Ep. 293 Break Free: Proven Steps To Get Rid Of Stubborn Belly Fat, with Cynthia Thurlow, NP & Intermittent Fasting Expert

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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 is a special treat. I’m back to do the third instalment in the Ask Me Anything. And today is all about weight loss resistance, plateaus, and belly fat. I think for every person who’s listening, this isn’t a particular pain point for most, if not all of us at some point in our lives and I do find women north of 35 in particular are really struggling in these areas. I say this because we have so many questions that you all have submitted. So, thank you for that. But also, this is probably one of the most common questions/concerns that we field across social media. So, I’m really looking forward to unpacking this, discussing it, and hopefully we can keep this discussion to under 30 to 40 minutes to make sure that it is a short and sweet discussion. And obviously if you’re listening to this and it triggers more questions that you want to ask, you know how to submit those, support@cynthiathurlow.com. So, let’s dive right in. 

First question is from Chantel. Question is, “My question is about the dreaded belly fat. I’m a 42-year-old who’s been fasting for nine to ten months now. I’ve had some great results with a few setbacks and weight gain, but one thing that is constant is my belly fat. I exercise, I do ab workouts, I fast 18 hours, but still the belly remains. Any tips? Thank you.” Well, first and foremost, when a woman is expressing concern over, I like to refer to it as fluff or belly fat or visceral adiposity as we like to refer to it. In a more technical vernacular, we’re really speaking to some of the hormonal changes that are occurring in this transitional period, late 30s, early 40s, the start of perimenopause. We know we become a little less stress resilient and we have to understand the role of cortisol. So obviously, this is a hormone that is secreted from the adrenal glands. And yes, not only do our sex hormones go through a pause, we also get adrenal pause and thyroid pause. So, our adrenal glands really take a bit of a hit as they’re trying to move from being a backup quarterback to really stepping in to help with not only progesterone but also cortisol production. 

The neat/frustrating thing is that we have 40x more cortisol receptors in our abdomen. So, if we’re dealing with chronic stress, we’re not getting good sleep, we’re not eating the right foods. It is not at all uncommon to see some abdominal changes. This could be just a little bit more subcutaneous, which is that fluff fat that we’re talking about, the stuff that’s less serious, less burdensome to the body, metabolically, but nonetheless frustrating. And for a lot of women in their early 40s, when they’re expressing concerns over more belly fat than they had to experience before, the first thing that I start thinking about is, are you insulin resistant? Do you even know what your fasting insulin is? Do you know what your blood sugar response, your blood glucose response is to certain types of foods, to sleep, to stress, to exercise? So, I think there are a couple of things to consider. 

Obviously, stress management is really important. It is not sitting outside for five minutes one day a week or doing meditation for five minutes. It really needs to become part of a daily practice. That’s number one, because things that can mitigate cortisol response, I think about oxytocin, oxytocin in terms of a hormone hierarchy and I’ll be bringing Dr. Anna Cabeca on later this fall to do a whole episode devoted to oxytocin. Oxytocin is an amazing hormone that actually will reduce cortisol. So, understanding the role of oxytocin and how it can lower cortisol, things like hugging a loved one, hugging your pets, hugging your significant other, an orgasm, doing things that bring you joy will help reduce cortisol. But it’s a temporary thing. It is not one hug is going to sustain you for the entire day. You really do need to integrate different things into your daily practice that can help with that. 

So just kind of be thinking about some of the things I’ve touched on. But the role of oxytocin so very important. I do talk about it in my book, so that’s a great resource. And I will be bringing Dr. Anna Cabeca back on because I told her I think this is a really important topic and one that I want to explore more with my listeners.

