EFR 823: Biggest FASTING Mistakes, Balancing Testosterone and Estrogen, and Why Boosting Your SEX Life is Good For Your Overall Health with Cynthia Thurlow

00:00 - Chase (Host) The following is an Operation Podcast production. What do you think is the biggest problem facing our health today that is not talked about enough?

00:10 - Cynthia (Guest) Oh gosh, I mean, I think the big gorilla in the room is. I think it's. 70% of Americans are consuming ultra-processed foods every day.

00:17 - Chase (Host) Still.

00:18 - Cynthia (Guest) Yes, and even with that understanding, if you look at the research, that we are consuming an additional minimum 500 additional calories a day, if we are consuming ultra processed foods on the regular, segue and also add the other thing that I think contributes to a great deal of the disease that we're seeing is, as a culture we don't value the role of strength training enough, we don't value the role of maintaining and building muscle throughout our lifetime. I think back back like had I known at 20 that I was not, I was going to miss out on opportunities to build healthy bone and muscle. The first site in our bodies that become insulin resistant are our muscles. That is how important muscles are. It's not just about aesthetics.

01:00 - Chase (Host) What is overhyped in health right now?

01:03 - Cynthia (Guest) I think that there is a great deal of overemphasis on minutia.

01:10 - Chase (Host) How important is our sex health, as it relates to our overall health?

01:14 - Cynthia (Guest) I think that this is not addressed enough, so I'm glad that you're bringing it up in conversation. Sexual health is a litmus for many other things in our lives. Unfortunately, I think testosterone gets all the focus and I think estrogen plays just as much of a role. Condition sexual health is a litmus for many other things in our lives. Unfortunately, I think testosterone gets all the focus and I think estrogen plays just as much of a role. So younger women, sometimes getting testosterone replacement, they're like, oh, this is going to fix my libido. And then they're like, no, that did not fix my libido, it is not just in your head. I mean, if you don't have your hormones optimized, it is going to make the desire to have sex much more challenging and I can tell you after 25 years of working in medicine, we're not heading in the right direction. We truly aren't. Hi, I'm Cynthia Thurlow, I'm a nurse practitioner and welcome to Ever Forward Radio.

02:05 - Chase (Host) Hey friends, welcome back to Everford Radio. I'm Chase, your host, Army veteran, certified health coach and wellness entrepreneur. But more than that, I'm just a guy that is so damn curious about the human potential and everything that I try pretty much everything that I try to help me move forward in life, in my personal well-being, in my physical, mental, emotional, spiritual well-being are all the things that I bring to my social media but are especially what I search for when sitting down for guests on the show and today is a very special treat I am joined by renowned family nurse practitioner, Cynthia Thurlow. Not only do we share a lot of common friends, but actually neighbors. Oddly enough, she is now residing back in my hometown, my home state, Virginia, and who knows, maybe next time I'm visiting my mom I might see Cynthia out walking her dogs in the same neighborhood. But you are going to hear a lot of information today that is going to address key areas of hormone health, fasting, obesity, reproductive health, sexual health. I really kind of had a rapid fire, if you will, of a lot of the most curious questions to me right now for my own well-being, but things that I see out there in the real world, out there on social media things that I have questions about, that I question in terms of who is saying it and their efficacy, and Cynthia really brings a unique perspective today.

03:36 Intermittent fasting and nutrition expert and two-time TEDx speaker, she's here to help people find wellness through the healing power of nutrition and fasting. Now, today we don't really dive a lot into fasting or her fasting protocols. We touch on it here and there, but if you're tuning in looking for pure fasting information, I would encourage you to check out another one of her other amazing podcasts over on her show. I'll link for you down in the show notes, but she is also a frequent guest out on other podcasts talking just about that. Cynthia believes that it is possible to feel better tomorrow than you do today, and she and I want to equip you to experience that freedom from this conversation today. Some of the hard hitting questions that she answers are what do you think is the biggest problem facing our health today? That is not talked about enough? Is she more pro sauna or more pro ice bath, More pro meditation or more pro breath work? Hormone health that seems to be of big interest to a lot of people right now. What are the best ways for men to optimize their hormones. How can women optimize their hormones and stay tuned towards the end? Because she really peels back the curtain in a very professional way, but no holds barred way, talking about how important our sexual life is, our sexual health as it relates to our overall health.

04:51 All this and more is waiting for you today with Cynthia Thurlow. If you're new to the show, welcome. If you're, repeat, welcome back. Either way, it would mean the world to me if you would take two seconds right now on your podcast platform of choice and just smash that follow button Apple Podcasts, Spotify, no matter where you're tuning in here today, just following the show. It helps us in big, big ways and make sure you're never going to miss another amazing episode. It pushes us out to other like-minded people so that we all can help each other move forward in life and live a life ever forward. Thank you and welcome to the show, Virginia, in the house. For those of you that don't know, Cynthia actually came in from my sort of kind of hometown.

05:33 - Cynthia (Guest) Is it okay if?

05:34 - Chase (Host) I talk about it. I saw it in an email signature so I assume it's out there, but Richmond Virginia and I think you're like, not far from my mom and stepdad.

05:43 - Cynthia (Guest) I am probably five minutes away, the great state of Virginia, the great state VA.

05:48 - Chase (Host) I love all my VA people. For those in the audience who have never heard of you, this is their first time kind of learning about you and all the things we're going to get into. Can you give us a quick breakdown of your expertise professional background, medical background just to kind of set the stage of who is this lady and why is she talking about this stuff?

06:05 - Cynthia (Guest) Exactly. Well, I started as an ER nurse in inner city Baltimore I'm a bit of an adrenaline junkie and I transitioned from being an ER nurse to working in cardiology as an NP for 16 years, and over the course of those 16 years I absolutely love everything related to the heart. But I grew increasingly disillusioned with the traditional allopathic model, which was really just focused on addressing symptoms and really not looking a little deeper at the role of lifestyle. And around that same time, I had a child that had life-threatening food allergies and I read a book called the Unhealthy Truth, which I always credit for changing my life. You know, sometimes it's amazing how impactful a book can be, and so Robin O'Brien's book I read that it made me angry, realizing how our food has been so adulterated and is driving a lot of the food sensitivities, food allergies, that we're seeing in not just adult, not just in children, but also in adults.

07:07 And so in 2016, I woke up one morning and told my husband I could not, would not work another day in that model, and that I knew that I'd be successful. And that was as much of a business plan as I had was that I had this blind faith that I can make a larger impact by leaving traditional allopathic medicine, and in 2016, I took a leap of faith and started a business which initially, was really serving women in perimenopause and menopause. So, you know, every woman that's north of 35, early 40s, mid 40s is probably struggling with the same problems that I was having, and so I attracted a growing group of women that were in group programs and one-on-one work and, as an introvert, I decided I was going to do something big and scary, and so I decided to do a TED Talk. The TED Talk turned into two separate TED Talks, but one of which went viral talking about intermittent fasting, and so 15 million views, kind of viral everybody.

08:02 A real viral entity, and so that changed the trajectory of everything. All of a sudden, um you know, there were opportunities that were opened up to me and allowed me to um speak on a lot of different platforms and, you know, grow my podcast and write a book. And now I humbly sit back and say, eight years ago, when I made that prediction about being able to make a larger impact, that was a real thing, and so most people know me for intermittent fasting, but I would say the majority of people follow me for perimenopause, menopause and stuff related to the podcast.

08:40 - Chase (Host) But to ask you directly what was so compelling about health care in general that you decided to not only choose that as your career path, but keep that as your career path for so long.

08:50 - Cynthia (Guest) Yeah. So when I was an undergrad, I was actually pre-law, so my first undergraduate degree was in international studies. I was going to go to law school, applied to law school, got in and then decided not to do it. And around that same time I happened to get a dog. I'd always wanted a pet. My parents were divorced. It wasn't realistic, and getting that dog changed my life.

09:09 I realized that I was passionate, interested in medicine, and so I went from working a full-time job to taking pre-med classes at the same time, to then leaving to do full-time pre-med work and then trying to make a decision about did I want to go to med school? Did I want to think about going into nursing, which my knee-jerk reaction was absolutely not, because my family is full of nurses and I don't want to do what everyone else has done, and so I really think that I ended up exactly where I was supposed to be. I have a mom who had a very, very successful career and wasn't home much, and I knew that if I became a physician, I would probably end up creating a similar path.

09:48 - Chase (Host) She was a physician.

09:50 - Cynthia (Guest) No, she actually ended up being a CIO of some very, very large medical systems, but was very, very involved in the healthcare system in one way yeah.

10:00 In a different way. And so I was sitting in a pharmacology class and this professor looked at me and said what are you doing in here? You're, you know, a couple of years older than the undergrads. What are you doing? And so I told him he said you don't want to be a physician, you want to be a nurse practitioner. I was like no, no, I don't want to be an MP, I don't.

10:26 I was applying to post-bac pre-med programs along with post-bac nursing programs, and so around that time I was also very interested in HIV and AIDS. This was back when HIV was a death sentence and I was working at a clinic in Washington DC at the same time and I realized where are the two big centers in the United States for HIV Hopkins and UCSF and I'm very much an East Coast girl, so it was an easy decision. I went and visited Hopkins, I applied to a dual-degree program to get an undergrad and a graduate degree, and so off. I went to Baltimore, which at the time was not nearly as safer than it is now, and so I just got lit up. It was absolutely the right decision.

11:05 Intellectually, I was around the smartest people I'd ever met and was so challenged, and you know, for me, helping and serving others is really at the basis of everything that I do, and so even now, even though I'm not working in that same environment as I once was, I still continue to serve people and that's really like that's my mission. Like I tell people, not jokingly I was meant to be married to my husband and have my two boys, there's no question. But in terms of occupationally, what I'm doing now is the work that I was intended to do my entire life. It just took me a bit of time to figure it all out.

11:46 - Chase (Host) What was it specifically about a dog that made you want to shift into healthcare?

11:49 - Cynthia (Guest) I mean, it was such a crazy thing. I had always wanted a dog and I just realized how much I enjoyed caring for her, as trite as that sounds.

