Ep. 283 Women & Intermittent Fasting: Enhancing Metabolic Health with Megan Ramos

Step into the world of metabolic health and fasting as we embark on a captivating journey with the renowned Canadian clinical educator Megan Ramos!

In an era when chronic illness and obesity have become alarmingly prevalent, and dieting has become a lifelong struggle for many, Megan is on a mission to revolutionize our understanding of metabolic health. Known for her expertise in therapeutic fasting and low-carb diets, she co-founded the revolutionary Fasting Method alongside the renowned Dr. Jason Fung and co-authored the bestselling book Life in the Fasting Lane. Now, she returns with her latest work, delving into the untold stories of women and fasting. 

In today’s captivating discussion, Megan and I explore the staggering statistics that reveal a nation plagued by chronic illness and weight issues, where even the average person has tried 126 diets in their lifetime. Megan shares her groundbreaking insights on women and fasting, unveiling the truth behind misdiagnosis, the myths surrounding intermittent fasting, the role of macros and insulin secretion, and the profound impact of the pandemic on our hormones, sleep, and stress levels. 

Prepare yourself for a thought-provoking episode as we tackle pressing questions from listeners, covering the dawn effect, gout, insomnia, and invaluable strategies for achieving fasting success!

“We see women every day that are living better lives at 60 or 65 than they ever did in their 20s. They’re so much healthier. They’re doing the most wonderful and wild adventures!”

– Megan Ramos

IN THIS EPISODE YOU WILL LEARN:

• My journey with PCOS
• Why does body composition matter so much?
• PCOS, the number one endocrine disorder in Westernized countries
• Common myths about intermittent fasting
• The fertility aspect of postmenopausal women
• The slippery slope of perimenopause
• Is fasting just an extreme form of calorie restriction?
• The impact of sleep and stress on glucose and insulin levels
• How to integrate intermittent fasting into your lifestyle
• Magnesium supplementation for insulin resistance
• How to deal with gout

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website

Connect with Megan Ramos

• The Fasting Method
• Find Megan on social media @Megan J. Ramos
• Purchase a copy of Life in the Fasting Lane
• Purchase a copy of The Essential Guide to Intermittent Fasting For Women

Previous Episodes Featuring Megan

Ep. 116 – Using Intermittent Fasting to Reverse Chronic Illnesses – with Megan Ramos

Ep. 188 – Troubleshooting Your Fasting Method with Megan Ramos

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.
Anyone that knows me or knows my platform, they understand how passionate I am about metabolic health. I recently reconnected with Megan Ramos, I recorded with her on podcast 116 and 188. And we dove into her new book talking about women and fasting and some of the fascinating statistics that are contained in her book center around how 52% of Americans have at least one chronic illness and 70% are overweight or obese and the average person will have tried 126 diets in their lifetime. Megan is a Canadian clinical educator and expert on therapeutic fasting and low-carb diets. She works closely with Dr. Jason Fung and is the co-author of the New York Times bestseller Life in the Fasting Lane and co-founded The Fasting Method with Dr. Jason Fung. Today we spoke at great length about her new book, her background in PCOS and misdiagnosis, the myth surrounding intermittent fasting, the role of macros and insulin secretion, the impact of the pandemic and hormones, as well as cortisol and its impact on sleep and stress.

We went through quite a few listeners questions centering around the dawn effect, gout and insomnia, and we also spoke about strategies to help with fasting success. I know you will enjoy this conversation as much as I did recording it. Well, Megan, it’s a pleasure to have you back on. Congratulations on your new book.

Megan Ramos: Thank you, Cynthia. It’s been a wild time for me. I’m super pregnant and feeling it every day. But I’m really happy to help, continue to spread the message and work on all of the good stuff that you and my colleague Jason Fung and everyone out there in the fasting space has done. So happy to be a contributor as well.

Cynthia Thurlow: Awesome. Well, I think one of the things that I really respect and value so much about your work is you walk the walk. You’ve been someone that was diagnosed with PCOS when you were very young. I myself was also diagnosed, although we understood a lot less about it at the time. But it certainly contributed to the fertility challenges that I had and I know you’ve experienced that. But let’s talk a little bit about TOFI and PCOS and your history, the brief history of NAFLD because I think that nonalcoholic fatty liver disease and being told that you were insulin resistant was a really powerful impetus to find solutions to ensure that you were on the path to better metabolic health.

Megan Ramos: So wild how traditional Western medicine, especially going back to when I was diagnosed as a teenager or preteen with metabolic conditions, really doesn’t understand body composition. I was 12 years old and I was classified as underweight by the BMI scale. I was like 16 point something. And everybody great aunts, grandmothers, “Oh, she’s so skinny, she’s so lucky, how fabulous.” My whole healthcare team assumed she must be in phenomenal health. And I was tired all of the time. I was nine and I had done enough research to think, “Okay, I think I have hypothyroidism at nine years old because I did not feel well.” And that was the first time I asked my primary care to check me for hypothyroidism. But everybody just kind of wrote me off because my appearance, how fortunate I was to be so tiny. I was chronically fatigued even as a kid, I knew it was weird. I couldn’t keep up with my peers.

We grew up in the suburbs of Toronto. We were fortunate enough that most of us had stay-at-home moms. So, we did music lessons, soccer, field hockey, baseball, swimming. We did all of the things, you had no choice, and I couldn’t keep up. I begged my parents all of the time, please let me just do one sport a season. I don’t want to do these 10 things like all of my friends, I don’t have it in me. And no one took any of my complaints about my health seriously. And I’d fracture myself all the time. There was a rainy day and I’d be out in the field and I’d slip and fall and fracture my wrist. I was just totally brittle. So, in hindsight, I didn’t appear to be overweight but my body composition was very poor. I didn’t have strong muscle mass. I clearly didn’t have strong bones because I was always in the [unintelligible [00:05:09]. [laughs] I was just a little sack of fat, which is reflective of my diet at the time. It was acceptable to take your kids to McDonald’s for a Happy Meal. That was a healthy thing parents could do.