Next question is from Kristen. Kristen said, “I had my gallbladder out, worst choice of my life while I was three months pregnant because I had such bad stomach pains and couldn’t eat. In hindsight, I think it was probably a food intolerance. As the doctor said, I didn’t have many gallstones, but I don’t know what else to do. I’ve recently started taking bile salts, which I think has helped. But could this be the reason I’ve struggled to lose belly fat ever since. This was removed in 2006.” So, I always say there is value in looking retrospectively at choices that we have made throughout our lifetime. However, 2006 is now almost 17 years ago. So, I don’t want you to spend time beating yourself up about the fact you had your gallbladder, which is called a cholecystectomy, removed, because you made the best decision for your health at that time. What I can tell you is more often than not, when someone is having gallbladder attacks that are dealing with gallstones, it can be mitigated and exacerbated by many things, our dietary choices, sluggish bile, and for those of you that are listening that are not familiar as what the function of bile is, bile is an emulsifier for fat. So, it’s literally acting as a surfactant to break up the fat so that it can be properly digested. So, for those of us that live through the low-fat, non-fat hysteria years, I’m so grateful we’re no longer there. 

Many of us did not have well-functioning bile. Certainly, the types of foods that you eat can exacerbate gallstone attacks or gallbladder attacks. If you’re having adulterated fats, seed oils, hydrogenated fats, thankfully there aren’t a lot of them left. But if you’re not eating the healthy, high-quality fats that are coming in the form of avocados and nuts and seeds and butter and ghee and things like that, if you’re eating an adulterated form, that can also put you at risk. There used to be an acronym years ago that wasn’t particularly nice, but it talked about who is at most risk for gallbladder attacks. And it’s usually 40, flatulent, which means your gassy, fat, or obese. There are a lot of things, but that doesn’t mean that this happened. I have just as many thin, healthy weight women that have struggled with gallbladder attacks. So, I wouldn’t judge yourself for the choice that you made years ago, but I do think that individuals that have had their gallbladder removed, bile salts and oxblood can be very helpful. 

These are supplements. I would discuss this with your healthcare practitioner. I’ve had people where it’s been life changing. They’ve just integrated these. And it will help with the process of understanding. When your gallbladder is removed, your body’s still producing bile, but it’s dripping all day long, so it no longer has this reservoir to hold the bile, which is what the gallbladder does, one of many things that it does. It’s also important for detoxification. Detoxification is not a buzzword. It actually is something that our body needs to be able to do. If we don’t have a sufficient or high-quality bile, it can impact our ability to properly detoxify. And when we talk about detoxification, yes, we breathe, we poop, we urinate, we defecate, we sweat, all these things help with detoxification. But I find for many women, by the time they’re middle aged, whether it’s from genetics, lifestyle, etc., they can start to struggle a little bit. 

We have two phases of detoxification that occur in the liver. Phase I, phase II, and then phase III actually occurs in the gut. So, the thought process is that phase I is helping to break down chemicals that we’re exposed to and even hormones and to water soluble compounds that can then be processed through phase II. And then phase III will allow us to get these to be excreted. So, sometimes the challenge can be that over years and years and years of exposure to toxins, our personal care products, our environment, our food, poor quality food that we’re eating, and most of us are not eating an unprocessed diet. Most of us are eating a standard American diet, which we know is devoid of fiber and phytonutrients and all sorts of things that I do believe fervently that we need. So, getting back to Kristen’s initial question, I think bile salts and oxblood can be very helpful for those who’ve had a gallbladder removed, number one. 

Number two, struggling with belly fat. That, again, can go back to the answer that I provided for Chantel’s question. So, be thinking about the things that contribute to belly fat and really getting conscientious about managing your stress and getting a little more oxytocin in your life and understanding the complex interrelationship of cortisol receptors on our abdomen. I think a lot of women, we put everyone else in our lives first. So, I would really encourage you to explore how you can destress your lifestyle. I’m not saying no stress, but I am saying that I really believe that destressing our lives is very very important.

Next question comes from Hannah. “How do I deal with cravings and weight gain during the week before my period?” Hannah, great question. And I think it’s important for us to reflect on what is going on physiologically in the body that week prior to our menstrual cycle starting. It’s understanding that this is when progesterone tends to predominate during the luteal phase. I do talk about this in the book, helping women understand this is time to liberalize the carbohydrates. I’m not talking about cake and cookies. I’m talking about high-quality carbs, sweet potatoes, root vegetables, low-glycemic fruit. Those are all going to be very helpful. Ensuring you’re getting enough magnesium, enough healthy fats into your diet. This can be a time when women may need 100 to 150 calories more of food. And although I do not put a lot of emphasis on tracking macros, I do think this can be helpful because those cravings are telling you that you’re missing something in your diet. It could be that you crave dark chocolate because you need more magnesium. And I think everyone listening very likely does not get sufficient magnesium in their diet. And that’s why supplementation can be so helpful. 

