Ep. 298 Women’s Health Chat: Questions, Tips and Advice with Cynthia Thurlow, NP & Intermittent Fasting Expert

I am thrilled to welcome you to another engaging episode of the AMA series!

Today, I dive into a diverse array of topics and address the questions that have emerged time and time again. As always, the sheer abundance of questions from all of you has made the selection process a delightful challenge!

For this show, I decided to address those questions sent in by many different people. Join me as I embark on an expedition through the most commonly asked questions, focusing on those recurring questions that have consistently caught your interest and shedding light on the subjects that have piqued the curiosity of a great many of you.

Sorting through the multitude of questions you submitted was an enjoyable endeavor, and I am delighted to address all the inquiries that resonated with so many of you today!

“Women transitioning from perimenopause and menopause are at increased risk (especially menopausal women) for urinary tract infections because of the loss of estradiol.”

– Cynthia Thurlow, NP & Intermittent Fasting Expert

IN THIS EPISODE YOU WILL LEARN:

• What is melasma?
• Is a continuous glucose monitor recommended?
• My recommendations for lowering LDL
• How to know if you are metabolically healthy or flexible
• What causes recurrent urinary tract infections?
• What I recommend as a preventative measure for recurrent urinary tract infections
• What can high sugar levels in the morning indicate?
• How to find a recommended functional integrative medicine doctor in your area
• The books I am currently reading
• How do I plan for success

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 are 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.

[unintelligible 00:00:31] for the next AMA episode. Today, we are diving into a variety of topics. As I’ve mentioned before, there are so many great questions. Obviously, hard to pick and choose which ones we are going to focus on today. But we’re going to start with questions that came up repeatedly so clearly, questions that many people are curious about.

First one is from Lorena, “Is melasma hormonal. I am 49 years old with a partial hysterectomy. My melasma has gradually worsened since my 30s. I am on HRT cream that has estrogen, progesterone, testosterone, and DHEA. I’ve only been on HRT a few months. What can help to improve the melasma?” Well, melasma is a skin condition that is exacerbated by exposure to light. So, obviously UV light, sun exposure absolutely can provoke this discoloration. It is a skin condition that oftentimes will worsen during pregnancy or exposure to oral contraceptives. Also, stress and genetics. We know that women are more susceptible to melasma than men are. Interestingly enough, when I was looking at the research, it indicated that it can be seen with both high estrogen and high progesterone.

So, I think from my perspective that there’s probably value in talking to a dermatologist to determine what would be the best course of action. Obviously, sunscreen is going to be really important. There are people that are certainly more prone to melasma than others. It’s not something I’ve ever suffered from, but I did have many many girlfriends in our 20s and 30s that had this and found that oral contraceptives in particular seemed to really provoke this. Obviously, you mentioned that you’re on HRT. I think getting your hormone levels tested can also beneficial, but I would definitely follow up with dermatology just to see what their recommendations would be. I know that the sunscreen piece is also really important for prevention.

Next question, we had several questions about glucose and first comes from Deborah. “Are continuous glucose monitors recommended for someone with a fasting glucose and A1c in the normal range?” The short answer is yes. I think that when you understand the interrelationship between a traditional glucose monitoring and also A1c. A1c 25 years ago was really cutting edge. I just find that it’s not the most helpful test when we’re trying to determine metabolic flexibility. This is where a fasting insulin can be very very beneficial. I know that I talk about this a lot. You can get them very inexpensively. It is covered by insurance.

A lot of traditional, allopathic trained providers are not familiarized with it. They’ll even say things like, “Endocrinology will draw that for you,” but you can go to companies like Own Your Labs. I have no affiliation with them. You can actually order the blood test for yourself. If your treating internist primary care provider is not interested in drawing that. Ideally you want a fasting insulin between 2 to 5 mg/dL ideally. Getting back to Deborah’s original question, yes, I do think continuous glucose monitors or glucometers can be really really helpful for determining your own bio-individual response to sleep and stress and nutritional choices and exercise. As an example, I am someone that cycles carbohydrates. I predominantly eat root vegetables, sweet potatoes in very minimal moderation because they tend to be a higher oxalate food for me and I’m sensitive to that, low glycemic berries, things like that.

