 To me, it was like an SOS. My body was telling me or screaming, you have to change what you're doing. And if you don't, guess what's going to come next. You know, unlike myself, who still sees patients six days a week, you decided to step back from clinical medicine because you wanted to have a bigger impact. Tell us more. In fact, what point in your story and your story is so compelling, did you embark on what you're doing now? Let's start with that. Yeah, it's a great question. I think for me, I probably was practicing as a nurse practitioner. My first love is cardiology. I was an ER nurse and then transition to effortlessly to cardiology. I love everything about clinical medicine, but probably 10 years into being a nurse practitioner, I kept asking myself, you know, I'm prescribing a lot of medication, cardiology, there's a lot of meds. I'm seeing patients in the hospital and I'm seeing patients in clinic. And I feel like a lot of what is persisting, the symptoms and the expression of disease and the progression of disease is mediated by lifestyle. And at that point, nurse practitioners in the state that I'm in were not autonomous. So we weren't able to practice unless we had a physician agreement. And so, you know, I continued to toe the party line and I started a PhD program and that didn't light me up. And then I did a wellness coaching program and that didn't make me excited. But what did make me excited was to talk about food and to talk about nutrition as medicine. And so I, you know, had young kids, my husband did a lot of travel and I just got to a point, I woke up one morning and I said, I cannot write another prescription. There has to be a better way. I really fervently believe that lifestyle medicine is the focus that I should be doing, that that is the root of a lot of the health and metabolic health issues I'm seeing every single day. And my patient population just kept getting younger. I was seeing 35 year olds, 30 year olds, 37 year olds with diabetes and cardiovascular disease and all these largely in many ways preventative lifestyle diseases. And I woke up one morning and said, I can't write another prescription. I didn't have a business plan. I don't recommend people do this. I took a leap of faith, gave my notice, my practice tried everything they could do to convince me to not leave. And I really leaped into the entrepreneurial space and nearly instantaneously, I started attracting women that were at my stage of life, early 40s, perimenopausal. And that started this trajectory of not only me figuring out things for myself at that stage of life but helping other women do the same. And I still love cardiology but I get to practice right alongside my colleagues but just in a very different capacity. And one that allows me to feel fulfilled and feel like I'm still making a tremendous difference. Now during this whole time, like you write in your introduction to your book, your health issues were challenging. I think that's important for our viewers and listeners to understand that, yeah, you weren't just writing prescriptions and got tired of doing that. You were kind of tired of where your health was. Can you go into that? Yeah, and I think for so many of us, what we do in our 20s and 30s no longer works for us effectively. And this, I mean, I was probably not sleeping enough. I was probably overexercising. I think I had started low carb and I felt good on low carb but when you're a perimenopausal woman, the 10 to 15 years pre-stating menopause, the game changes. You can't do the same things and expect the same results. And I actually started becoming weight loss resistant and when you're five foot three, five to 10 pounds makes a big difference in how you feel and how you look. And all the things I used to be able to do effortlessly were no longer effective. And so through my journey of figuring out that I needed to remove gluten and dairy and I was probably abiding by the guidelines I recommended to patients. Eat frequently, stoke your metabolism, eat snacks and mini meals. And when I started changing how frequently I was eating and what I was eating, that's when I was able to see some tremendous impact along with changing prioritizing sleep and not exercising quite as vigorously like I had been made a big difference. Was there a tipping point for you that finally said enough is enough or did this evolve as you started coaching women and what worked, what didn't work? For me personally, the tipping point was when I could, I didn't have enough energy to get out of bed, that I was really tired and I knew I wasn't clinically depressed, but I really didn't understand even as a Western medicine trained provider, I did not understand the changes that were occurring in my body in perimenopause that were exacerbating a lot of what I was experiencing. And then add in the fact that I learned I had a parasite infection and I was over taxing the body, we become less stress resilient. And so for me the tipping point was when I didn't have enough energy to be the mom that I was, to be the clinician that I was, to be the wife that I was, that I had to take some very hard looks at what I was doing and to recognize that I needed to make some changes because if I continued on that path, I was not going to continue being a healthy person. I was going to head in a direction that I wasn't willing to go in. And I think for so many women in particular, but it happens to men as well, we're conditioned to believe that because we are north of 35 or 40 or 45 or 50, that whatever's happening is a function of aging. Now for some people that provides them reassurance, for me it just made me angry. I didn't wanna be told that. I was like, I don't lean into those limiting beliefs. I do believe that there's a better way, I just need to figure it out. And so once I was able to figure it out, then I started discussing and sharing it with anyone and anyone that was willing to listen to me because I felt like it was in many ways the missing piece for so many individuals. Again, not just women, but men as well. Because you were a practicing nurse practitioner, I mean, did you go to your colleagues and say, hey, you know, this is happening to me, this isn't, you know, this is weird. And did you get the usual response of, well, of course, you know, you're perimenopausal or you're 40 years old and you got two young kids. Of course you're tired and you work full time. Yes. I don't wanna put words in your mouth, but I bet you heard that. I did. And what's interesting is, you know, I