So, I think, Hannah, the more you understand what’s going on in the body and with progesterone, it’s a hormone that’s encouraging us to relax more, to do less, to make sure we’re getting a little bit more carbohydrate in our diet. Again, high-quality carbohydrates, making sure that we augment our exercise. So, this is not the time to be hitting personal best in CrossFit. This is a time to be doing more yoga, more restorative therapies, getting a little bit more sleep and rest can all be very very helpful. So, I also think it can be advantageous to ensure that you also– keep a food diary, keep a dairy. Are you eating enough food? For those of you that are intermittent fasting, are you eating enough food? I don’t think intermittent fasting should be part of what we’re doing the week before our menstrual cycle. I think this is the time when women should do no more than 12 to 13 hours of digestive rest and then really be getting three meals a day. 

I think those kinds of changes have a large impact and also making sure you’re getting enough healthy protein. I always say protein-centric diet, so getting 30 to 50 g of protein in each one of those meals, backing off on the fasting piece, and then keeping track of the cravings that you’re experiencing. It could be that you’re craving salt because your adrenals need some support, and it may mean that you need to go to bed earlier, or maybe you need to be using more electrolytes. So, I would definitely keep a journal of your symptoms and how adding some of those healthy fats, protein, and additional carbohydrates can really diminish the cravings you’re experiencing. 

Next question is from Darlene. “Hi, Cynthia, I’m 61. At times I’ve lost or gained weight, but I’ve almost always been 170 pounds for over 24 years. Am I stuck with this being my set point? Can I change it? If yes, how? Thank you.” Well, Darlene, so obviously at 61, you’re in menopause. I always like women to understand physiologically what’s happening in our bodies in that perimenopause to menopause transition. I think knowledge is power, and so there’re many many things that contribute to weight loss resistance. I think the first thing I have to say is I don’t know how tall you are, I don’t know your build. It might very well be that a 170 pounds for you, if you’re a very tall person, may be exactly where your body wants to be. I oftentimes will hear women say, “I want to be the weight I was at 18.” Well, if I were the weight that I was at 18, I would be 10 pounds lighter, I would not be a healthy weight. I think sometimes we, as women, do ourselves a disservice fixating on weight when weight is just one metric or one representation of what’s going on with our bodies. 

So, let’s unpack the things that contribute to weight loss resistance. Number one is sleep. I think sleep for every single person listening should be the one thing you work on at first if you are struggling with plateaus, if you are struggling with weight loss resistance. Because more often than not, what I find is the women that are struggling the most have the poorest quality sleep. So, what does high quality sleep look like? You don’t, per se, have to have an Oura, although I love mine or a Whoop band, or some people track their sleep on their Apple Watch. I think it’s important to understand what high-quality sleep is. High quality sleep means you fall asleep easily. You wake up without an alarm clock. It means that you are sleeping for no less than 7 to 8 hours. You wake up rested, you are not tired and dragging. 

It means that you’re not waking up multiple times a night. Now, if every once in a while, if you wake up in the middle of the night because you drank too much water before bed, that happened to me the other night. That’s totally fine. But if it is a habitual problem, if you have a “overactive bladder” I actually just did a great podcast with Sally Norton and we were talking about how sometimes sensitivities to certain types of foods. In her case, oxalates were driving nocturia, was driving this need to get up and urinate at night. Some of you have sleep apnea and you’re not getting deep restful sleep because you have untreated sleep apnea. And sleep apnea in and of itself can contribute to why you’re not getting concentrated urine. Because your body’s not getting this restful sleep.