I had two very busy professional– well, my father was very busy and professional. He’s a lawyer downtown. My mom was very sick from her own health journey, so it was just survival. Pizza is fine to have every Monday night, that type of mentality. I think we cooked at home once a week. So, at 12, I was diagnosed with fatty liver disease. I’m at The Hospital for Sick Children in Toronto. It’s one of the most prestigious institutions in the entire world. People get airlifted there from all over all of the time. And I remember them saying to my mom, she’s too skinny. Like, this is a disease of an obese child and she’s not obese, so she’ll just grow out of it. I remember that thinking, “Okay, this is kind of weird.” My uncle died also when I was nine from his third heart attack at 36. So due to some of those situations in my family, I became pretty health conscious and understood early on and then at 14, I started to get those terrible cramps and weird cycles. I started to cycle when I was 10 years old, which is pretty wild in the first place. And so, by the time I was 14, I had a well-established period, but it started to really change and transform, and it wouldn’t be uncommon for me to experience such excruciating pain and weird bleeding and end up in the hospital. And then that was a diagnosis of PCOS. And I remember at the time, our primary care was a good family friend.

She said to my parents, “You guys have money.” When she’s off in university, try to get her to freeze her eggs. You don’t know, she probably won’t be able to get pregnant. Surrogacy is going to boom because PCOS is booming. So at least if she has frozen eggs, she might have that option down the road. And also, there was just huge confusion because, again, I was still classified as underweight at the time, I was a string bean. People used to write in my yearbooks, we hate you because you can eat whatever you want, size zero clothes fall off of you. So, we really don’t pay a lot of attention to people unless we think they physically look like they have some sort of metabolic impairment. But usually, it’s the ones that fall under the radar that are at the highest risk for disease and are experiencing real serious metabolic health challenges and they don’t even. I think this is a really terrible, just problem we have in our culture is we just celebrate extreme thinness without realizing that body composition matters.

I share [laughs] in my adult life, I’m barely 5’3″. Sometimes a 5’3″ might be a little generous. And in my adult life, I’ve weighed almost 200 pounds. Eventually, everything caught up with me and I gained a lot of weight and I weighed 97 pounds. And I tell everyone once I got to a place of around, I was around 120 pounds, but I had less body fat, I had stronger bones, I had good lean mass, so I had less body fat in the 120s than I ever did in the 1990s and I was more obese at 97 pounds than at 120 pounds. And it’s just really discouraging how the medical community weighs you. I come from Canada, Toronto, and I will say there really wasn’t a huge emphasis on weighing patients outside of their annual checkups. Now I’m a pregnant woman in America, and they weigh you like five times the visit. 1 I’ve never been weighed so much in my life in these last 18 weeks than [laughs] I have in the last 18 years. [Cynthia laughs] And it’s just wild. You have a little bit of constipation, your weights up, then you’re not constipated, but your weight looks down. And everybody’s just so panicky about things not being up a pound or only being up half a pound. And you can’t rely on this.

It can’t be your only measurement of how well my pregnancy is progressing since we’re not doing these ultrasounds. My weight can’t tell you everything about the health of this baby. So, I remember several years ago, we have a colleague diet doctor, Andres, actually these memories just popped up on Facebook the other day, which was really nice. But back in 2018, I was there and they asked, “What is one thing that you could do?” And I said, “I wish we could just change the discussion and not focus on weight and really focus on body composition.” And people stop criticizing people on how much they weighed or giving medical advice based on what that scale says. But rather, do you have strong bones or do you have osteoporosis? Do you have good lean mass that’s going to protect you as you age, or are you wasting away your muscle mass to sarcopenia? How much body fat do you really have? I mean, you can be exceptionally healthy at 160 pounds or you could be in trouble at 160 pounds. You don’t know without understanding that body composition. And it’s as critical for people who might look like they have metabolic syndrome. It’s as critical, if not more critical, for those who don’t look like they might have metabolic syndrome.

Cynthia Thurlow: I think you bring up so many good points, and for anyone that’s listening, PCOS is the number one endocrine disorder that we now see in most Westernized countries. So, it is pervasive about 25% of individuals with PCOS. Megan obviously fell into this category, I fall into this category are thin. And so, the thin phenotype PCOS, people phenotype just means the physicality are literally dropped through the cracks that more often than not, because we are not obese or overweight, people make these assumptions. We can’t be insulin resistant; we can’t have a degree of inflammation and oxidative stress going on. And I do agree with you wholeheartedly that many of these individuals are at greatest risk because they’re not being monitored closely. And the other piece that you kind of touched on so eloquently is there’s so much focus on the physicality, the weight on the scale, and yet not really reflecting on what is most important and certainly at the stage of life I’m in, and most of my listeners are in.

They’re in this 40 plus year old stage right now where sarcopenia is a real thing, this muscle loss with aging. And what many of us didn’t realize was in our 20s and 30s, that’s when we have peak bone and muscle mass. And if we’re not working to ensure that we have healthy bones, that we have enough physical lean mass on our bodies, we really get into trouble metabolically north of 35 or 40. And so I think you bring up so many good points. And the other thing that I would say is, as a clinician, it’s always humbling when I go to a doctor’s appointment, which I don’t do all that often, but when I go and I get weighed and I remember I had patient the nurses would weigh them and they wouldn’t look at the numbers. There’s so much fear and anxiety about what that number represents. And I always say it’s just one piece of a puzzle.

