarrassing thing is that my entire family now uses it. So, when I get on it, my dogs get on it with me. 

Ben Azadi: Yes.

Cynthia Thurlow: I found my husband asleep on it one night and he was like, “This is fantastic.” So, he gets on it every day. He does jujitsu sometimes in the evening, showers, comes home and then he takes a nap in the corner. It’s kind of funny. [Ben, laughs] 

Ben Azadi: I love it. Yeah. Same thing in my household every morning it’s part of my morning routine. First Natassia does it and she does meditation while she lays on it. And the cats love it, so they are actually there on the mat before she comes in here waiting for her to turn it on with the red light. And then I do it. I have my dog lay on it throughout the day as well. Now, that does cost money, but you could get similar benefits by grounding outside, just walking barefoot on grass or dirt. But I also love that you brought up the circadian rhythm part of this with the glucose. That’s very important, we don’t want to negate what Cynthia said there is undervalue what Cynthia said there because morning sunshine and just syncing your circadian rhythm is going to help with pretty much every area of health, especially the blood glucose. I know that what we don’t recommend is eating too close to bed. Having about at least three to 4 hours of fasting. Something that’s interesting, I’m reading a book from Dr. Satchin Panda, not The Circadian Code, but a more recent one called The Circadian Diabetes Code, which he’s making the case, and he’s making a pretty good case that most of these insulin-resistant diabetes cases are a result of a mismatch in their circadian rhythm. There’s a study in the book that was fascinating. It was done on mice, but mice have this what is it called, suprachiasmatic nucleus, it’s an internal clock in our brain. Mice have it, humans have it. In the study, they found that mice were in the habit in the labs of sleeping during the day, eating at night and following their natural circadian pattern, they had pretty good glucose levels. The only thing they changed in the study is they actually removed the, I always have trouble saying that word, suprachiasmatic nucleus from their brain. I know it sounds awful, but they survive and it distorted them. So, their internal clock distorted them where they were eating during the day and they developed diabetes as a result and that’s essentially what’s happening to us. We are having mismatches like us removing this part of our brain. We want to get back to our natural circadian rhythm and morning sunlight is a fantastic way to do that. 

Cynthia Thurlow: It’s really interesting. I haven’t read his newest book, but I’m super familiar with his research and I think it just provides further validation that we are designed to eat when it’s light outside, not eat before bedtime. It’s aligned with the way that we’ve thrived over thousands and thousands of years. But it’s only since the advent of light, and the processed food industry that all of a sudden people are doing exactly the opposite and in many ways to the detriment of our metabolic health. 

Ben Azadi: That’s so true. Especially, when you think about all these artificial lights that are everywhere and it serves the purpose. Like, thank God, we could light ourselves up in an indoor environment, but we want to do our best to get outside. Even I know what you’re thinking, those listening and watching, but Ben, you live in Miami, you got sun all the time. [Cynthia, laughs] That is true but even on an overcast day you could still get the benefits. Just take off your sunglasses and just get that morning sunshine. But you all not eat at least 3 hours before bed. Just doing that alone will make a big difference with your circadian rhythm. 

Cynthia Thurlow: Absolutely. It’s interesting because I was just 5 hours ahead so I was in London last week and one of the things that I was trying was different strategies going over and coming back to be able to address jet lag. So, I’m planning on doing an IG Live later today to actually talk about it. If not, it’ll be over the weekend. But I think for so many people it’s understanding that our body takes in so much information with these light and dark cues and how it impacts metabolic flexibility and insulin. It’s so, so important. I love that you brought up Satchin’s new book. I need to actually grab that. 

Ben Azadi: Yeah, it’s really good. I’m loving him, about halfway through. Have you interviewed him yet? 

Cynthia Thurlow: I have not.

Ben Azadi: Yeah, me neither.

Cynthia Thurlow: [crosstalk] mental radar.

Ben Azadi: Yeah, me too. When I’m done with the book, I’m going to reach out. Yeah, his work is fantastic. Real quick back to the HRV piece. The Oura Ring gives you that heart rate variability score, which is great to get your baseline and work on building that up. The drawbacks though of Oura Ring is that it doesn’t give your HRV throughout the day. They can’t because they use light technology, and if you’re moving, it’s hard to capture HRV, but when you’re sleeping, you’re put so it doesn’t give you a good score overnight. I don’t know if you knew this, Cynthia, but there’s a company out there called Hanu Health and they created a continuous heart rate variability monitor. I’m actually wearing one right now. 

Cynthia Thurlow: I need to hear more about this, Ben.

Ben Azadi: Yeah. It’s like a heart rate strap and on my phone, I could see exactly what my HRV is throughout the day, and it gives you different scores. That’s pretty cool to gauge how your nervous system is. One of the things that I’ve learned with that app and I interviewed the gentleman who owns it, Dr. Jay T. Wiles, is that you could significantly get into parasympathetic with some simple breathing exercise, like, in a minute. I interviewed him yesterday and we did a 60-second breathing session and I raised my HRV to133% in a minute by just breathing in. It was like breathing in for about 5 seconds and then exhaling slowly for about 4 seconds for a minute. That might actually help with glucose numbers. Just getting into that parasympathetic state and just breathing through your nostrils and get out of the habit of mouth breathing. 

Cynthia Thurlow: That’s really interesting. A lot of that is stimulating the vagus nerve and that’s always my cheat. Ben and I obviously do a lot of public speaking and sometimes I get excited before I’m doing a lot of public speaking. And so, my way of slowing my heart rate down and getting myself out of that fight or flight mode is to do rhythmic breathing. But I love that, I’ll have to connect with you separately because I may be interested interviewing this individual as well. It sounds very exciting. 

Ben Azadi: I think you’ll love it. Yeah. 