This is where I think it can be very very helpful to determine what your own bio-individual responses are to those specific metrics. So yes, I’m a huge fan of this. NutriSense is the company that has an app that will interpret the data from a FreeStyle Libre. That is the type of continuous glucose monitor that I do recommend. I think it’s very easy to use. If that’s not within your budget, then a glucometer is certainly another option. Obviously, you have to prick your finger multiple times a day, but I think that that exercise can be very valuable. NutriSense is one of our podcast sponsors and we do have a discount code if you would like to get a CGM through them.

Next is, “What high sugar levels in the morning mean?” This is a question from Anna. Well, you have to define what is high. So, in my estimation we want to see a fasted glucose between 70 and 85. That’s ideal when we’re waking up in the morning. If your blood sugars, your blood glucose is running in the 90s to low 100s on a consistent basis, that can be a sign that there may be some latent insulin resistance. So, definitely something you want to investigate. As I’ve talked about before, Dr. Robert Lustig, who I’ve done an amazing podcast with. Dr. Lustig talks about how a fasting glucose between 90 to 99 is not benign. You have a 30% increased risk of developing diabetes. So, if you’re continuously seeing those numbers, you definitely want to get a hold of that. Obviously, there’re lots of tips and tricks. I’ve done a recent podcast with Kara Collier. She’s the head registered dietitian with NutriSense. It would be a great resource for you as well. But ideally 70 to 85 is what we’re shooting for. That’s ideally where we want to be.

Also, important to tie in the fact that as we are getting older, we become less insulin sensitive. So, if you are north of 40 years old, you may notice that those numbers are creeping. As you are losing muscle mass, those glucose readings may start to creep. You may notice if you drink the day before or you eat a dessert the day before that may influence your blood glucose readings. There’re a lot of different things. Physical activity influences blood glucose readings. So, you definitely want to understand the lifestyle piece as well.

Next question, “My insulin response to glucose numbers is confusing.” This is from Georgette. She mentions that “Her numbers ranged all over the place from the 200 to the 100s. What does this mean?” I think I’d have to understand what specifically you’re referring to. She also mentions 16.3. So, I’m assuming she means that her fasting insulin was 16.3, which is quite high. That is a sign of insulin resistance, which would explain why your blood glucose levels were fluctuating from the 100 to 200 range. This is definitely something that you want to stay on top of. As I’ve mentioned with some of these other questions, I’ve already answered in this little vignette, the things that can impact blood sugar, sleep quality, stress management, physical activity, muscle mass, food choices, all of which are very very important. I think this is certainly a circumstance where a glucometer or continuous glucose monitor would be very helpful. Also, getting baseline lab work done would be very helpful to determine what the next steps need to be. If you are perimenopausal or menopausal, you may even benefit from hormone replacement therapy and/or you may need to be on a supplement or a medication that will help bring down your blood sugar, your blood glucose within a healthy range.

Now we’re going to pivot and talk about cholesterol. “What are your recommendations for lowering LDL?” This is a question from Carrie. So, I don’t know what the levels were. That’s number one. Kind of the traditional allopathic model is they do a lipid panel which incorporates a total cholesterol, LDL, HDL, and triglycerides. If your LDL is considered to be high and I’m putting this in air quotes for those of you that can’t see me saying that. I think it’s imperative if your LDL is on the higher side, meaning more than 150, 200 plus that you have a special test done to show particle size. So, there are different types of LDL. It’s important to note that some are pathogenic or more atherogenic than others. They can be light and fluffy. They can be small and dense. On top of that, looking at advanced lipid analysis, so looking at an ApoB, which we want less than 80, and looking at LP(a) can also be very helpful for determining what your specific risks is.

Now, the question is always, are you metabolically healthy? Some people have a genetic susceptibility. I’m one of those people. I’m a lean mass hyper responder. It means my LDL is always going to be on the higher side. It has nothing to do with not having a healthy diet or being insulin resistant. In fact, I’m down a rabbit hole right now with my own medical professional to kind of troubleshoot on this. So, the big takeaway is a “High LDL”, is not in and of itself something you treat in the absence of cardiovascular disease or diabetes. If you are an otherwise healthy individual, you definitely need more information. You need that NMR, the particle size, you need to look at ApoB, you need to look at NMR. If those values still remain high or there’re some concerns, there’re different types of testing that you can then do to assess risk.

