Ep. 290: Elevating Health, Fitness & Dieting through Nutrition with Cynthia Thurlow, NP and Intermittent Fasting Expert

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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.

Y’all, this is the AMA with me #2. Like I said, I was totally very gratefully overwhelmed with questions. Today, we’re going to talk about nutrition, little bit about me, lot of questions about me, and then possibly we may dive into some intermittent fasting questions. We’ll see how many we get through. If you’re loving these episodes, please let us know. Please keep the questions coming. We were completely overwhelmed with questions that were submitted, but I think it goes without saying that we are very appreciative and grateful to have your input on what you’d like to learn more about.

So, let’s dive into a commonly asked question. This comes from Aaron. “I see you often choose a burger when you eat out. Are you concerned about it being conventional beef versus grass fed?” This is a great question and more often than not, the reason why I will eat a burger if I’m traveling is that I can get it just about anywhere. I can have it naked with some salad. That’s usually my standard fare. In many instances, it just seems to be wherever I am, it’s something that I can easily get. If I need to have a double burger, I can do that. I can add some bacon, I can add some avocado but to answer Aaron’s question, I will refer back to Sacred Cow with Robb Wolf. He co-authored that book and I’ve interviewed him on the podcast about this. The real differences between conventional vs grass fed beef and this is why I don’t stress about it when I’m away from home, is the differences between the omega-3 to omega-6 ratio, so anti-inflammatory to inflammatory ratio of fats.

From my perspective, eating a couple of burgers that are more conventionally made, over time I’m not really worried about it. I think we have to be considering that. Keep the big picture is what I’m trying to say. And when I’m out, I try to avoid seed oils. That’s usually a given. Beyond that, I’m really just focused on hitting my protein macros, getting in some vegetables, and lots of hydration and electrolytes. So, I wouldn’t worry about that too much, but Sacred Cow would be a great resource. The first podcast I did with Robb Wolf, we definitely dive into some of the research and science behind that. He’s very transparent. He kept saying, “I wish I could have found more differences, but I really couldn’t.” It was really differentiated. The real differentiator was the omega-3 to omega-6 fatty acid content.

The next question comes from Lynn. “I’m wondering if you’ve heard of stomach issues with alternative sweeteners like allulose or monk fruit? Oh, my gosh. This is something that Vinnie Tortorich, who’s been a guest on my podcast multiple times, talks about. Many people get digestive distress. And Lynn mentions here, “I’m experiencing digestive issues suddenly and trying to figure out what’s going on. I had a colonoscopy done. No issues.” Yeah, the artificial sweeteners can create a lot of gas and a lot of bloating and just make for a pretty miserable experience. So, from my perspective, I think that if your gut doesn’t feel good while consuming something, I think it’s a good communication to let you know that your body is telling you to avoid it. I think there are certainly some other sweeteners out there that have a more negligible impact on blood sugar, things like stevia. Having said that, I think all of us need less sweeteners in our lives.

I’m not saying that they don’t have a place, but if you’re feeling like you’re not doing well with artificial sweeteners, probably best to limit them or eliminate them entirely. Vinnie Tortorich talks a lot about this. In fact, he’ll tell you a funny story about, he was at a keto event and he mentioned that the bathrooms were a disaster because people had so many digestive issues related to the artificial sweeteners that were in a lot of the keto processed foods. So, just something to keep in mind.

Next question is from Karen. “Three years of beef, pork, eggs, and fish, and only water for liquids, but not seeing improvement with body fat, composition, and hypothyroidism. Any suggestions as to what to test for or any advice would be greatly appreciated.” When someone is weight loss resistant or they’re having body composition changes, it’s almost always speaking to hormones. Karen, you didn’t mention if you’re taking medication for the underactive thyroid, what life stage you’re in? I think it’s just important to understand that a lot of women go through not just adrenal pause and also thyroid pause. And so, it’s important to understand that what is changing in our bodies as we’re kind of navigating the transition from perimenopause to menopause. A lot of people are no longer insulin sensitive. So, I would want to be looking to see what your fasting insulin is going on. I’d want to look at an oral glucose tolerance test to see what your postprandial numbers are looking at, probably value and having a glucometer or a continuous glucose monitor so you can be looking at those things. How’s sleep? How’s stress? Are you lifting weights? Are you eating anti-inflammatory diet?