Cynthia Thurlow: Absolutely. Okay. Janie has asked. I’m always trying to get more protein within my fasting window. I try to have two protein-rich meals a day in an effort to reach the 100 grams per day goal, more on a really good day. My question is, how much protein can my body absorb at one time? I keep reading that the body can only absorb 30 grams of protein in any four-hour period or is it more important to have a certain amount of protein in a 24-hour period? Thank you. 

Ben Azadi: Yeah, it’s a great question. Cynthia, one of your close friends is Dr. Gabrielle Lyon, so I’ll let you take the question first, and then I’ll just add to whatever you share because I know you’ve done a lot of research on this topic. So, what is your answer? 

Cynthia Thurlow: Yeah, absolutely. It’s interesting. So, Janie, Gabrielle is indeed a good friend and I have had many conversations with her about this. It’s the amount of protein over a 24 hours period of time. I think many years ago, there was some faulty recommendations that the protein bolus your body could handle at any one time was 30 grams, we know that’s not the case. It’s over a 24-hour period of time, so don’t let that be a concern. I aim for no less than 50 to 60 grams per meal. I’m always aiming for-

Ben Azadi: Oh, wow!

Cynthia Thurlow: -100, 120, so I get some pretty large protein boluses and I’m not the least bit concerned because I can maintain muscle mass and build from where I am with that consumption. Ben, what would you say, what have been your experience? 

Ben Azadi: Yeah, that’s interesting. I didn’t know you were doing 50 to 60 grams each meal. I like that. I agree that 30 grams is bogus, there’s no truth to that. It’s really over the 24-hour period. If you do consume excess protein, if you have healthy kidneys, you got to just filter it out. If you have a history of kidney disease, then you might want to take caution and of course, none of this is medical advice. But I know Gabrielle Lyon is a big fan of having enough protein at whatever that time that first meal is and whatever time that last meal. I think like her minimum recommendation is 40 grams. If you’re at least doing that, let’s say you’re having two meals at noon and at 6:00 PM, if you’re at least getting 40 grams of animal-based protein on each of those meals, you’re probably going to be getting enough protein. Of course, if you could increase that, especially if you’re strength training or over the age of, like, 60, that’ll be even better. 

Cynthia Thurlow: Yeah, absolutely. This is definitely an area of great interest, I think, to both of us, because so many of the people that we work with are north of 40, and so we know sarcopenia or muscle loss with aging is a real thing and we want to work against that. One of the ways we do that, other than strength training, is eating enough animal-based protein. 

Ben Azadi: Suzanne says, this is not a keto question, so if it isn’t relevant, don’t ask it, but we will ask it. “I was wondering if there is anything you have found to help shift the metabolism of estrogen away from the 4-OH pathway.” I have tried two different liver cleanses and live an extremely clean lifestyle, nothing seems to be changing it. Thank you. 

Cynthia Thurlow: It’s a great question. And for anyone that’s listening that has zero familiarity with what Suzanne is referring to. She’s referring to a test called the DUTCH, where you can incorporate dried urine and/or saliva, looking at many different variables. But she’s specifically speaking to estrogen metabolism in the body and there are three key areas of estrogen metabolism that are looked at in this particular test. 2-OH, 4-OH, 16-OH. And rather than go down a massive rabbit hole of explaining in great detail what each of them demonstrate. We want the bulk of our estrogen to go down this beneficial 2-OH pathway and you want to think about the 16-OH it’s kind of in the middle, not good nor bad, but 4-OH is obviously the one we get most concerned about. This is the one that has the potential. I’m going to emphasize potential to bind to and damage our DNA. So, I start really thinking about environmental exposure, I start thinking about the plastics in our environment, I start to think a great deal about things in our food, sourcing from clean areas. 

I know that Suzanne mentioned that she eats a pretty clean diet, but really understanding that it’s our cumulative exposure over time and then also personal care products. And this is why as much as it’s a total bummer, they have to think so diligently about parabens and phthalates and all these estrogen-mimicking chemicals. I start to really think going down that additional rabbit hole and considering that you may need to clean up more in your diet. I do think there is some degree of genetic susceptibility. This in particular is the 4-OH when I’ve seen them really high. I do think it’s a combination of genetic susceptibility, meaning you could have the genetics that are primed to make you more susceptible. I do think it’s also a combination of personal care products, environment and food, and then just really realizing that you have to keep those detoxification pathways healthy and optimized. It may be that you do need to do purification programs with products that are going to support the liver, really leaning into foods that are going to support the liver, and then getting retested and obviously working with someone that can help support you in that process. Ben, are you doing DUTCH interpretation in your programs? 

Ben Azadi: Yeah, we do. That’s exactly what we look at, those 3 pathways and we see that a lot, actually, with the 4 pathways being a little bit high. So, your advice is spot on. I always talk about those environmental toxins, so get out of the habit of drinking water out of a plastic bottle as much as possible, go glass, think about the Tupperware, the cooking supplies, like the pans, everything in the household, and even like, your detergents and soaps and everything in the household. Just start chipping away and getting and replacing it with healthier alternatives. The good news is that there are healthy alternatives out there. You just have to kind of do some research to figure out which ones they are. But I do have a question for you. In this situation, would you suggest something like DIM or just increasing cruciferous vegetables, where would that fall into place with this?

Cynthia Thurlow: Yeah, depending on what their phase, so we’re speaking to phase 1 metabolism and then there’s phase 2 depending on what their information. So, you want to think about it as a drain, like it’s this drain; phase 1, you get a clog in one area of the drain, and phase 2, it’s a clog in another area of the drain. I’m oversimplifying things. I do find that DIM and calcium D-glucarate can be very helpful, just depending on where those clogs are. Thinking about sulforaphane and broccoli sprouts and things like that can beneficial. I do feel like when the 4-OH is high and high to a point where the provider kind of says, “Okay, this is an outlier.” This is not the norm, this is not a little bit above the norm, this is significantly over the norm, that you really have to be a little more aggressive.