It’s just like a blood pressure or a temperature or a respiratory rate. It is not who you are. But yet it is such an important indicator of, are we in a position that we need to do some education? Are we in a position where we need to be talking to this patient about what their risks are? Because I feel like traditional allopathic medicine is really just focused on, it’s like we’re waiting for you to get a diagnosis. And everything up until then is kind of like, “Well, you don’t look that bad. You’re not that sick. You’re not that heavy.” And I think we miss opportunities to preventatively ensure people don’t go on to develop disease, as opposed to kind of the traditional model is we wait for people to get diabetes, we wait for people to have full blown fulminant cardiovascular disease instead of kind of intervening at a much earlier point in time.

Megan Ramos: What we get to do every day now. My mom was very sick from a young age. Obviously, I had this family exposure to metabolic issues at a young age and became very concerned about health and well-being. I had diseases myself that no one really understood. So as early on as I can remember, I remember my first biology lesson and thinking, “Okay, yeah, I love this stuff. This is what I’m going to do. I want to help people get better.” And I just remember I was fortunate. My father traded kids for one summer with his good friend who is a nephrologist. That’s how I got into the nephrology field in the first place. That summer I met Jason. And so, from 15, I got kind of immersed in it, and I was just so depressed come 26 years old, I worked in it every summer, every school year. It then became my school project.

At one point, it became sort of my thesis and everything I went to work on. I grew up in nephrology, and it was just heartbreaking. I came to the conclusion, “Okay, we just watch people die, and we try to give them prescriptions to lessen their symptoms, and that’s literally all we do.” I was actually sort of taking a year off from figuring out my life. I was still working in nephrology because I had bills I had to pay, but trying to figure out. Am I going to go to law school? Maybe I’ll just follow in the family footsteps here, because that way you’re not as emotionally attached to people if you’re doing corporate litigation, there’s a line there. But I said, “I can’t just go on it and just manage people’s demise. It’s too heartbreaking.” And that’s not what I thought medicine was. And now I get to go to work every day. You get to go to work every day. And all we do is hear about people getting better or at least being able to improve the quality of their life substantially.

For me, I have a large focus on diabetes. That’s how Jason and I got started. And almost every day, there’s someone who’s been on insulin for 20 or 30 years, they’re off of it, and they’re having normal glucose responses. They would pass an oral glucose tolerance test, and when they do the equivalent with an insulin response test, they have a normal insulin response to these foods as well. It’s just mind blowing that we get to help get people their lives back. And I think social media has so many pros and cons, but one of the pros is the voice of people who have really focused on disease prevention and the root cause of disease being able to be out there sharing their story, and now other people are learning, “Okay, maybe type 2 diabetes isn’t something like a chronic progressive disease that I have to live with. Or maybe I don’t have to live with the symptoms of PCOS or this fatty liver disease that they tell me I can’t get rid of.” I can actually reverse that in several months with lifestyle changes. So, it’s really rewarding that we get to do this every day.

Cynthia Thurlow: Yeah. What an incredible story for listeners that may not realize that your work as a teen was really working in nephrology. That’s how you met Jason, and then this very serendipitous friendship, collegial environment ensued. And so, thank you for all the contributions that you both have made. It certainly has influenced the work that I have done. And so, let’s pivot and talk about one of those strategies that I know has been so effective for your patients. And there’s growing awareness around intermittent fasting. And almost every time I get interviewed, people are like, they want to talk about the myths around intermittent fasting. And so, I thought it might be helpful because there’s still a lot of misinformation about it. Jason has a quote in the book that I wanted to share because I loved it. “Snacking is healthy. If were meant to graze, we would be cows.” [Megan laughs] And so really helping people understand that snacking is problematic in and of itself. And this constant influx of food, how this is eroding our metabolic health and how it’s contributing to all these metabolic diseases that are increasing at alarming rates, including PCOS, including diabetes, including hypertension, etc. So, some of the common myths about intermittent fasting, what are the ones that you hear most frequently from your patients?

Megan Ramos: Yeah. So, the myths extreme calorie restriction, another one is the muscle loss that we have, so the starvation, essentially, and one of the most over nourished, we’re also one of the most malnourished, but over nourished populations on the planet. So those big misconceptions and this but it’s not safe or effective for women. And there’re all these weird stigmas at various age points throughout the woman’s life. In years of fertility, it will harm fertility. Well, here I am about to turn 39 years old, pregnant. I did have to bank embryos because I don’t have that many eggs left due to my PCOS history. But I don’t really have tremendous infertility issues. I just want to make sure that when I’m 41, I want to have a second kid. I’ve got viable eggs or embryos available to have that child. So, there’s the fertility aspect it’s going to ruin your chance or there’s just no hope for postmenopausal women and I do feel bad. This is one thing too, and I do take everyone’s feedback very seriously and really try to think about it.

Even in my book, a lot of feedbacks come. There is nothing really specific about postmenopausal woman, we talk about estrogen dominance and how that plays a role. And of course, that affects postmenopausal women too but postmenopausal women can really fast like men. There’re very few restrictions on things. And of course, I will be happy to take some lovely bioidenticals as I get older, give me a little bit of progesterone, let me sleep, [Cynthia laughs] let me [chuckles] enjoy life. So, I’m very open to that. But I also have the knowledge base. That’s something that’s missing. We talk a bit about that in the book too. But we have so much great success with this postmenopausal population. And most of the people I work with do have some degree of diabetes. That’s why they come to us in the first place. But as we treat the diabetes, the weight loss does come. So, every different stage, at perimenopausal your hormones are too weird, you can’t do anything. You must continue to snack and graze like the cow. That’s not the case either. There’s a lot that you can do during these hormonal shifts. So, very weird insights across the adult female age spectrum.