So, for everyone listening, cold dark room. If you have to wear a sleep mask, I wear one. There’s no shame in it. Wearing blue blockers at night if you’re going to be on electronics, making sure you get to bed ahead of schedule. So, I always say that last night was a good example. I started watching a new series and I got really into it and I overrode my body’s intrinsic desire to go to bed about 30 minutes earlier. I had to remind myself it’s just time to go to bed. I have to put away the iPad. I don’t care how much fun this series is, I just need to go to sleep. I was absolutely correct. I think for a lot of us, we get caught up in a series, we get caught up in a book, we get caught up having a conversation with a loved one, I get it. 

But more often than not, we want to make sure we’re getting high quality sleep and things that can be helpful if you’re not yet in menopause, many women need a little bit of progesterone a week prior to their menstrual cycle. So, oral progesterone, 100-200 mg. Again, not medical advice. Talk to your doctor, your nurse practitioner, your PA about this. Am I in a position where this is appropriate for me to be doing the week before my menstrual cycle? Especially if you’re starting to experience a lot of insomnia at that time. Understanding that things like estrogen can be very beneficial. Progesterone can help with falling asleep. Estrogen can be very beneficial for staying asleep. I also think about if your melatonin levels are low, is there a need for some melatonin? Obviously, I love myo-inositol that’s why I created it. It completely changed my sleep architecture. 

Creatine can be very helpful for sleep architecture. I think about also things like L-theanine that you can get from green tea, obviously, drinking decaffeinated green tea before bed, but just getting into rituals about the things you’re doing prior to bedtime, soaking in magnesium, maybe those things can beneficial. So, sleep is number one. Number two is managing stress. We’ve kind of already talked around this topic about how important it is to manage stress. I know for myself, “I’m less stress resilient at this stage of my life.” So, I have to work a little harder. For me, it’s connection to nature in the morning. It is not checking email in the morning right when I get up. It’s not getting on social media reflexively immediately upon waking up. Meditation, gratitude journaling, all these things can be very very helpful. It’s also creating healthy boundaries. I think, again, as women, we are conditioned by society that we are the caretakers.

We are the ones that just continue to give and give and give. And as a 52-year-old woman, I can tell you that I never had more healthy boundaries than I do right now. And it means saying no sometimes to things I don’t really want to do, whereas before I might have done them. And I’m sure many of you understand that this sense of obligation to do things socially or do things for other people. I’m not suggesting that you not be a loving, wonderful family member and loved one and friend, but there are times when you have to take care of yourself first and that recognition is step one. So, healthy boundaries can help with that as well. And in my kind of lifestyle, if it’s not a hell yes, it’s a hell no. And that’s really how I make most of my decisions personally and professionally. Otherwise, you are constantly in flux. If you can’t make a decision, if you have analysis paralysis, it’s very likely that you need to just say no.

Next, I think about macros. I know talking about nutrition for some people may not be of interest, but we need more protein as we get older. We become less insulin sensitive as we get older. So, carbohydrates become important. The quality of our carbohydrates, the quantity of our carbohydrates. If you are at a healthy weight, your insulin sensitive, you’ve got a good amount of lean muscle tissue. Your ability to consume carbohydrates in terms of quantity is very different than someone who is 50 pounds overweight and is insulin resistant and leptin resistant.

So, understanding where you fall, not every person listening needs to be low carb. Not every person listening needs to be ketogenic. I am not ketogenic. I am a carb cycler. So, depending on how physically active I am, determines how much carbohydrate I eat. I do like carbs. I’m not anti-carb, but I’m also metabolically healthy and at a healthy weight. So, I have a bit more wiggle room. Now, where I think the distinction needs to be made, is helping us understand that protein is the most important macronutrient for maintaining muscle mass as we get older. It is the most important macronutrient for satiety. For many of you, because you share with me so graciously your experiences. When you’re undereating protein, you’re chronically hungry, you’re never satiated. You’re continuing to look for more food. Generally, in the terms of something that’s quick and highly processed, I totally get it. But when you are thinking about setting up yourself for success during the day, more protein, adding in healthy fats if it’s not already part of the protein. 