There’s a coronary artery calcification score or CAC. There’s CIMT, which is a special type of carotid ultrasound. There’s Cleerly, which is literally like if you’re really wanting to get a sense for what’s going on, it’s like a CT angio on steroids giving further quantification. But those are more advanced diagnostics. That’s not the original question that Carrie had asked, but I wanted to make sure I dovetailed that into the conversation. So, you need more information. Obviously, there are things you can do to help lower overall LDL. Things like intermittent fasting, weight loss, increasing fiber in your diet, physical activity, phytosterols. So, thinking about things like pumpkin seeds, apple, extra virgin olive oil, all of those can be very helpful. Also, the reduction of saturated fat, so eating leaner meat, more monounsaturated fat, so extra virgin olive oil, macadamia nuts, things like that are going to be helpful. All of those can help impact LDL, but there’s a lot more to LDL than just that lipid panel value.

Next is a question from Marla. “I have listened to so many podcasts and have clean fasted for 2.5 years, but I’m still very confused. How I know if I am metabolically healthy or flexible. I am 54. I am menopausal. I weigh 159 pounds. I haven’t really lost any weight with fasting, but I still love the lifestyle, and I would love to still lose around 15 pounds. I’m 5’7” and stay active with exercise classes, walking, and tennis.” Great question Marla. The things that I think about when we’re talking about metabolic flexibility, number one, you can look at metabolic syndrome markers. So, number one, looking at blood pressure. If you have a blood pressure greater than 130/80. If you need to take blood pressure medications, that’s almost always a sign of insulin resistance.

Number two, waist circumference. So as a female, you want to have a waist circumference less than 35 inches for male, less than 45 inches. Number three, you want to make sure that your triglycerides are within range. Now, what is in range for me might be very different than the guidelines. They like to see your triglycerides under 150. I like them under 75. Looking at HDL in women, we want to see an HDL greater than 55. In men greater than 45, looking at fasting glucose. Now, I’ve already talked about the fact that usually the first biomarker that dysregulates in response to insulin resistance is fasting insulin. So, if we’re looking at fasting glucose. Sometimes we can miss these people really looking at a fasting glucose under 100. Now those are the guidelines. I would like it lower than that.

As I mentioned earlier, I would like to see a fasting glucose 70 to 85. I don’t like to see it in the 90 range. I would add on to their fasting insulin. We want to see a fasting insulin between 2 to 5 mg/L. Now, with that being said, people that are metabolically flexible are able to utilize different types of fuel substrates, either carbohydrates or fats. This is an oversimplification just to try to keep things as high level as possible, but understanding that our body can effectively use stored fats as a fuel source or stored glucose. So, an individual that is metabolically flexible is going to have sustained energy. They’re not going to get energy slumps, they’re not going to get tired after meals, they’re going to be able to lose weight, they are going to be able to go more than 2 to 3 hours without eating.

All of these things can be hallmarks of metabolic flexibility. Now, because you are menopausal, because you are weight loss resistant, I did an earlier AMA talking all about weight loss resistance and plateaus. I would definitely go back and listen to that podcast because there’s a lot of really good information about the things that can drive weight loss resistance and I think would be particularly relevant. Just because you’re menopausal, it does not in any way, shape or form mean that you have to accept this as a normal function of aging. There are so many things that contribute like loss of muscle mass, meal frequency, macros, sleep, stress, gut health can all impact weight loss resistance amongst a myriad of other things. So, just really keep that in mind. You need to dig a little bit deeper, but definitely reference that third AMA that I did earlier this summer.

Next is sleep. “What is your sleep stack?” This is a question from Sally. Well, for those of you that have purchased inositol, I will be doing a sleep webinar for free for anyone who’s purchased inositol in August. I don’t have a specific date yet. It is coming. We’re just trying to do a lot of moving pieces with my kids moving back to school, and I will talk about my sleep stack in that webinar and that is again free if you have purchased inositol. If you would like to join the webinar, there will be a $39 charge that goes along with it and you can find more information on the website, but stay tuned for the sleep stack. Lori asked a question regarding the Oura Ring. “I would like to know why there is such a difference between the sleep scores compared to the beta sleep timing. How to assess looking at our Oura data, the impact of supplements on good sleep hygiene habits, and how to interpret and improve our HRV?”