I think a lot of people don’t realize that things like sugar, alcohol, gluten, grains, and dairy can be hugely inflammatory. It is very bio-individual. There’s a lot here that I think is kind of unanswered. Obviously, you’re eating good protein sources and drinking water. I think that’s all very important but there’s a lot else that could be going on. I think this is when some diagnostic testing and digging a little bit deeper into what’s going on. If you’re in menopause and you’re having body composition changes, I almost always think it is related to a couple of different hormones, cortisol, insulin, certainly thyroid, because we have a thyroid receptor on every cell of our bodies. And then probably a little bit of testosterone as well. And if you recall from my first AMA, about 25% of women still maintain healthy testosterone levels in menopause. The rest of us do not. And so, there’s a lot to unpack there, but body composition is complicated business. It is lifestyle, probably hormonally mediated, all of which have to be examined to figure that out.

Next question is from Janice. “I have not been counting calories. Do I need to be concerned about hitting a certain number of calories each day to maintain a healthy metabolism?” Janice it’s a great question. I think it’s important to focus on macros, making sure you’re getting enough macros into your diet. And by saying macros, I’m talking about protein, fat, and carbohydrate. I find most women don’t eat enough protein. They eat the wrong types of fats, namely seed oils, and they overeat on carbohydrates. So, I think tracking macros can be very insightful. Cronometer is a free app. I have no affiliation with it, but that would certainly be something I would focus in on, really aiming for 100 g a day of protein.

Definitely, if you don’t have my book as a resource, that would be a really good resource to kind of check out. But those things can be very helpful. I don’t think that calories tell the whole story. I think there’s a component of calories and hormones, things like the carb-insulin model, meaning if you’re overeating carbohydrates, your insulin levels are high. It’s going to make it very hard to tap into fat stores for energy. I also always like to mention that things we’re exposed to in our environment, personal care products, and food. Namely, toxins, endocrine-mimicking chemicals can also be problematic. So, just to understand, there’re many things that contribute to a healthy metabolism, but a lot of it has to do with the things that I’ve mentioned in that response.

Great question from Joey. “Can you talk about your approach around food with your teenage boys? I am the mom to a 14-year-old athletic boy who was raised with a pretty clean, nutrient dense real food diet. As he’s gaining independence, I’m watching him start to consume more sugar and junk food and I’m torn between letting him have his freedom and wanting to chime in. The last thing I want to do is cause him to have a messed-up relationship with food or an eating disorder, while at the same time I want to protect him for health issues and sugar. Can you talk about what a sane approach you looks like in regard to your son?” This is the one thing that up until your kids are in high school, you have a large amount of influence and control over what they’re eating and what you’re bringing into the house. And then as they’re becoming more independent, they see how lot of their friends eat, maybe they’re going away to camp. I mean, both my boys just came back from Duke. So, they were navigating eating in a cafeteria. And Duke University has a pretty [laugh] awesome cafeteria with many many options. They can eat 24/7.

I tend to have a pretty relaxed approach to this, because we’ve invested a lot in helping them make good food choices and gravitate towards healthier food. “Do they eat some junk?” Yeah. And I’ve just decided that with a nearly 18-year-old and nearly 16-year-old, I can’t control everything. And so, the things that are in our house are not junkie things. But if they choose to eat crappy food when they leave the house and it gives them an upset stomach or they don’t feel good, then that’s the consequences of their actions. We do encourage our kids, who are both very athletic, to remain physically active, to exercise. I think that’s really important. In fact, my 17-year-old came back from this engineering program he was in, and the first thing he said was, “I understand the Freshman 15 is a real thing.” And then he said, “I’m going to have to play club lacrosse in college.”