So, if you’re having a salmon steak or a ribeye, you don’t need to add copious amounts of healthy fats. However, if you have a chicken breast or if you have a piece of cod, you certainly can add some healthy fats to a salad, to your meal, etc., and then layering in the carbohydrates, which should come from nonstarchy vegetables. And then adding starchy vegetables as you tolerate, as you are physically active, low-glycemic berries. I do think that we tend to overconsume fruit because we like the sweetness. I get it. And we undereat vegetables. So, a 3:1 one ratio, three vegetables to one piece of fruit. And if you can kind of keep a ratio like that, you will never be in the wrong. You will always be making good choices.

Next is meal frequency. I used to tell my patients 25 years ago to eat to stoke your metabolism because that was what I was taught, even though I was at a big research hospital. We now know that is not in fact the case. Whether you choose intermittent fast or not, that is totally fine. But we should be eating two to three distinctive meals a day and not snacking in between. If you are struggling to get from breakfast to lunch or lunch to dinner, it is because you are not putting your meals together properly. Generally, not enough protein, generally too much carbohydrates, generally the wrong macro composition. This is something that it took me time to figure this out. So, if you’re not at this point in time able to go from breakfast to lunch and lunch to dinner, you can change that. That’s where I say track your macros. Chronometer is a great app. I have no affiliation with it. It’s a really easy way and they have a free version. You can track your macros and your micros. Your micros are your micronutrients, the mineral content of food.

Even if you just do it as an experiment for a week or two, it can be very enlightening. At least a 100 g of protein is what you want, 1 g per pound of ideal body weight. I know for many women, the most protein they eat a day is 50 g. So, you’re grossly undereating protein, which impacts satiety, which impacts muscle loss, which we’re going to talk about in a minute, which impacts insulin resistance. I’ll have Dr. Gabrielle Lyon, who’s a dear friend. I will have her back on the podcast in September prior to her book launch. And we’re going to dive deeper into this topic than we have before, but really really important, the macro piece, meal frequency piece, understanding we don’t want to be eating all day long because every time we eat, depending on what we’re eating, depending on what macronutrient ratios we are eating. 

So, if you eat a bunch of carbohydrates, you’re going to get a much more exaggerated glucose and insulin response than if you eat MCT oil or if you eat a stick of butter. Not that I would advocate that anyone do that, but fat is the most negligible impact on glucose and insulin. So, just keep those things in mind. Chronometer is a great way to track these things. But if you’re eating more than two to three times a day, this is definitely something you want to work on.

Next is gut health. I think that I actually have a podcast coming out with Dr. Felice Gersh. She’ll be the third podcast we’ve done, talking about the interrelationship between declining estrogen in our bodies in perimenopause and menopause, and the impact on immune function and gut health. So, when I’m talking about gut health, I’m talking about susceptibility to opportunistic infections. 

The way that you can test for this is with specific types of stool testing, whether it’s a GI Map, whether it is Genova’s stool testing, whether or not it is the 360 testing that’s done, which is really really involved and fascinating/disturbing because it’s three days’ worth of stool testing. But understanding what’s going on in the gut microbiome, is there an imbalanced microbiome? Do you have H. pylori? Do you have parasites? Do you have significant amounts of dysbiosis? Do you have a latent candida? Do you have steatocrit, which means that your body isn’t properly breaking down fats and it’s showing up in your stool? Do you have enough pancreatic enzymes? Are you recirculating your estrogen because beta-glucuronidase is high and you need support with detoxification and this goes on and on and on. So, I think gut testing is very very helpful. More often than not, you have to do this through a functional or integrative medicine provider. So, obviously, the traditional stool testing in allopathic medicine is not going to be per se looking at all of those factors, but I do think this is very very helpful.

Next, I think about just the loss of muscle as we get older. This is something I really did not appreciate enough until I was a middle-aged person, because I was never taught this. So, there’s a technical term for muscle loss with aging called sarcopenia. This accelerates after the age of 40 and if you don’t work against it, you will be left with muscle that is suddenly infiltrated by fat. So, let’s talk about my favorite example to provide visually. So, a filet mignon is nearly all meat, muscle meat. Then you look at a wonderfully delicious ribeye. The ribeye has a lot of marbling, there’s a lot of fat in there. That is the difference. The fillet is young muscle, the ribeye is old muscle.