worked for this amazing cardiology practice. Many of my colleagues were my own age. So their wives were experiencing the same things. Many of the colleagues I worked with that were 20 years older than me. And more often than not, they were like, oh, this is our nurse practitioner who likes to talk about nutrition. Like they would almost like pat me on the back like, oh, this is so cute. You know, we'll send patients to her so she can talk about food. So I think the younger physicians were certainly sensitive to it because their wives were experiencing the same thing. The older physicians that I worked with, both men and women would just say, oh, just get used to it only gets better from here. And so I think on a lot of levels, there's a poor understanding of the role of metabolic health in conventional medicine. And instead of fixating on symptoms, if we're really looking at the root cause of a lot of what we're seeing, it will give us a different appreciation. And to me, it was like an SOS. My body was telling me or screening, you have to change what you're doing. And if you don't, guess what's going to come next. And so I just wasn't willing to lean into that. But, you know, I would say the bulk of my colleagues were very supportive. Even some of the MPs thought the food piece was cute. I mean, that was how they kind of put me in that box of this nurse practitioner is interested in talking about preventative nutrition and lifestyle medicine. And we don't have time to talk about that, but we'll just send them to her and she'll help our patients. All right, well, let's talk about nutrition now. One of the myths that you like to bust in your book, and I've been trying for many years, is this idea that we ought to eat, oh, six small meals a day to keep our metabolism revved up. And that's probably one of the farthest from the truth things that most of us either learn personally or we see it in our patients every day. So I suspect that you were doing that like most of us did because that was the smart thing to do. And maybe even because of a cardiology practice, you were eating a low-fat diet. And so why is that prevailing idea that the six small meals a day snack throughout the day, revs up our metabolism? What's wrong with that concept? Oh, I love this question. I think on a lot of levels, it's this conventional dogma that we've all been schooled with or experienced from a societal perspective. And when I think about what the net impact is of someone eating frequently throughout the day, where you really look at this model of insulin and insulin's not a bad hormone that unfortunately has gotten a bad wrath, and understanding that every time we eat, our blood sugar, depending on what we're consuming, whether it's carbohydrates, fats, or protein, there's a resultant rise in blood sugar. And when your glucose goes up, your insulin is secreted to bring your blood sugar back down. Of course, this is an oversimplification. But if you're doing this and you're giving yourself four to five hours in between, your insulin levels and blood sugar will come back down. That's how we're optimized. And then our bodies are able to be more metabolically flexible. But if we are eating every two hours, guess what happens? That threshold for glucose, insulin security comes back down, but then you eat again. And so the cumulative net impact over a day, a week, a month, over time, is that you are not burning the food that you're efficiently, you're consuming, you're storing it. Like almost like these hibernating animals, they're storing fat for winter, but you're doing this all day long. And I think the other piece is that if you look at these ancestral health perspectives and you really understand that throughout human history, our bodies are designed to be able to sustain themselves in points of time when we have feast or famine. And unfortunately, we live in an overabundance all the time. And so we are conditioning our patients and our clients that they need to eat frequently to quote unquote, stroke their metabolism. It's actually going to do the exact opposite. And I remind people that the way that our bodies are designed to thrive is that we are eating less frequently. I know the word intermittent fast or the phrase can sometimes be triggering, but I remind people that that is how our bodies are designed to thrive, but the concept or the rigid dogmatism about the meal frequency and eating to stoke your metabolism could not be farther from the truth. And the fact that our metabolic health is declining at such a rapid rate here in the United States and many industrialized countries is really demonstrating for us that things need to change. So since you brought up intermittent fasting, and of course that's the name of your book, Intermittent Fasting Transformation, you actually and I are advocates of time-controlled eating or time-restricted eating. And I want to take a minute just to mush around there is a difference between intermittent fasting and time-restricted eating. And I'll start. Intermittent fasting actually came about from mouse studies where you could control when they ate. And the mouse studies, which are fascinating, one day the mouse got to eat, the next day he didn't eat. And even mice who were compared to mice who ate every day, they got the exact same amount of calories. They got two days worth on one day and nothing the next day. They lived a lot longer than the mice that ate every day. And it was called intermittent fasting because they literally were fasting intermittently. It became popularized with the 5-2 diet, which five days of regular eating, two days of not fasting, but actually less calories, five to 600 calories. And so those, let's call them intermittent fasting. What you're proposing in your book, and correct me if I'm wrong, and what I propose since actually 2006 when I first wrote about it, I think I'm the first person to ever write about it is time restricted eating or time controlled eating. Would you agree? I would agree. I think sometimes the terminology gets interwoven together and I think there can be some degree of confusion, but I would agree with you that there are periods of time when we eat and periods of time when we do not eat. And so I think that that is the prevailing theme that we're both trying to embrace and to recommend to people that they lean into that and not be fearful of going periods of time without eating. Yeah, and you're right. It's clearly built into our genetic. In fact, interestingly enough, breakfast is a very modern