Untitled episode

when we're in this unfed state we have all these benefits that are conferred it's not starvation we are just choosing to be purposeful about when we eat and when we're not eating I wonder if you break down for us the different types of fasting which ones are the best and where you might get the biggest bang for your buck in terms of approaching the strategy of

how to use fasting or intermittent fasting or whatever you want to call it or for your help you know you're so right that intermittent fasting is not newer novel it dates back to Biblical times and for a lot of individuals like wrapping their heads around doing something that's completely contrary to what we've been telling our patients to do for years it takes a little bit of

an adjustment but I like to start with intermittent fasting and describing it as eating less often and depending on the individual and what their goals are as an example a 16 out eight which is 16 hours faster with an eight hour feeding window is a good goal to work towards for most individuals from there we have lots of other variations we have people that that are

doing one meal a day we've got time restricted eating we have a five two which is or alternate day fasting where people are having alterations between a day of a regular eating pattern with a 24-hour fast with another day of an irregular of a regular feeding pattern another day of a 24 hour fast and I think in terms of what makes the most sense is really

figuring out for each individual what what their goals are and then we can help them select the appropriate time in which to fast I think it also comes down to Life Stage you know where people are in their life and also men and women need to fast a little bit differently but I think a good rule of from is to really think about that 16-8 and

understanding that when we're in this unfed state as you appropriately stated we have all these benefits that are conferred it's not starvation we are just choosing to be purposeful about when we eat and when we're not eating in an unfed State we have upregulation of things like autophagy this waste and recycling process that goes on behind the scenes we have lowered levels of inflammation we certainly

have improved biophysical markers as we are transitioned to being more metabolically healthy as our bodies able to effectively utilize either stored fat or stored carbohydrates as a fuel source and as you appropriately mentioned um more often than not you know 92 to 93 of Americans are not metabolically healthy so they're stuck using sugar as a fuel source when it as you become more metabolically flexible your

body's able to use different types of fuel substrates and it's in these opportunities when our bodies are able to have lowered insulin levels that we can go in and use stored fat as a fuel source and we know that for individuals that are metabolically flexible they have a preferred ability to be able to be flexible in terms of using different types of fuel we know that

if we're able our bodies are able to produce things like ketones we can get diffusion of specific types of ketones across the blood-brain barrier which can help with mental Clarity and energy things that I know so many individual are really struggling with these days but those are some of the kind of high level Concepts and then I think as clinicians we know that patients that are

embracing fasting are going to very likely have improved biophysical markers improved triglycerides HDL they're very likely going to have improved blood pressure that will go on to have improved inflammatory markers I think about high sensitivity CRP home assisting and things like this and that's just the Tipping Point you know as you appropriately mentioned you just wrote this book on longevity but we know based on Research

that individuals we look at Blue zones we look at specific parts of the world the people that are that are more physically active and are not eating as many calories per se are having improved quality of life and Longevity metrics yeah you know the Holocaust Survivors muffin live very long time uh yeah it's interesting they they had very very little very little food and uh they

lived to be 90s hundreds it's it's quite interesting not because it's a genetic thing because something I reprogrammed in their biology by the act of starvation now I wouldn't recommend that as a strategy but I think that it speaks to the power of activating these ancient survival mechanisms that are embedded within our body to keep everything running right and what you just said just to break

it down was a lot of benefits I mean you and we're going to talk about the kinds of fasting a little bit more thing it's unclear but you basically reset your biology to a healthier pattern you you lose fat you build muscle you build bone density increase mental Clarity improve inflammation and you help regulate your blood sugar or your blood pressure or your cholesterol your growth

hormones stress hormones all these things that tend to age us all and prove in the right direction with this one simple you say free and flexible and what was the other thing you said uh easy to do uh approached it just basically doesn't cost anything uh and it's amazing uh now when people talk about it you know they say well you could do a 12 hour

overnight fast or 14 hour or 16 or maybe it's better to do a 24 to 36 hour fast a week or a three day fast a month or a seven day fast a quarter or water fast what what what do you recommend and how different are the different types because people can go keto and get the same benefit they can do a cow restriction with a

fasting mimicking diet which is 800 calories a day for five days they can do a 5-2 diet where you restrict on two days and eat normally five days you can do a 12 14 16 hour fast you know so it's a lot of different things what what is the best thing to do you're saying 16 8 is really the best thing is it that much better

than 14 8 or 12 12 or 14 10 or 12 12 or what what what's the Nuance here well I think that it really really comes down to who are you as an individual what stage of Life are you in what are your goals so if you are a lean 32 year old female I'm going to talk to you about 12 hours of digestive rest as

opposed to doing really long fast because your body is so exquisitely attuned to uh you know food and your Peak fertile years very different than my obese 45 year old perimenopausal woman that may need to do some longer fast because she has plenty all of us really have plenty of stored fat to use as a fuel source but this is someone who's looking to change body

composition looking to lose weight probably as a little bit of insulin resistance and so some of those longer fasts in the context of dialing on the lifestyle getting high quality sleep making sure they're managing their stress that's an individual that can probably get away with a 24 or a 36 hour fast I do think that it's it's a graduated approach meaning you know when we go

from irrespective of gender if we go from a standard American diet being very physically sedentary to suddenly evolving into a paradigm where you're going to eat less often it starts with stopping snacking you know we've been conditioning our patients it's the worst thing that ever was invented I mean who the heck I mean it's a whole industry of junk food that's been pushed on us and

somehow we were taught that we need to snack and we need snack foods all around us and snack foods in our house and snack foods at the airport and snack foods and every corner it just it's the worst and I think if you know I think there's two things people could do to dramatically improve their health is get rid of liquid sugar calories and don't snack