And that’s the way to think about is understand that as we are losing muscle mass, we are losing insulin sensitivity. So, people start to wonder why in their 40s their appetite changes, their body composition changes. It’s harder in many instances to maintain and build muscle at this time. And that can be from a variety of hormonal changes. But we’re talking specifically about sarcopenia. This is why muscle becomes this organ of longevity. This is why lifting weights becomes very important. And if you’re not lifting weights right now, that’s okay. You can change that. You can start with body weight exercises. You can move on to band work, you can move on to light weights, you can move on to heavier weights. And if you’ve never worked out in a gym, hire a trainer so that you can learn how to do this properly. 

But ultimately you want to get to a point where you are lifting heavy, heavy meaning that you can only get through five to eight reps. Heavy meaning that you go to failure. And you’ll know that you get to this point because you’re going to feel the stress on that muscle and not in a bad way. You’re not looking to hurt yourself. This is why I’m a huge proponent of trainers, especially trainers that work with middle-aged clients. I’d like to think about Debra Atkinson, who’s been a very popular podcast guest who’ll be back in the fall for the same reason, to reorient ourselves into the things you can be doing throughout your lifetime to maintain muscle mass. But number one is lifting weights. Number two is eating enough protein. Go back to the macro piece that I was just talking about. Muscle, muscle, muscle, it is not just about aesthetics. It’s really about metabolic health.

Then thinking about physical activity, because there are many individuals that don’t understand that going to do CrossFit at 6 o’clock in the morning and then sitting on your butt from 8 until 6 o’clock at night, you are undoing a lot of the benefits of that physical activity. So, we talk about NEAT, we talk about non-exercise induced thermogenesis. So, that is walking up and down the stairs, that is walking through your neighborhood, that is parking your car farther out in the parking lot, that is walking around the grocery store. The things we do throughout our day that just keep us physically active are very important. Zone 2 training is very important.

Physical activity in and of itself is a means of a glucose disposal unit. Meaning that when you are walking, when you are physically moving your body or lifting weights, your body is using up glucose and the muscle as it’s contracting is using up glucose. So, it’s important to understand we don’t want to be sedentary. If you have mobility issues, joint pain issues, even walking in a pool where you’re a little bit buoyant, or finding ways, whether it’s getting on a stationary bike, there’re lots of different ways to become more physically active. But we want to make sure that we’re moving throughout the day. I have an Apple Watch. I like to kind of monitor how physically active I am during the day and it really keeps me honest with myself. We know that just the simple act of walking after a meal, 10 or 15 minutes, really has a substantial net impact on blood glucose regulation and physical activity requirements. I also think about endocrine-mimicking chemicals. So, when we’re talking about toxins in our personal care products, our environment and our food, we do genuinely want to be focused on these things. Not so that we’re paranoid, but that we are aware. Some of these chemicals can actually offset the receptor sites for hormones, and they can, in some instances, be 1000 times more potent. And that’s why I think it’s important to be aware of what you’re using on your body, what you’re putting on your body, what you’re using around your body, whether it’s filtered water, whether it’s being conscientious about the body lotion you use, the deodorant you use, the toothpaste you use, all these things definitely add up.

Then lastly, I could talk about hormones for hours, but some of the more common hormones that are going to impact weight loss resistance, number one is cortisol, which we talked about, insulin which is part of that hormone hierarchy, I think a great deal about testosterone. A lot of women focus on estrogen and progesterone in the perimenopause and the menopause time period. But I do think that testosterone doesn’t just impact libido. It’s also integral in body composition changes. And for a lot of women that are saying, “I don’t know why I have all this abdominal obesity and this fluff,” that can also be a byproduct of testosterone. And about 25% of women, even in menopause, still make enough testosterone, that’s not the majority of women. I know that the FDA has not officially supported testosterone for women. So more often than it has to be compounded, I think women do best with compounded creams as a starting point. Obviously, I have colleagues that work with subcutaneous testosterone, even in women. But I think that isn’t on a case-by-case basis.