Cynthia Thurlow: Yeah. It’s interesting because almost every day I get tagged in something. Oftentimes people want me to engage or argue with someone else. And I don’t think that’s particularly effective. There are people who believe what they believe and they’re not interested in entertaining different opinions. And I would agree with you that a young, under 35, lean athletic woman is very different than a young diabetic woman or a woman with PCOS. And can they fast? Absolutely and especially if they’re not metabolically healthy, for the same reason why, for me, intermittent fasting allowed me to feel like I got my life back because I was on that slippery slope of perimenopause. And listeners, I talk really openly about this. I’d never been weight loss resistant and all of a sudden, I was. And I kept saying all the information I used to tell my patients, isn’t effective. What am I doing wrong? And so nearly every woman I speak to, they hear from their healthcare providers, “Oh, you’re just whatever,” insert whatever age they are. “Oh, you’re 45.” “Oh, you’re 50.” “You’re never going to be as thin as you were at 30.” “No, it’s probably your thyroid.” “Oh, your thyroid is fine.” “No, it really isn’t.” Or you have to just accept that you’re exhausted, you don’t sleep.

Not to mention the fact that a lot of women are still told by their providers that bioidentical hormone replacement therapy is not a good idea. I’ve had women say to me, “I want to navigate menopause naturally.” And when I explain that we have progesterone and estrogen, and testosterone receptors on nearly every part of our bodies, you understand the net impact of those decisions. And so, I would say, “Make a fully informed decision.” If you’re working with Megan and Jason, they’re going to talk to you so you understand you have options. And I would agree with you that menopausal women have a much easier time because they’re not dealing with fluctuations between estradiol and progesterone throughout the month. They’re not dealing with a menstrual cycle anymore. And sometimes I feel like it’s easiest to speak to that community because in many ways, most clinicians don’t get enough education around these middle-aged women. And so many women are just told, “Oh, it’s just the way things are.” This is the age that you are. So, I can imagine much like it is for me, middle-aged women are so happy when they start having some degree of fluctuation in body composition and changes in their insulin sensitivity and better sleep and all these things that can beneficial in terms of looking at their trajectory throughout middle age and beyond.

Megan Ramos: There’s so much hope for women. I don’t know when the tides change. I was born in 84 and I just remember all of this praise for my, “thinness or skinniness” growing up. And I felt terrible for some of my cousins because I would be prized over certain family members because of my petite physical experience. I ended up being the most unhealthy of all of them combined at a certain point. Yeah, there’s just celebration for thinness and whatnot. And as we enter our 20s, then the messages from older females, “Oh, enjoy it now while it lasts.” You’re going to turn 30. You’re going to start gaining a couple of pounds every year. Wait till you turn 40, doomsday, doomsday, doomsday. Like, this was just preached at me by not just family members, my parents, friends, other family friends, teachers at school, other parent’s friends. Like it just went on.

You’re a woman and you’re totally doomed once you hit 30. It’s just downhill. And it doesn’t have to be. I mean, we see women every day that are living better lives at 60 or 65 than they ever did in their 20s. They’re so much healthier. They’re doing the most wonderful and wild adventures. And throughout the whole process, they might have had to come off of a bunch of blood pressure medications, diabetes medications and whatnot. But women, we can really just enjoy life as we get older. And the best years are still yet to come. I’m so much more healthy at 38 than I was 28, which is really cool. I had this whole issue with mold in between that I thought was going to kill me. But I’m coming out on the other side of that now, pregnancy might kill me also. [laughter] I’m not convinced, but I’m still a lot healthier, so that makes me really excited for what 48, 58, 68 can bring. So, I look forward to the future now rather than being terrified about it. But there’s this whole, like the whole culture is that you’re just going to lose it and you’re going to spend your life on medications, obese, at doctor’s offices as you get older for women.

Cynthia Thurlow: Well, and it’s interesting, my team and I created some content around weight gain doesn’t have to be a normal function of aging. And it was 99.9% of people were very supportive. And then a couple of people got triggered to a point that my team was like, “How do you want to handle these comments?” And I said, “I think what we have to realize is that there are people who are not receptive to that message.” They want to believe fervently the best years are not yet to come. They want to find a reframe that’s not a positive reframe. They want to reflect on the negativity. And I always say there’re challenges at every stage of life, but I definitely believe that I am healthier, happier, more physically active now than I’ve ever been. And so, one of the questions that came in, Megan, was help us understand the concept of CICO, so calories in and calories out versus the paradigm that I know we both kind of fall into that talks about this carb-insulin model and how calories is just one component of how people can gain weight. It is not the only thing that people need to be cognizant or aware of.

It’s so funny. We invest so much time and energy and thought into this whole calories in, calories out. We need to move more and consume less. It’s a simple math equation. There’re 1000 plus dietary programs out there that are all based on this model, but yet obesity is at unprecedented rates and just continuing to skyrocket. So, we’re trying. You know if I had a quarter for every client, women, men who came to us and said, “Hey, we spent over 100 grand so far on all these dietary programs or we started when were nine years old and we only lose the weight for a little bit, and then we regain it all back and we can’t sustain it. We don’t feel well. We develop all of these health issues, and then they buy another dietary program.” Some are based on points, some are based on shakes, some are meal plans whatever they are, they’re all based on the model of calories in versus calories out.

They just have different packaging. It’s like going to Costco. There’s Costco brand toilet paper, then there’s the toilet paper with the cats and the toilet paper with the bears. They’re all toilet paper. They’re just in different packaging, what packaging and what price point works for you. But at the end of the day, they’re all going to serve as toilet paper. So, we do all of these diets, that Beach diet, that Point diet and we expect to have different outcomes, but we end up having the same outcomes over and over again. And I get into this debate a lot in my personal life over the years, but it’s funny that my personal people are more likely to come at me about calories aggressively. But if you have 150 calories from a can of soda versus 150 calories from a handful of olives or if you’ve got 200 calories from three cookies or 200 calories from a piece of salmon, there’s a very big difference. You know, diabetics know, people who have been stuck in this weight loss circle know, having that 150 calories of soda or 200 calories from cookies is not going to aid in their efforts. But when we look at the almonds or when we look at the salmon, we know that’s going to not raise our blood sugar levels. It’s not going to contribute to weight gain. It’s going to aid in weight loss. So, the calories are the same. Why do we have such different expectations?