And so, in conjunction with speaking with the patient, really diving into that lifestyle piece, really getting granular about how much you can push, and when I say push, depending on how old the patient is, sometimes the woman may not have a lot of circulating extra estrogen and so giving them DIM may provoke low estrogen symptoms, so that may mean hot flashes. That may mean they have more vasomotor symptoms; they may have more vaginal symptoms. Unfortunately, the loss of estrogen is systemic. It’s not localized to one part of the body when women are transitioning into menopause. I think it’s really looking top to bottom, but definitely DIM and calcium D-glucarate and sulforaphane and broccoli sprouts and all those things would definitely be part of that. But I do think it would be a multi-pronged approach. Also, is this someone who needs methylation support? Is this someone that needs additional cofactors to be able to support their body and then retesting. I always tell if the 4-OH is high, it is absolutely, positively important that we are retesting.

Ben Azadi: Yeah, well said. Methylation is a good idea to explore. A lot of people, they’re just not methylating properly. The DUTCH test gives you an idea of your methylation, too. We definitely utilize different methyl groups and methylation supplements to help with that, especially if somebody has, like, the MTHFR gene, they really need some support, maybe some B vitamin complex. But, yeah, looking at the full picture, and I’m glad you said that and you explained it so well. Because if somebody just goes on, like Dr. Google, maybe they get a DUTCH test and they see their 4-OH is high. They might say, “Oh, I’m just going to go on DIM.” But that might not be the best solution for you. That actually could create a lot too much estrogen being lost in those low estrogen symptoms that you mentioned. That’s why it’s important to have a practitioner look at the full picture, like Cynthia just described and then make those custom recommendations. So, I’m glad you explained it like that. 

Cynthia Thurlow: Well, thank you. I think one of the things that’s important that I’ll just tie into the DUTCH is that the DUTCH is probably one of the most complicated tests that I’ve ever worked with. Sometimes I get calls from physician friends that want me to review DUTCHs. I always say that it’s important to work with someone that’s looked at a lot of these because it takes time to become proficient at interpreting them. And I always jokingly say that the first time I looked at the DUTCH test, I was like, oh my gosh, there’re dials and numbers. Now that I understand the subtleties of the DUTCH, as I’m sure you do as well, it’s like, it’s really an exciting test to be able to educate people about their bodies. Really, really exciting. 

Ben Azadi: Yeah, it’s a great test. It’s my favorite hormone test. You’re right, in the beginning, I’m like, “What am I looking at? “Dr. Pompa show me how to read this” and he taught me. [chuckles]

Cynthia Thurlow: Exactly. Okay, next question is how to use fasting to help with candida. This is Karen’s question.

Ben Azadi: Yeah. Well, you know when you fast, especially like a prolonged fast, let’s say fast 24 hours, your innate intelligence, your body is going to be starving down bacteria, good and bad in the gut, including candida. Candida feeds off of food, feeds off of sugar, feeds off of heavy metals as well. So, when you’re in a fasted state, there’s not a lot of food for candida to feed on. So naturally, you’re going to probably get a decrease in candida because you’re starving it off. That’s where it could help. But here’s the thing, you want to make sure you break the fast properly and refeed with prebiotics and maybe even probiotics. So, sauerkraut, kimchi, you want to break it the right way and not just break the fast with like a donut or a pizza and just feed them all again, you might feel awful too. Depending on how long you fast, you’ll get more of that starving down, which can, by the way, result in some die off symptoms. Just keep in mind that might be the case as well. So, you might want to go low and slow and kind of build that fasting muscle up, but that’s how fasting could help. What are your thoughts on that, Cynthia? 

Cynthia Thurlow: No, I think you bring up such good points. I would say that autophagy, which is this waste and recycling process that goes on with fasting, can be very beneficial. Not just for candida, but any type of opportunistic organisms, whether it’s parasites, worms, God forbid, dysbiosis, all these things that don’t belong but have found their way into our digestive system. 

Ben Azadi: Yeah.

Cynthia Thurlow: I think it’s also very helpful to understand that there are therapeutic benefits from things like caprylic acid or MCT oil. Obviously, working in conjunction with your own provider that’s made recommendations therapeutically, I will oftentimes say having some MCT oil or caprylic acid can be very beneficial therapeutically for killing off off the candida and I love that you brought off and this can happen in any antimicrobial program, but understanding that you have to have biofilm disruptors so each one of these opportunistic organisms, they will adhere to the cell wall and they create a biofilm. And so, part of you want to break up the biofilm and then you want to have something bind to it so you can get rid of it. Very, very important to understand that a biofilm breaker and a binder are critically important when you’re working on these protocols and understanding you may need more detoxification support, more dry brushing, sweating, sauna, exercise, rest while you’re going through these protocols. Because the die off is no joke. I’ll be the first person to say that– we’re just talking about the DUTCH and phase 1 and phase 2 liver detoxification. And sometimes when you do these protocols, if you’re working with someone, they’re already thinking ahead that has the potential for being an issue. One of the reasons why we use binders and why we use biofilm breakers is to help support the body in addition to everything else we’re doing. So, really understand there’s a very comprehensive approach. We definitely want to be careful and conscientious. I agree with you wholeheartedly low and slow is always the way to start because you never know, you could speed up phase 1 and phase 2 comes to a crashing halt and then you’re not going to feel very good. That has happened to me personally. It was pretty miserable until we had figured out what was going on. 