concept and breakfast, the word comes from break fast. And from my reading, it actually became prevalent in Victorian England over a hundred years ago with the Industrial Revolution when men had to go to factories early in the morning. They did not eat lunch, they did not have breaks and there was nothing that they ate until the evening when they came home and from my reading, wise prepared the men a break fast before they went. It was actually the Ramadan diet and you write about the Ramadan diet in your book as do I. So yeah, breakfasts are very modern concept. It's interesting because the concept of breaking your fast can really happen at any point. It's what you choose to break your fast with that I think is of greatest significance to set up the rest of your day and the modern day perspectives on breaking your fast is with carbohydrate laden products that are going to set you up for a significant degree of blood sugar dysregulation as opposed to having an omelet or sitting down and having leftovers from last night that tend to be higher in protein and maybe some vegetables. But it's the modern day concept of breakfast that in many ways is really setting people up to not succeed throughout their day and to deal with those blood sugar fluctuations and hangariness, that's my new word. When they're hungry and they're angry and they're grumpy just like I have teenagers now and just like when they were toddlers and they got hungry and they got grumpy, kind of the same thing we're dealing with now at this stage of life. I get a chuckle Kellogg's corn flakes was actually advertised as the first pre digested meal and you think about that for a second and the last thing you and I would actually want is to have whatever we're eating already pre digested which means it will instantly become sugar in our bloodstream and yet Kellogg's proudly actually advertised that it was the first pre digested meal. Isn't that wonderful? It's really a disgusting concept. I think about birds and when mother birds are feeding their babies they will actually give them pre digested meals and it makes sense for a baby bird but certainly not for adult humans for sure. Yeah, that's right. All right, let's switch gears for just a second. When women experience health issues they are more likely to be misdiagnosed or dismissed by doctors or something less critical like, oh, it's a normal period pain. In fact, one study published in academic emergency medicine found that women who went to the emergency room with severe stomach pain had to wait almost 33% longer than men with the exact same symptoms. And one of the reasons I wanted you on today is to offer tactics for our female audience to take back their power and get the care they need. A lot of this has to do that you write about in the book with women in hormonal fluctuations. So what's normal and what are the signs of a hormone imbalance? That's a great question. And I can honestly say that working in cardiology we would see women that always showed up later with heart attacks and other types of issues because women are caretakers. We take care of everyone in our lives and worry about ourselves last. But when we're talking about hormonal fluctuations for women at their peak cycling years, peak fertility years and you're 35 and under they have a menstrual cycle every month. So they're having fluctuations in their sex hormones their estrogen, estradiol, testosterone and progesterone week to week, day to day throughout a menstrual cycle. So that's a normal fluctuation. But as we're starting to see more and more women dealing with infertility, polycystic ovarian syndrome which is the number one endocrine disorder in the country it's not an underactive thyroid. As we're starting to see more and more women that are dealing with metabolic disease slash end or hormonal imbalances you're starting to see more people that are not having regular menstrual cycles and that can show up as very heavy bleeding irregular cycles, weight gain. They can have hertsudism which is inappropriate hair growth. They can deal with acne. They can deal with a multiplicity of symptoms that they can go through. But what's of interest to me is as women are getting closer to perimenopause so this 10 to 15 years prior to menopause average age of menopause in the United States is 51. Perimenopause is an interesting time for women because all of a sudden we're having less progesterones to create it by the ovaries which exacerbates underlying depression, anxiety and sleep issues. We also have this relative imbalance of estrogen so this is when women will sometimes see much heavier periods. Women would describe them as the crime scene period very heavy weight loss resistance. They may have trouble sleeping. They may struggle with food sensitivities all of a sudden maybe they've been able to tolerate certain foods like gluten and dairy and grains and all of a sudden they're not. And then as they're transitioning to menopause which is 12 months of that menstrual cycle and women are dealing with this cascade and fluctuations of waning ovarian reserves so less circulating progesterone. Sometimes women in perimenopause will have the highest levels of estrogen throughout their lifetime because their body is acclimating to this reverse puberty situation and estrogen is starting to falter up and down depending on where they are. So it shows up as these irregular cycles. And then as they get closer to menopause they may have lower and lower levels of estrogen which can contribute to bone health issues. They can start having palpitations. They may experience hot flashes which for anyone who's listening to ever experience they're not fun. And then you go 12 months without a menstrual cycle and the decision needs to be made about whether or not someone's leading into replacement of those hormones or going through menopause without hormones but the lifestyle piece in perimenopause and menopause becomes much more of an issue. And those are just kind of the highlights in terms of hormonal imbalances that you can see. The other thing that I think is really relevant to our conversation is to talk about the role of estrogen or estradiol which is the predominant form of estrogen a woman's body makes. But when women are navigating perimenopause and they're having fluctuating amounts of estrogen that impacts insulin sensitivity. As we're losing muscle mass it impacts insulin sensitivity. So there's this double whammy and people assume that our metabolism both men and women slows as we get older. We know