When we had our clinic in Toronto, patients were forced to be there. No one saw us electively, it’s all covered by insurance. Their doctors referred them. They showed up. There’s this nice doctor, this nice guy who says, “I want you to not eat 50% of the time and I want you to go see this young blondish redhead person who looks to be in perfect health, and she’s going to tell you how to do it.” It’s ridiculous to actually think about. So, I had to share my story with them to get them to understand there’s light at the end of the tunnel, but I had to get them to shift their paradigms. And we used to hold these in person– sounds so archaic now. In person, seven-hour bootcamp class to get everybody to the same base level of education. We did it every Friday, and the first thing I asked everybody when they sat down, they’re all diabetics. And I say, if you’re trying to control your blood sugar levels or if you’re trying to lose weight after a holiday, what are five foods that you consider to be real foods, not fast food or junk food that you would cut out of your diet to have better blood sugar levels and to lose weight. And I give them a few minutes without fail every single time in those few years that we did this every Friday. Rice, pasta, corn, potatoes, bread.

Now, we know some of those foods are barely processed, but most people look at things like pasta, bread and white rice, and think that they’re healthy natural foods that haven’t been processed. So, here are these foods and I’d say back to them, “Okay, well, these are low-calorie, low-fat foods, so why are you trying to avoid the low-calorie, low-fat foods in order to lose weight?” And then you start to see the hamster wheels turning in the room, okay, this doesn’t make sense. She is right. These are low-fat, low-calorie foods. But if I eat lots of them, I gain weight or if I eat any of it, I see my blood sugar levels worsen. So, it’s really about our hormonal responses to the components of those foods. If we look at our foods across all cultures, I had the extreme privilege of being raised in Toronto, which is the most diverse city in the entire world. And as we’ve got this baby coming, there’s a lot of discussion about moving back so they can have that similar experience. But all of our foods are made from the same building blocks.

At the most simple form, we have macronutrients, the biggest building blocks, fat, protein and carbohydrates. And they all have different hormonal responses when consumed by the body. And it’s these hormones that largely can drive weight gain and the development of metabolic illness like type 2 diabetes or prevent it. So, when we consume natural dietary fats, things like the salmon and the avocados, or the coconut oil, the grass-fed beef, what we’re really giving our body is the base of all the hormones that we make, the base of healthy cholesterols. We give our body the potential to absorb some really good nutrients and vitamins. And we also are producing a fuel source, but a fuel source that can act independently of insulin.

When we eat carbohydrates, there are different categories for carbohydrates. They used B complex and simple and processed and unprocessed carbohydrates; they are primarily a fuel source for the body. They do serve some other functions, but they’re primarily a fuel source for the body. So, they do require assistance, though, from insulin in order to be utilized as a fuel source. And they also require insulin to help store it so it can be retrieved as a fuel source later on if required, but lead all of the time. So, you have this macronutrient that’s largely dependent upon insulin. So, we’ve got these two primary fuel macronutrients that have these very different hormonal responses with insulin. And insulin is primarily a fat trapping hormone and a hormone that when it’s produced in too high levels in the body, it becomes toxic, and that it can contribute to the development of insulin resistance where our cells actually experience resistance to our own insulin from the overexposure of it.

Whether you’re just eating a lot of processed and refined carbs that produce a ton of insulin or you’re eating all of the time and you’re just constantly exposing your cells to insulin. So, our bodies respond hormonally very different to these macronutrients. So, when we tend to eat a diet that prioritizes things like avocado, salmon, grass-fed beef, duck eggs, olive oil, we don’t produce in response a lot of this fat driving fat trapping hormone. And so really looking at the hormonal response is so critically important. Another big thing too isn’t fasting just an extreme form of calorie restriction? And one thing we like to talk to our community about is if your household budget was reduced by 30%, you could figure it out. You might have to sell a car or downsize. You might cancel that Netflix subscription and get a Hulu subscription. I don’t know what’s cheaper. [laughter]

You might buy food that’s on sale versus just buying whatever you want at the grocery store. When your household incomes first splash by 30%, you’re going to overspend. But a few months down the road you’re going to have figured it out, so you know how to accommodate to the new dietary or the new household budget. So, if you think of calories sort of as this dietary budget in essence, if you reduce your caloric intake, say by 30% in the hopes of losing weight, your metabolism is going to keep your body running like normal for the first little while and you’ll lose some fat. But then it figures it out. It says, “Okay, I only have $1,200 a day instead of $2,000 a day to budget on, so I’m going to slow down cognitive function, respiratory function, reproductive function.” And then what happens is people start to feel like they’re running slow and on empty and not full robust capacity, so they’re not feeling great and they stop losing weight. When you’re doing something like fasting, like what we work on with our communities is you’re not really giving them anything, 35 calories from a cup of coffee or a cup of green tea here and there, the body can’t function on that.