yes and I couldn't agree more so when we're talking about the standard American it's really saying stop snacking rip that Band-Aid off because it's going to force you to reallocate your macronutrients your protein fat and carbs with your meals and then and only then is someone really in a position where they can say okay I'm not going to eat from breakfast to lunch and lunch to

dinner and from dinner to breakfast and so it may start with 12 hours of not eating and they evolve to 13 to 14 and I find for a lot of my patients who are very metabolically inflexible that are insulin resistant or diabetic we have to do this pretty slowly because their bodies are so inefficient it's almost as if they've been putting the wrong type of fuel

in their bodies for so many years that their body is not able to tap into fat stores as a as a first step so for those individuals it's a really slow stepwise approach kind of getting them to a point where they're they're putting on training wheels so they can get to a point where I can encourage them go 18 hours go 20 hours Go 24 hours

oh really yes I mean so it's slowly and I find that I get better results if we do it slowly now do I have magical patients that want to start with a 24 hour fast right off the bat yes but I've come to find that they are few and far between there's a degree of tentativeness because we've conditioned our patients on so many different levels you

don't need you're gonna die right snacks and maybe emails I mean stoke your metabolism you need all these things and so we're having to reprogram all of this cognitive kind of Disconnect that they've they've like affirmed for so many years and even clinicians I find sometimes are a little reticent to make these recommendations I'm like listen we wouldn't be here as a species if we weren't

capable of going through longer periods of time without food without you know and understanding that you're still your body has plenty of stored fuel to be able to fuel your body it's just kind of reframing that perspective about meal frequency what we're eating how frequently we're eating and I think for so many of my patients they feel so much better almost instantaneously that it for them

it's it's it's this kind of slow crawl to get to 18 hours 20 hours 24 hours and helping them understand there are different benefits at different intervals 12 hours to me is digestive rust it's a great it's a great way to everyone should be doing that right I have teenagers I don't recommend that they fast they're very metabolically healthy 12 hours of digestive rust for them

is sometimes challenging because they're still growing but you know from my perspective any adult should be able to get to that and then slowly depending on the individual kind of working up to those metrics you mentioned these longer fasts you know doing a fasting mimicking diet doing a three to five day fast I think that my perspective on this has started to shift a little bit

as I'm getting older I know how important muscle mass is to maintain muscle mass with age and how that plays a role in insulin sensitivity I think you have to be very purposeful about and very I don't want to use the word calculating but very uh exacting about what are you trying to gain and and finding that balance for me I don't do really long fast

anymore and I'm happy to explain why but I do think that there's a lot of therapeutic benefit depending on what people are working towards yeah that's right it's it's I would say you know fasting in all the forms I think it was a medical intervention like a drug and you have to find the right dose for each patient and the right exact treatment for each patient

and they're different if you're a you know 350 pound obese diabetic with hypertension good heart failure you might benefit from a 21 day water fast you know a lot if you are someone like me who you know maybe has 10 body fat I I can do a 24 hour fast but I tend to kind of lose weight pretty fast and I worry about losing muscle at

63. so like today for example wasn't that hard I had dinner at six o'clock last night and I woke up this morning I did a bit of sort of work and uh worked out and did a sauna and I had my healthy aging protein shake and it was probably 10 o'clock 10 30 in the morning so I went from like six o'clock at night to 10

30. that's a 16 and a half hour fast it wasn't that hard right it's not like I'm starving and need to get food first thing in the morning my body just have that space to not eat what you know what you're saying is such a contradiction to what was so much the Dogma nutrition recommendations which is you need to eat three meals a day you needed

snacks you have multiple small meals to keep your metabolism going and to burn more calories and you have to stroke the fiery metabolism otherwise you won't lose weight and can you speak to that how did we get it so wrong and what changed well I think you know I certainly started in medicine in the 1990s and I got as a nurse and as an MP got

little to no nutritional education or information I think that from my perspective based on what I know about Ansel keys and the Seven country study and this kind of shift after President Eisenhower had a heart attack had a had an MI that all of a sudden there they wanted to take the focus off of sugar put the focus on fat that you know with the rise

of this processed food industry I think it really created opportunities for um you know Health Care Providers to be telling their patients well you need to eat these small frequent meals this is going to be a benefit no fat fat is bad you know don't eat butter don't eat it don't eat nuts don't eat avocado and study these adulterated seed oils um you know try these

processed highly inflammatory fake sugars you know even high fructose corn syrup which is about as far away from what real sugar is like so I think it started to Pivot in the 1950s you know based on everything that I'm I'm aware of what changed here in the United States but certainly Ansel Keys gets a lot of the the blame I think on a lot of different

levels you know deflecting the focus on of uh looking at Sugar as being this inflammatory um food substance and then making it all about fat and of course you and I know that that's not the case and in fact when I started in cardiology as an NP I did that for 16 years I cringe at what my handouts look like back then but it was based

on you know it was based on my plate and the food guy pyramid and eat heart healthy grains and eat very small portions of very very lean meat but don't eat a lot of meat eat a lot of those grains and you need five to six servings of carbohydrates a day and no it was sick it was six to eleven servings of bread rice cereal and

pasta yeah it's terrible so so I think that that has certainly contributed along with this hedonistic hyperpalatable environment that we live in I mean I I think about ubereats I was trying to no no offense to ubereats but I was trying to make a I was explaining to my teenagers that you know years ago you had to get in a car and go to the store

things weren't just delivered and now people can get anything they want you know 24 7 and so yeah I think there's years ago you had to go to your dial-up phone that was connected to your wall you didn't walk around with your phone there was there was no cell phones yeah we're definitely dating ourselves but I think it really plays back to the start of being

convinced that we needed to eat a lot of uh processed carbohydrates along with the rise of seed oils I mean when I look at the research seed oils high fructose corn syrup uh the Advent of those into our diets and the fact that they proliferate I mean the number one consumed fat in the United States right now is soybean oil and so when I reflect on