11:59 And really dogs are the best. They are free, which makes me sound a little crazy best they are, I agree, which makes me sound a little crazy, but getting her just really changed the way I looked at the world and affirmed for me that being in some degree of service to others. And someone would probably ask why didn't you become a vet? I'm allergic to cats like horrifically, horribly allergic to cats and so it was clear to me that I could handle taking care of dogs, but very likely would not have been a good small animal veterinary, their veterinarian and so for me, I sit in complete gratitude that specific people and specific things have come along in my path in life that have affirmed for me that I ended up exactly where I was supposed to be. And I think for so many people there's not enough stillness in their lives to acknowledge that when they have those moments.

12:46 And for me, I think 2019 for me changed everything, and I always say there was the before 2019 and then there was the post hospitalization, and for me, I'm not the same person, and so now I really take notice of how I feel the stillness. You know, even coming to LA to do podcasts, people say, oh, what are you going to do every night and I was like you don't understand, like I actually just enjoy not having so much on my plate. Like, do I feel like taking a walk? Do I want to order Uber Eats? You know what do I want to do?

13:18 - Chase (Host) Doing nothing out of your normal environment is like a vacation. It truly is.

13:23 - Cynthia (Guest) I told my husband, I'm going to read a book. I'm pretty excited, but no, I think it's so much of my life is forward facing that when I have the opportunity to be more introspective, to be quiet, that's what really recharges me ultimately. I'm with you Absolutely.

13:40 - Chase (Host) Okay, so now I want to just kind of dive into a lot of questions that I have seen on the interwebs a lot of trending topics in the health, fitness, wellness content space. So first up, what do you think is the biggest problem facing our health today that is not talked about enough.

14:00 - Cynthia (Guest) Oh gosh, I mean, I think the big gorilla in the room is people. Well, I think some of us are talking about nutrition, some of us are talking about these things, but I think it's the combined we use the term multifactorial in medicine the combined effects of a sedentary lifestyle, this overly stressed, overly fixated culture. We don't talk enough about the poor quality nutrition that most, if not all, of us are consuming. I mean, I think it's 70% of Americans are consuming ultra-processed foods every day. Still, yes, and even with that understanding, if you look at the research, that we are consuming an additional minimum 500 additional calories a day if we are consuming ultra-processed foods on the regular. So I think about those things, like it's very easy to say oh, it's. The problem is this. The problem is that you know we have an issue with toxins in our environment. Yes, we do Do. I think that's the primary driver of this poor health issue. I think it's these lifestyle mediated issues that we don't talk enough about. And I would probably segue and also add the other thing that I think contributes to a great deal of the disease that we're seeing is, as a culture, we don't value the role of strength training enough. We don't value the role of maintaining and building muscle throughout our lifetime. And I'll give you an example Many women and I say this without judgment because I was on oral contraceptives from, you know, probably my early 20s until I got married At the peak bone and muscle mass years.

15:28 For women, they're kept in such a low estrogen state they miss these opportunities to build their peak bone and muscle mass. How does this show up? It shows up with women that are developing osteopenia, which I would argue is actually not a real diagnosis, it's just one of these outlier ramifications when they're looking at DEXA scans and bone health. But why are we dealing with such metabolic health issues? And a great deal of it is because if women, as an example, are on oral contraceptives to prevent pregnancy which I mean, that's an important thing we can decide when we want to become parents, but at the expense of understanding that that form of contraception is one example is limiting our ability to build and maintain bone and muscle mass in our peak years. So they get into their 40s and they're already behind the curve. They're not as metabolically healthy. With less muscle mass, they're going to probably be at greater risk for developing bone issues later in life, and you know, I'm living proof of this because I think the first time I had a DEXA scan done, it was like at a a clinic example, I think it was the hospital I worked at.

16:37 They were like oh, let's check. You know, we'll check a DEXA scan, you're one of the providers to come over here. And they're like cynthia, you're like 32 years old and your bones are already osteopenic. At the time I didn't fully appreciate or understand what that meant, but they were like now you need to have serial dexa scans to monitor this. And the first thing I said to my gyn was why would an otherwise healthy 32 year old not have healthy bone density, like what would be? Because, cause, I'm not anorexic, I've done plenty of exercise. And the first thing she said to me was you've been on oral contraceptives for years, and so I starting to put those things together. So, getting back to your original question, I think there's many things that feed into this problem, but I think we don't talk enough and do enough. For the nutrition piece. Uh, I think a great deal about Dr Casey Means and Callie Means and how they're bringing greater awareness to what's going on.

17:30 - Chase (Host) Shout out Good Energy.

17:31 - Cynthia (Guest) Yes, great book how they're trying to bring greater awareness. But these are tough discussions. People don't want to change lifestyle. It's hard to do that, I get it. But if we're not willing to change lifestyle, we're not going to change the trajectory that we're headed in. And I can tell you, after 25 years of working in medicine, we're not heading in the right direction.

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19:32 If you'd like to learn more and even save a lot of money on top of an already great bundled deal, you can head to fatty15.com. Slash everforward. You're going to be able to use code everforward at checkout to save an additional 15% off of any bundled offer they got posted up there for you. That's F A, t, t Y one fivecom slash ever forward to learn more and to save an additional 15%, linked for you as always in the show notes today under episode resources, where we are now with access to information, access to providers, now, for a lot of different people, for a lot of different reasons, access still is limited, for whatever reason. But with social media, with the Internet, you still feel like health care, the health care industry as a whole, is not progressing in the right direction.

20:17 - Cynthia (Guest) No, I think we do. We do a good job with emergencies. We do a good job with urgent needs.

20:22 - Chase (Host) Acute care Correct.

20:24 - Cynthia (Guest) Obviously I benefited from that, you know, when I was so sick. But we don't do a good job with prevention. We continue to do a really crappy job with chronic disease prevention and management, and the reason why is you start looking at metabolic disease obesity, ascbd, so atherosclerotic cardiovascular disease, metabolic syndrome, pcos. You start to look at the rates and how they're escalating, not to just mention. I think it's even more important that we reflect on the fact that we have more children that are developing metabolic diseases that we saw in adults type two diabetes, non-alcoholic fatty liver disease. I mean, you're starting to see adult diseases in children that are a reflection of lifestyle mediated choices and kids aren't choosing these things for themselves.

21:10 - Chase (Host) Right.

21:10 - Cynthia (Guest) That's. That's why I think to me that is a poor prognostic indicator for our future. If our children aren't healthier than we are, what is that demonstrating?

21:21 - Chase (Host) And that's a really good point. That's a really good point.

21:23 - Cynthia (Guest) 's a really good point, yeah, and so I I think that those are the things that keep me up at night, drive me crazy, because I I've been able, I've been witnessed, I've been privileged to be able to see the the trajectory of what's gone on the last 25 years and I I listened to what my peers are telling me, my friends who are still in the trenches, still in the hospital, the things that they're seeing, and they would echo that, and so I think it's hopefully a wake-up call like that.

21:50 We know that these things are preventable if we're making the right steps towards changing diet, getting more sleep, managing our stress easier said than done but understanding that the long-term payoff is huge I mean it is enormous and because I was able to sit witness for all those years, especially in cardiology, because generally our patients didn't just have one problem, they had many problems, they were seeing many specialists and understanding that most of the dietary information I was giving out, especially as a new nurse practitioner, I don't agree with. I think that the whole information I was giving out, especially as a new nurse practitioner, I don't agree with. I think that the whole concept of fat bastardization thankfully that's starting to turn around but the glorification of processed carbs and telling people to eat seed oils and things like that. That's the kind of information that I think the average person, if they did nothing else, like they. Take one actionable step after listening to this podcast read food labels and avoid seed oils. If you did nothing else, that in and of itself, would make a huge net impact on your health.

22:55 - Chase (Host) I recently. By the time this airs, this episode will have aired Dr Kate Shanahan.

23:00 - Cynthia (Guest) I love Kate. I'm reading her book.

23:01 - Chase (Host) She just had her on I would just had her on comes out, I think like next week, and I was Kate I'm reading her book. She just had her on. It comes out, I think like next week, and I was blown Very, very passionate, very passionate but very well-researched and very well-informed, and I was blown.

23:12 - Cynthia (Guest) Well, and it's interesting that the last podcast that I did, the gentleman who was born outside the United States and one of the first questions he asked me was why are Americans so obese? And I said I think there's a lot of things that impact that. And I said, unfortunately we're now in this changing scope. What we see is and acknowledges normal is not normal anymore. And so, like as an example, my husband, my kids and I, we went to Portugal for spring break and if anyone that's listening has ever been to Portugal, I mean the people are amazing, the food's unbelievable. I mean you must go, it's incredible. And the one thing that every like consistently people would say why are Americans so obese?

23:59 - Chase (Host) Really yes.

24:01 - Cynthia (Guest) And they weren't asking to be rude. Right, it's obviously you and your family are not.

24:04 Right but why are Americans so obese? I said our food, our food. I said our food, our food. I think that is the primary driver of why we're seeing so much poor metabolic health and you know, couple that with a few other things that I've alluded to. But you know, when I think about what has changed so dramatically over the past 25 years rise of the processed food industry, because it's just continued to grow, seed oils are cheap I understand why, intellectually. I understand why they're they proliferate. But combine that with the perfect storm of, you know, social media. People are super sedentary, they're gaming all day long. They're less physically active. You know, just thinking about, you know, the sleep issues that people think it's normal, like I met someone recently who hasn't slept well in 10 years and I was like if I don't sleep well for two nights, it's a problem.

24:52 - Chase (Host) Oh, yeah, one night I'm diving deeper. What's going on here Exactly? I can't repeat this.

24:58 - Cynthia (Guest) No, no, and I have a puppy at home and I was telling my husband I can't wait to go to LA because it means I get to sleep. Three considered what is considered to be abnormal is now normal. So that's why I think it's people become outliers. The older you get, you'll see this Chase. The older you get people will be like you look so good for your age. Well, why are they saying that? They're saying that because the norm has become so abnormal that anyone who looks relatively healthy it's like oh well, that's unusual normal that anyone who looks relatively healthy it's like oh well, that's unusual.

25:36 - Chase (Host) To pick up on that point. I want to go back to what you're talking about with hormone therapy. What's the word I'm looking for?

25:40 - Cynthia (Guest) Excuse me, Hormone replacement therapy no no With.

25:43 - Chase (Host) Oh my gosh, chase, you're an idiot right now. Should I keep this in and let the people know how dumb I am Not dumb?

25:49 - Cynthia (Guest) We all have birth control.