We actually have this really cool nervous system response. We engage our sympathetic nervous system and we produce these cool counterregulatory hormones and those help us liberate our body fat, burn it and use it as fuel. So, when we look at all of that– we’ve been really fortunate in our fasting space to have a lot of great randomized control trials come out comparing true alternate daily fast to traditional calorie restriction diets. And we see it fasting superior across the board, more fat loss, more trunk fat loss, better attention of lean mass to help comfort the minds of those who are concerned about that. But we also see this great maintenance of resting metabolic rate in the fasting group, where we see a clinically significant reduction in every single RCT of the calorie restriction groups. So, this nervous system response is a big differentiator that keeps our body accessing all these fat stores, accessing all that extra fuel that’s been stored for use later on. Diabetics will say, “Hey, Megan, I don’t get it. My blood sugars are still 180 while I’m fasting.” Well, your body is just going into those stores. So that extra cake that you had on your 40th birthday or that extra donut that you had the day that truck had flipped over on the expressway and you were late for work, like, all of this stuff. It’s there, we’ve never burned it, and we’re liberating it now.

Cynthia Thurlow: I think it’s really helpful for people to understand that complex in a relationship, because there are still the naysayers out there that want to just count calories. And I explain to them all the time that it’s so much more nuanced and you did a really beautiful job. I would love touch on the role of, or the net impact of sleep and stress on our glucose as well as our insulin levels, because I think especially coming out of this three-year social experiment/pandemic [Megan laughs], I think a lot of people are now probably starting to understand that not getting enough sleep, not managing your stress is not going to allow you to navigate having optimized or optimal metabolic health long term.

Megan Ramos: I think that prior to COVID too busyness was very rewarded and celebrated. And what we have is a generation of younger people seeing generations of older people just being really sick. I don’t have to convince any of my younger cousins that they shouldn’t drink soda or juice. They understand what happens to that when you do consume those things. My mom drinks orange juice, she needs now diabetic medication. It can’t be good for you. So, this is, I think, started to get highlighted before COVID that, “Hey, maybe busyness isn’t something to celebrate.” Ending up in your retirement years, going from doctor to doctor and taking 18 medications a day, that’s not how we should function. And it’s so– I’m sure in the population you work with, in our population too these people are killing themselves trying to do everything they can to– in my group, really reverse their type 2 diabetes and get the perks of that, like, fat loss, down the road they’re overhauling their diets.

I do pretty intensive fasting with the diabetic patients. Not forever, for about six months, but they’re doing a lot. And there are sacrifices that do come with that therapeutic choice, but they’re not sleeping. They’re working all hours of the day. Even when they do eat, they’re working through those meals. And all of this stuff is really counterproductive towards our health goals and our longevity. And I do think, like you said, COVID was a big wake up for a lot of people because that was just an extreme amount of stress in a very short period of time. And I see family members and they look like they aged 20 years in three years. It’s been wild. So, cortisol is our primary stress hormone and it’s so important to understand that doses really makes a poison with so many things. We talk about and I’ve talked a lot already in this episode about toxic levels of insulin being problematic.

Well, we know if there’s no insulin, that’s also problematic. An individual has type 1 diabetes and requires medical intervention for that for the rest of their life, and there’s risk associated with it. So, cortisol is a stress hormone and a little bit of stress on the body is a very good thing. It helps us grow and thrive and become resilient. That’s what fasting and therapeutic fasting are. Positive stressors in most situations. There’re some situations where it’s not ideal or optimal, might be too much stress. And we call this whole concept of finding the right amount of stress or hormesis is. So, when someone asked me, “Hey, Megan, where should I start off with fasting? Do I start off with 14 hours or should I jump into 14 days?” It’s kind of like going to the gym and you’ve never been to the gym before. Do you pick up that two-pound dumbbell or do you pick up that 50-pound dumbbell to do bicep curls?

If you pick up that 50-pound dumbbell, you’re probably going to hurt yourself and end up in PT. You’re seeing a sports chiro the next six months. You’re going to set yourself way back. Two pounds might not stress your muscles out enough. So, we know typically when we go into the gym, we have to find the right amount of stress. So, it’s about finding the right amount of stress in life. So, we don’t want no cortisol being produced. That’s a very bad thing. My mother actually doesn’t have either adrenal gland. They were surgically removed, her adrenal glands produce cortisol. So now she’s on all this fun medication for the rest of her life and ends up in the ICU for two months every two years [unintelligible [00:41:34]. No one wants to live like that. So, we don’t want to have the ability not to have any cortisol or produce it on its own. But we also don’t want to have too much of it either. And there’s a hormonal cascade of things.

Everything in the body is a song and dance. I even had a very physiology 101 reminder the other day that, “Oh, progesterone increases calcitriol levels.” I had those things so compartmentalized in my brain after all of these years, but everything really interacts with one another in the body. So, when our cortisol levels go too high, we have an insulin response, we see our glucose levels become elevated, we activate fat storing, and that you can’t be in both fat storing and fat burning at the same time. So, if you’ve had this nervous system response, the stress response that activates fat storing, you’re not fat burning. And so, you’re really driving up your risk factors for disease. And so most people look at stress, and they think financial stress, marital stress, stress from aging parents, work stress. But stress comes in a variety of different forms, too, like chronic busyness, not taking downtime, not getting proper sleep. Sleep is a foundation of just everything. So, if you don’t have sleep, your body is going to be chronically stressed. You could have the most rainbow butterfly, Buddhism life, but if you’re not sleeping, your body is going to be under physiological stress.

I’m pregnant and we spent a lot of time, effort, and money and emotions into getting pregnant. [laughs] It’s stressful, though. I’m so grateful. I’ve never been so grateful to be so sick in my life. But it’s stressful, it has impacts. Weddings, I love my husband, our wedding was unbelievably stressful, planning it from Toronto and it was in the United States and not seeing the venue until the day before the ceremony. And it was stressful having our families come together for the first time the day before our wedding. So, all of these great things too in life do come with some associated stress, and we just let it consume ourselves nowadays, rather than focusing on getting a rest, taking care of it, stepping outside, taking some fresh air, doing some deep breathing, we’ve got to take care of ourselves. Because stress on its own you could have the most perfect diet, the most perfect fasting plan, and you can’t outeat or out fast a stressful lifestyle.