that and I talk to my kids about what soybean oil is I'm like that's not a real fat our bodies don't recognize that as a real fat and so I think that there's multiple things combined with an increasingly sedentary population people don't sleep well you know we we have this hedonistic culture we can binge Netflix any time of the day or night we can order food

any time of the day or night and I just think it's this accessibility you know on every level this kind of dopamineer dopaminergic society that we live in is probably also contributing to why we're seeing such poor metabolic health no I get it it's you know when I go to a city I'm just amazed at how easy accessible everything is when I live in the country

in the Berkshires and there's no ubereats there's no Uber there's no delivery of food you literally have to go out and get it or make it yourself I think you know what I want to sort of understand is what's the 80 20 for people in terms of the techniques to make it simple do you have to do 16 is 14 enough is better to 18 like

where's the 80 20 for people and how often you do a dude every day you do it once a week you do it three times a week what's the best strategy for people and why for people who may be listening and say I want to try this it sounds good it's going to turn on all my Wellness Pathways it's going to reverse my biological age it's

going to help me lose weight it's going to improve my metabolism sounds great well what's the best place to start and what is the what is the dose and the prescription yeah no I love this question so we start really conservatively we start with the stop snacking because that effectively is going to force you to kind of adjust your meals you know more protein more healthy

fats discretionary carbohydrates depending on what they are maybe it's some root vegetables that's step one and step two and then step three is going from dinner to breakfast the following day without eating and so many of us you know we're just coming off the tail end of the pandemic I think so many of us have you know you know through many months of uncertainty and fear

people were doing a lot of drinking and eating in the evening and so effectively not eating at night after dinner until the following morning and so starting with 12 to 13 hours and opening it up from there your question is what's the prescription and I think it's really dependent are you a woman that's still getting a menstrual cycle because we know that there's benefit uh to

utilizing fasting as a strategy in the follicular phase when estrogen predominates when you your body is capable of more hormetic stress when your body can do more intense exercise you can do a little bit more fasting and then as we post ovulation when progesterone predominates this is when I encourage women to do a little less fasting kind of back off the gas maybe they're doing 12

or 13 hours of digestive rest is very different than a man and a post-menopausal woman because they have less hormonal fluctuation day to day week to week so that is certainly an interplay you know where are you life stage wise you know what gender do you identify with and then kind of determining are you very Physically Active you know if you're doing uh if you're training

for a race I'm not going to tell you to restruct your your food intake because you're actually going to need a little bit more fuel if you're sedentary then maybe intermittent fasting is going to be helpful for you to embrace most days of the week I personally because you asked um I tend to fast anywhere from 14 to 18 hours a day it really depends on

what exercise I'm doing what my Sleep Quality is like how am I managing my stress I think those are very important you know contributing factors but I think a good starting Place based on the research based on what I'm seeing is to aim for 16 hours fast so with an eight hour feeding window because eight hours will allow an individual to consume at least two good

sized meals and I'm very big on making sure we're getting sufficient amounts of protein so that we're not impacting and blunting um muscle protein synthesis but also not putting ourselves in a state of muscle loss which sarcopenia is a real issue you know I'm I'm middle-aged and it's something I think about a lot that's why I think finding that balance between not over fasting and making

sure I can get into really good sized meals a day is certainly very important but I think there's multiple variables as I mentioned you know life stage um certainly you know where you are life stage um whether you're male or female whether you're menopausal or not um accounting for that menstrual cycle and then the lifestyle piece and this applies to everyone if you have terrible stress

you're not sleeping um you're over exercising that is not the time to be adding gasoline to a fire maybe you're just doing 12 hours of digestive rust which is going to still confer some benefits not as much as you know when you're pushing 18 20 24 hours but it's helping patients understand that there are different levers there's consistency that's important but helping people understand that depending

on where you are in life stage can be very very beneficial but it's okay if you don't fast every day maybe you start off fasting two days a week that's why the five two or alternate day fasting I think can be very advantageous for people who are just ready to try alternate day like intermittent fasting I mean yes yes yeah or we time restricted eating is

maybe a better term you think than intermittent fasting because I think that's a broad category right yeah intermittent fast can be like a week fast or you know a 21 day fast or two three-day pass it can be also be time restricted eating so it's like it seems like the overarching category within it there's different technique right correct there's different strategies and it really depends I

mean as you appropriately stated if you have a obese diabetic patient like doing a prolonged fast might be a really great great way to help them break through a plateau may be beneficial for helping them um you know recalibate their palate you know many people feel uh and obviously this is not my area of expertise but in talking to other experts on my podcast talking about

food addiction and individuals are really struggling with with those kinds of Cravings that sometimes those longer fasts can help them kind of recalibrate their pal and get ready to do fasting on a more regular basis great so in terms of the you know the obvious is nobody should be snacking in between meals and giving yourself at least 12 hours and then you can kind of push

it to 14. it's not hard to eat dinner at six o'clock it might does eating breakfast today in the morning right it's not it's not we're not talking about something that's unachievable it's just a sort of a little bit foreign to most of us because we're you know taught to snack and have bedtime snacks and eat late and that's the war worst thing we can do

um I want to I want to sort of dive in a little bit to the mechanisms and then I want to get into like really more detail about who should fast who shouldn't fast why and what what some of the benefits are so can you take us through some of the mechanisms we talked about some of the benefits right the cholesterol the blood sugar the blood

pressure the weight the metabolism but how does it actually work what are the what are the sort of mechanisms of action from a scientific perspective about how fasting can activate all these these longevity Pathways and these healing pathways I think I really start with talking about autophagy so when we're in an unfed State we have much like anything in the body it's all about balance we