based on research that really doesn't happen until after age 60 and it's only at 0.7% each year. So it's fairly small amount. But what I think becomes problematic for a lot of people north of 40 is this loss of estrogen signaling the pro-inflammatory state more oxidative stress less insulin sensitivity. All of a sudden it becomes this domino effect that can really impact the way that we view ourselves and our world around us. Okay that's a great segue into okay so what does all this have to do with time controlled eating for women? So and second question, in what way should this be particularly different for how women practice time controlled eating than what men can do or should do? Yeah, well I'm gonna answer the gender piece first because I think this is important. You know when we're looking at men and women I always say if you look at the research and my clinical experience men and menopausal women so women that have not had menstrual cycle for more than 12 months and average age here in the United States is 51 they tend to have an easier time with time restricted eating because there's not as much hormonal fluctuation day to day, week to week, month to month. Now what I do think is important that younger women so women 35 and under that tend to be at peak fertile years have to be particularly attuned to their menstrual cycle. So I'm gonna make an oversimplification we have the follicular phase when estrogen predominates when we can get away with more fasting more carbohydrate restriction where our bodies are more resilient to more stress from more rigorous physical activity is very different than when in our menstrual cycle progesterone predominates in the luteal phase when we generally have to back off on the type of activity we amend our fasting window or in our time restricted eating window and we probably need to be doing more rest we probably need to be doing more yoga we may need more carbohydrate at that stage of our menstrual cycle than we do in our follicular phase. So I always say that women at this very important stage in their lives at peak fertility, there's a time in your menstrual cycle when you can get away with fasting and there's a time when I generally recommend no more than 12 hours of digestive rest and that's what I call it everyone should really be doing digestive rest and then pushing the levers depending on where we are in regards to perimenopause because I think this is important as we're making that transition and we have these fluctuating estrogen and progesterone signaling that's going on in the body this is when I remind women that lifestyle is important so what's your sleep quality like? How do you manage your stress? And that's not five minutes in meditation once a week what's your nutrition like? I know that you speak and you really lean into the nutrition piece but this is when I start talking about inflammatory foods the standard American diet has no place in our diets but looking at the role of gluten and grains and dairy if those work for you sugar, alcohol in particular and understanding that once you are sleeping well you're managing your stress you're removing those inflammatory foods then yes, intermittent fasting can also be beneficial but I think it's just important to say that men and women do need to fast differently because our physiology is different but I do find the bookends men and menopausal women generally have a much easier time because there's not as much fluctuation but when we're looking at overall benefits to time-restricted eating, intermittent fasting I start thinking about the basic ones like we were talking about poor metabolic health so we know that fasting can help with reversing insulin resistance it can prove hypertension or high blood pressure our lipids especially triglycerides helping to lower LDL looking at the inflammatory markers high sensitivity CRP some of the other lipid markers that I'm sure you probably have spoken about also looking at how it helps improve neurocognitive function so we know that as an example many women are protected from neurocognitive issues until they go into menopause and a lot of it is believed to be both an issue with insulin signaling and also this loss of estrogen so lowered risk of Parkinson's, lowered risk of dementia understanding that an increased gut function if we fast long enough we'll get some stem cell activation I know we'll probably touch on that and then understanding that for many of us it's as simple as we sleep better we lose weight, we change body composition lowered inflammation in the body I'm sure you've seen this with your own patients but patients telling me my joints no longer hurt I don't have pain in my knee I don't have pain in my feet so understanding that there are all of these interplays that go on with fasting I think a lot of us like to focus on the body composition and weight loss improvements but there's so much more than that I always say people stay for all those other benefits and lastly I would say just the mental clarity and energy from utilizing, being able to utilize different types of fuel substrate so being able to activate and utilize fatty acids so breaking down fats into fatty acids and we know our brains love fat so this improved mental clarity and energy are two of the biggest things that I see Let's talk about your program because a lot of your book correctly states that most of us are insulin resistant metabolically inflexible and asking somebody as I've written about to suddenly instead of eating breakfast at seven or eight o'clock in the morning your first meal of the day is at noon is like falling off a cliff and most people can't do it because they cannot access their fat in their fat stores because of high insulin levels and I like the fact that you've got this 40 day transformation tell us what you've learned obviously and what I've learned that you gotta do this one step at a time you don't wanna jump into the deep end No, I agree with you I think it's not sustainable if we are in a position where we feel like we're in a lose lose like you're asking me not to eat as frequently but now I'm gonna feel like I'm starving and so it's reminding people that it's baby steps it's as simple as the first week of my program really speaks to cleaning out your pantry start reducing the amount of carb process carbohydrates that you're eating if we know the average person is consuming 200 and 300 grams of carbs a day lowering that can be terrifying but understanding that we're looking to do a couple of different metrics