25:50 - Chase (Host) Excuse me, yes keep this in and let the people know how dumb I am. Um, um, we all have birth control, excuse me. Yes, so in that same kind of light of this has become the new normal birth control. I'm, I'm I'm not a woman, I've never been through it. I don't know. My wife was on birth control.

26:02 I've been with other partners on birth control and I've seen a lot of different variances of types of birth control. Um, benefits to it for personal reasons, for actual, just birth control. Benefits to it for personal reasons, for actual, just birth control, but other hormonal balance and just lifestyle choice. And I've seen, you know, some really interesting side effects from that. And I do think please correct me if I'm wrong but I do think there is a new normal for a lot of women, if not most women, at a very young age to just start on birth control for those general purposes. But what you were talking about earlier of the real, specific female need for these unique hormones in certain levels, in those key muscle building years, why is that the new normal now? And what would you do differently if you were to say you're the chief education officer for all young women to go down this path or not go down this path. How would you kind of lay out these other benefits of not using birth control?

27:04 - Cynthia (Guest) Yeah, it's such a great question. I think what we're really speaking to is fully informed consent. I do not believe, nor am I accusing any of the GYNs over the years that prescribed me oral contraceptives, but I don't even think they thought about it. It was just. This is a solution to a problem. I have mild PCOS and so the solution to fix my wonky periods was to put me on the pill, not realizing you're not actually getting a menstrual, you're not actually even having. It's like breakthrough bleeding is what ends up happening. You're not really having a menstrual cycle.

27:36 But for a lot of women, they have the first 10 years. They're getting their menstrual cycles. They're abnormal, they're heavy, they have terrible cramps. It's a solution to a problem and so I get that and intellectually I understand that. But I think now that we know so much more and there's so many other options. But I go back to I'm the parent of all boys, but I think about if they were girls. I would want them to have reliable, easy to use contraception and allow them to have the decision making ability to decide when they want to become a parent. I think that is paramount. Like that supersedes anything I'm about to say.

28:10 - Chase (Host) Now, is that mostly because of what? What is blocked because of long-term birth control use in terms of the other muscle building and hormonal balance.

28:21 - Cynthia (Guest) Well, I think so. I think the biggest thing is understanding that most oral contraceptives when you take them, they're blocking communication between the brain and the ovaries. That's what prevents pregnancy. It's an untoward side effect. That probably isn't discussed often enough is that if you are kept and a lot of women just take the pill for two or three years, that's different. I was on the pill for a long time, like most of my girlfriends were, for the same reasons. Um, but it's understanding that the long-term sequelae of having low hormone levels because you're keeping estrogen low, you're keeping testosterone. The sad, cruel fact is your testosterone plummets so you have no sex drive.

28:56 - Chase (Host) Yeah, most women don't realize how vital healthy levels of testosterone is for them.

29:02 - Cynthia (Guest) So estrogen and testosterone are kept low and understanding, and you're also when you're taking oral contraceptives. They are synthetic contraceptives, they are not bioidentical. The other thing is we know and Dr Felice Gersh talks about this a lot, she's a GYN actually in Southern California she talks about their endocrine-disrupting chemicals. So no one says to patients oh, by the way, here's the side effects and it impacts the gut microbiome and we know so much about the gut microbiome now and how that is a it's like this massive domino effect. So to get back to your original question, I think if someone had sat down and explained that to me I would have been like no, my periods are wonky.

29:40 I mean, this is, you're emotionally immature as a teenager, young adult, and you're thinking like I just don't, I want to have reliable birth control or I want to get regular cycles, even though they're not a cycle. So I think it's a dual-edged sword. I think it's understanding that there were so few options at that time, but understanding young women now there are other options. I think that you know, obviously, if someone's in a monogamous relationship, that makes those decisions easier. What's also interesting if you look at the research on oral contraceptives is that it changes who you're attracted to what?

30:14 - Chase (Host) How?

30:15 - Cynthia (Guest) Because it's the pheromones are changed. So you know, pheromones are these natural chemicals that we make, and so I'm grateful, when I say this, that you know I met my husband when I was on the pill and went off the pill fairly quickly. We then got married and I'm still attracted to him. But, understand you attract different partners.

30:34 - Chase (Host) That immediately made me think. Is birth control ruining relationships, and people don't even realize it.

30:41 - Cynthia (Guest) I don't know.

30:42 - Chase (Host) That's a good question You're on birth control and you find this one person attractive, you get off and, for whatever reason you're not, yeah, or vice versa then you're not, yeah, and I don't know enough about.

30:54 - Cynthia (Guest) You know continued research in that area, but you start to understand synthetic hormones have lots of effects and you know. If you're taking the oral contraceptives for a specific purpose which, again, no judgment I was on them for a while but you think about the long-term effects, like I think back, like had I known at 20 that I was not, I was going to miss out on opportunities to build healthy bone and muscle because I've always been kind of a lean, thin person. It takes a lot of effort to build muscle. Some of that's genetics, I understand that, but I think about like I missed all those opportunities. No one counseled me on that.

31:26 - Chase (Host) How could you effectively inform somebody, a young woman, teens, early 20s, beginning to go down this path, who is not interested? Maybe they don't have a workout routine, they don't strength train, they don't yoga, they don't whatever. How could you convince them of like? This is actually some? This is an important factor to at least consider.

31:46 - Cynthia (Guest) Yeah Well, I think it goes back to the first site in our bodies that become insulin resistant are our muscles. That is how important muscles are. It's not just about aesthetics. I think many of us, myself included, used to believe it's an aesthetics thing. That's why we lift weights you know you want to look good in whatever you're wearing but understanding that it is metabolic currency.

32:07 So helping people understand like we have this metabolic health crisis we know 92 to 93% of us are not metabolically healthy. How do we starve that off? Maintain muscle it's that easy. And so, like even my teenagers understand this. Like you know, they're teenagers and so they like to be buff and muscular. But I'll say them, like, you are allowing yourself to be able to have a great more latitude with what you eat. You are. You know your basal metabolic rate is that much higher. It means you are that much healthier.

32:36 And so I think when you're communicating with a patient, or if I'm communicating to listeners, it's finding out what's important to them and then using that as an opportunity to talk about and reinforce why strength training is so important, why adequate protein intake is so important. I think, unfortunately, for so many people, they never have those conversations and I think, traditional allopathic medicine. Again not being critical of them, they're thinking safe, effective. No pregnancy periods get better, less complaints from patient done. I think about the three nieces that I have and all the other young women that I know and I feel strongly that these conversations have to be had so that their metabolic health is protected. I think that's so important.

33:23 - Chase (Host) Absolutely. I feel like maybe it's just my little corner of the world. I feel like, with all of the information and content and access to information about metabolic health, longevity, muscle being important for health purposes beyond just what you look like and how much weight you can move, I feel like we're kind of getting there. I don't know, but I feel like using that with other information as true sex ed, like beyond just your sexual health, contraception, all of that. Here are other factors to strongly consider that play a role into how you treat your body, how you, you know, navigate being with a partner. It's so much more than just that act Right. It's so much more Right.

34:03 - Cynthia (Guest) And I think it's interesting for me, like retrospectively, to look back over the course of you know all my close girlfriends, because we talk about these things now and I'm like all of us got started on the pill so young but, for good reasons. I mean, obviously my periods were totally wonky and I had other friends who had terribly painful periods, but then you stay on it because you're like it's convenient, I don't have to think about it.

34:25 - Chase (Host) Becomes. Habit becomes routine. It's just what you do.

34:34 - Cynthia (Guest) Correct and it was funny when I went off the pill when I got married I remember saying to my husband I don't have bad PMS. I had terrible PMS when I was on the pill and I said I actually didn't have bad PMS, it was the synthetic hormones like just that wash of you know the breakthrough bleeding that you would get in between different you know packs of pills, but I was like holy cow. I felt like a different person. Packs of pills, but I was like holy cow, I felt like a different person.

34:50 - Chase (Host) Let me ask you, then what is currently talked about more than you think needs to be? What is overhyped in health right now?

34:59 - Cynthia (Guest) Oh, let me think. What do I think is overhyped? I think that there is a great deal of overemphasis on minutia. I'm going to give you an example Focus on the macros. When I say the macros, think about the big things.

35:17 - Chase (Host) Not macronutrients. No, sorry, I want to clarify.

35:20 - Cynthia (Guest) Focus on the big things instead of the small things. So we have people who can't, who choose not to change their diet, choose not to exercise, don't prioritize their sleep, don't manage their stress and not to exercise, don't prioritize their sleep, don't manage their stress and they're focused on um infrared sauna, or they're focused on cryotherapy, or they're focused on cold plunges or they're focused on I love this.

35:42 - Chase (Host) I love, I love, I love this.

35:43 - Cynthia (Guest) They're focused on um things that I think of as more advanced strategies, like until you dial in on the big things, like don't worry about the small stuff.

35:51 - Chase (Host) They're focusing on optimization when their baseline is so far off center.

35:56 - Cynthia (Guest) Right, and, and I tell everyone, the first thing to focus in on is sleep. If I can't get you to sleep through the night, I can't fix anything else out and and and. What I find fascinating is I have this platform where people are communicating with me or my team every day and I can't tell you every day. In fact, we laugh about this. One of the most common questions is I can't sleep through the night, and I know you've said that I shouldn't fast if I can't sleep through the night, but and I always say like Answering their own questions, Right, it's like?

36:31 well then it tells you you shouldn't be fasting. But I remind them that it is so foundational to our health that, if you are choosing to go, you want to do your ayahuasca tour, you want to cold plunge, you want to do the cryotherapy Like they'll just, I want to do my IV drips. I'm like, yes, you're doing everything you can to deflect attention from the big things that will have the largest net impact on your health.

36:56 - Chase (Host) Because when I post me in the sauna or in the cold plunge or doing plant medicine it's better than here's me asleep, right.

37:02 - Cynthia (Guest) And that's why I find that fascinating and I think that well-meaning companies that are out there I mean I believe that they're well-meaning, they have all these gadgets and fun and I love gadgets. I do truly Like. I'm like. I'll talk about my Oura Ring. I'll talk about my watch. Yes, apple Watch, exactly, I love all the metrics, but everything else is so dialed in that it makes sense Like don't add in a gadget or do advanced biohacking strategies when you haven't done the basics. Like someone said to me, it's measuring in the minors.

37:33 - Chase (Host) Oh, yeah, absolutely.