have something called autophagy and we have something called mtor and they're always looking for balance it's not as if one gets turned off and one gets turned on but understand this upregulation so when we're in an unfed State our body can go in and effectively get rid of trash you can go in and get rid of diseased disordered organelles mitochondria things that have the potential again

emphasis on potential to go on to create disease and so when we're able to effectively take out the trash it can lower our risk for developing certain neurocognitive issues as well as cancer I also like to think about the fact that we have specific types of proteins called sirtuins that get upregulated specifically with fasting and these along with other mechanisms ampk and NAD can be very

very effective for helping with longevity Pathways in the body I think that when you're fasting you mean that you mean NAD right NAD plan yes which people hear about nmn NAD and are what you're saying is when you fast you increase the amount of NAD which then stimulates this pathway called sirtuins which has all these longevity benefits right improving mitochondrial function improving insulin resistance reducing inflammation

activating DNA repair um inducing autophagy so it's all it's incredible stuff that happens just from the simple Act of not eating that activates these ancient pathways absolutely and I think a lot of people have probably heard of the term mitochondria but they are like the spark plugs of ourselves but after the age of 40 for many of us we have some degree of mitochondrial dysfunction and

usually is that the basis for most of the chronic disease states that we see so anything that's going to be improving mitochondrial function like with fasting and upregulation of these different Pathways can be hugely impactful and I I unfortunately think that there's so much Focus as you know in traditional allopathic medicine to addressing symptoms as opposed to root cause what I love best about fasting is

it's looking at these mechanisms in a way that allows our bodies to intrinsically help heal themselves yeah it's pretty amazing actually like it's like when you look at the science of the you know the one of the Hallmarks of Aging which is a lot of the ways in which fasting works it works on these Pathways that have been termed when they go wrong deregulated nutrient sensing

and that's something I talked about in my book young forever and I think it's sort of the meta Hallmark that's above all the other Hallmarks in a sense because it drives changes in all the other things that we see go wrong with aging so it's almost like you have this secret weapon of fasting to do things that are really powerful that almost no drug can do

uh maybe rapamycin might have similar benefits it's sort of like a it's like a drug that actually seems to mimic fasting without fasting because it inhibits the pathways called mtor which fasting does that induces autophagy which what you just talked about is basically a way to to kind of activate this longevity switch I call it and so you've got these four different Pathways that you mentioned

ampks or twins mtor which you implied through autophagy and also insulin signaling all are improved through fasting and I talk a lot about these in my book as essential things that you have to focus on that are regulated about what we eat that drive all the chronic diseases of Aging that drive all the accelerated biological aging and we can we can influence these dramatically through a

whole range of different lifestyle factors through the quality of our diet through reducing sugar but but fasting and time restricted eating are very powerful set of tools that we have as a drug literally I would consider them as a drug medicine to activate these things so really we talk about food as medicine but in a sense fasting is medicine too and I couldn't agree more and

and to me it's it's such a powerful kind of statement that there are more and more of us that are speaking so openly I think many people come to fasting out of a curiosity to change body composition or lose weight but I always say there's so much more to fasting that maybe perhaps people are less aware of that I think is far more powerful and certainly

more impactful yeah so tell me you know there are certain people who shouldn't do this right so if people are listening and you know this sounds great uh you understand the mechanisms it seems simple it's free it's accessible anybody in the planet can do it but maybe who shouldn't do it uh old young sick um hormonal State like what what's the right person to really focus

on this and who shouldn't I would say let's start with who should not obviously people that are still growing so I have teenagers at home I always say if you're not a fully grown adult this is not a strategy to use with children or teenagers I would start with pregnant or breastfeeding women I know this can be controversial but I always remind people if you're growing

a human or feeding a human this is not the time to restrict your caloric intake anyone that's got a disordered relationship with food obviously there are eating disorder correct so if you have a history of anorexia bulimia binge eating unless you are in conjunction with your eating disorder specialist feel that you're in a position to be able to engage in these activities probably not a good

idea I always say individuals that are frail um unfortunately I got hammered in my TED talk because I the organizers asked me to say above a certain age so I said 70 and I've just gotten hammered by you know very healthy 70 plus year olds so I think it's less about your age exactly less about age and more about if you're frail if you are brittle

diabetic you're not aware when you have hypoglycemic episodes if you're someone who just left the hospital you know I lost 15 pounds in 2019 and better believe I didn't fast for about four or five months anyone that's got a chronic health condition it's not that it's a contraindication but I think it's helpful to to get your health care practitioner involved your internist if you're on diabetes

medicines or blood pressure medicines because you may need adjustments it's not to suggest that it's a true constification if you have a lot of health issues you might actually end up having a problem because you might need less medication yep exactly exactly so kind of looping in your intern is your primary care provider so they can be monitoring you more closely but beyond that I find

most people do really well I think the other caveat I would add is you know if you are if you went through just went through a divorce you just went through you know a contentious move you had some major stressor in your life intermittent fasting is a is a form of hermesis a beneficial stress in the right amount at the right time time don't add gasoline

to the fire if you're not sleeping your stress is out of control you're over exercising and under eating that could be problematic so I would say that's the other cohort but I do find that most individuals actually do really well as long as they are aware of the things that we just referred to but also the fact that if you're a woman under the age of

35 you probably don't need to be fasting with the same intensity and regularity than a menopausal woman can get away with because you still have a menstrual cycle um especially if you're lean and certainly if you are an athlete I get a lot of questions from women that are you know they want a body build or they are you know student athletes and I'm like I

have to tell you I think it's it's not helpful to restrict your macro intake at that point in time but certainly doesn't mean that at a later point in time that might not be a beneficial thing for you to do so yeah looking at women in different stages of life is also important I think that's important to mention because I think you know for women and

things changed throughout their life and and you know if you're menstruating it's probably a good idea if you have different hormonal issues but it can be also helpful too right if you're sort of an overweight premenopausal woman with fibroids or severe estrogen next test I mean maybe this is a therapy that can actually help reduce some of that yeah and I've definitely had some patients with