we're looking to reduce our carbohydrates not too low of a level because moving too quickly can be problematic and then we're asking people to increase their protein so we know protein can be very satiating protein is important especially as we're getting older because we actually have more protein requirements as we're aging as opposed to when we're younger and I find that if we start kind of making little changes and by those little changes it's like let's reduce let's be cognizant of how much carbohydrate we're consuming so start tracking macros start being conscientious about eating a little bit more protein with your meal maybe you're having four ounces of chicken try six and I find that that can be helpful I think that's the first thing the other piece of it that I think is very important is teaching people to stop snacking because you have to rip off that band aid once people understand they don't have a buffer in between meals all of a sudden they're like okay if I'm not going to eat in between my meals I need to eat enough for breakfast and enough for lunch and enough for dinner to be able to get successfully to that next meal so I think the snacking piece is also very very important and then the next big step is going from dinner to breakfast and for many people they're convinced if they don't have a snack before bed if they don't have dessert if they don't have that glass of wine if they're gonna starve and I remind them even thin people have plenty of stored energy we're not going to starve but we're gonna make sure you're gonna have a nice piece of protein you're gonna have some non-starchy vegetables you're gonna add in some fat you're gonna be absolutely fine because you're gonna spend most of that time sleeping so a lot of what I'm doing is coaching people and I know even in your book, Mitre Code you increase the fasting amount by an hour like each week which I think is brilliant so you're making it very sustainable and I tell people that the more carbohydrate dependent they are so if you're someone that is metabolically unhealthy insulin resistant left and resistant et cetera it's gonna take you longer to get to a point where you're gonna be able to go longer without eating and that's okay so sometimes it takes people a couple weeks to start being able to utilize fat as it fuels substrate others it takes longer and that's okay but it's really designed to be a step-wise approach and also the other pieces the other lifestyle pieces like going, getting a little more sleep becoming physically active many people really aren't physically active we've gotten conditioned where we're in a climate controlled environment 24 seven with very little physical activity and you and I both know that insulin resistance starts in our muscles so I remind people that encourage them take a 10 minute walk after a meal and sometimes they're initially not understanding why that's so important but understanding that with each muscle contraction your body is using up some of that glucose or thinking of your muscles of the sponge using up some of the blood sugar that's circulating to be able to dissipate it and bring your blood sugar levels back down but that's like a kind of a high overview of my methodology and one that I found has worked really well for thousands of patients. Yeah, I think in my first book there's a fascinating study looking at people who were asked to walk for either 10 minutes before their meal or 10 minutes after their meal same distance, same speed the people who walked before the meal didn't lose any weight the people who walked after the meal lost weight even though it was the same meal and again, I think this goes back to our ancestral signaling if we walk, we gather something and then we ate and okay, we're done, let's store that on the other hand, if we eat and then we start walking again our computer program says, wait a minute I don't know if this guy's gonna walk for a mile or 20 miles, the last thing I wanna do is store this stuff I wanna make it available and yeah, this is important signaling information and that's why in Europe it's fascinating the number of people who just stroll after a meal they're not running, they're just walking and enjoying the environment and I think we can all learn from that Well, I think it's ironic my husband and I used to joke about all the middle-aged people that used to walk in our neighborhood and at the time when you're in the throes of young kids and you're working and it just became this thing that you observed and now we have become the middle-aged couple that walks in the morning, walks in the evening with our dogs and I really fervently believe that that type of, I always think of it as neat exercise or neat physical activity we know that degree of thermogenesis has so many benefits and just walking for 10 or 15 minutes after a meal is such a great way like if you're out to dinner and maybe you're over eight like take a walk after dinner, stroll around I mean, it's such an easy way to help support your health without having to go to extreme lengths to do so And like I always say, the best prescription I've ever written is to get a dog I have two, yeah. I've got four unfortunately, so. Two of them are rescue, so we can't resist a rescue dog, oh well. But yeah, dogs make you go out and walk at least twice a day, whether you want to or not even in the dead of winter, they don't care. No, they don't. I jokingly laugh about, I have dogs that walk several miles in the morning and several miles in the afternoon and they're better behaved because of that Same thing when I had, my boys were younger I used to tell my husband, my goal was to make them tired so we did a lot of physical activity and I think for so many of us we just forget that parking a little farther away from the grocery store not taking the elevator like there are little things that can add up to that degree of additional physical activity that can be very beneficial. Yeah, you're right. I've always advocated, look folks take the elevator up but then walk down the stairs and there's this amazing Austrian study that I cite of people who were either asked to walk up a ski lift and then ride the ski lift down or ride up the ski lift and walk down and it turns out that they thought the people hiking up were gonna get much better effect. Turns out it was exactly the same because you're actually working against gravity both ways. So that's okay. Take the elevator up and walk down. It's a good way to just get in some exercise that isn't too