Well, there’s a lot here, obviously. Oura decided to adjust their metrics for REM and deep sleep. Why they did it, I don’t know with 100% reason, what their reasoning was. I do know that quite a few patients and clients have reported significant shifts, especially in their deep sleep. Now, heart rate variability is something that I find really really interesting. So, this is the balance between our autonomic nervous system looking at the sympathetic and the parasympathetic. And what I think is most important is understanding that most of us are sympathetic dominant and as we get older, our heart rate variability is going to decrease. So, I would not expect a 50-year-old woman’s heart rate variability to be the same as a 20-year-old. So, that’s number one. We do see age-predicted changes that go on. HRV can be impacted by dehydration, sleep quality, food choices, whether or not you’ve recovered, chronic stress, metabolic inflexibility, there’re a lot of things.

I can tell you quite honestly. If I allow myself to sleep, not sleep in as and I sleep too long, but if I don’t force myself to get up when I’ve only slept 7 hours or six and a half hours, my heart rate variability is always better. I am very sensitive to dehydration. So generally, if I’m not properly recovered from a workout or I am not properly hydrated, it’ll show up in my HRV data. But I think that this really is very bio-individual for a lot of women. They can see improvement in sleep metrics based on what they are doing outside of the bedroom. For me, inositol has been a total game changer for sleep quality, sleep architecture, deep sleep, etc. When I am taking inositol, I always hit my sleep metrics and I do like to see a minimum of 90 minutes of REM and deep sleep, even in my middle-aged clients.

So, if you’re listening and you’re looking at your data, don’t freak out if your values are not within that range. Just know that there are things you can do to improve it. So again, if you come to the sleep webinar that I am doing in August, we will talk more about all of these topics.

Vicki asked, “What do you recommend as a preventative measure for recurrent urinary tract infections?” From a very basic level, I think about just general hygiene pieces. Some people are prone to urinary tract infections after sexual intercourse. Some people are prone to them depending on where they are in their menstrual cycle. Some people are prone to them because they have diabetes or they are insulin resistant and they’re just more likely to get infections. We also know that women that are transitioning from perimenopause into menopause are at increased risk, especially menopausal women, for urinary tract infections because of the loss of estradiol in the urethra. The genitourinary system is very very susceptible.

So, when I talk about prevention. Obviously, there’s some lifestyle piece, but for a lot of women, one of the reasons why they start vaginal estrogen or estradiol is to offset the impact of that loss of estrogen in their genitourinary space. So, for some people they need vaginal estrogen. Sometimes, they can take it systemically, meaning transdermally absorbed through the skin or through a patch, or they need localized vaginal estrogen. So, this is a conversation you definitely want to have with your GYN because they can do a physical examination and take a look at you. I know that sometimes some people are more prone to UTIs just because of their anatomy. So, if you are middle aged, you probably are aware of this. I have a family member who’s younger and has dealt with some very early onset urinary tract infection symptoms and it found out that it’s related to her anatomy. So, that could certainly play a role as well.

Next question is from Julie, “I am looking to find a recommended functional integrative medicine doctor in my area. I can’t find a recommended practice. I don’t currently have a general doctor and I’d like to have a functional recommendation or a good source to consult. Thank you for all you do.” Okay, number one, a lot of the physicians, NPs, PAs I bring on my podcast are very well vetted and they are a good starting point. If any of them do not live in your area another good starting point is www.ifm.org. That’s the functional medicine organization. Obviously, not every single one of those providers may be savvy in the area that you are interested in, but you can do a search on your zip code to try to find someone in your area. You can look on their websites, etc.

A lot of questions came in about who my functional medicine provider is and it’s Dr. Aaron Hartman. He has been a guest on this podcast. He is amazing and is a good friend as well. But I have found that the functional medicine providers, integrative medicine providers, will go above and beyond the traditional allopathic route. Obviously, they can do that as well, but IFM is a good resource. I used to recommend NAMS, which is the North American Menopause Society. But I’ve come to find that not every provider there is HRT savvy or pro HRT. So, I think that those of you that are in perimenopause and menopause, you deserve to have a conversation with someone that will at least go over the benefits, the pros, and cons and then you can jointly make a decision.

So, that could be another potential place to look. But I’ve gotten feedback that not all of those providers are pro HRT, although NAMS in 2018 changed their position on hormone replacement therapy. So, just kind of take that with a grain of salt. Again, go look at some of the providers I’ve used or interviewed for the podcast www.ifm.org or look at NAMS website to find a provider in your area. That’s a good starting point. The other thing is, if your girlfriends love the person they’re seeing, obviously that might be a good avenue to go as well. I think referrals are always a good option.