37:34 - Cynthia (Guest) And so I can't remember who said that, but I want to give them credit. But it's so true that this is what we do as a culture, because the bright, shiny objects are far too fun. You know, like you said, it's not sexy to take a sleep mask photo or mouth tape on.

37:49 - Chase (Host) Who wants to watch a reel of sleep? I mean, I'm sure there's probably some people out there, right? But you know, when you scroll through social media, especially these days, at least in my feed, it's all of that. Yeah, it's all of that.

38:01 - Cynthia (Guest) Right, and I think the other thing is most of what I recommend, that are the big picture. Things probably don't cost anything, whereas all these minor things cost money, and when someone is trying to make these changes, I'm like I would rather you invest in better quality food. Honestly, I would rather you do that before you worry about you know, and I love Dave Asprey but, before you worry about, like Dave Asprey's like newest, hottest thing that he's talking about.

38:33 you know the acupressure mat that someone sleeps on. I'm like, well, that's great, but let's focus on these other things first, because they are going to not only from a longevity perspective they're going to have greater weight, but far more impactful than the little tweaks like oh, I want to burn more fat, so I'm just going to fast for five days. No, please sleep.

38:55 - Chase (Host) Let's pick up there a little bit more. Where do you think the general public can start for optimizing sleep and by optimizing sleep I mean getting quality, consistent sleep, before you get into tracking, hacking any of that stuff when can the general public start for better sleep?

39:15 - Cynthia (Guest) Oh well, you have to prioritize sleep. So that's number one, like really you have to prioritize going to bed earlier than you think you need. So I've had to train, I've not trained my husband, but I've had to convince my husband of the worthiness.

39:28 - Chase (Host) We need training. We need training. He's a night owl.

39:30 - Cynthia (Guest) So he'll stay up late like watching a hockey game, and I'm like you need to go to bed. So the first is the acknowledgement that you need more sleep than what you're getting. So that's number one. Number two is creating the perfect environment for you to sleep in. You know we were laughing about this before we started recording you. Actually, if you look at the research, 65 to 67 degrees is supposed to be optimal for sleep quality. So drop your thermostat, you know. Make sure it's dark. You actually have photoreceptors, not just with your eyes but on your skin, everywhere, and those light clocks they pay attention to that. They'll slow down the secretion of melatonin and that's very important.

40:08 I also think about getting off of electronics. It seems trite, but like how many people tell me oh, I take my laptop to bed. I'm like what? My laptop never comes to the second floor of my house, ever, ever, ever, ever for that purpose. They take their iPad to bed, they take their phone to bed there and I said get off Kindle, read a physical book, do something the hour or two before bed. So you are setting yourself up again. You notice none of these things cost anything, I think. The other thing that I consider is um, you know, some people do well with raising their core temperature before bed, like do like taking a brief hot shower. Some people do well with wearing socks before they go to bed, cause it just kind of primes their body for, you know, sleep induction, I don't like wearing socks to bed, so occasionally I'll take that shower.

40:52 - Chase (Host) I hate it. It's so weird.

40:54 - Cynthia (Guest) Yeah, my feet need to be free.

40:56 - Chase (Host) It's like I hate having my sheets tucked in too. I need to kick it off and I need to lose. I'm like that old Seinfeld episode. It's like one tuck, one, no tuck. One tuck, one, no tuck.

41:04 - Cynthia (Guest) Anytime my mother comes to visit, like hospital corners, I'm like you're killing me. I'm like trapped.

41:09 - Chase (Host) I had to do that in the army. Maybe that's why I'm so anti-tucked now. It's just like no drill sergeant. Yeah, it makes makes complete sense.

41:21 - Cynthia (Guest) But those are the things I think about not eating three hours before bedtime because we know that can be incredibly disruptive.

41:23 - Chase (Host) Why not eating three hours before bed?

41:25 - Cynthia (Guest) So again we have these. We have these circadian clocks throughout our body and many of them reside in the digestive system and so if you eat a large bolus of food right before bed, your body's like time out. I don't need to secrete melatonin, I've got to process this bolus of food. So it's going to increase cortisol, it's going to keep you up later and we know that.

41:45 The other thing about not eating so close to bedtime so it disrupts sleep, we know we're less insulin sensitive at night too, so maybe that's not an issue until you're closer to middle age, but I do know for most of my patients that are north of 35, 40, it becomes a larger issue. And so being conscientious about if you're eating not so close to bedtime, making sure you understand what should your your macro break up breakdown, be like to kind of optimize sleep. It's generally not eating like a big. I mean Ben Greenfield may disagree with me because we've had conversations about this Most people are not eating like a big bowl of pasta and going to bed Like that's not going to work out well for them.

42:22 You know, meal timing is certainly important. That's not the time to scroll your inbox at work and get stressed out. I mean, that's going to also, you know, dysregulate your melatonin and cortisol as well, and those are like the very basic things that I find we think about a lot and are very intuitive to us. But when I'm talking to patients they're like oh, cold bedroom. Oh, it's been hot in my bedroom. It's, you know, typical Virginia summers. It's like a sauna. Yeah, those kinds of things can be very impactful, cost nothing, and those are things I would suggest doing before you add supplements. Um, you know, certainly, uh, there's lots of other like tricks to the tray before you yeah, let's say they got the baseline stuff covered down.

43:04 - Chase (Host) Now we want to get into what is a supplement or two, what is a biohackack, what is a next level thing.

43:09 - Cynthia (Guest) I can do for sleep optimization um, I would say that I mean there's a couple things, I think, that, depending on what age you are, there are supplements that I've had really good success with that are inexpensive. Myo-inositol is one in particular that has completely changed my sleep quality and I I actually titrated up and down, which means some days I need more, some days I need less, and part of that's?

43:34 - Chase (Host) do you do that based on biofeedback, kind of like inventory of other things you've done, maybe like caffeine energy levels?

43:39 - Cynthia (Guest) Yes, absolutely, and I'm a fast metabolizer of caffeine so for me some days I'm like I've been traveling. I probably haven't been as dialed in with things. Maybe I need a little bit more. I think about things like L-theanine and GABA were like really easy and again I can titrate them up and down depending on what I feel like I need. I do that before I start getting more down into the weeds of supplements, like I have gotten so savvy with supplements that a lot of it's intuitive with certain patients, but so savvy I probably now am better with supplements than I ever have been, and so I think about adaptogenic herbs if that's appropriate If someone's dealing with a particularly stressful circumstance. Ashwagandha, ralora, rhodiola are all great for sleep, very supportive. They're very tonifying, so they're helping to buffer cortisol, which is certainly very impactful.

44:27 - Chase (Host) What's your thoughts on magnesium.

44:28 - Cynthia (Guest) I love magnesium. I was about to say magnesium, so there's different formulations of magnesium. And the joke is, with cardiology we did so much electrolyte repletion that I learned from the electrophysiologist, so the special cardiologist that dealt with arrhythmias, and so I learned all of their tricks and adopted them into my practice. And so magnesium two ways. I like magnesium transdermally, meaning I like it sprayed on the skin. I also like oral magnesium, and that is one of the best ways to buffer.

44:58 - Chase (Host) Is it just because of like absorption and bioavailability?

45:01 - Cynthia (Guest) And because how many people don't know that they're taking a poorly absorbable form of magnesium? I'll give you an example Magnesium oxide. You absorb about 10 11 percent of it. It's like a garbage.

45:12 - Chase (Host) We used to give it out in the hospital all the time is that because of the, the form of it, or do you and or? It's the combination with most people's like we're in a very poor gut health. Yeah, no, this is.

45:23 - Cynthia (Guest) This is purely based on that formulation. So if you have magnesium oxide at home, toss it in the garbage. Um, what I do like and I actually just interviewed someone on the podcast who said that and she's a physician all magnesium is absorbed across the blood-brain barrier, it's not just magnesium L3 and 8. So I want to just point that out Is that true.

45:40 That's what she told me. She said actually the people that did the research around magnesium L3 and 8, that got the patent, have been able to kind of extrapolate their study, which wasn't actually like a good study. I haven't looked at the study so I want to be really clear about that, but there's no reason for her to kind of identify that.

45:59 - Chase (Host) Yeah, I want to explore that a little bit more In my off time. But I've always heard it's mostly certain forms of magnesium in conjunction with other electrolytes. They kind of need like a transport to like to go there, especially potassium especially potassium, yeah, so definitely magnesium. Three and eight crosses on its own correct.

46:17 - Cynthia (Guest) So magnesium, l3 and eight um, and there's other. Like I'm not going to tell you, I'll tell you off air okay because I'm I've got something in the mix.

46:24 But magnesium l3 is great for sleep support because we know it crosses the blood-brain barrier. I have a lot of women who tend to be like constipation motivated, demotivated, unable to have a bowel movement every day, and so magnesium by glycinate or glycinate can be very effective for both sleep support and bowel tolerance. The wonderful thing about magnesium is that the worst thing that's going to happen if you take too much is you get loose stools, and that's what I used to tell my patients. We're like, we know you've taken too much if, but it's not something that's going to hurt you and it's self-limiting, it goes away. But I also think about when I'm working with women, helping them understand that if we really want to get your magnesium levels up, we're going to use transdermal magnesium Like Ancient Miner spray.

47:14 I have no, I've heard of the brand, not that particular product and they even have a sense that if you have sensitive skin, they even have a sense in skin formulation. But I usually do that in oral magnesium. I think it's very efficacious. It's very cost-effective. Um, that's usually like what I play with and then I'll go beyond that, like if someone. If we've looked at magnesium and we've looked at melatonin and their melatonin levels, we make less of it north of 40 and it's a master antioxidant. It's not just a hormone. I think a lot of people forget that this can be controversial Melatonin is an antioxidant.

47:39 One of the biggest ones.

47:40 - Chase (Host) I have not heard that.

47:40 - Cynthia (Guest) Yeah and so. So making sure we have adequate amounts of melatonin is super important and I think for a lot of people it's helping them understand we make less with age. I don't have any problems with any of my patients taking melatonin Um my regularly yeah, my 16 year old taking melatonin. I'm usually chasing him out of the pantry Cause I'm, like you make plenty Um. But helping people understand that melatonin can be helpful and then, especially for middle-aged women, the use of estrogen and progesterone can be life-changing.

48:11 - Chase (Host) I mean.