painful. Yeah, absolutely. And I think on a lot of levels one thing that I think people find interesting is they'll go to a very intense class, boot camp, crossfit and then they'll sit all day at work and I have to remind people I don't care if you set a timer so that every hour you walk to the bathroom or you get some water or maybe you do two laps in your office space but if you go and do intense exercise and then sit for 10 or 12 hours a day you have just undone all the benefit of what you were doing in the gym or at your local boot camp class. So just encouraging people to be physically active throughout their lifetime. And I'm sure both of us, I saw so many of my patients that were in their 70s, 80s, 90s and the ones that were thriving I always wanted to know what do you do that you think has moved the needle the farthest for you. And some of them talked about mindset and some of them talked about remaining like on top of electronics so they could still communicate with their younger family members. And then many of them would say I walk in nature every day. I do yoga, I do meditation and so I very much reflect on how much my patients have taught me over the years and the things that have always stood out and I'm like, I get it now. Like I understand why they always encourage you like be active, like don't just sit in your house or sit at work and then, you know, drive home and then be sedentary for the bulk of your day because that has a huge negative impact on your health in general. You brought up, you know, women who were in their reproductive years and the internet is full of horror stories warning women in their reproductive years do not do fasting and time controlled eating. So what say you? Yeah, I probably get asked this question or I get tagged in things on social media almost daily. So this is something I'm well prepared for. I think it's always in context. I think we always have to be thinking about the end of one, the power of each individual. So if you are a young woman who's 25 who's an athlete who is very lean or your body is already dealing with a tremendous amount of additional cremesis or beneficial stress, guess what? I don't think you're gonna get a lot of benefit from adding more stress to an already very lean individual that's already putting their body underneath a great deal of physical effort. So it's always in the context of how old are you? What is your stress level like? Are you already really lean? Then I'd probably say you don't need 12 hours of digestive rest. Remember what I said, go back to the 12 hours of digestive rest is not gonna hurt you and you wanna fuel your body for the degree of physical activity you're doing. On the other side, I think about the PCOS, Polycystic Ovarian Syndrome patient that's young that is insulin resistant is just a variant flamed and is struggling with metabolic poor health. That woman can definitely benefit from some time-restricted eating or intermittent fasting because if they've got underlying insulin resistance which is at the basis. So the basis of PCOS is inflammation, oxidative stress and insulin resistance. You are gonna benefit from eating less frequently. You are gonna benefit from adjusting your macros, your protein, fat and carbohydrates. You are going to benefit enormously, again, depending on where you are on your cycle and most PCOSers are not cycling, they have a luteal phase defect, they've got a progesterone deficiency but I find for many, many women that have PCOS when they start fasting, things start to fall into place and obviously working in conjunction with a knowledgeable GYN or MD or MP that can help support them as well. These are people that I lean into specific types of nutraceuticals that can be very beneficial. Now, to suggest that intermittent fasting or time-restricted eating is not beneficial for women would go contrary to the fact that it is what is allowed us to exist as a species for as long as we have. So when I hear the fear mongering, I always say, what's the context? If it's someone who's going through a divorce just got fired, just had a big move, is already really thin, then I'm going to say that's probably not the time to do it but for the other individuals, there's probably some play that you can have 35 and under, maybe you're doing it once a month, maybe you're doing it once a week but the insulin resistant individuals, I do believe there's a lot of value. Again, with the caveata, where are you in your cycle? Are you trying to conceive? Because I see a lot of that, people are trying to get pregnant or they're pregnant or they're breastfeeding. Those are not the times I feel that women should be restricting their food intake when you're trying to grow a human or feed a human. Fun fact, and I think a lot of women will relate to this, when I was breastfeeding my kids, I was never more hungry. I was voraciously hungry. It is not the time to restrict the amount of food you are consuming but outside those contexts, I think in many ways, fasting can be beneficial but I think unfortunately there are people who don't understand the physiology of women enough to be able to make that determination. I see these blanket statements and I always remind people, each individual is their own individual. There are men who should not fast. There are women who should not fast but to give a blanket statement and say that it's harmful or detrimental to women is really doing a tremendous disservice. Let's talk about the other elephant in the room on the internet. It's full of horror stories of women suppressing their thyroid function because of fasting and time-controlled eating. As someone who writes about her own little thyroid, what say you? Yeah. Well, let's look at what intermittent fasting does in terms of mitochondrial health. And so I think on a lot of different levels that many people benefit from intermittent fasting, it's done properly because it's improving mitochondrial efficiency. I didn't talk about autophagy as a benefit but mitochondrial efficiency, these are the powerhouses of ourselves. And so again, at that context, are you a woman with an underactive thyroid that doesn't sleep, that doesn't manage their stress, that overexercises, that restricts their food? Yes, fasting is not gonna help you under those circumstances but most women that I speak to and that I interact with, they're sleeping, they're eating a nutrient-dense diet, they're managing their stress, they're not overexercising and fasting for them can be that one strategy that may improve the quality of