Ben Azadi: Yeah. Cynthia already went through the pain. You don’t have to go through the pain. Learn from Cynthia’s lesson and you’re right, I see that all the time. So low and slow, you always want to think of this as a muscle that you’re developing over time. And you could definitely get yourself there in a short amount of time, but just don’t do it day one [crosstalk]. 

Cynthia Thurlow: Exactly, exactly. I have a great question from Michaela. “I was recently diagnosed with gallstones. Apparently, I have one blocked duct. I did some research and found saturated fat is not supposed to be so great for this condition. I plan to do a gallbladder liver flush, which will take care of the stone issue. But until then, what would you recommend I eat? I still want to be keto. I finally achieved metabolic flexibility and I’m fat adapted, and it just makes me want to cry to think that I have to go back to eating the other way. I do not want to do that. Do you have any thoughts for me at all on this Ben? Thank you so much.”

Ben Azadi: Yeah, Michaela is in my academy, and I know that she’s having that challenge right now. So yeah, absolutely, you definitely don’t have to go back to your old carbohydrate ways. But here’s the thing when I interviewed Dr. William Davis, author of Wheat Belly and other incredible books, Super Gut, we talked about this. We talked about the gallbladder, gallstones, obstructed bile ducts, and why a lot of conventional doctors think it’s a saturated fat or a fat issue and why that’s a big misconception. It’s actually your body got so used to being a sugar burner and eating carbohydrates. Now you’ve increased your fats including saturated fats and you don’t have the proper efficiency or enzymes for proper bile flow, bile acids to start breaking it down, which can actually lead to those symptoms. That’s where they’re telling you it’s because you incorporated the fats that’s causing it, but it’s really because you stayed away from the fats for such a long time, your body kind of forgot how to break them down. So, what do you do? Yeah, I think a gallbladder flush, awesome, that’s a great idea. You want to go really low and slow. You want to actually have smaller meals more spread out throughout the day. 

I wouldn’t practice OMAD, one meal a day. I wouldn’t even do two meals a day with two big meals of fats. I would have three to four, maybe even five meals that are smaller and give your gallbladder, give your liver time to adapt. It might take a month; it might take a little bit longer. In the same time, you could take some bile salts, you could take some digestive enzymes, definitely increase your digestive bitters we talk a lot about that, Cynthia right, arugula, lemons, and limes even high-quality coffee, artichokes, apple cider vinegar. Find ways to support the liver, find ways to support the gallbladder, have those meals that are smaller. This is the only time I would probably recommend smaller, more frequent meals back to the personal training days. But in this scenario, you don’t want to have a whole bunch of fat in one sitting. You want to spread it out, give your gallbladder, and your liver time to adjust. And over time, it will. I know that it will. I don’t know how long it will take, but definitely it will over time if you just put that protocol into place. What are your thoughts, Cynthia? 

Cynthia Thurlow: No. Such a good point. I wish I could say that this is not uncommon, but I do see a lot of women in particular that start doing a lot of healthy fats after eating a standard American diet, and sometimes they’ll get stuck in keto or they’ll get stuck like plateaus. Obviously, having gallstones is an inconvenient and uncomfortable thing, and I’m so sorry to hear that. I can’t speak to gallbladder or liver flush because I’ve never advised anyone around that. However, I love the idea of lower fat, leaner meat and items to be incorporating into your diet and supporting your body in additional ways. Ben, brought up bitters. I think about oxblood, bile salts. I think about incorporating those bitter foods that are going to be able to support your body very gently. And then really understanding that when you were eating a standard American diet and transitioned to a ketogenic low-carb diet and you’re incorporating less processed foods, but your body has had a lag. 

There was this period of time when it was probably functioning fairly optimally and then when you’re eating a more processed diet, your gallbladder, and you’re just not breaking down and emulsifying healthy types of fats. And so, it’s just become inefficient. It’s like the gallbladder has just been on hiatus and now we’re asking it to come back and play in the Super Bowl, and it’s just not ready. I think on a lot of different levels, it’s understanding that it’s not the saturated fat per se that is creating the issue. It’s probably the incorporation of these healthy fats. Your body’s struggling to help and break them down and you just need to kind of back off on the accelerator. I do agree with Ben that you probably want to have smaller meals with less fat. So maybe you’re having leaner meats, chicken breast, fillet, cod, leaner meats and fish that are going to make it easier for your body to assimilate.  Hopefully, in conjunction with working with your healthcare practitioner, you’ll be back to feeling better very soon. 

Ben Azadi: That’s a great analogy with the Super Bowl. Well, the Super Bowl is coming up in just a few days, so perfect analogy. Yeah, you’re right. You have this football player, the gallbladder, who has been on hiatus, retired for like, I don’t know, 10 years, and now you’re like, “Hey, you’re starting in the Super Bowl in three days, you got to get ready to go.” That’s not going to be fun, so you got to train that player, you got to train the gallbladder and what we just shared is exactly how you train it. 

Cynthia Thurlow: Exactly. Next question is from Leena. “I’ve been doing strict keto with OMAD for three months, but my last bloodwork shows my GTT is very high, 92 in Canadian measures. Could it be too high because of fasting?” 

Ben Azadi: This is very similar to the previous question of Michaela. I don’t know if you’re also doing fasting with keto. And if that’s the case, if you have incorporated more fats, then it could be the similar issue with Michaela, to go low and slow. And add in all the things that we suggested. I’m not sure Cynthia, I read the question earlier, and I haven’t seen that become a problem with fasting, but maybe you have. I’m going to throw the question your way and hear your thoughts. 