And then also thinking about thyroid. How many women share with me that they are struggling with hypothyroidism in particular? That’s the most common thyroid issue we will see, especially Hashimoto’s, which is the autoimmune component.
And how many of you are not therapeutic on thyroid medications? Do not give up. It took me a while. It took me finding a really really dedicated physician who did microdosing adjustments for months and months and months. Finally got my thyroid back online and I feel 1000% better. And then lastly, leptin and ghrelin, these are those hunger and satiety hormones, making sure these are all properly supported so that we feel satiated when we eat and we’re appropriately hungry when we should be.

Next question is from Patricia. “I’m 68 years old and so sad that I didn’t have all this information when I was in perimenopause. I exercise five to six days a week. Weight training started about six months ago. I had my hip replaced and I’m doing well. I just cannot get 20 pounds off. I have been on estradiol vaginal inserts for six months. I’m not sure what else I can do. I do intermittent fasting most days.” Well, Patricia, there’s a couple of things. If you’re on estrogen, you need progesterone too. When you talk about the estradiol vaginal inserts, that’s not systemic estrogen, that is estrogen that is localized to the vagina, which can be very helpful, especially if you’re having those genitourinary symptoms of menopause, which is this terrible acronym of GUSM. But basically, it’s talking about vaginal atrophy. As we are losing estrogen in our vaginas, it changes the pH level and that kills off the healthy lactobacilli that used to be important for many functions in this area of the body. But vaginal estrogen is not systemic estrogen, it’s not transdermal estrogen, it’s not patch estrogen. So, you’re not getting the systemic effects. And when I think about systemic effects of estrogen, it’s talking about brain support, it’s talking about bone support, it’s talking about heart support. So just something to consider.

Also, progesterone is equally important. And we don’t just take progesterone. If you have a uterus, we actually have progesterone receptors throughout our body. Progesterone is very very helpful for sleep. So, you definitely want to make sure and you may very well be on this, Patricia, but just didn’t mention it. And then lastly, looking at those labs, what’s going on with your thyroid, what’s going on with your gut health? There’s a lot there that I think can definitely be looked at and you have to look at it comprehensively. So, I would keep digging to figure out what combination of things you need to change in conjunction with a healthcare practitioner to ensure you’re meeting your goals.

Next question is from Lori. “Hi, Cynthia. I love that you’re doing this. I would love your thoughts on body set weight after losing over 110 pounds using intermittent fasting.” Congratulations. That’s an incredible achievement. “My weight has settled about 10 pounds higher than I would like to be in order for my BMI to get to a normal range. I’m very happy with my size. I went from a 20 to a size 6 and seem to have stabilized at this point. Just curious on what your views are on this matter. Thank you.” Well, I would say, first and foremost, BMI is a reflection of some things, but not everything. Like if you have muscle on your body, your BMI may actually be higher. And that’s not per se a bad thing. Like my husband’s BMI, if you look just at his BMI, technically he would be in the obese range, but it’s because he has so much muscle mass on his body that pushes him into that different range. So, I would not per se just take the BMI as a be all end all of your health. I would be looking at metabolic markers, I would be looking at blood pressure, blood sugar, waist circumference, all these metabolic syndrome markers that I think are far more impactful. And if you use the bioimpedance scales, the scales that give you a sense of fat and muscle mass, those are much more accurate and helpful. So, it could very well be that you are at a very healthy size and weight for you. It may be just that mindset shift of understanding that BMI gives us some information, but not all the information.

Next question is from Janet. “Why can I not lose weight? I’m 56, I’m managing the fasting without any problem, but I’m still not losing weight.” Janet, I definitely identified a bunch of things. One thing I did not mention that I want to make sure I include with those other weight loss resistance areas is trauma. I initially first learned about this interrelationship from my conversation with Dr. Sara Gottfried and mentioning and understanding that adverse childhood events impact not only our risk for autoimmune conditions, but also impact our ability to be weight loss resistant or to be able to lose weight. So, investigating– did you grow up in a traumatic environment? These ACE scores, you can take these tests online. My ACE score for my childhood is actually quite high. It’s no surprise that I’ve had multiple autoimmune conditions. I was never putting those pieces of the puzzle together until the last few years. So, understanding that there’s very likely multiple reasons that are continuing to being weight loss resistant. I would say the trauma piece is really important. Understanding the interrelationship with if your body perceives that you are under chronic stress and you’re sympathetic dominant. So, let’s back up.