PCOS so polycystic ovarian syndrome that have done really well because at the basis of PCOS as an example is this insulin resistance inflammatory oxidative stress component and so eating less often for them can oftentimes help them kind of reverse the degree of insulin resistance they're experiencing so I think it's always in the context of who is the individual what life stage are they in what other

stressors are going on in their lives hmm now now you had your own personal experience with this right you you actually had an autoimmune disease um and you use fasting as part of the approach including eliminating gluten can you talk about what that was like and what you did and you know what you learned from it yeah so I'm sure most of your listeners know that

if you have one autoimmune condition you're more prone to others and so by the time I was 40 um I had two autoimmune conditions and just on a whim I decided to go gluten-free and what was amazing was that my dermatologist kept saying what are you doing differently and so my psoriasis has never come back I had pretty mild psoriasis but I still had it nonetheless

after being traded for Lyme and then with the intermittent fasting piece allowing my Hashimoto's although I had negative antibodies allowing my Hashimoto's to go into remission and to you know I have very very stable thyroid function with the gluten-free diet and also adding in the intermittent fasting I don't over fast because I think that's important to kind of identify but for me I felt better almost

instantaneously even better than I did when I started thyroid replacement therapy with the intermittent fasting so I think it's a powerful statement because there's so much misinformation like oh if you have a thyroid condition then you know you can't you can't tolerate intermittent fasting I think it actually helps improve mitochondrial function if you're doing it properly interesting um so so mostly I most people think if

your thyroid's not working it may not be a great idea because your metabolism is already slow and you shouldn't probably do it but you're saying with an autoimmune condition like Hashimoto's you can actually see changes and then your did your autoimmune condition get better did the antibodies go away or what happened yeah I mean I haven't had um positive antibodies and at least initially my functional

medicine provider thought maybe I didn't have Hashimoto's but we've come to learn that that's not the case with that being said I have very very stable numbers and um I I have to believe because I'm very conscientious about the lifestyle piece and this is where it's important for people to understand like I sleep well I manage my stress I don't over exercise I make sure I

get enough food in during the day as you mentioned more often than not patients that have hypothyroidism if they've got to slowed metabolism they're gaining weight they just keep thinking less is more less food is going to be better more fasting is better and having to kind of find that reframe to help them understand that actually eating less food and over fasting is going to exacerbate

what's what's going on with their body so funding of very happy medium and I always say the power of the end of one but I have lots of patients that have found the same thing that their thyroid function has actually gotten better making sure they're they're understanding how to properly fast or not absolutely interesting so in terms of muscle let's talk about muscle for a minute

because as we get older we need to be more diligent about protecting maintaining building increasing muscle mass and function and fasting and you know can actually cause you to lose muscle potentially so how do you navigate and thread that needle between the benefits of fasting and the need for building muscle because a lot you know a lot of people specifically in the in the field of

longevity are talking about how we really need to do everything we can to mimic fasting and to reduce our stimulation of mtor and we should all be vegan what should you know so but then you can't build muscle so it's really it's really an interesting conversation I'd love to know your perspective on it yeah and I I actually get this question often as I'm sure you

probably do as well I think it really comes down to understanding the role of sarcopenia which is this muscle loss with aging and after the age of 40 most of us are it's this kind of accelerated muscle aging and understanding that um and I love this analogy that I use if you want to think about young muscle it looks like a filet flies are delicious and

wonderful right yeah exactly and then as we're getting older our we're starting to replace muscle tissue with adipose tissue and that's like a rib eye which is equally delicious but we don't want to become the rib eye so helping individuals understand that there has to be adequate muscle protein synthesis so you need enough stimulus on the muscle so strength training is important um understanding that you

eating enough protein and I'm going to go out on a limb and say that you know for me personally this is the end of one I find that animal-based protein I do much better having animal-based protein in my diet getting at least 40 to 50 grams of protein with each one of my meals combined with you know good quality sleep and not over fasting so how

even as a menopausal female I'm 51 um and for me it's very very important um I would say the other piece of that and this is very much um personal preference uh you know how you and whatever relationship you have with your GYN or your functional medicine provider are you using hormone replacement therapy because you know about 75 percent of women are going to have much

lower levels of testosterone in uh perimenopause and menopause and I'm definitely one of them and so I do believe that hormone replacement therapy testosterone and estrogen and progesterone can be very beneficial for helping me to continue to build and create more muscle so again that's a very much a personal preference and I'm happy to talk more about that but I do think for me personally muscle

is what I equate with having this organ of continued longevity you know maintaining insulin sensitivity metabolic flexibility I feel fervently that muscle is very important so this is why I don't over fast this is why I'm conscientious about not doing a lot of long fasts but I am metabolically flexible if I were not I would have to kind of rethink that strategy mm-hmm interesting so we

talked a little bit you mentioned bioidentical hormone therapy and and I like to talk about that and it's a little bit different than the fasting conversation but it's related because you know what happens to women after menopause is often their metabolism slows down they get that belly fat they feel like this is just inevitable and I hear this over and over from women and I know

it's not inevitable I know it's not something people have to expect as normal but it is it is very common and the question is you know what's causing that and how do they combat that because one of the biggest questions I get all the time for my patients who are menopausal women and and and two um what role does hormone therapy play in managing all that

yeah that's a great question I think there are many things that contribute I know that women are less stress resilient we go through adrenal pause not just menopause we go through adrenal pause and as our ovaries even in menopause we still have some ovarian function left it's just greatly diminished as our ovaries are producing less progesterone our adrenal glands are helping to produce some progesterone and