Cynthia Thurlow: Yeah, yeah, so when I see liver enzymes that are elevated, I start thinking about what’s going on with the liver and the first thing I think about is fatty liver or non-alcoholic fatty liver disease or NAFLD as it’s now called. I don’t know what your baseline was, so it’s always in the context of what was your lab before and what is it now. And so, I think that’s significant. One elevated lab is something to monitor. I’m not by any means discounting it, but I think it’s also important. Like, are you in a position where you need to have an ultrasound of your liver? I mean is there something else going on? I start to think about insulin resistance and I think it’s great that you’ve been doing OMAD and you’ve been having success with it, but I also start to think prior to initiating that, were you in a position where you were less insulin sensitive? Were you in a position where you were insulin resistant and there’s some degree of fatty liver that we just need to be looking for.

I’m in the process of preparing for a talk and it’s talking about insulin-sensitive obese people and what the metrics are that help you understand. Like, who are the people that are going to go on to develop full-blown diabetes and insulin resistance? One of the big prognostic indicators is, do you have a fatty liver? So, from my perspective, this would be something that needs to be followed up on. I doubt it’s probably from the fasting. It could be a byproduct of this transition. I don’t know where your numbers were before, so that doesn’t give me context, but I think it requires a little bit more information, a little bit more research, and very likely might be an existing mild issue that might just need to be followed.

Ben Azadi: Yeah, well said. That’s fascinating because you’re right, with fasting you’re going to pull fat from the liver. If anything, it’s actually needed for fatty liver or high GGT markers but you never know. Sometimes there are scenarios where there’re different things at play here. But I do know this, one of the best nutrients you can give your liver is choline. Either eating eggs or taking some choline supplementation and that should nudge things in the right direction. To Cynthia’s point, those numbers could be on its way down. It could have been much higher a few months ago before you started to implement OMAD, we don’t know unless you do have those numbers. So, I would see if you do have those numbers, look at the previous test results, and if you don’t have them then follow some of the protocols you’re learning and then retest in about 90 days and see where it’s trending, and even potentially go get an ultrasound done to see if there’s anything else going on.

Cynthia Thurlow: Yeah, I always say when there’s one elevated test, we pay attention to it. We’re not at all suggesting not to have the conversation with your ordering provider about what they want to do. One test without having context makes it challenging to interpret. 

Ben Azadi: Absolutely. Yeah. 

Cynthia Thurlow: Okay, we got lots of questions about insomnia.

Ben Azadi: We did. 

Cynthia Thurlow: Okay, number one question, “Why do we experience insomnia while doing a ketogenic diet?” And then the other question was, “How to address chronic insomnia patterns.” So, lots of concerns about sleep. The first question was from Yousef and the other one, I was literally DMed the other question by multiple people on Instagram this morning.

Ben Azadi: Yeah. I’ll preface this and say I’m not an insomniac expert or a sleep expert, but I have written a book on sleep and I have studied sleep a lot and sleeping patterns Cynthia. I’ve never seen the ketogenic diet cause insomnia. I’ve never seen that. I have seen the ketogenic diet cause sleep issues. I’m wondering if this was something before that, this is reoccurring because keto triggered it somehow. I’m not sure. But here’s what I would recommend for those who are struggling with sleep on keto, I would recommend actually increasing your carbs a little bit. Meaning maybe it’s not going to be low enough for you to remain in ketosis, but just the way is your body to kind of adapt a little bit and get some carbs. Also having some raw honey right before bed, give your brain some glucose. About a teaspoon of raw honey before bed could help with sleep. If you’re struggling with sleep on keto, I’ve also seen taking some MCT oil or coconut oil before bed help with that as well. If you’re doing that and you’re still having insomnia, then I would definitely speak with somebody who’s an expert on that. I know that it also depends if it’s acute insomnia or if it’s chronic. They’re treated very differently.

My fiancée, Natassia, she’s had intermittent insomnia in the past and it’s always triggered from a stressful event, like if her mom was in the hospital. That ruminating of like, what’s going to happen to my mom? The mental stress gets her into an acute insomniac state, where some of the things that we’ve learned for her is, when she’s lying down in bed and let’s say it’s 30 minutes and she’s just thinking about, why can’t I fall asleep? Why can’t I fall asleep? One of the things we do for her is, “Okay, get out of bed, do something else.” Don’t just lay there thinking about it. Do something else and then go back and retry. You don’t want to just lay in bed thinking about why you’re not falling asleep. At least for Natassia, we got her out of bed, she did some things for about 10-20 minutes, laid back in bed, and that seemed to help as well. And getting to the root cause of what is causing that mental stress and figuring out what the blessings are there. I know you said you think its keto doing it, but there might be some other things at play here. So those are my thoughts. Cynthia, what would you add to that? 

Cynthia Thurlow: No. So wise and I love that you are so lovingly supportive of Natassia, when she’s having sleep issues. I would say MCT oil is always probably my go-to when I suspect it might be a blood sugar dysregulation thing. Lots of things to unpack. There’s acute versus chronic insomnia. Acutely, I do see stressful events, the rise in cortisol, rise in blood sugar, rise in insulin. That can definitely get people into a troubled sleeping pattern that can then develop into chronic insomnia. There’s a differentiator. There’s difficulty falling asleep and difficulty staying asleep and I think both of them need to be addressed a little bit differently. So, if you’re having trouble falling asleep that’s a sleep hygiene thing. Whether or not it’s related to the stressful event or you’re moving or you’re changing jobs or you’ve had a breakup, or there’s something just going on in your life, and really trying to get your brain out of. And also understanding that we have the amygdala, which is our lizard brain. If that overrides our prefrontal cortex and we’re like ruminating thoughts, we can’t think straight, we’re frightened, we’re scared, really understanding we need to do things to calm that central nervous system. And so, whether or not that’s taking a light walk, whether or not that is connecting with a loved one, doing some meditation, expressing gratitude, or as Ben likes to call it, vitamin G, which I love. [Ben, chuckles] Maybe taking a hot bath, maybe you’re soaking in magnesium, maybe you enjoy aromatherapy like lavender that kind of helps you get out of that fight or flight response, breathing exercises. There’re also supplements that can be helpful. I think about phosphatidylserine, so I like Seriphos in particular. 