48:12 - Cynthia (Guest) I well, when I, when I take an intake form for a client, I can tell without before I even get to the page who's taking HRT and who is not, because there's no reason, kind of the hearkening. For women's fertility is ovarian aging and one of the first signs that we have less circulating progesterone that can show up as poor quality sleep, shows up as anxiety and depression, mood disorders. It's a pretty simple fix, right? I mean, your ovaries are making less of it. Our ovaries are as old as we are, versus men making sperm every like three days. Um, helping people understand that oral progesterone can be a total game changer for sleep and really starting at a low dose and kind of monitoring and then later maybe adding in some estrogen.

48:53 - Chase (Host) Does that mean it needs to be taken at night to support better sleep, or can you take it anytime?

48:58 - Cynthia (Guest) No, you would fall asleep. So I always say, take it when you're ready to get into bed, like it works so quickly. So micronized oral progesterone is super cheap, like super inexpensive. It will cost you like $5 a month.

49:11 - Chase (Host) That's how cheap it is and you just get it over the counter. No, no prescription.

49:15 - Cynthia (Guest) Okay, um, but there's also compounded options, and so I always like to point out if the cheap oral stuff that you can get at the pharmacy works great, don't even go to plan plan B. A lot of my women need a sustained and an immediate release, and so the compound it can be very, very helpful.

49:32 - Chase (Host) Okay. So if you've been listening to the show for any period of time, you've definitely heard me talk about one of my favorite partners, my favorite supplements, in fact. And if I could only choose one supplement, one capsule supplement, to take for the rest of my life, it would be today's sponsor, it would be Timeline Nutrition and their incredible product, mitopure. And it would be Timeline Nutrition and their incredible product, mito Pure. And I'm here to share some big news, because the Mito Pure that you love, that I love, for longevity, for energy, for enhanced muscle endurance, recovery, strength, is now in a new veggie capsule Clean label and NSF for sport certified. I love this product so much I wanted to really put it to the test and the beginning of 2024, I went off of it for an entire month and I'm not going to say that I felt like crap, but I will 100% stand by the fact that I noticed a significant decrease in my overall baseline energy. That told me that this stuff really works. I've been back on it now, absolutely love it. But don't take my word for it. They have so many human clinical trials proving this. We're seeing boost in energy strength. In fact, muscle strength increases by up to 12% after 16 weeks of taking it. Muscle endurance increases by up to 17% after eight weeks.

50:41 And the key ingredient here we're talking about in MitoPure is this metabolite compound called urolithin A, and this results from the transformation of a lot of different things going on in our gut bacteria, but most of us are not producing enough, or really adequate levels at all, of urolithin A due to a lot of other issues going on Poor nutrition, poor nutrient absorption, poor gut health. Urolithin A is the only known substance clinically proven to trigger a crucial recycling process within our cells called mitophagy. Urolithin A cannot be found in any food source. It can only be produced as a byproduct when gut bacteria digests specific ingredients such as pomegranates. Now, unless you're going to chow down all day, every day, on pomegranates, by all means go at it.

51:28 For me, I'm just going to take two small capsules of Mito Pure a day. And call it a day If you'd like to learn more and save some dollar dollar bills at the same time. And call it a day If you'd like to learn more and save some dollar dollar bills at the same time. Check the show notes under episode resources or head to timelinenutritioncom. Slash ever forward to learn more and make sure to use code ever forward to check out to save an additional 10%. You brought up HRT hormone replacement therapy and I know this is a big part of your work specifically with women over 40, the hormones could be the issue yeah, what's interesting is a lot of the hrt experts will say don't draw labs, it's.

52:03 - Cynthia (Guest) It's more about symptoms. I personally like to look at labs, but that's that's. I'm very quantitative, like. I'm like I like to look at things you know. Typically you want to look at a, an estrogen level, on day three of a cycle. You want to look at progesterone on day 19 through 20-ish 21. That may not be feasible for everyone, so I'll just disclose that up front. I do think doing labs is always helpful to look at other things. Common symptoms that we will see in early perimenopause sleep disruptions, mood disorders, heavier cycles.

52:36 - Chase (Host) Unexplicable right.

52:37 - Cynthia (Guest) Yeah, and for some women it's really. They feel badly the week before their menstrual cycle and that's when you know the five to seven days. Some of those women just need progesterone that week and it could be that easy. One day out of the week excuse me, one day of the month you take oral progesterone and you know you feel a whole lot better. But it becomes this relative estrogen dominance. So that means, as the ovaries are producing less progesterone, you get this relative imbalance between estrogen and progesterone and they're really designed to like a seesaw and so when that happens, you can start seeing breast tenderness, heavier cycles.

53:12 I used to call them crime scene periods. You can sometimes see oh, wow, yeah, I mean, yeah, it was not fun Crime, crime scene periods. You can sometimes see yeah, I mean it, yeah, it was not fun Crime scene periods. You might, you might be weight loss resistant. So this is when women like they feel bad, they're not sleeping, they're, you know. They get prescribed antidepressants, anti-anxiety agents. Um, they're put on the pill because that'll, that'll fix the problem. They're offered an IUD, uh, an ablation, sometimes a hysterectomy if things are really over the top. And the unfortunate thing is what women are not counseled on is that when you have a hysterectomy, even just a partial, meaning your ovaries are left it will hasten your menopause transition by about a year and a half.

53:49 Wow, and so that's significant, like if it were two months, I would say, eh, not a big deal, but women are not being properly counseled on these things and and I always like to say, I had all of the above and didn't know any better, and I think that's kind of what got me so interested, invested in, in helping educate women and men so that they know, you know, you're not losing your mind, um, you're not having a midlife crisis, that these things are real, but those are the most common things that we see. Obviously, some women start experiencing joint pain.

54:18 People end up with a frozen shoulder. Sometimes women will start having digestive issues. They develop food sensitivities, they're having a lot of bloating, just all sorts of unpleasant constellation of symptoms. Brain fog is another one which, if you've ever tried to recall something in your brain and it doesn't come very fast, that's not a fun feeling either.

54:38 - Chase (Host) And so I think that was me at the beginning of the podcast. Couldn't remember birth control, yeah.

54:43 - Cynthia (Guest) Yeah, well, you know, it's just one of those things. So I think that throughout a woman's lifetime there are missed opportunities for helping educate. So I'm sure, even though your lovely wife is in her early thirties Um, maybe because of the work that she does, she'll be thinking about those things. But most of us had no idea. No one ever had a conversation with us, so we had kind of had to figure it out ourselves.

55:06 - Chase (Host) What are the primary lifestyle changes, lifestyle recommendations you would give a female who is maybe experiencing some of these things you just talked about, before considering HRT?

55:17 - Cynthia (Guest) Yeah, I would say you've got to dial in on those things. Sleep You've got to try to sleep in a colder room. Try to wear a face mask. Try to make sure that you're disconnecting from electronics at night. Try to make sure you're not eating right before bed. Easier said than done. Try to manage your stress, especially if you're already dealing with less circulating progesterone. You're going to feel more anxious. You might feel more sad.

55:41 You have to really work at being de-stressed and this is where I said it does not mean five minutes of meditation once a week. It could be that you walk in nature in the morning. It could be that you ground your feet. It could be that, instead of doing CrossFit, you're now transitioning to do more yoga, and by that I mean not Ashtanga yoga, I mean yin yoga or flow.

55:59 - Chase (Host) A wind-down flow. Right, exactly, you know, like a slow flow, which is— Something that ends in a sound bath, too Right, exactly A little bonus, that would be great.

56:06 - Cynthia (Guest) And then, unfortunately, we have to talk about anti-inflammatory nutrition and people really don't like this. I always use the example of whole. 30 is a great thing to do for a month not forever, but pulling out the most inflammatory foods, so gluten grains, dairy soy, alcohol. Alcohol is a big problem for a lot of people.

56:25 - Chase (Host) Beyond the obvious of, you know, becoming an, you know an alcoholic, I guess you know why do you think alcohol is so problematic for most people?

56:33 - Cynthia (Guest) I think there's a huge mommy drinking culture that we don't talk enough about. I certainly experienced a lot of that in Northern Virginia, you know. No, I would go to these like mom things and it was like insane the amount of out, like I would literally say why aren't you drinking? I'm like cause I have to see patients in the morning and I have to like have my mental faculties like really sharp. Welcome to the South, yeah exactly, I mean you should see how it is with the South.

57:14 That anti-inflammatory nutrition piece and a lot of women drink alcohol before bed to wind down. I get it, but it disrupts your sleep and exacerbates your. It reduces your REM. It reduces your deep sleep. It was the only thing that provoked hot flashes in me ever, and so I just was like we don't drink alcohol anymore. That works for me.

57:34 - Chase (Host) I'm not suggesting that has to be the case for everyone else. Can they just go from you know lowering consumption? Can they go from same consumption to you know more time before they go to bed? You know what's the kind of titration down to that.

57:44 - Cynthia (Guest) I think it's get honest with yourself If you're drinking two bottles of wine in an evening, conscientious about consumption quantities, I think that can be very helpful.

57:54 Don't drink by itself, have a meal with it, so you're going to slow the absorption. Alcohol is processed like a toxin. I think it's just important, just to say without judgment, just being conscientious. Um, I think the other thing is that for a lot of individuals, like when you say go gluten and dairy free, people are like all my fun foods, like what are you talking about? No ice cream, no cheese. Dairy seems to be one of the biggest sticking points for a lot of middle-aged women, largely because I think there's a degree of addiction and when I use the term addiction it lights up our brain in very pleasurable areas, and so it can be very challenging for people to cut those things out. But it allows you to build awareness around what might be driving some of your symptoms.

58:37 - Chase (Host) Right.

58:37 - Cynthia (Guest) Yeah, but I do find gluten and dairy seem to be like big offenders for most individuals. And then, quite honestly, swap out the CrossFit. Stop doing all the CrossFit and the Orange Theory of Fitness five days a week and wondering why you're weight loss resistant. You need to start lifting some weights. Explain why.

58:52 Well, now, when you're in your twenties and thirties, I think you can get away with a whole lot of hormetic stress. So, talking about beneficial stress in the right amount at the right time, what I find for a lot of individuals is that as they're navigating their 40s into their 50s, or even late 30s into 40s, you know that load of cortisol I mean that is. You end up becoming in this catabolic state unless you are really managing the strenuous degree of activity that you are doing. Like I used to do CrossFit, like activities in my late 30s, early 40s, and I had to stop doing it because it would just burn my adrenals out. I didn't recover as easily.