Cynthia Thurlow: That is so true. And I think for a lot of people, perhaps the last three years has forced them to kind of reappraise where they are in their lives, what they’re doing, how they choose to interact with others. I am a big fervent believer of boundaries, whether that’s personally or professionally. I think that’s very important. I love that you’re talking about that connection, the nature saying no, doing less to be busy. It’s interesting I just watched the, I’m embarrassed to say that, I binged a documentary on Arnold Schwarzenegger, but essentially, he admits to the fact that he’s kept himself so busy that he never had to deal with the death of two loved ones. And he was very transparent about how was his work ethic. He’s Austrian, and they’re supposed to be busy and not complain and just keep plodding along and he even mentions how destructive that can be long term.

Now, in terms of people, if they’re listening to a conversation, they’re interested in intermittent fasting. What are some of the kind of core concepts? Obviously, if you’re diabetic, brittle diabetic, you’ve got significant health problems. You want touch base with your healthcare professional. But when we’re talking about general overviews of strategies for people to kind of slowly integrate fasting into their lifestyle. What are some of your common best tips for that?

Megan Ramos: Yeah. Be mindful of how many times a day you’re causing your body to produce insulin in response to food. You don’t have to do any crazy fasting. And this is where the not grazing like a cow, Jason [Cynthia laughs] comes in. Just don’t snap. I always joke with people; you want to go back to those Leave It to Beaver days. I actually had a community member and she came across an old episode on some TV station and she said, “You’re right.” The Beaves, he got in so much trouble for sneaking an apple before dinner because that meant he hadn’t saved his appetite for his healthy, proper meal. And just the fact that they looked at an apple like he had ate an entire box of cookies for a very long time. We ate square meals in modern day human history and we didn’t eat in between. So just being conscious, even if it’s just three meals a day, if you want to have those almonds, have them at lunch, have them at dinner.

Even if you did want to have some berries, okay, have them at lunch, have them at dinner, being mindful of how many times a day you are asking your body to produce insulin. And I think if we did that, if largely first world countries that have the privilege of this 24/7 access to abundance of food, very cheap processed and refined food. If we just cut out snacking, I think we see metabolic illness rates reduced by about 50% easily and a huge drop in obesity levels. So that’s the best place to get started. It’s not always about eating less, it’s about eating less often. Of course, what you eat is really important as well, but eating less often is a really good place to get started.
Cynthia Thurlow: Yeah. I think that’s certainly really helpful. Now, we had specific questions that came in around things like what if I start fasting and my sleep quality erodes, what are some of the things that you like to suggest or recommend to your patients? Because obviously the bulk of my listeners are north of 40 and sleep becomes problematic because of these fluctuations in progesterone amongst other things. But this was a common concern that people were curious to know, what are your workarounds?

Megan Ramos: Yeah. Usually if someone comes into, say, a consultation and their sleep is already nonexistent, I will have the conversation with them about getting their sex hormones looked at, investigating progesterone or even, like, Vitex or something that they can do if they’re more comfortable going that route just to help. Because fasting is just going to have the– well, the most common side effect we see of the longer fast that we do is sleep disturbances. They’re usually temporary, they last for a couple of weeks, so I wouldn’t encourage anyone to start it during a really crazy time. I have had this book launched, now wouldn’t be the time if I was new to fasting, to start fasting, for example, when things are a little bit more normal in your life, in your routine, you’re not going to be traveling or working crazy hours. That’s a good time to start your routine.

At the most minimal invasive recommendation is magnesium supplementation, typically for improvement with sleep and just overall relaxation in the nervous system. We recommend magnesium glycinate or bisglycinate, they are the same thing, but different bottles say different things. We’ll encourage people to take it sort of early evening. That way it’s got a chance to sort of let the body relax before going to bed. I find one of the things is people take it, go to bed right away, then they’ve drank water, they have to wake up to go to the bathroom. There’re all different types of problems with that or it takes a couple of hours to really relax them when they want to be sleeping. So, magnesium supplementation individuals with insulin-related issues. Insulin really causes our body to burn through an enormous amount of magnesium. So, a lot of the data shows that individuals with insulin resistance actually need a ton of magnesium every day. Sort of the daily RDA is around 400, but the data shows that a lot of insulin resistant people actually need around 2000-2400, which is way different than the RDA.

Now, not everyone can tolerate that there are gastrointestinal effects of taking too much magnesium, but even taking the daily RDA in that early evening can help. Another thing that I found to be really effective, and we have all kinds of people that want to do five-day fast, 10-day fast. So, if there’s no reason why we can’t support them, we will support them. And during those times, I’ll recommend Epsom salt baths or Epsom salt foot soaks if they don’t have a tub or they’re not comfortable getting into a tub. The Epsom salts is just pure magnesium sulfate that absorbs transdermally through the skin. There’s now magnesium oils and gels that you can purchase nowadays as well that do something similar. So, magnesium can be really relaxing on the body. In some cases, too, we’ll encourage people to get their melatonin levels checked. A lot of women can do that through the DUTCH urinalysis test.

Melatonin is an interesting thing. As we get older, our systems definitely can have the potential to become depleted in it. So that’s something we want to see naturally how much we can optimize that first, limiting a screen time, you’re going to read and need a light, getting a little red light just to help. We really want to generate this melatonin production as naturally as possible in the evening if it’s deficient. Sometimes we just can’t produce adequate enough and then that leads to conversations about supplementation. We tend to supplement pretty high here in North America compared to what is even considered to be legal in other parts of the world. So, it’s not an abundance of supplementation, your half a milligram or a milligram can often do the trick with good bedtime etiquette. But it’s important to know because a lot of the times, too, we can maybe feel fatigued from having too much melatonin. And too much melatonin is another one of those hormones that, if it’s not in the right amount, has negative consequences. One of them being insulin resistance. And all of the fun that comes along with that, we want to avoid all of that stuff.