Ben Azadi: Yeah, me too.

Cynthia Thurlow: Yeah, I use that as needed myself personally. I do recommend that as a supplement as needed. We don’t chronically want to be lowering our cortisol, but if you’re feeling like you’re stressed and can’t gear down for bed, get off electronics, read a book. I mean, there’re so many things. It is a big difference from people who chronically wake up between two and four, one and three every night. I see a lot of women that struggle with this, but I know men do as well. Some of it can be hormonal, like, are you in perimenopause? Your ovaries are making less progesterone. Progesterone is this inhibitory hormone that’s designed to be relaxing and sedating. And I’ll see women that are waking up in the middle of the night, they’re more anxious and depressed. That can be a byproduct of this loss of progesterone. The other thing to mention is, yes, our adrenal glands kind of step in to help support progesterone production, but then we become a little less stress resilient. If you have a stressful event, it can make it much harder to manage and mitigate the stress. It doesn’t mean you can’t handle stress, we’re just not as good at it.

The other thing to think about is get your hormones tested. Is it a progesterone piece? Because I see a lot of therapeutic benefit from transdermal or even compounded bioidentical progesterone. I jokingly tell my functional medicine doc that I will be taking progesterone till the day I die because it has such a great net impact on my sleep quality. There are lots of foods that can help with progesterone support in the body, but they’re not going to replace the hormone so just something to think about. Beyond that, I think about blood sugar dysregulation, what’s your meal plan like? There are ketogenic low-carb treats and I think for a lot of people they assume, “Oh, I’m eating ketogenic diet, but I’m eating keto junk.” It’s still junk. We want to make sure that our meals are fortified with healthy fats, protein, and non-starchy carbohydrates.

The other thing is sometimes I do have some women that they’re too low carb and that disrupts their sleep. So, experimentation with carbohydrates, maybe you have of carbohydrate with your dinner. Maybe you’re trying the MCT oil. I think there’s a degree of experimentation and then also understanding if you wake up in the middle of the night, what are you doing for that? I do find things like Myo-inositol can be very helpful for not only inducing sleep, but also helping if you wake up in the middle of the night. And actually, Huberman Lab talks about how it’s part of his sleep stack. I always say another objective opinion, things that can be very helpful for falling back to sleep, I think about GABA, I also think about L-theanine. And if you’re noticing, I’m talking about single ingredient supplements because I do see the value in supplements. If you’re doing all the other lifestyle pieces first, and then you can targetedly add them in.

Those are the things I really think about. But the good and positive thing is that personally and professionally we can work on sleep stuff absolutely, positively. Obviously, if it persists, I get concerned about the net impact on blood sugar regulation. I know we touched on that earlier. I think about appetite and satiety. When you don’t get high quality sleep, you don’t crave broccoli, you’re going to crave junk. [Ben, chuckles] Just thinking about cumulative net effects, one thing I do see, and I’m starting to talk more openly about it, is this over fasting, over restricting, over exercising paradigm. I call it the triad. This can happen to men and women, it’s not just women. Really understanding that you could be overdoing it unknowingly. And then the last piece I would add to that, just being mindful of time is where are you in your menstrual cycle? So, if you are a week out of your menstrual cycle, and progesterone is lower that could exacerbate sleep. Obviously, if you’re male, that’s not the case. I just wanted to make sure if there’s anyone listening that’s trying to kind of put all these pieces together, definitely wanted to make sure that was not an issue. Anything else that you would think of, Ben?

Ben Azadi: It’s a great list of things to consider. [Cynthia chuckles] Great list. I’m also a big fan of the Seriphos, the phosphatidylserine, as a way to calm the adrenal glands. Something that I would add to what you shared is that if you find yourself consistently waking up in the middle of the night between like 1:00 and 3:00 AM that could also give clues to the liver that’s in Chinese medicine, it’s the liver time. Sometimes when the liver is sluggish and overwhelmed, then it could be working very hard and has this cortisol response in the middle of the night and you’re just wired and tired laying there. Taking some binders, doing potentially a coffee enema, just doing finding ways to support the liver. We’ve mentioned a lot of ways during this episode.

One more thing to it would be your breathing, your airway pathway, the passage. A lot of people are dysfunctionally breathing because of many factors. I’ve interviewed a few people on this but if you’ve had braces when you were younger, sometimes that crowds your teeth. That’s my problem right now. So, I’m working on expanding it. It forces you to breathe through the mouth instead of the nose. What I do is I mouth tape at night. I wear a small adhesive which forces me to breathe through my nose, and then I wear a Breathe Right strip, and then I have my earplugs. My fiancée is always making fun of me because I look like crazy [laughter] It helps, you might want to explore the breathing issue if that might be the case. You could find a biological holistic dentist to do an assessment. There are sleep studies that you can do at home now. You actually don’t have to go to a clinic to do it. I never thought that made sense, by the way, going to a clinic to do a sleep study because you’re out of your environment, you’re probably worried, it doesn’t make sense to do it somewhere else. You could do sleep studies at your own place. I would explore the liver if you’re waking up and then also your breathing patterns to see if that’s the issue there. 

Cynthia Thurlow: That’s a great addition. I did a podcast last year with James Nestor, in his book Breath. 

Ben Azadi: Yeah.