59:29 I was finding that I was sore for a long time. I was finding that I was really struggling with sleep. Too much intensity for too long a duration of time. I'm not suggesting that listeners not do intense exercise. It's the period of time over time, and for a lot of people they're still working out like they did when they were 22. And our bodies change, and not in necessarily negative ways. It's just I work out smarter and so.

59:58 I think it's that, and I would also say, before you even consider HRT, think about eating less often, or compressing a feeding window or even 12 hours of digestive rest.

01:00:08 I think as a culture we have just been so indoctrinated into eating and snacking all day long and we just don't realize how detrimental that is to our metabolic health. And understanding what happens when we eat certain types of foods Like, as an example, fat is the most negligible effect on blood sugar, versus carbohydrates are going to have the largest impact on blood sugar. And so if you're sitting down and eating a big bowl of pasta with no protein, guess what's going to happen? That's going to happen very differently than if you sit down and have a steak with some broccoli with a little bit of butter. I mean, that's a very different blood sugar response. And so helping women understand what are the macros that are going to be most beneficial, putting them together properly and not eating too frequently Like I don't even. I don't even necessarily jump immediately to intermittent fasting for these individuals, but maybe 12 hours of digestive rest, that might be a lot for them to do.

01:00:59 - Chase (Host) Yeah, why this longer period of our bodies not needing to break down and metabolize and digest food? What benefit does that have?

01:01:07 - Cynthia (Guest) Yeah, Well, I mean from a very basic level. It's understanding that.

01:01:11 - Chase (Host) Yeah, let's pull out from, you know, late 30s, 40s women considering HRT. You know, let's say general population.

01:01:16 - Cynthia (Guest) Yeah, general population. So intermittent fasting is not appropriate for teens or individuals who are still growing. So sometimes, you know, you'll see 19, 20 year olds that are still getting taller, gaining muscle mass. So when we're looking at adults in general, men and women, helping them understand that when we are not eating, what is going on behind the scenes is very important. If 92% to 93% of us are not metabolically healthy, that means that our bodies cannot effectively utilize different types of fuel substrates. So our bodies can use stored glycogen, which is stored carbohydrate. They can use stored fatty acids. It's harder to get to the fatty. It's harder to get to the fat. It's very easy. I always liken it to my dad was one of these people that when he filled up his gas tank he would get to a quarter uh, like three quarters of a tank and he filled it up again and he was like that his whole life.

01:02:08 - Chase (Host) He believed that by full tank I get better gas mileage. Probably it was bizarre. I mean like the things you look at with your parents like I don't fully understand that you can't get below half a tank. You get worse gas mileage.

01:02:19 - Cynthia (Guest) No, no, I was always like I don't understand, I wait till I get to a quarter tank, so your car doesn't have a metabolism.

01:02:23 - Chase (Host) Correct it doesn't quite work that way.

01:02:24 - Cynthia (Guest) But it's helpful to provide that analogy, to say that that is how most of us eat. We eat reflexively, we get. We're not necessarily hungry. We eat breakfast. We have a snack in between breakfast and lunch. We have a snack in between lunch and dinner. We probably eat after dinner. We're eating all day long.

01:02:41 - Chase (Host) Because we're bored, correct?

01:02:43 - Cynthia (Guest) Bored and conditioned to eat at certain times.

01:02:58 Yeah, absolutely. And so the other piece of that is I also think about the fact that when you help people understand that all you're doing is siphoning off the top of the gas tank when you're eating so frequently, you're not allowing your body to burn off the stored carbohydrates and be able to get to a point where it's working to get the stored fat burned and this is very much an oversimplification of the whole process. But we want to be able to use both carbohydrates for fuel and fat. We want both. That's called metabolic efficiency.

01:03:16 - Chase (Host) Okay, adaptation, adaptation. I've heard, yeah, carbohydrates for fuel and fat.

01:03:18 - Cynthia (Guest) We want both. That's called metabolic efficiency. Okay, and so helping people understand that when you are going from a standard American diet and being a couch potato to intermittent fasting or 12 hours of digestive rest, you're helping your body along with that process and as you go to longer periods of not eating, you're allowing your body to go in and look for stored fuel, and that is an oversimplification, but that is how I generally like to explain what is going on behind the scenes.

01:03:44 - Chase (Host) We're becoming more efficient at utilizing the nutrients and energy we already have.

01:03:50 - Cynthia (Guest) Right, and that's a very important fact because that's how our bodies are designed to thrive. They're not designed to eat snacks and mini meals and eat all day long, and I think the last time I looked at some research it was saying the average American eats 10 to 12 times a day.

01:04:04 - Chase (Host) I might be close, I don't know. I maybe maybe like eight, like snacks here and there kind of thing, but but you're metabolically healthy. That and I've always been that way. So I feel like there's an an innateness in me, you might just be a snacker. My grandmother used to say growing up as a kid, she's like Chase, you have two hollow legs.

01:04:21 - Cynthia (Guest) I think I probably have heard similar things, like we talk about how our kids have two dinners, two lunches, like they just they're.

01:04:27 But I think it's there. They have a large amount of muscle mass, very likely like you do as well, and you know you just got kind of a fine-tuned metabolic engine, but most of us don't have that, and so intermittent fasting can be a way of tapping into those true intrinsic rhythms of the body. It also helps people understand that, as an example, we have something called the migrating motor complex in our gut and it's like the janitor. The janitor doesn't work effectively or efficiently if we are constantly eating because the janitor can't do his job and literally it's like a street sweeper. It's like pushing food forward bacteria, viruses, things that don't belong, and if that gets mucked up people are at greater risk for opportunistic infections. And so when I'm talking to patients I usually say you really need four to five hours between a meal. Like you, having a snack is different, like if someone's eating every two hours a big meal, I mean it is really not allowing their body to be.

01:05:23 - Chase (Host) So four to five hours between large meals is ideal.

01:05:26 - Cynthia (Guest) Yeah, that's ideal Cause that allows that migrating motor complex to do its job, like, for example, if you've ever heard of small intestinal bacterial overgrowth. In many ways, we think, yeah, sibo Not everyone's familiar with the acronym, that's why I was like I'm just going to say it.

01:05:40 - Chase (Host) We just had a reference episode masterclass in this with Rachel Shear recently. It was on the show Awesome.

01:05:45 - Cynthia (Guest) Yeah, but helping people understand that we think that one of the mechanisms that gets damaged with SIBO or SIFO is the migrating motor complex is not working optimally. So, just as kind of a nerdy side, kind of tangential conversation, helping people understand that when we're eating less frequently we have lowered inflammation. We are able to tap into this fat stores. If we fast long enough, we may actually diffuse ketones across the brain.

01:06:12 So beta hydroxy yeah beta hydroxybutyrate, and that's where people have a lot of mental clarity when they're fasted Like I'm like. This is great. Two podcasts today, no eating, very mentally clear, not looking for word finding.

01:06:25 - Chase (Host) Do you ever use exogenous ketones?

01:06:27 - Cynthia (Guest) I have. I don't think they taste good.

01:06:29 - Chase (Host) Oh no, they taste like crap, but I love the feeling I get.

01:06:32 - Cynthia (Guest) Yes, I've done them. Sometimes I went through a period of time where I did them around public speaking and then I got to the point where I was like, well, I don't know, I think I feel I feel the same if I.

01:06:42 - Chase (Host) I take them for the last two years before every podcast.

01:06:45 - Cynthia (Guest) Oh.

01:06:45 - Chase (Host) I've missed like two podcasts without them Interesting Ketone IQ. Ketone IQ. Yep, shout out.

01:06:50 - Cynthia (Guest) Yeah, yeah, I mean, I don't know, I guess it was one of those things. I thought I'm very much a taster, like a hyper taster. So, for me. I was just like.

01:06:59 - Chase (Host) I love to take it like a shot. I love bitter things, so I like it. Then you probably like vegetables too. I love root vegetables all day, all day long. That's awesome Love it.

01:07:08 - Cynthia (Guest) That's awesome. But you think about all the other benefits of intermittent fasting reduced inflammation, improved biophysical markers if you fast long enough. Autophagy, which is this waste and recycling process that goes on with disease, disordered organelles. So there's a lot of benefits that you can see with intermittent fasting beyond just the I want to lose weight. I want to get into longevity.

01:07:31 - Chase (Host) What is your approach to longevity? I've had some guests on the show talking about how there is no such thing as anti-aging. You can't do anything about it. You can kind of have this different approach to longevity. Basically, anti-aging and longevity are two totally different approaches. What is your when you think longevity? What does that mean to you? How do you approach it?

01:07:50 - Cynthia (Guest) Longevity means I'm going to optimize my life so I live a good, full life. I want to be mobile, I want to be intellectually, cerebrally astute, I want to be able to chase after my grandkids. So when I think about longevity, I'm thinking about fall prevention, I'm thinking about maintaining metabolic health, I'm thinking about maintaining cognitive health. I mean there are a variety of things that I think about especially now, at 52, that I might not have thought about 10, 15 years ago. I'm like I am pretty dialed in.

01:08:24 I don't love the term anti-aging, mostly because we are denigrating a natural process. Natural doesn't mean optimal. I will say that doesn't mean optimal. I will say that. But I do think that there's such a over-preoccupation with not aging. Aging is a privilege. That's honestly how I look at it right now. I want to see my kids grow up, I want to see my grandkids, I want to be able to continue living a full life.

01:08:58 I don't want to be focused on the negative, and so when I think about longevity, to me that means staying as sharp and vital as I am today, which is why I lift weights, which is why I do balance work, which is why I do flexibility work, which is why I eat the way I do, which is why I prioritize certain things in my life, not just physically, but emotionally and spiritually. I'm now in a point in my adult life that I really only want to be around like-minded people, and I don't mean that to sound like I don't entertain differing opinions. It's just. I look at it as I want to be around other self-evolved individuals. I don't want to be around people that aren't at the same kind of mindset and frequency that I'm at Like. I'm a big believer in energy work and consciousness.

01:09:43 Yes and so, um, for all those reasons, like when I hear longevity, I think a lot of people like protein restriction and upregulating mTOR and you know all these are, you know all these other like scientific principles. But when I think about longevity vis-a-vis as a human being those are the things I think about. I don't. I don't so much think like I need to eat less protein.