So, I think there’s finding a balance. And I know certainly, when I was first off in college, I didn’t eat pristinely. I survived. I think that we’ve given our kids a really firm foundation and it sounds like you have as well. So easier said than done. I wouldn’t stress too much about it. Obviously, there’s a lot of food freedom. They’re experiencing different things. I just about went bananas when I found Gatorade in my refrigerator. Trying to explain to my kids, there’re so many other options that don’t involve massive amounts of artificial sugars, but in the grand scheme of things, you don’t want to end up having your child be restrictive or secretive. And so, we’ve just kind of taken a very much of balanced approach of focus on the protein, have the veggies, and my kids actually navigate things pretty well, but I wouldn’t worry too too much about it. Sounds like you’ve done a lot to invest in your son’s perspective.

So, all I can say is, all the good information we’ve been providing them with and certainly good modeling behavior rubs off even if they aren’t willing to admit it to us, but a pizza here and there is not going to be the end of the world. An occasional Gatorade outside the confines of my house will be okay. It’s just not stuff that I would have in my house at all.

Okay, next question is from Marissa. “How do I cut down on eating too many good fats and still feel satiated?” Nuts and cheese get women into a lot of trouble. I think these are two particular foods that people think are free for all. And Marissa, I’m not picking on you. I’m just kind of saying this is a broad concept. I think a lot of people go overboard with nuts and cheese. Portion sizes are hard to keep small. They’re delicious. They’re salty. It’s like the perfect little party in your mouth of flavors and textures. Fat just really is sometimes hard to kind of turn off those urges. “What helps the satiety protein?” You need more protein in your diet. I find that the more protein I eat, the less I’m gravitating towards a lot of fat. This is just what personally works well for me and for many of my clients. Protein, protein, protein-centric diets, eating 30 to 50 g of protein in a meal and then measuring out your portions of healthy fats. Don’t just put a block of cheese down. Don’t put a bag of nuts out. Measure out the portion, put it away. If you can’t moderate, then don’t have it in your house. I know that sounds severe, but there are certain things I just don’t have in my house because they’re just too easy to overeat. And that’s worked really well for me. For some ungodly known reason, I can moderate dark chocolate, and I can have that in my house, and it’s not a big deal. So, just kind of keep those things in mind. Marissa, you probably need more healthy fats and you probably need to be really conscientious about your portions. Like, if it’s a quarter cup of macadamia nuts, measure it out, put the bag away. If it’s 1 oz of cheese, cut off that portion and put it away. If it’s like you’re kryptonite, then you need to not have it in the house.

Next question is from Kimberly. “Are drinking greens as good for gut health as advertised? Do they help with bloating? I am a 54-year-old woman who has recently gone off of HRT. Bloating is a big problem for me. Thank you.” Well, what I would say, Kimberly, first and foremost, I think it’s very bio-individual. I drink AG1 a few days a week. I can’t tolerate it every day because I’m still a little bit oxalate sensitive. For a lot of people, they just like having an all-encompassing drink, and I think it’s fine to have that a few days a week. The bloating can be precipitated by a lot of different things and this is definitely something to discuss with your internist or your GYN, whoever prescribed you the HRT. This could have a lot to do with gut health and hopefully they are doing some integrative or functional medicine testing, stool testing, food sensitivity testing to try to figure out why you’re bloated. Bloating can be from a lot of different things, but I do find underlying food sensitivities and latent gut infections can be a big precipitant.

Next question is from Marina. “My mother-in-law is a type 2 diabetic taking four doses of insulin per day. What do you advise about gradually moving to a lower carb diet and gradually incorporating fasting with severe type 2 diabetes?” Well, first and foremost, if she is a brittle diabetic, she needs to loop in her internist or primary care provider because she may need adjustments in her medications. There’s a really excellent book by Dr. Jason Fung called The Diabetes Code. Excellent, excellent resource, would be a resource for you as well as the internist. I do find with diabetics, especially those that are brittle diabetics that maybe, may not be cognizant of their blood sugar being low, like being hypoglycemic.