Cynthia Thurlow: I’ve read it twice. I get something different out of it every time I read it. And as someone who is allopathic trained, I’m like, why did we not talk about this? I was exactly that person, braces, pulled a bunch of teeth out, I’m the classic example. What’s interesting is, for me, what I found that’s been hugely beneficial, cold dark room, blue blockers, sleep mask. I mean, I look ridiculous when I go to bed. I’ve got blue blockers on, I’ve got a sleep mask on, it’s like all these things. What’s interesting, much to your point, my husband has to wear a mouth retainer because he was an obligate mouth breather at night. I would tell him, like, “You’re snoring.” He was insistent it wasn’t happening. It starts to change the profile of your mouth, your oropharynx. And so, understanding that undiagnosed sleep apnea is really prevalent. It’s not just happening in people that are obese or overweight and working with someone that can help you understand your own personal anatomy if you do suspect that sleep apnea might be contributing. I did actually do a sleep study last year with a little probe on my finger. Yes, you can do them from home now, they’re very inexpensive, and they really provide some really great information. I’m glad that you brought that up. 

Ben Azadi: Yeah, it’s so important. You know so very important. Like your husband, I was a chronic mouth breather too. That was because I had a couple of wisdom teeth pulled out, had braces for a long time, and then I ate a standard American diet, so mushy diet. And then my teeth got crowded and naturally, I started breathing through my mouth because I had less room for my tongue and just less room for my nostrils to get enough oxygen. So, I became a chronic mouth breather. I’m working with my biological dentist right now. I’ve been wearing this damn thing for three years, [Cynthia, laughs] but it’s a palate expander where I wear it every night up and below two little pieces of device. It’s slowly expanding my palate to change that facial structure so I could naturally breathe through my nose. Because to your point, a lot of people have undiagnosed sleep apnea or just breathing issues. The solution is not to go on a CPAP or supplemental oxygen. As a matter of fact, when you get on those, it actually makes your own natural mechanisms for oxygen lazier and you actually are just relying on something exogenous and as you’re teaching your body not to do it naturally. I’m not saying to get off that if you’re using it now, but I’m saying you want to get to the cause, and that is proper airway passages.

Cynthia Thurlow: Well, we have one last question and this question is from Mary Joe. I take Cynthia’s Creatine supplement powder, can she clarify when is the optimal time of day to take it, before, during, or after working out? Should it be taken on rest days, during the fasting window, etc.? Thank you. 

Ben Azadi: [chuckles] Yeah, so that’s your question. [laughs] 

Cynthia Thurlow: What I would say is I take Creatine in my feeding window because it will technically break a clean fast. I do recommend that women supplement every day in particular because we have less endogenous creatine stores in our body, 70% to 80% less. It is absolutely essential that we are taking creatine exogenously outside our body because we can’t get enough in our foods. It would be great if I could just eat enough steak and eggs and that would do it for me. 

Ben Azadi: So, when you say 70-80%, you mean less than men? Is that what you’re saying? 

Cynthia Thurlow: Yeah. 

Ben Azadi: Okay, interesting. 

Cynthia Thurlow: We have less. What’s interesting is you look at the research about women’s menstrual cycles. There’s time in our cycles where we need more creatine and there’s really good research supporting its use in perimenopause and menopause. I always remind women; I think many of us thought of it as a ‘bro supplement’ like it’s a gym bro.

Ben Azadi: For sure. Yeah. 

Cynthia Thurlow: We know based on research women need 3 grams a day, men 5. If you’re vegan or vegetarian, you actually need more because you’re not eating that animal-based protein. But, yeah, it’s really easy to take it daily. My product in particular blends seamlessly into water and anything else so it’s really nice. But, yeah, Creatine is my surprise supplement. I think it’s, for me personally I always like to share this, but being a menopausal female and being able to consistently lift more weight week to week, so we’re at a metabolic disadvantage in menopause as we’ve lost testosterone and estrogen unless we’re on HRT, it’s harder to build and maintain muscle. And so, for me to be able to get in the gym and do that every week really speaks to the fact that it works. There’s a friend of mine who’s 70 years old, she’s a clinical psychologist, she’s 90 pounds. She was showing that she did a 300-pound leg press in the gym. 

Ben Azadi: Whoa.

Cynthia Thurlow: She was like, “If anyone can build muscle, I can.” So, I love knowing that a lot of people are driving a lot of benefit from it. 

Ben Azadi: That’s amazing. So interesting, okay, so 3 grams for women, 5 grams for men, vegans need more. That makes sense. What is it about the creatine? So, you’re saying it breaks the fast. You’re saying it’s best to have it during your eating window. What is it about the creatine that breaks the fast that activates mTOR, there is a glucose response? What is it about it? 

Cynthia Thurlow: It kind of upregulates ATP production so in a lot of ways, it’s like an amino acid. I remind people that– there are people that are like that’s the only time I can take it. I’m like that’s fine. 

Ben Azadi: Yeah.

Cynthia Thurlow: It’s with the understanding that we want to optimize when it’s consumed. It doesn’t have to be consumed while you’re exercising. We just know that we want it to be consumed in your feeding window. You really just need that one dose a day just really easily, can be incorporated into water beverages or however you prefer to take it. 

Ben Azadi: Awesome. Yeah, that makes sense. Creatine is one of the most researched supplements out there. There’s a lot of research on the benefits of it and there are a lot of misconceptions out there. It’s not just for bros at the gym. It’s for every human being. I didn’t know the women have 70% to 80% less creatine and they actually need more, which makes a lot of sense. So, yeah, I have a bag of your Creatine on my account. I need to get more consistent with using it now. [Cynthia laughs] You’ve inspired me. [chuckles] 

Cynthia Thurlow: Yes. So, when people ask, does it need to be taken in your feeding window or is it only consumed on days you exercise. I just refer people to the fact that you benefit from taking it every day.