our adrenal glands are designed to be this emergency backup system so if you're chronically stressed not sleeping cortisol levels are high we have 40 times more cortisol receptors on our abdomens so women describe this cortisol belly that's a source of frustration so I think about that I think about if cortisol is up you know chronically we've got high insulin we've got high blood sugar blood sugar

goes up and then insulin is secreted to help bring it down I think about the changes just with testosterone that we know that I fervently believe that that is probably one of the largest contributors to changes in body composition for women and endless source of frustration so I think testosterone absolutely contributes we know that estrogen is this anabolic hormone and so if you're losing estrogen and

so it's interesting and perimenopause if you look at the research we have some of the highest amounts of estrogen in our bodies during perimenopause because our brain is desperately trying to send this SOS to the ovaries and pumping out so sometimes you have very high levels of estrogen and then you sometimes have lower levels but as women are at the tail end of perimenopause into menopause

losing estrogen is also contributing to some of these body habitus changes as well as changes in insulin sensitivity so you can be doing all the right things you know exercise eating right sleeping and end up having some metabolic changes so from my perspective I think there's multiple things that come together and also you know just the amount of hypothyroidism or thyroid disease that we see in

women that's one in five women who most many are undiagnosed yep it also really contributes to so I think it's multifactorial which is the fancy way of saying it's multiple reasons why this happens I think the degree of changes in sleep architecture also contribute we know if you sleep less than six hours a night you know you're less likely to be able to have properly managed

leptin and ghrelin levels these appetites the Tidy hormones blood sugar regulation and how many women I speak to they fall asleep they can't stay asleep they toss and turn for hours they're having hot flashes and so I think there's a lot that contributes along with the you know women treat their bodies like they did in their 20s and 30s and I always say jokingly everything changes

and not in a bad way we have to do the right types of exercise we have to change the way we're eating um I know we're both huge proponents of anti-inflammatory diets and nutrition and then managing stress it's not five minutes of meditation once a day but I think all of those things can absolutely impact and I'm starting to read more and understand more about the

research surrounding adverse childhood events and how the impact of trauma can impact women's weight loss resistance later in life their risk for autoimmune conditions and so I think there's a lot of different things at play at this stage of a woman's life that can really impact um their frustration with the way their bodies are changing yeah I haven't talked about you know the four hormonal changes

that happen around perimenopause and Men pause at heart hugely impactful for Women's Health and Metabolism more in some resistance more stress because they're in the sandwich generation between their kids and their parents who they have to manage and their careers thyroid dysfunction and sex hormone changes so you've got those four interacting hormonal systems that are all kind of going a little bit off center and that's

what drives so much of the symptoms and dysfunction and they're all treatable they're all fixable a lot of it's through through dietary and lifestyle practices sometimes for moral therapy but it's super important so when I want to talk about next is is some of the things you use sort of help with with uh muscle and sensitive accelerate some of the benefits of fasting did you talk

about creatine and myoinositol can we kind of dive into what is the use of these compounds what are they what's creatine what does it do and um why supplementing it was so beneficial who should be taking it and why yeah go to myoinositol yeah yeah um so creatine monohydrate is probably one of the most well-researched supplements or ergogenic Aids on the market I think unfortunately you

know 20 plus years ago it really got a bad route because the bodybuilders are using that in conjunction with a lot of anabolic steroids at very high doses um what it is is it's actually something that we have intracellularly so inside our cells creatine monohydrate interestingly enough women make 70 to 80 percent less than men so I like to say like we are already added disadvantage

manage that we make less of it and that's why supplementation can be so beneficial I think about it in terms of muscle protein synthesis but I also think about cognition and brain health and sleep support and a lot of what I find are huge pain points for women especially at middle age is they struggle to build muscle and maintain muscle and they struggle to sleep and

creatine you know to me has been a game changer I have 70 year old patients that are using it and they're on leg press machines I myself have been using it for the past year and from my perspective it has helped the Sleep architecture and also helped me continue to build and maintain lean muscle but helping people understand that if you look at the research we

have different creatine needs throughout our menstrual cycle which I find fascinating interesting and then helping women understand that we just make less of it like men actually have much more of it in their muscle muscles and their muscle cells but we actually need we can't get enough just from eating meat I would love to be able to say yes you can get everything that you need

in terms of dietary um needs just from from meat but it doesn't work that easily so supplementation can be hugely helpful for muscle and cognition and and these are things that consistently women are concerned about at this stage of life that they feel like they have to work so much harder they're just not seeing the same gains that they want to see in the gym or

their Sleep Quality is eroded um you know for me it has really been a very humble experience to understand and to look at creatine very differently than I used to because I used to think about it as a gym exactly exactly Jim bricks the muscle heads and the gym muscle heads in the gym all pounding on the creatine to build muscle the woman talking about it

as a therapy for both sleep and and and maintaining and building muscle throughout your life so um you know how does it exactly work for building muscle and how does it work for sleep and when I kind of started diving into this because initially I wasn't I was kind of skeptical like I am about a lot of things um we know that we have creatine monohi

we have creatine actually in our muscle cells and so it's helping to repeat those muscle cells which actually will then contribute to um you know being able to build more myocytes and you know get to a point where you're able to um help with strength and duration of mechanism of action when we think about the brain piece it helps with sleep onset um it helps with

that sleep architecture so I think for a lot of not I think I know for many women one of the big pain points is deep sleep you know having that kind of restorative sleep that when the lymphatic system is up regulated when this waste and recycling process goes on in the brain we're getting rid of um you know plaques and proteins that have the potential to

go on again potential to go on to um you know impact neurocognitive function but understanding that creatine can be very beneficial with promoting deep sleep which can help with this upregular nation of the glymphatic system and this waste and recycling process in the brain I'm surprised to hear you know I'm trying to think about as a doctor what the mechanism of action is for creatine sleep