You have to make these changes very slowly. So probably starting with augmenting some protein, so maybe larger portions of protein, probably being conscientious about the quality of carbohydrates she’s consuming. So, the processed variety need to be removed, the pasta, the grains, the rice. Hopefully, she’s not consuming these things anyway. Removing the junk from the house, giving her whole food sources of carbohydrates. I would get a Cronometer app so that you can help her track, even if you help her do it. An app of what is she eating right now? Is she eating 300 g of carbohydrates a day or she eating 100? Because the instructions for someone with 300 g of carbohydrates a day would be different than someone with 100.

But I would absolutely, positively, before you do any of those things, loop in her primary care provider to make sure that she’s being monitored really closely and that they are in full support of making these changes. The reason why I say that is, when I talk to my colleagues who have high volume of these types of patients in their practices, the first thing they’ll say is they always appreciate and value when the patient or their family comes in and kind of loops them in so that maybe they need to do office visits every two weeks to monitor their blood sugar, to monitor their weight, their blood pressure, etc. So, that’s probably a good starting point. And I would say The Diabetes Code by Dr. Jason Fung is excellent. He’s also been a podcast guest.

Next question is from Meredith. “If I were able to reduce cholesterol or triglycerides following a lower carb whole food diet with intermittent fasting, how long would it take to show up in blood work?” So, what I would say is, if your triglycerides are high, that is a reflection of carbohydrate intake and I would imagine within six to twelve weeks you should see improvement in your triglyceride levels. I like to see the numbers under 75. Meredith also asked, “What are healthy lipid ratios? If I’m not successful reaching healthy levels, are there preferred statins?” I understand that this question is too specific to my situation to answer. So, Meredith I’m answering your question because I think it’s an important one.

When we’re looking at ratios, I don’t even really worry about total cholesterol. Oftentimes, I want to see the triglycerides under 100, ideally under 75, and I want to see your HDL as a female greater than 55. Those are two things to look at. If your LDL is also high, I like to look at NMR, which is looking at particle size, because a lot of clinicians and physicians are quick to put patients on statin therapy. The first thing I say is, no medication has no side effects. Right? So, we want to make sure if someone’s going to be recommending medications, that it isn’t something we can fix with lifestyle first. I find that most people with elevated triglycerides and low HDL, it is a byproduct of some degree of insulin resistance. You also have to make sure thyroid is within a healthy range. So, make sure a thyroid panel has been done, making sure a fasting insulin has been looked at, because if you have some degree of latent insulin resistance, that can also drive those numbers to a degree of abnormalities. This goes for anyone. If you’re listening to this and you’re told your cholesterol panel is abnormal, I would say rule out insulin resistance and make sure that your thyroid is functioning properly. Because, I cannot tell you how many lipid panels I looked at over the years for people who had underlying insulin resistance or they had an underactive thyroid and that would obscure their lipid panel. So, just something to think about.

When it comes to again, the elevated triglycerides, carbohydrates, and processed carbs, in particular alcohol, sweets, sugary things are really going to impact that significantly. So, understanding that fasting can be helpful, lowering your carbohydrate threshold, and I think tracking first to get a sense for where you are. So, if you’re eating 150 g of carbs a day total, not net. Net is a cheat and it is a byproduct of the processed food industry, maybe you need to get it under 100, but I would start there before I would consider medication.

Next question is from Tamara. “Good morning, I am 47. I’ll be 48 in August. I’m in perimenopause with chronic Lyme. I’ve been following your program for a week and I love it.” Yay. “I no longer have night sweats or extreme joint pain.” That’s fantastic. “I’m struggling to get in enough protein. I am 5 foot 3 and 118 pounds. I cannot eat red meat and I am sensitive to whey protein as well. Thank you.” Well, some people that have tick-borne illnesses can get something called alpha-gal. I saw quite a bit of it in Virginia. And so, this is when they actually develop a mammalian meat allergy. So, more often than not, it’s pork and beef. And so, this can be problematic. As you can imagine working in cardiology, a lot of people had to go to surgery.