Jess wrote in a very long question about, “Seeing a functional medicine doctor for the last two years, diagnosing her with multiple issues.” She has a healthy lifestyle. I’m paraphrasing because it’s a very long question. She’s on bioidentical progesterone and testosterone and takes DIM along with a literal, “ton of supplements.” “I’ve done a lot of expensive testing. I still don’t feel great. Some days I feel like I’m walking through wet cement.” Her question is, “How do I get to the root cause of these issues to rebalance and get relief? I know they’re all linked, but instead of treating all of these issues simultaneously, should I focus on just one? At what point something has to give? Thank you.”

Jess is not someone that I’m working with. So, I don’t know your entire situation, Jess. I do sense your frustration and I’m completely sensitive to that because there’s nothing worse than feeling like you’re doing a lot of work and you are stuck in inertia, you’re not moving forward. I think that just like allopathic medicine, there are great providers. You find excellent providers in functional integrative medicine, but perhaps the person you’re working with is not a good fit, because if you’re not feeling like you’re getting improvement, then you’re wasting time and money because it’s not inexpensive to go to these providers.

So, I would go back to the question I just answered. I would look at IFM. I would talk to providers in your area. I would look at some of the providers I’ve interviewed on this podcast to see if someone’s in your area, because you don’t need to suffer needlessly. Unfortunately, I think that none of these things occur in a vacuum. It’s a slow drip. Perimenopause starts and we get these sex hormone imbalances and there’s a lot of extra stress on our adrenals and there’s extra stress on our thyroid gland. If we understand that it’s not just perimenopause and menopause, it’s adrenal pause, it is thyroid pause and because of that, we have to think comprehensively about how we manage these things.

I think I’ve spoken very openly that it has taken almost three years to get my thyroid fully back within a therapeutic range and that is because my thyroid medication was discontinued. I went from natural desiccated thyroid to Synthroid and Cytomel, and I was on crazy doses of Cytomel and I was not feeling better. Then we got to a point where I was seeing multiple different providers, all of whom were well intentioned. Let me be very clear, I’m not being critical of anyone. I’m just saying you have to find the right provider for you. I finally stumbled upon the right provider for me, and we were doing microdose adjustments for every two to four weeks for months until we got to where now my thyroid, for the first time in almost three years, it’s finally therapeutic. So, the point I’m making for you, Jess, is you probably need to work with someone different. That’s not to say the person you’ve been working with isn’t great at what they do. But if you’re not feeling better and if you’re already on a lot of supplements and you’re not feeling like you’re making progress, then it’s probably time to pivot, as tough as that can be because I know it’s hard to make changes.

We’re going to answer a couple more questions today. These are questions that listeners asked specific to me. I’m going to answer a couple today just to kind of keep things light. Kelly asked, ‘What current books am I reading?” Well, Kelly, if you know anything about me, I’m usually reading multiple things at once. I’m currently reading, The Dorito Effect by Mark Schatzker. I am also reading Hooked by Michael Moss. I am reading The Tiger Protocol by Dr. Akil. The other book that’s in the queue right now is I just finished Toxic Superfoods because I reread it for a podcast I did very recently. But I am rereading the book Next-Level Metabolism by Dr. Jade Teta. So, at any one point in time, I’m usually reading three or four things at once. I’m also about halfway through Peter Attia’s book, but a lot of it has to do with sometimes I’m like a squirrel, I get distracted and then I have to go back to things.

Sometimes, Peter Attia’s book is a great example. I really am enjoying it and I want to savor it. I don’t want to rush it. So, I’m reading a chapter at a time. But those are my current books. I’ve had a little less on my podcast schedule this summer, which has been wonderful. So, I haven’t had to read as often and as much for the podcast. I’ve just been reading for pleasure, and that’s something I really enjoy. I’m also currently listening to a book about The Silk Road, and for anyone that isn’t familiarized with it, it’s a gentleman, a libertarian who created Silk Road so that he could sell drugs online, which has been fascinating and disturbing at the same time.

Question by Suzanne, “Where do you anticipate for your work, any future books and overall platform to be in the next five years?” This is a really great question, Suzanne. I think the big thing for 2023 has been expanding my speaking to not just being about intermittent fasting, so talking about metabolic health, talking about mindset, talking about the entrepreneurial journey, talking about going from surviving to thriving, so, different themes. I think as a speaker, it’s really interesting for me to be able to be challenged in different ways. Obviously, the podcast is a huge focus, continuing to expand that we have some big audacious goals for the podcast. I am in the midst of writing another book. I’m not in any position to be able to share what that is about, but it is not solely focused on fasting. I’ll just put that out there and in five years I would love to maybe publish another book. I’d like to be in a position where maybe I’m working differently in my business and I’m in a position where I’m doing more travel. Obviously, in five years my kids will both be in college and so that’s going to allow me to have a little bit more flexibility in what I’m doing. But for now, definitely expanding supplements, podcast, social media presence, speaking opportunities, all are on the table.