The autonomic nervous system has the sympathetic side and the parasympathetic side. We need both. But most of us in our modern-day lifestyles, our bodies, even if we don’t perceive it, think we are running away from a rabid animal 24/7. And that chronic elevation in cortisol is going to elevate your glucose, subsequently elevate your insulin. That can contribute to weight loss resistance. So, I would do a bit of digging and go back to that other question where I kind of talked about many reasons why we can be weight loss resistant. I always say getting really honest with ourselves is step one. Step two is getting some testing. Step three is the lifestyle stuff, all of which can be done in the same kind of timeframe, but getting really honest with ourselves so that we can realistically set about finding the right practitioner to help us figure this all out. 

Next question is from Vicky. “What do you suggest for a 52-year-old to jumpstart weight loss? If I do intermittent fasting and eat pretty healthy, but I’m not losing. I have about 20 pounds I’d like to lose and I’m also doing hormone therapy.” When I think about jump starting weight loss, I think it goes back to basics. What’s your sleep like? Are you managing your stress? Are you weightlifting? Are you putting your macros together properly? Because a lot of people intermittent fast, and I know this because they share this with me, but they’re still eating crappy processed diet and they don’t understand that the degree of inflammation that their body is dealing with is one of the things that is hindering their ability to lose weight. So, when I talk about jump starts, it’s really not that I want you to lose weight quickly. It’s understanding that the basics really do play a large role. I would also think about hydration, how many people walk around being chronically dehydrated and they don’t understand that being dehydrated in and of itself can also contribute to weight loss resistance. So, Vicky, I would go back to that section in this discussion where I was kind of touching on a variety of reasons that we can become weight loss resistant. But when you’re trying to get things started, go back to basics, don’t over fast, don’t over restrict your food, don’t over exercise, all of those things can make it harder for us to lose weight.

Last question is from Giselle. “I am in menopause and regularly fast minimum of 12 hours, often anywhere from 14 to 16 hours per day. I recently added two 36 hours fasts in one week. I even take a break, each eating higher carbs. However, I’m not losing weight as I had hoped. I fluctuate a few pounds, but I still remain approximately 10 pounds heavier than I should be. What can I do differently to lose weight? I lean towards keto and low carb already. I also run three times a week, bike, or walk to keep active. I am one frustrated senior gal.” Well, Giselle, I don’t want you to be frustrated. I do want you to be kind to yourself. I would go back to some of the other recommendations I’ve made during this podcast. It’s interesting, my perspectives on really long fasts are starting to shift. And for full disclosure, I no longer do anything, not willingly. I do not fast ever beyond 20 hours. I think that part of the challenge that we can get into for the sake of “longer fast,” we can start impacting our muscle mass. 

And I’m already lean. I don’t want to lose weight. I want to maintain what I have and continue to build on what I have. So, if you’re doing two 36 hours fasts a week, it may just be too much. On top of that, you’re also running. I would swap out the running and do some weight training. I would remain physically active. I love that you are biking and walking, but doing a lot of running can raise the cortisol and if cortisol goes up, glucose goes up, if glucose goes up, insulin goes up. This is part of that triad that I start seeing the over fasting, the over restriction of food, the over exercising through no fault of our own.

I think for many of us, it’s with good intentions that we start doing these things, but ultimately, if our bodies perceive that we’re under too much stress, physically, emotionally or otherwise, it is going to hold on to that weight. So be kind to yourself, dial back a little bit, liberalize. Maybe you need to go back to weight training twice a week, doing plenty of walking, get some time in nature, make sure you’re hitting those protein macros, make sure you’re not undereating in your feeding window because that’s another concern that I see quite often and definitely keep me posted.

Well, y’all, I love these AMA episodes. We’ve got more coming up. As I’ve mentioned before, we have been inundated with questions, which is a wonderful thing. My team and I are super organized, so we’re going to do themes for these AMAs and obviously today’s, was talking a lot about big pain points, weight loss resistance, plateau busters, belly fat, things that many of us are struggling with as middle-aged individuals. 

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