So, what I would say is I would really work on poultry, I would work on fish, I would work on eggs. Because you are dairy intolerant, obviously whey protein is out. I would definitely start with making sure you’re eating enough animal-based protein because that is going to be superior to plant-based protein. I would say, the other thing is because you’re feeling so much better with fasting, it’s showing you that there’s a degree of reduction in inflammation, which is wonderful. But that’s probably where I would start, Tamara. And just work on 30 to 50 g of protein with each meal and making sure that you are aiming for 100 g of protein a day. That’s what you’re working towards. If you’re not there yet, don’t stress about it.

Okay, next question is from Adriana. “How many grams of meat should I eat to reach the 60 to 100 g of protein required for my perimenopausal body?” So, typically 30 to 50 g per meal is a good starting point. If you need to weigh your portions, that’s fine. I now know that if I have half a pound of shrimp, I know that’s about 60 g of protein for me. So, I try to get about 50 to 60 g in my first meal and then maybe I’ll have 40 in my second. That works for me. I can get enough protein in in two meals, but some people may need to break it into three and that is okay.

Next question is from Patty. “I am 61. I’ve been trying to eat more protein in my window. I have heard on podcasts if you eat too much protein it turns to sugar.” Not really. I mean, if you are a diabetic you may not process protein as efficaciously as someone else. You mentioned here “My recent A1c was 5.8.” I think that we need to look at a fasting insulin. It’s a very inexpensive test. I always talk about this in a lot of podcasts. It’s inexpensive. It’s $12 to $20 if you pay for it out of pocket. You can go to ownyourlabs.com. I have no affiliation with them, but you can purchase labs there and work with your primary care provider or internist if they’re not willing to do them. But a fasting insulin is so easy. You want it between 2 to 5 mg/dL. That’s ideally where you want to be. And I find in many instances that will find latent insulin resistance way before an A1c. The other thing is checking your blood sugar postprandially. So, after your meals, finding out where is your blood sugar when you get hungry. Marty Kendall calls this the trigger point. Where is your blood sugar after you eat a meal? Very very important, especially in perimenopause and menopause because you’re losing insulin sensitivity. Did a great podcast with Marty Kendall and he has a great resource on this as well.

Deborah says, “I struggle to hit 90 g of protein, but when I do, I feel satiated.” Any chance you recommend smoothies with protein powder that can help us get there? Yes. So, I would say if you tolerate whey, that’s going to be the superior option. I like MariGold whey. They have like a chocolate malt that’s delicious. They have peanut butter. They have vanilla. They have unflavored. I also like Paleovalley and we’ve got a discount for them. For full disclosure, they are a podcast sponsor, but they also have bone broth protein. Bone broth protein is not a complete protein, but if you add in some branched-chain amino acids, that can be a nice supportive process.

The other thing Deborah you can think about is doing either full fat or like, low fat or non-fat Greek yogurt, usually has 16 to 20 g of protein in that. You could add some protein powder to really kind of bump things up. So, those are some good options. You can have bone broth protein. Obviously, I don’t want that to be like a replacement for a real meal, but if you’re feeling like you need another 20 g of protein or as you’re slowly working up to over 100, those are certainly reasonable.

Adriana asked, “Cooked or raw what is best regarding vegetables and oats?” I’m not a fan of oats. I think oats are too many carbohydrates and oats are considered to be a grain. So, I find that a lot of women are very reactive to the oatmeal and I just think it’s too much carbohydrate. And actually, I’m a fervent believer that we want no more than 30 g of carbs in a meal. So, oatmeal can get us way over that. Cooked or raw vegetables, I think it really depends on the individual. I certainly like salads, but I do prefer roasted vegetables. Some people find that their stomach is really sensitive when vegetables are not cooked. So, I think that this is personal preference and what works best for you. That was also a question asked by Holly.