Merit’s question, “How do you plan for success? Is it a mindset thing? The night before, prep food in the fridge? I have so much coming at me that on the days my kids are home or the schedule changes, I lose my focus. It’s hard to fast when my kids are asking for biscuits and omelets on Sundays.” So, planning for success means prepping for success. So, I have teenagers, and if we don’t meal prep, we collapse as a family. It is really hard to exist in our world without meal prep. So, that is definitely part of it. It’s deciding what are the factors going on this week, how many games do we have, who’s traveling, how many meals do we have to prep for?

Usually, we do meal prep twice a week to be able to stay ahead, and that’s usually mostly protein and vegetables. My kids will fill in the gaps with carbohydrates. They both are huge fans of rice. They eat a lot of rice, a ton of rice. It’s obscene how much rice they eat. So, I think for me, the mindset piece starts with being prepared ahead of time. So, for me, over the weekend, it’s looking at the next week, what do I need to have organized? What are the tasks I have to get done this weekend to make sure I’m ready for the week ahead? So, part of it is mindset and then part of it is physical prepping. Whether it’s getting a closet cleaned out, whether it is getting things organized for a trip that’s coming up, whether it’s doing the food prep piece.

Give yourself grace, especially with kids. If you’re enjoying having your kids home and they want to have biscuits and omelets on the weekend, enjoy the biscuits and the omelets. Just know that you want to plan to get back on track so that you’re not feeling like you have gotten into a position where maybe two biscuits have turned into an entire day of binging or not eating the foods that make you feel good. As Dr. Will Cole says, “Part of honoring our bodies is focusing in on the foods that make us feel great and avoiding the ones that don’t.”

Deborah asked, “Your recipes in your book are so delicious and flavorful. Any chance you plan to create a cookbook or more supplemental recipes?” Beth Lipton is who helped me create those delicious recipes. I’m sure Beth will receive that wonderful compliment. Thank you so much, Deborah. “Are there ideas about doing a cookbook?” Maybe, if there’s enough interest and listeners let me know if there’s enough interest to do that that would probably be a side project that we would do together. But yeah, I’m very passionate about cooking and food prepping as simple as possible because all of us are busy, irrespective of what life stage you’re in. I understand that the processed food industry has convinced us that cooking is supposed to be difficult and arduous, and they’ve created all the shortcuts, and I’m here to tell you that’s not the case. There are ways that you can definitely create meal plans and meal programs and food prep so that you can have delicious, healthy food available to you that is not going to derail all of your health focus and wellness goals.

Next couple of questions are about tours. I have Adriana from Germany and Carol from New York are asking, “if I’m going to be doing any live talks or book tours.” I would love to do that. Obviously, I’ve had a lot of people that live in Germany asking this in particular. Adriana’s question, yours is one of many. In fact, I got three DMs on Instagram today with the same question. I would love to make that happen. I would have to talk to the German publisher to see how to make that happen, but I will definitely keep that in mind. Thank you so much for your support. Carol, I will probably be coming up to New York in the fall. There are a couple podcast opportunities. I will see what we can do in terms of a book signing or some type of opportunity for me to connect with followers and supporters up in the New York area. But stay tuned for sure.

Well, you all. I love these AMAs. Please keep your questions coming. Today, was kind of a grab bag and I decided to do it as a grab bag because it was allowing me to pull different questions from multiple sources of multiple people that had submitted questions. We do have more AMAs coming. We have some that are going to be dedicated to fasting. We have others that are going to be dedicated to menopause and perimenopause and probably two that will be devoted to supplements. There were so many questions about supplements. I think so many people are just confused about how to take supplements, how to source supplements, what should they be taking, what should they not be taking. Obviously very bio-individual. But just know that those future AMA episodes are coming.

We are endeavoring to do at least one AMA just with me as a solo episode every month. But keep the questions coming support@cynthiatharlow.com. Jamie is organizing all of them. So, that we can stay really really laser focused. Thanks so much for your support.

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