their thyroid health. And I think for so many people, it's like half the conversation with your healthcare practitioner, am I at a point when I'm ready to do this? And it's interesting, I've asked a lot of thyroid experts, what are your thoughts on fasting? And without exception, they all say the same thing. We know it's beneficial for the mitochondria, we know it can help with ATP production, we know that it can help with metabolic flexibility. And so I think it's all in the context of what is the amount of stress in your life? This is one of many types of stressors. So hormesis is neither, it's generally good, but if you have too much stress in your life, that may not be the time to push that lever. All right, let's talk about other stressors. You and I are both right about how it's important to exercise on an empty stomach, which goes against the prevailing wisdom that I better get this giant smoothie in my belly or my energy bar before I go work out. How come that's a dumb idea? Well, you know, it's interesting because I used to be of the belief system when I didn't know better that I wanted to have that protein shake before I went to the gym and I wanted to have another one as I was driving to the hospital. And I think the first person to say, if you want to utilize stored fat as a fuel source, go to the gym and work out fasted. But it's always in the context of, you know, where are you in your menstrual cycle? So if you're in the luteal phase, it's a week before your menstrual cycle, you may not feel good. But I think for most people, they feel so much better. They don't want to be working out and having their blood shunted to their gut to help digest a meal. They want their body to be able to free up stored fatty acids and to fuel their body and fuel their workout. And they'll worry about eating later. This is not a question of not fueling your body properly. I do think there are certain types of activities where people do need to bring food with them. If you're an endurance athlete, I mean, as a good example, but you don't have to eat the carbs before you work out. You can actually have some fats as a fuel source. But I think for a lot of people, it's helping them understand that you can power through a workout when you become fat adapted, when you become metabolically flexible. And it makes them so much easier. When I go to the gym, I just have water with me. That is the one thing I think about. And other than that, the food can wait until later. Now you write a lot about sleep and you actually write the kind of even before thinking about this transformation, get your sleep in order. Now, what ways do you find it help you prioritize sleep? You got any fun gadgets that you like to use or do you use other techniques? No, no, I do a lot of different things. I do love my aura. So I like to track my sleep. That's really important. And I'm a data person, probably not surprisingly. I mean, I like data. I would say that in terms of technology, I have a bunch of things. I have Apollo Neuro, which is a device that was designed for PTSD patients, but they now understand that it's very helpful for kind of evoking the autonomic nervous system, parasympathetic, getting us out of the fight or flight mode. I have something called Somnox. This was gifted to me. I didn't buy it. And it's a device that you actually hug while you're sleeping. And it actually like calibrates your breathing. And so it's a way of again, getting you into the parasympathetic and that it looks like a bean. That's a Danish company that actually gifted that to me. And I have no affiliation with them. I think it's a really nice gadget. I also have a PEMF mat. And this is probably one of my favorite things that I will lay on that. I'll lay on it after a workout. I'll lay on it before bed. It's just very, very relaxing. And that's also improving communication between the mitochondria. It's very relaxing. There's different settings. I would say gadget-wise, those are the things. But the big things that I think about during my day, I'd start thinking about sleep quality when I get up in the morning. I start thinking about how important it is to get light exposure on my retinas. I think about that physical activity piece. Obviously not eating too close to bedtime I think is really important. In fact, my aura will scream at me if I eat too close to bedtime. And that doesn't happen very often. But if I'm traveling or at business events and you're having a late dinner, sometimes you don't get the option to close your feeding window at five o'clock at night like I normally do. But I think those are the things I lean into. And obviously there are supplements that I think can be very helpful if people perceive they're experiencing an extra amount of stress. I am a firm believer in progesterone for women that need it. Obviously I'm at a stage of life where I'm in this ovarian reserve failure piece of my life. So progesterone I think is incredibly beneficial and that up-regulates a neurotransmitter called GAVA which is very calming in the brain and I see a tremendous amount of benefit from that. Now at least in California, progesterone is a prescription drug. And I assume it is in Virginia. And I'm a big fan of progesterone, particularly in postmenopausal women and I am convinced it's helped my patients sleep among other things. So who should ask their practitioner to prescribe it? Well, I would say if you have a diagnosis of polycystic ovarian syndrome, you may very well benefit from progesterone during the luteal phase of your cycle. So number one, I think about that and that wouldn't be someone taking that every day. That would just be during the luteal phase and some practitioners like 14 days and practitioners like seven really depends on the clinician. Women in perimenopause, we know that the kind of transitional point that starts to happen is the ovaries, our ovaries are as old as we are. Unlike sperm that get through generated every three days, our ovaries are as old as we are. So late 30s, early 40s, we're already in early ovarian failure. And so as there's less progesterone produced, I do find for many women, especially if they're experiencing sleep issues, anxiety, depression, progesterone can be hugely impactful in perimenopause and in menopause as well. Oftentimes in perimenopause, it may just be cycled around that the last seven days of the menstrual cycle. It's interesting, I'm starting to see more emerging research about women cycling progesterone even in menopause. I think that's probably highly