So, getting your levels checked, I’m a big proponent of targeted supplementation. I take a handful of things myself. I either know I’m nutritionally going to be deficient in because I don’t eat enough of it or I do the testing and just make sure that I’m getting adequate nutrient levels across the board. Melatonin is one of those that you want to do, you just don’t want to take blindly. And you certainly don’t want to take a lot of the higher doses that you see at the store these days.

Cynthia Thurlow: No, I think it’s certainly worthy to kind of first start with emphasizing the sleep hygiene piece before we start over supplementation. Just two more things to jump on, dawn effect so a lot of the listeners are savvy with what this represents. I know you mentioned in the book that it’s sometimes the hardest thing to work on, especially for those who are already insulin resistant or diabetic. But for people that are looking at continuous glucose monitors or glucometers, trying to figure out why that dawn effect is still magnified even though they’re doing fasting as a regimen, any tips?

Megan Ramos: Yeah. You’ve got to be patient with it. My colleague Jason Fung has the last thing that gets better. If you have an A1c that’s close to optimal, and you still might be combating blood sugar levels that are slightly elevated in the morning time. These hormones produced in the morning time that help us get ready to wake up and conquer the day. And they do cause our liver to spill out any excess glucose that might be in there. So, the body is just purging and dumping. There’s also a stress response that happens in the morning that triggers this as well. So, focusing on those stress strategies, in addition to all of the great diet and nutritional strategies, getting your cortisol in a good and healthy range and sort of a normal circadian rhythm curve, getting good sleep, all of that can really help expedite the recovery of those morning blood glucose levels.

Cynthia Thurlow: Yeah. The most important thing is to be patient. I think we want instant gratification as a society and that’s not entirely realistic. Last question is around gout. There were a lot of questions about husbands who have gout or women that have experienced gout. Why do we need to be careful if we are fasting and we have a history of gout? And for the listeners that don’t know, gout is a metabolic issue. It is not benign. It’s not just about eating too much cured meat or cheese. It is a sign of high uric acid levels, which are a reflection of metabolic health.

Megan Ramos: Yeah. It’s so funny to have gotten into this because gout is something I’ve combated with patients again since I was 15 years old. I was creating a medication database. And the crazy thing for renal patients or kidney disease patients is that they end up having gout-related issues because their kidneys are failing and unable to excrete the uric acid. So, it builds up, but then the medications that are prescribed for gout worsen the kidney function. So even this is, I’ll say, was probably the only holistic thing that we ever looked at through a lens and looked at prior to Jason and I going off into more of this fasting, functional nutrition space was are there different ways to mitigate that. So, a lot of people come to programs or communities like ours, and they’re terrified because a lot of the food we recommend is typically food that they don’t suggest you should have if you have gout and it’s like, “No, you have high gout because you have high insulin levels and metabolic syndrome.” And as we work on that, we well improve it over time.

So, when someone is new to fasting with a history of gout, it can get flared up. When we first start fasting and our insulin levels are high, they do drop very quickly. This causes water loss and electrolyte loss. This can lead to the buildup of uric acid and gout symptoms, I’ve never experienced, but I hear are quite excruciating, so I never want to experience. So, we do tend to start off someone with a history of gout just a little bit slower so we don’t really see their insulin levels tank. We don’t see issues with dehydration. We do spend more time talking to them about the importance of water and salt and how it relates to them. There’s some additional supplementation that we recommend, even something as benign as citrus juice so that can come in the form of lemon or lime water. Lemon and lime juice are very effective solvents for uric acid. So, we would use this in kidney patients even going back like 30 years ago now. Lemon, lime juice so it really helps just to dilute the blood of the uric acid.

Cherry fruit extract or cherry tart extract, depending on what country you’re in. I’ve learned to call them different things. That’s also helpful so in cases of more extreme, sometimes we’ll get diabetic who’s like on 300, 400 units of insulin, we’re eager to fast them more aggressively. We don’t have several weeks or months to build them up to doing some longer fasts. So, we’ll say we’ll have a few tablespoons of lime juice or lemon juice in your water. Try taking the cherry tart or cherry fruit extract, and this usually helps mitigate the symptoms. Actually, we have had that one clinic patient. We never really did many fasts beyond 14 days, but sometimes people had different desires. So, Lent was a big one for religious reasons. A lot of our patients wanted to do longer fast. We had one lady with a severe history of gout, not always the best diet. She went through a lot of life changes and was struggling with finding comfort in food. So, for a spiritual reason, she wanted to do a longer fast. So, we utilize some of these tools, really focus on hydration, tried to bring her insulin levels down as much as possible through nutrition before starting the longer fast. And she went for actually quite a long time without having any issues. I checked her uric acid levels twice a week and we had no issues. But that will get better over time. But don’t go crazy restricting beef and seafood? That doesn’t contribute to it at all?

Cynthia Thurlow: Well, it’s certainly reassuring and lots of little tips that I was not aware of. Megan, thank you so much for your time today. Please let listeners know how to connect with you to purchase your new book, how to connect with you on social media, etc.

Megan Ramos: Thank you. So, all information about us can be found on our website thefastingmethod.com the links to the books are there. Canada, the United States, Australia, the UK, and more places as it becomes available, you’ll be able to find it there, but all of our social media links as well. You can find us at thefastingmethod.com everywhere @meganjramos as well.

Cynthia Thurlow: Thank you again. It’s been a pleasure as always.

Megan Ramos: Thanks, Cynthia. I really appreciate our discussions.

Cynthia Thurlow: If you love this podcast episode, please leave us a rating, and review, subscribe, and remember, tell a friend.