01:10:05 - Chase (Host) Sauna or ice bath. If you had to pick one.

01:10:09 - Cynthia (Guest) I prefer being warm, but I, I make myself do not as much cold plunges. Cryotherapy, okay, uh, because I I abhor being cold and that tells me when I. The things I avoid doing are things I need to do, and so so you do it more of kind of the mindset approach.

01:10:25 - Chase (Host) I really really don't like to do this. I'm going to force myself to do it. No, rather than you do it for more kind of a physiological reason well.

01:10:32 - Cynthia (Guest) So in there, remember, we talked like I the the role of horm beneficial stress in the right amount at this right time. I think for me I get enough hormetic effect from a cold shower or cryotherapy, whereas like a cold plunge for me I think would be like that hormetic bucket would get dumped and I know I have friends that love to like sit in that and I'm like there are other things I will do for hermesis that they probably wouldn't want to do, but for me I would do the cryotherapy because it's like taking that medicine. I know I need to do it. It's good for me Like I have a bunch of cryotherapy set up when I go back but I'm like, okay, this is what I need to do. It's almost like medicine because I it's easy for me to get in the infrared sauna.

01:11:16 - Chase (Host) What do you think about for the general public? If you were to say blanket statement, I think most people could benefit from either ice bath, cold shower, cold plunge, whatever or sauna.

01:11:27 - Cynthia (Guest) And why. I think it depends on the person to be honest with you.

01:11:29 - Chase (Host) I think that when I have Spoken like a true professional. Yeah, no, bio-individuality, it has to be it depends.

01:11:35 - Cynthia (Guest) No, no, it bio-individual. So if a woman comes to me and she's weight loss resistant, struggling, you know, if we know that she's got her detox pathways optimized, then I'm not as worried about infrared sauna. But I do like cryo for a little bit of that hormetic, like shock value, um, and also helping them understand that we can beige white fat to brown fat, like helping them understand, like what's going on physiologically below the surface. That could be a benefit versus if I have someone who is, who comes to me and says I went on HRT and I gained a bunch of weight.

01:12:05 I'm like, okay, well, very clearly, we need to support you know, there's some detoxification pathways and that's where I think, okay, maybe you're at a position where we can optimize doing infrared sauna. I do like both, so I would say that I do like patients doing a combination of, I think, sweating in general. So if you don't have the ability to get in a cryotherapy tank cold showers, if you don't have the ability to have an infrared sauna at your house I get that Then just make sure you're sweating. I mean that's very important. A lot of people will say to me I don't sweat a lot.

01:12:35 - Chase (Host) You brought up detoxification a few times in relation to, to heat, to sauna. Is that more of the angle you like with sauna?

01:12:42 - Cynthia (Guest) Yeah, I mean, I think sauna can be really relaxing for a lot of people. I think traditional Swedish saunas for a lot of people are just intense, and so when a woman tells me I don't sweat a lot, I'm like, oh, we got something we need to work on here.

01:12:57 - Chase (Host) So sweating is a good.

01:12:59 - Cynthia (Guest) Sweating is a beneficial thing. That's how we get, that's one of many ways that we get toxins out of our bodies and you know people will hear that and they're like, oh the boogeyman. About toxins we are exposed to on a daily basis. You know personal care products, environment and food. We are exposed all the time and from my perspective, I think that being proactive about supporting detoxification, we have phase one, phase two in our liver. Phase three is in our gut. I see a lot of women who don't have an optimized gut function and their estrobilum. They can't process and package up and get rid of excess estrogen. So it's not just estrogen that they are taking if it's hormone related or it could just be the estrogens in their environment and so it's again very bio-individual we get a lot from plastics right.

01:13:42 Microplastics tons yeah and and understanding that men and women yeah, and it's one of the main reasons why men have low t is, you know, exposure to toxins drastic decline in fertility rates it's terrifying. Yeah, are you familiar, dr shana swan in her book countdown.

01:13:57 - Chase (Host) That book blew the lid open for me in the world of. I was reading it just around fertility health, but when she dove into microplastics, they're everywhere. Holy shit, yeah, they're everywhere.

01:14:09 - Cynthia (Guest) And it's interesting to me because when I when I say the word toxins, a lot of people go. I don't want to hear that Just because you can't see it doesn't mean it's not problematic. Like, I think it was Fiji water. Just had some type of article came out. I didn't read the whole thing, but a friend passed it along to me and it was like don't drink Fiji water. And I was like why?

01:14:28 - Chase (Host) Get all the Fiji out of the studio, out of the fridge they were talking about the microplastics and like some type of fecal contaminant. No, yeah, honest to God.

01:14:35 - Cynthia (Guest) Yeah, honest to God, I'll have to pull it up on my phone.

01:14:37 - Chase (Host) Well, I'm so glad I literally just switched to this like super high quality water delivery system, and I used to get Fiji water bottles in the studio Not anymore.

01:14:46 - Cynthia (Guest) Well, my functional medicine doc was like you need the trace elements in that and I was like not anymore, not anymore, nope, yeah, I'll get them somewhere else, yeah.

01:14:54 - Chase (Host) Yeah, I'll just element, good old element, meditation or breath work, again, general public recommendation.

01:15:02 - Cynthia (Guest) Anything that's going to support the parasympathetic nervous system. So, autonomic nervous system, sympathetic, parasympathetic Most of us tend to be fight or flight fight, flight or flee and less about rest and repose, and so we're always again looking for balance. But I would say 95% of my patients tend to be sympathetic, dominant. So anything that is going to help get you into the parasympathetic rest and repose where your body feels safe, your body's relaxed Personal preference, I think for me personally, I'm much better about doing breath work because I can do it anywhere, anytime. Meditation I'm like a squirrel, like I get so distracted when I'm meditating I have to literally be in like a corner. Wow, because I just I'm very visual, I can get very visually stimulated and, yeah, I'm not as good with meditation. But I think it really comes down to like what appeals to you most. I can do breath work anywhere.

01:15:56 - Chase (Host) What can you consistently do?

01:15:57 - Cynthia (Guest) I can do breath work anywhere. What can you consistently do? Yes, absolutely. I think that's key, Because if I am sitting here saying I'm in the ivory tower and I'm going to tell everyone what they should be doing, well, that's not realistic. It's like what are you going to do consistently? That's really the question.

01:16:09 - Chase (Host) Across the board. Correct With everything.

01:16:11 - Cynthia (Guest) What can you do consistently?

01:16:13 - Chase (Host) So to piggyback off of what a lot of what we talked about earlier with hormone health, how important is our sex health as it relates to our overall health?

01:16:23 - Cynthia (Guest) I think that this is not addressed enough, so I'm glad that you're bringing it up in conversation. I think that sexual health is a litmus for many other things in our lives. I think that it's very easy, especially as someone who's married and has kids, to make for not connecting with your partner. It's like you love your partner, you're committed to your partner, you're not making time for your partner and so, um, like, as an example, we have like date, we used to do date days. Um, cause we were always like our kids were young, we had to have a sitter and like, why should we go out at night? Like we should have the sitter here when the kids are really active, so that the sitter gets tired out the sitter gets tired out.

01:17:02 So we used to do that quite frequently. But making time for your partner is one of the most important things you can do, like honoring your partner. And I'm not saying like every time has to be sexual intercourse, but having some degree of intimacy, like do you have real conversations? Are you really sharing? Are you exploring things that that fright really sharing? Are you exploring things that frighten you? Are you exploring things that don't make you feel good? Now, certainly I know throughout the trajectory of my marriage there were times like when you have newborns at home, when your kids are really little. You're just exhausted. You need to find other ways to connect and it doesn't again necessarily have to be sexual intercourse. But making time, you know, creating hobbies, things that you enjoy doing together. My husband and I love traveling. That's like our one of our big things that we love doing together. We've traveled all over the world. But, having said that, I think that a lack of physical activity is a litmus for other things going on, and sometimes it's not that you don't love your partner.

01:17:54 It could be like a lack of sexual physical activity can be sign sometimes, and certainly these are things that patients share with me. It's painful, you know. Maybe their partner's not particularly understanding, maybe they're feeling pressured, and so, ensuring that you're having a conversation with a healthcare provider, could there be something physiologically going on? Right, yeah, you know, hormones definitely drive a lot and unfortunately, I think testosterone gets all the focus, and I think testosterone gets all the focus and I think estrogen plays just as much of a role. So younger women sometimes getting testosterone replacement, they're like, oh, this is going to fix my libido, and then they're like, no, that did not fix my libido.

01:18:34 So I think it involves like testing, being honest with your partner and then making time for that connection, because it's very easy, very, very easy, for people to get disconnected and not talk about it, cause they're like I don't want to have that uncomfortable conversation, and then it just makes it worse and before you know it, you're not having sex at all, and then that it becomes this kind of like snowball going downhill, and so I think that half the battle is having the conversation, because once you've had the conversation, you're like, okay, this is the elephant in the room that we're not talking about, and then getting help if that's indeed needed. I think for a lot of women and this is important for listeners to understand that when women go into menopause, as an example, by the age of 60, it's some crazy number like 70% of women will have something called genitourinary symptoms of menopause, which is a really sexy way of saying they will have symptoms of pain you know, tearing discomfort with sexual intercourse, so that is normal related to that loss of estrogen.

01:19:31 - Chase (Host) Now is that a temporary thing. It's just to like a transition.

01:19:33 - Cynthia (Guest) It's completely reversible In fact we all talk about like every woman should be given vaginal estrogen, like probably TMI for your listeners.

01:19:40 - Chase (Host) But just kind of saying no.

01:19:41 - Cynthia (Guest) Thank you for sharing no no, but I think that if you aren't the person suffering from the problem, there's someone that probably is, but I think it's important to have the conversation.

01:19:48 - Chase (Host) And they're probably not talking about it.

01:19:50 - Cynthia (Guest) Right no-transcript. So it's one of those things that's like a dual-edged sword we're preventing a problem, we're also creating another one, so understanding that for a lot of women there are people who have. I have a college roommate who insisted that she had this genetically mediated issue with low libido. She's like Mom had low libido, I have low libido. Well, we found it had nothing to do with that. It was actually she wasn't with the right partner. Now she's remarried and she's very happy. She was like I thought all these years it was me.