Next question is from Karen. “Do you agree with the apple cider vinegar trick to help keep glucose levels from spiking? If so, how much should you have per day or per high carb?” I think apple cider vinegar is fine. I think that keeping in mind that other things can help mitigate a blood sugar response, like walking after a meal. Glucose Goddess, who I’ve interviewed on the podcast, talks about having fiber first before the meal and then having the meal and then having– if you’re going to choose to have dessert or something that’s sweet doing at the end of your meal. She talks about diluting apple cider vinegar in water and then using it as like an apple cider vinegar kind of cocktail, if you will. I think that it’s fine. Maybe start with a teaspoon and see how you do with that. But again, thinking of other ways that can be helpful for glucose disposal and that includes movement after meals, that includes building muscle, that includes not overdoing carbohydrates. Like, I’m not a fan of having more than 30 g of carbohydrates in a meal. I think any more than that it can be hard to mitigate a blood sugar response especially in middle aged women.

Okay. Next question from Debra. “Are continuous glucose monitors recommended for someone with a fasting glucose and A1c in the normal range?” Here’s my general feeling about continuous glucose monitors. NutriSense is a podcast sponsor, so I want to fully disclose that, but the FreeStyle Libre is the type of continuous glucose monitor. NutriSense is the app to read the data. What I can tell you is that having and wearing a CGM has been one of the most insightful things I’ve done for my health personally. There are certain foods that I would not have known I was reacting to because I wasn’t feeling poorly. I didn’t feel like my blood sugar was high. I always talk about my beloved plantains that do not like me. It does not matter how I prepare them it always spikes my blood sugar. So, they’re now avoided, but I would not have known that. It also is very helpful to know the impact of sleep and stress and specific foods as I’ve mentioned, exercise.

The only way to figure that out is to at least for a period of time, wear a CGM. Obviously, a glucometer is at a different price point, and for some people that is within their budget and their constraints. You just have to prick your finger multiple times a day, and you’re just getting, like, a point in time reading versus with the CGM, you get a whole lot more data. So, it really depends on your budget and your sanity, what makes the most sense. So, I do think CGMs are very helpful. And way before the fasting glucose and A1c becomes abnormal, the fasting insulin will start to dysregulate. So, I do think that there’s value in doing a fasting insulin. I do think there can value in doing an oral glucose tolerance test. I do think that it’s important to know what your blood sugar is when you’re hungry and what your blood sugar is after a meal. And if your blood sugar goes up by more than 25 points, it can be a sign that you had too much carbohydrate or it was the wrong combination of foods that you put together.

Last question. This is from Marina. “I will be trying to conceive in the next few months.” Congratulations. “Any diet changes I should make when trying to conceive? I’m currently doing pretty strict keto. Is keto harmful when pregnant? Is doing a more lenient paleo diet more appropriate?” Okay, Marina not medical advice. I can tell you that in talking to a lot of the physicians in the nonketogenic space, many of them don’t like their patients doing keto when they’re trying to get pregnant. Oftentimes, they feel like there could be a little liberalization and it depends. If you are metabolically healthy, being liberal in your carbohydrates may beneficial, but this is probably a question better for your GYN or your midwife, like what their recommendations are. I do find for a lot of people, if they’ve struggled with being overweight and obese, it can be very challenging to wrap their heads around having a little bit more discretionary carbohydrate. I think this is very bio-individual and I don’t have enough information. I do know that myself and a lot of other medical professionals don’t like to see people doing intermittent fasting while trying to conceive or breastfeeding or pregnancy and I don’t think I’m going to change my position on that. So, I think you just have to be careful and conscientious, but I would definitely– talk to your healthcare provider about this.

Well, y’all, this was AMA #2. Thank you so much for your questions. Please don’t hesitate to send more to us. Like I mentioned, we have so many questions. We have hundreds of questions. It will take me a long time to get through them all, but I appreciate each and every one of you. If you’ve not already subscribed to the podcast, please do. As we get closer to Episode 300, iTunes will start limiting the amount of episodes that you’re able to see unless you are subscribed. You just have to hit the subscribe button, upper right-hand corner on iTunes. Super easy. Thanks so much.

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