I understand what is for muscle how does how do we know how it works for sleep it's interesting so um initially when I started looking at this I thought okay it's just about muscle and then when I started looking at the sleep and I'm happy to share some of the studies that um I I have kind of cataloged to support it for sleep but my understanding

is that it's it's helping with that deep sleep that restorative sleep helping um with the the waste and recycling process that goes on in this lymphatic system and and like I said I'm happy to to pass along the the research that I've looked at which you might find interesting because I I was surprised I kind of stumbled upon that as a secondary kind of indication we'll

share that in our in our show notes but it's it's interesting that you know mitochondria is really the key to all this and creatine is a key mitochondrial compound that helps with energy production so I think that probably is explaining why is through the mechanism of action of mitochondria which we often have less of than we need they're often not functioning as well as we need

and they're often and poisoned by our environmental toxins by Sugar by an overload of calories by our changes in our microbiome by anything that cause inflammation so they're kind of under constant assault by our modern lifestyle and we can do a lot about keeping your mitochondria healthy and a lot of the Aging research is really ultimately comes down to mitochondrial function that's how a lot of

these four longevity switches that we talked about earlier are sirtuins ampk insulin signaling in into our work working partly by actually helping to recycle low mitochondria to build new ones to improve their function so there's a lot of interesting science around the mitochondria and as a common thread for all of this it's really pretty cool I I think you also talk about myoinositol so tell us

about what that is and and what are the benefits and who should take it and by the way it's creatine before we drop off a creatine what's the dose it should be 5 grams 10 20 grams what do you recommend for the average person or is it yeah so if I'm say three grams a day unless you are a vegetarian or vegan so we know that

vegetarians and vegans actually need more because they're not consuming this animal-based protein men and vegetarians and vegans should be five grams a day and that's based on the best study of research that I've been able to look at when you mention the 10 20 Brands there used to be loading doses you don't need to actually do that we do know that there's benefits from consuming it

every day taking the the creatine every day in terms of the you know the muscle and brain health benefits even if you're not actually even if you're not exercising correct correct it's like five grams a day yep so five grams for men vegetarians and vegans three grams for women in terms of myoinositol I think before before you jump onto that a lot of people think about

loading notes of creatine like 20 milligrams for five days 10 grams after exercise is there a benefit to more um based on my research that the loading doses weren't necessarily necessary and if people understand that creatine monohydrate is going to hydrate the muscles this is where people will get flamoxed over oh my gosh I stepped on the scale and I gained some water weight and I

don't know what happened and I just explained that if you start doing loading doses you may in fact gain some water weight which will be you know improved upon when you get to kind of the standard dosing uh pattern and I don't think that there's any clinical benefit from doing loading dosing I think based on everything that I looked at and other experts that I spoke

to in that field they fervently believed as did I based on the current research that three to five grams is really a good standard dose for most individuals mm-hmm that's good okay so you don't need to go up higher than that even even when you're working out and training you shouldn't go to 10 or 15 or 20. not based on not based on my uh my

research that I did and then when we talk about myoinositol um this is another one of these kind of interesting fell off my radar supplements I think a lot of us are familiarized with research related to polycystic ovarian syndrome um this is actually a secondary message messenger for hormone signaling um it's actually part of the cellular membrane and it was interesting when I first started doing

research it used to be called B8 you know as an old name but it's actually a misnomer because you can actually you don't actually need to per se you can actually get some of it in your diet your body can make some of this myoinositol but it's very helpful for metabolic syndrome insulin sensitivity polycystic ovarian syndrome um you'll see quite a bit of research on infertility

I mean obviously that's not that's not my area of expertise but reproductive Health can be helpful and that kind of ties into this insulin piece with you know polycystic ovarian syndrome as well has some neurologic benefits I personally started taking it Guinea pigging well over a year ago and it's very helpful for Sleep architecture goes back to inducing and maintaining sleep so if you get up

in the middle of the night it's very helpful to kind of quiet the autonomic nervous system fall back to sleep which is a huge pain point for a lot of middle-aged women they their Sleep Quality kind of erodes especially with the waking up between 1 to 4 a.m um as being something that is very very common we can get some from our diet but it goes

back to you know the things that you can get in the diet we start to think about beans nuts and Grains I know not everyone is consuming those things in their diets but I have found that for a lot of people myself included that this is a particularly helpful adjunct to other you know lifestyle mechanisms that you're doing to support sleep I've had really great success

with a lot of women that have PCOS even the thin type PCOS so people that are about 25 percent of women with PCOS are thin and they oftentimes get lost in the medical system because people assume there's no way that you're insulin resistant and they can actually be insulin resistant um kind of standard dosing is to start with one gram a day and then people can

work their way up um I'm not a clinical psychologist or a psychiatrist but I do have colleagues that use this with great um success in their patients that have mood disorders and even obsessive-compulsive disorders so there's good research to show that it has some mental health benefits but that is not my area of expertise and so I always leave it to the experts to touch on

that yeah it's interesting because it does it does it does affect uh you know serotonin production infects dopamine improves blood sugar control and house fertility in women with PCOS and can help depression and and um it's pretty safe and effective so the interesting thing about the inositol is there's different forms so myoinositol is the one you're talking about the studies I've seen on PCOS and insulin

resistance are more on decairo and acetol can you talk about the difference and do you need to take the Cairo it's harder to get than my own house at all yeah it's interesting because I looked at decairo because initially I wanted to understand and why some are used over others I do have GYN colleagues that will use a combination of both with their PCOS patients in

terms of like broad reach when I looked at the research on myoinositol this is the one that is most abundant in like brain and nerve tissue and most impactful for serotonin and dopamine pathways the research I read was that myoinositol was the one that would be most beneficial for Sleep support and so I didn't I do think you can use a combination but what was interesting