Ben Azadi: Yeah, makes sense. Awesome. 

Cynthia Thurlow: Are there any other supplements, Ben, that are part of your day-to-day existence like your must haves? I’m just curious. I’m asking Ben a question now. 

Ben Azadi: Yeah, I love it. [chuckles] I’m a big fan of supplementation from quality supplements just because the soils are so depleted and we’re just not getting enough quality vitamins and minerals from the food we eat, even if we’re eating organic like I tend to do. The way I see supplements is as a rotation. I like to rotate supplements. I think everything in nature is cyclical. I mean, you talk about women’s menstrual cycle, it’s cyclical. I mean, we have different seasons. So, with supplements same thing, especially supplements with herbs and mushrooms, your body could develop a tolerance to it and you start losing the benefits. I’m a big fan of supplement rotation in general. The ones that I definitely use more than others would be a magnesium, whether it’s like an UpgradedFormulas, Nano or a magnesium blend. Magnesium because we’re just so depleted in that, the magnesium is a go-to. I also love Zach Bush’s. I actually have it on my desk. I sip it throughout the day. ION is something that I drink throughout the day. It just helps with your tight junctions. 

Cynthia Thurlow: What is it? 

Ben Azadi: And then it depends. If I’m traveling, I’ll take some immune support, like a vitamin D complex and some Liposomal Quercetin, etc. What else is a go-to for me? Now, it’s Creatine. [laughs] You’ve inspired me to stay consistent with Creatine, so I’ll be on that. I think those are the ones that are like my go-tos on a consistent basis. I’ll rotate things like vitamin E and other sources, antioxidants, etc., but those are like my staples. The magnesium, the ION, and now it’s going to be the Creatine. What about you, Cynthia? 

Cynthia Thurlow: You now to be honest with you, I rotate too. In fact, my family, I’m like, don’t ever touch the supplement cabinet because I have it-

Ben Azadi: Specific order [chuckles] 

Cynthia Thurlow: -strategically aligned and ironically enough, my functional medicine doc likes me to stop everything before I come to see him. I always remind him I will stop everything but my sleep support, so [Ben chuckles] definitely magnesium. I use adaptogens as needed, so whether or not it’s ashwagandha, Rhodiola, Relora, depending on what my stress is like. Definitely for me it’s the sleep piece, so Myo-inositol without question, GABA, L-theanine, those are typical and some melatonin because I’m of that age and it really makes a big difference. So, for me those are kind of the non-negotiables and everything else. Especially, when I travel, I might add in some binders, I might add in same with you, some immune support. There’s a product by Designs for Health that’s literally like six supplements in a little bag and so I just take those with me when I travel.

More often than not, I try to think about less is more. Like, I never want to be on too much, like occasionally I’ll take a probiotic, but I don’t do that consistently because I try to get it from my food. And I do think that’s important. The other piece I would say is that there’s a degree of supplement fatigue that I think everyone can experience. If you’re feeling like you’re overwhelmed that’s a good sign that you need to definitely pare down and simplify things because no one wants to be on 40 supplements. I’ve had points in my life when I’ve been on that many and it’s like a second job trying to figure out what I need to be taking. And God forbid I leave my house because I have to have all these supplement containers. I’m fine doing that on the short term, but I don’t want to be going to a state of craziness every time I travel. 

Ben Azadi: Yeah, well said. It is like a second job with a time commitment and then you might need a second job because of the money. [laughs] 

Cynthia Thurlow: Exactly. [crosstalk] It gets really expensive. What I always say is buy the best quality you can afford and try to keep it simple. Like trying to find a simplified regimen I think makes a big difference. 

Ben Azadi: Yeah. In general, Sundays are a day where I take no supplements, I drink no coffee. It’s like a day to just not have any of that. So, I think it’s a good protocol to have that in place. 

Cynthia Thurlow: I love that. It’s interesting. I typically drink green tea most mornings of the week, and I’ve kind of gotten out of the habit because sometimes I sit down and I’m like, I don’t want to be in the midst of drinking green tea. I have to get up and pee while I’m doing all these calls back-to-back. But I’m reminded that there are benefits in these plant-based compounds. I think I love that you take a break from coffee once a week. Just like myself, I don’t ever want to be dependent on caffeine to be able to get through my day, which is why I try to not do it every day. I’m definitely one of those people, like, I can consume quite a bit of caffeine and not have trouble sleeping. So, it’s also that other piece of kind of figuring out what works for you or what doesn’t for that matter. 

Ben Azadi: Exactly. What a great bonus question there. [laughs]  

Cynthia Thurlow: Yes, absolutely. Well, Ben, as always, it’s a pleasure to connect with you and our listeners both on Keto Kamp and Everyday Wellness if you love these conversations, these are very organic conversations from our communities asking us to answer questions, please let us know. I certainly enjoy these interactions. It’s kind of nice as a podcast host to have a truly kind of organic conversation flow, etc.

Ben Azadi: It is super nice. I enjoyed it. Let us know. Leave a rating and review on our podcast saying, “Hey, do a round two Ben and Cynthia, do a round two.” Let us know if you enjoyed this. We sure enjoyed it. We would love to do a round two. So, we want to hear from you. Yeah, Cynthia, I love what you’re doing. It was a pleasure to collaborate with you. Can’t wait to see you in person again and share another stage with you, share another steak dinner with you, whatever it is, I can’t wait to see you again. 

Cynthia Thurlow: Absolutely. I think I’m going to see you in Denver. 

Ben Azadi: Oh, yes. I’m going to see you very soon, actually. That’s true. So, I can’t wait. 

Cynthia Thurlow: Awesome. 

Ben Azadi: All right, Cynthia. Thank you so much. 

Cynthia Thurlow: Thanks. You too. 

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