dependent on the clinician and what's going on with the patient. But I think the progesterone is being a pretty benign form of hormonal support in the body. I like compounded progesterone because it's more consistent, but the regular progesterone that's made in a pharmaceutical industry is very inexpensive. So this is not a super expensive product. If it's compounded, it will be more expensive. I've just found that works better for me personally and some of my patients, but I'm a huge proponent of progesterone. I think it makes a big difference in sleep quality. You've mentioned the importance of listening to your body and I think that's incredibly important as well. How do people practice listening to their body? And can you learn how to do that? I've found simply when people follow my program, when they deviate for whatever reason, they know it and their body tells them, hey, what are you doing this for? Have you found that to be true as well? I have and I think a lot of listening to your body really speaks to slowing down. I think we're in this hairy culture where it's go, go, go, go, go all the time and I will encourage women to slow down and to just be mindful. How do you feel when you wake up in the morning? Do you feel refreshed? How do you feel after a meal? Do you wanna take a nap? How do you feel after exercising? Do you feel like you have to take a nap two hours later? That's certainly a sign that things aren't working well for you. So I think it's the slowing down in the awareness, but I think it's also just being cognizant of the variables that we have in our life. Do you feel good when you hang out with this individual? Do you feel that they, do you do activities that bring you joy? I think just getting very attuned to your lifestyle piece and how that works for you or against you. I think that's certainly a first step, but I would say from the perspective of metabolic flexibility and people being able to intuitively eat, I think a great deal of that is a byproduct of just paying attention to like, how do you feel when you have more protein? How do you feel when you have a little more fat? How do you feel when you have too much carbohydrate? And then you can adjust your macros, your food intake pretty readily. All right. I warned you that we're gonna have some audience questions and these are perfect. So it's time for our audience questions. This is from my Instagram post about shortening your window of eating. From iCarly-TA, does lemon in my water break the fast? What do you say? Okay, well, technically it's fructose. Technically it'll break a clean fast. However, it is not, you know, it's a pretty benign thing to do. I think for many people they get caught up in minutia and get very granular. And so some of my team and I will have to decide like, does it break a clean fast technically? But I don't want that to be the reason why you don't enjoy some lemon. Cause I think lemon water is one of my favorite things that I do. And I like to squeeze lemon in my water. So I think on a scale from zero to 10, it's like a 0.5. I agree. It's such a tiny amount. And, you know, in Walter Longo, my friend at USC has actually shown in humans that having a basically a nut-based bar does not change ketosis. So that's the purpose of the fast, which it is. Don't worry about this minutia. All right, and from Greer Gomez, do you think intermittent fasting leads to disordered eating? Please give tips on how to avoid this. Yeah, that's the other elephant in the room. So what do you say? Back in the good old days during my training, I actually interned at one of the leading eating disorder units on the East Coast. And so I had the experience working with patients that have disordered relationships with food. Do I think that there are people who are more susceptible to disordered reading and that intermittent fasting is not a good idea for them? I absolutely agree. I think if you have a history of anorexia or bulimia or binge eating, you have to be very careful. And this is in conjunction with your therapist or your physician that you're working with. You need to make a determination if you are healthy to participate. For most other individuals, I think it's always in the context of these strategies are not designed so that you don't eat. These strategies are so that you eat within a certain feeding window. So if you are eating a healthy amount of food, protein, fat, and carbohydrates, I don't think that will lead to disordered eating. However, I do think that there are people on social media who I see all the time that I think hide their disordered eating in the guise of intermittent fasting. So I think that you have to be honest with yourself. I've had several women who've been very honest and who have said, I did really well initially, but then I felt like I started to binge and I just then time out. And maybe this is not a strategy for you. So I think it's getting really honest with yourself, asking for help or support if you need it and then being observant of your behaviors, your cues. And I think that's the best way. I would say, have I seen it happen? Absolutely. It's thankfully the minority, but it's also the people who are also a little bit aware of their behavior and they'll come for help. They're looking for help. How do I do that? And to answer her second question, how do I navigate this? Number one, don't overfast. There are a lot of people who are like that a little bit of fasting is good and more is better. I don't like to see women as an example with a very tight feeding window. I don't want to see OMAD as a sustained strategy. You're not going to be able to get enough food in. And those are the people that I sometimes see can sometimes be at greatest risk for binging because their body is just looking for more fuel. Number two, it's like, where are you in your menstrual cycle? Because if you're white knuckling it and you're in the luteal phase, okay, back off. Remember 12 hours of digestive rest is great. And then number three, like if you've got some extraneous stress are going on in your personal life and you feel like you're having more cravings, your needs aren't being met, back off on fasting. Like this is something that is not designed to be rigid. It's designed to be flexible. It's designed to kind of work around our lifestyles and not be a huge detractor from having success with it. Make sure to check out the next one here. The average American, believe it or not, eats 16 hours a day. Literally from the minute they get up to the minute they go to bed.