for me was that I wanted to simplify things and I wanted to use the version of inositol that would be most efficacious and everything that I was reading was suggesting that myoinositol was going to be more efficacious and more advantageous for a broader variety of conditions or concerns it seems like for things like mental disorders you might need more alike up to 12 grams a day

or PCOS are many two grams or yep um so yeah so starting is usually one gram and then um I actually have an expert coming on to talk about the the mood depression anxiety OCD next month when you're looking at PCOS I've seen anywhere from two to two grams twice a day or two grams bid with individuals with like OCD and anxiety and depression and again

talk to your healthcare provider if you're on an antidepressant or have these these issues to get their input I've seen as much as five grams a day but really I think the starting dose is one gram and then kind of a titration based on symptoms we've already gotten some feedback that some individuals are having improvement with two grams a day both with mood and with sleep

well amazing it's amazing amazing stuff um and in terms of um other therapies around sleep you talk about the importance of sleep you talk about my own hospital for Sleep creatine for sleep sleep is really key for our overall health and well-being and a lot of our Sleep Quality is declined and we've talked about a bit uh a bit about this on the podcast but we

we have less deep sleep less REM sleep more disruptive sleep how do we fix our sleep how do we get to deeper sleep and improve deep sleep because that seems to be the most restorative sleep and actually what are the techniques we can use to help sort that out yeah one of my favorite questions so I tell patients that when you wake up in the morning

that's when I want you to think about sleep I want you to get light exposure on your retinas within you know within the first hour of sleep so 10 or 15 minutes of getting outside whether you walk your dogs have a cup of coffee a cup of tea that's very important to help suppress melatonin and increase cortisol to tell your body it's time to get moving

I think really simple things can be helped helpful are you hydrated are you physically active and it doesn't mean that you have to do CrossFit it just means being Physically Active throughout the day confers benefits I think managing your stress there's no one without stress but I always say you know you get a little bit of oxytocin release if you hug your pet or your significant

other or your family your loved ones your friends just getting in some oxytocin hits throughout the day I think it's also helpful to have a sleep strategy so just like when my kids were babies and toddlers there were things I did in the evening that were telling them that they were telling their bodies that it was time to go to sleep so you know wearing blue

blockers if you're going to be on your iPad or you're in front of your computer um you know not having bright light shining on your on your face after it starts getting dark I think um you know keeping the thermostat low you know in our house it's 65 degrees at night I wear a sleep mask that is probably one of the least expensive low-tech easy things

I've done for Sleep Quality I mean my husband laughs at me my whole family laughs at me but I'm like my sleep is golden and then thinking of things that you can wind down for some people they like to rub essential oils you know maybe lavender on their skin I like to get on my pmf mat and I don't fully understand the technology I know it

impacts the mitochondria but it's very relaxing um you know for me things that gear me down get you know kind of tap into that parasympathetic rest and Repose side of the body I think is very helpful and then you know thinking about magnesium like I will soak in magnesium whether it's Epsom salts I don't do this every night because I don't like to be like sounds

like my program for Sleep um that is really helpful and and if I can share with your listeners um probably one of my favorite ways to come kind of potentiate the um absorption of magnesium is to combine magnesium and borax and baking soda so I usually do a cup of magnesium Flakes a cup of baking soda and then I'll do a tablespoon or two of borax

and it borax is safe outside the body I think everyone always says the same thing oh my God I'm like no you're soaking you're soaking whether it's your feet or your body it really helps potentiate it this is coming back from my Cardiology days where we did a lot of electrolyte replacement and then I would say the other thing is just putting yourself to bed earlier

than you think you need to I it's not a super sexy strategy but more often than not I don't sit in bed and like read a book or get on my my iPad I will just go to sleep because very likely and I can track it on my aura my sleep latency isn't very long so even if I don't think I need to go to bed

I will put myself to bed by 9 30 or 10 and I just do really well with those strategies and those are all for the most part pretty low Tech but very very effective yeah very simple stuff and it's amazing how some of the simplest stuff can be the most effective and the most healing to our bodies and I think you know the strategy we talked

about ranging from intermittent fasting to sleep modification to balancing of hormones to using certain nutraceuticals can be extremely effective in helping us to sort of modulate our biology and I think I think your work is so important um are there any kind of like take-homes you know punch lines that you want to share with the audience about what actually can be the most effective in terms

of these strategies where do they start how do they begin yeah I think that's such an important question so tangible things that you can walk away with today number one stop snacking um I sometimes will walk through airports and I'm surprised at like six o'clock in the morning how many people have a bag of you know a thing a container Pringles out and I'm like oh

my goodness so stop snacking we don't need to snack and if you're putting your meals together properly you have enough protein of healthy fats you shouldn't be hungry in between meals in fact if you are it's a sign you didn't eat enough um find a way to get more physically active I don't care if you just walk every day um you don't even have to start

with strength training um find you know find a hobby find something that brings you Joy I think if the last three years have taught us nothing it's really important to understand that something small could be reading a book it could be getting on Audible and listening to a book it could be connecting with a loved one I mean find things that bring you Joy in your

life and definitely embrace them and I would say lastly don't be afraid to intermittent fast I think that you know eating less often doesn't have to be a practice that you do every day but I just find that for many of the patients and clients that I work with their health improves exponentially when they realize that they don't have to be Tethered to worrying about food

all the time you know that food Obsession that we've been kind of conditioned or we can't go more than two to three hours without eating that doesn't have to be your destiny and we can change things at any time so irrespective of what life stage you're in understanding that there are always things that you can do to improve your health if you loved that last video

you're going to love the next one check it out here your body has its own innate healing system which is way way more powerful than any drug ever invented and can reverse almost every disease if we know how to activate it