01:20:31 - Chase (Host) Turns out it was this guy the whole time.

01:20:32 - Cynthia (Guest) Yeah exactly, and I was't said enough, so no one who listens will know, who I'm talking about. But, having said that, I think that sexual health is equivalent to mental health, is equivalent to other types of physical health, and we have to bring greater awareness to it, because I think a lot of people live in shame, they're embarrassed, they're uncomfortable, they don't want to talk about it, and it comes from both sides. But I think for a lot of women it's very easy to get in that cycle of not having sex at all.

01:20:59 - Chase (Host) On top of everything you just said which was very informative and I agree with everything. What could someone do in terms of their daily health to support higher sexual health, better sexual health? Is there maybe something you would recommend in terms of nutrition supplementation, maybe a different style of exercise. What can they be doing to support general physical health, that they could see a carryover into higher libido or maybe just more enjoyment out of the current sexual health, sexual activity they have?

01:21:33 - Cynthia (Guest) I would say number one get your sleep so that you know you feel like you are well rested to engage in whatever it is that you're interested in in doing in terms of like nutrition. I mean, if you look at the research, there are certain things that they say are aphrodisiacs. I don't, per se, necessarily think that's the case. I think that the best thing you can do to maintain sexual health and we know that, as an example, like erectile dysfunction is one of the first signs of insulin resistance, really yes, and so I was taught 20 years ago erectile dysfunction is a form of well, it means you probably have some nitric oxide production issues, but also can be a first sign of insulin resistance, because you think about blood flow, you think about sensitivity, all of which can play a role. So I always say, like erectile dysfunction is not benign and it should definitely be evaluated.

01:22:26 But when I think about the things that are the biggest needle movers, I think it's being comfortable with your partner. So, before I would even say like foods or exercise, I would be like find ways to connect with your partner, even if you're like, maybe, like you're trying to like, get your mojo back. Like, exercise together, make a date together, do things together, you know, do things that bring you both pleasure. It doesn't necessarily have to be sexual pleasure, but connect as human beings, even if you like just snuggle or you take a bath together. I mean, just do things where you feel connected, because oxytocin is like one of these.

01:22:58 It depends on proximity and closeness and touch Absolutely and so I think for so many people it's like, if you you know, it's like riding a bike. I'm like you have not forgotten how to ride the bike, you just need to get back on the bike. Right, exactly, you just need to get back close to the bike, like get back to you know snuggling and and maybe you know you hug or.

01:23:16 - Chase (Host) But so I think that give the bike a tune up.

01:23:25 - Cynthia (Guest) Maybe you, you give them pleasure and you kind of like get you know. Just remember, it's supposed to be given and received. But I think for a lot of people it's that they've got to get back in that space of being together and like finding things to do together. Um, in fact, my husband and I used to like we used to go like do dancing lessons and we would find things that just you learn together, you're having fun together, and I think that is very important, because I'm at the stage now where I have two teenagers One's leaving for college in August, the other will go in two years, and so I'm like I'm going to be half an empty nester and just that realization, like if you haven't fostered that relationship with your significant other, get ready, right, and so that's where you see a lot of people get divorced, a lot of divorce, yeah.

01:24:04 And I don't think it necessarily has to be the case for everyone. So just know that even if you've gotten off course, you can get back on and, as you appropriately stated, like oxytocin is a really powerful bonding hormone and helping people understand, like sometimes you just have to be in that orbit to confer. I mean, take a bath. You don't necessarily have to have sex, like take a bath, be close to one, another Touch, and doesn't necessarily have to be, you know, touching specific body parts. It can just be one of those discussions where you're talking about the thing like tell me the things you like, tell me the things you want.

01:24:38 - Chase (Host) Intimacy can start orally and not the way you think Correct, and I think that's for me.

01:24:44 - Cynthia (Guest) I tell my husband all the time, like when I'm feeling like I'm being heard, then I'm like, oh, okay, maybe, Like he says, you scratch my back.

01:24:53 - Chase (Host) I scratch yours, no, like literally scratch my back.

01:25:00 - Cynthia (Guest) Yeah, exactly, and it's like understanding that, all those things like being playful, like that's very important. And I certainly have seen over the past 20 years I've seen friends, marriages and things that have happened and I think the strongest people keep that communication Like that is the most important thing. When you stop communicating, that's a problem.

01:25:15 - Chase (Host) I'd like to go a little bit further as we kind of get towards the end in the sexual health world. If you would be comfortable talking about solo sexual health you mentioned earlier. Men create sperm every three days. No-transcript, just not a good thing, Like it's actually healthy to release within a certain time window. I'm curious is that true, and is the same window? Is there a window for women? You know, talking about self-pleasure?

01:25:50 - Cynthia (Guest) Yeah, I don't know the research on that. I would imagine that it's as varied as the individual. Like there might be men who have a high sex drive and want to feel like they masturbate in between having relations with their partner, and I'm like, hey, whatever works for you, that's great.

01:26:07 - Chase (Host) Is it healthy? Do you think at like a daily level, or is it again just so individual?

01:26:11 - Cynthia (Guest) I think it's probably so individual.

01:26:13 - Chase (Host) Is healthy, even the right word.

01:26:14 - Cynthia (Guest) Right. I mean, I think whatever is your normal is probably your normal. But I have enough friends who are urologists that over the years conversations that they've had around me, I've just kind of said I think it's very bio-individual. I hate to keep bringing it back to that, but I do think that there's a frequency like whatever the frequency is that that drives, drives you or makes you feel good. I think that's reasonable If it's disrupting your daily routine or you're getting obsessive about it.

01:26:39 - Chase (Host) Or maybe you're not having sex with your partner because of.

01:26:42 - Cynthia (Guest) Yeah, that's a problem. Or maybe you're not communicating with your partner and that's why you're not having sex, because you're getting whatever you know, whatever fetish you're having in your head. That's what you're thinking about. Maybe you need to be telling your partner. I do find that even with women, talking about masturbation is still kind of this like taboo subject that I ha. I definitely had girlfriends in college that would talk openly, but most of them were like, oh, I don't masturbate. I'm like really.

01:27:08 - Chase (Host) Like. How do you figure out what you like if you don't do that?

01:27:11 - Cynthia (Guest) So, so I think that, um, it's very bio-individual. I can tell you, I know many women now in middle age that are like oh, I don't have a libido anymore. I can tell you, I know many women now in middle age that are like oh, I don't have a libido anymore.

01:27:21 And then I have other friends who are like oh yeah, we're still having sex. And so I just kind of marvel at the range, yes, the frequency, the honesty about what they like, what they don't like. I think it comes down to are you happy in your partnership? If that's working for you, great. The other thing is I think that certain women, depending on where they are in the testosterone estrogen trajectory I know many women when they go on HRT, they're like oh, I have a libido again. This is great. So if you're not on HRT and you're in that age range, like, definitely have that conversation, because it is not just in your head. I mean, if you don't have your hormones optimized, it is going to make the desire to have sex much more challenging. And and jokingly my husband's always like anytime, anywhere, I'm ready to go. And so I think about how I think that's how most guys are. They're like I want to be with my partner, I love my partner. I'm usually just in the background going, I'm just waiting whenever you're ready?

01:28:15 - Chase (Host) Put me in coach Right, exactly.

01:28:17 - Cynthia (Guest) Exactly so. I think it really comes down to like communicate with your partner and make sure you're both on the same page. And you know, I think masturbation is, you know, whatever frequency people want it to be. I think that's such an individual. I mean, I'm still at the stage where, like, dogs and kids are always coming in. So I, you know, for me it's like one of those things, like it has to be a very thoughtful exercise because I'm so rarely by myself.

01:28:41 Just from that perspective and I think a lot of people that have kids at home probably feel the same way they're like you know you don't ever want to get caught.

01:28:46 - Chase (Host) That's why we knock Junior. We knock before entering.

01:28:49 - Cynthia (Guest) Oh, I can tell you a funny story, yeah.

01:29:01 - Chase (Host) So, having been a podcast all about so many health topics, I want to kind of poke at content like this a little bit. Haven't we said it all by now? Is there really anything new about the body and health and stats and attention to metabolic health and longevity and hormone health and all this stuff? Are we just going to keep spinning the wheel? Do we need another podcast about this? Do we need another clip about the top five reasons you know your hormones are out of balance.

01:29:26 - Cynthia (Guest) Why are we still here talking about this? No, I think that it has to. The trajectory of these conversations is that the more we talk about it, the more focus will come to it, and so my feeling is like, when I think about my podcast as an example, there's certain topics I've talked about 195 times, times a thousand, and I always say but they're always still relevant, because someone's always looking for a fresh perspective, Someone's always looking for something more nuanced, someone is there. It's like that endless quest. For you know, like I know, my opinions have evolved over time.

01:29:58 I'm sure yours have, I'm sure you know many of your listeners have, and so, from my perspective, it's always like one of these things that I think we just take it for granted, like we were screaming it for the mountaintops. We're talking about it all the time, but it might be the 15th, the 20th, the 25th time someone hears that, that they're like okay, now I'm ready. So that's why I think these conversations are so important that, you know, for the long I don't want to use the word longevity, but for the perpetuality of helping people understand, like maybe they need to hear it 100 more times before they're ready to take better care of themselves. To you know, look more inwardly.

01:30:33 - Chase (Host) To you know be open to the possibility that there's something new for them. Yeah, yeah, that's um that lands a lot with me today, thank you for your response on that. It's something that been doing this show for over seven years now. This week, as we're recording, was episode 816.

01:31:02 - Cynthia (Guest) Wow.

01:31:03 - Chase (Host) And so I've been doing this for that long, with that many repetitions, and then I'll share with you. Before, for four or five years I did it for a living, you know, in a clinic, working with people one-on-one. So at some point I kind of begin to question am I just banging my head up against a wall? Am I saying the same thing over and over? Does the world need another person talking about this? Does the world need another podcast about that?

01:31:28 But it's a reminder of the commitment I guess we have made as healthcare providers, as wellness professionals, certified health coach, you know, clinical, clinical health coach for many years, and it's just kind of like that commitment you've made to wanting to better your life by helping better other people's lives as well. And it's so true, especially nowadays with so many accounts and so many shows and so many this and that, where anybody can log on to anything, anywhere, anytime, and really kind of probably hear the same thing. You know they can go listen to any show with me on it, any show with you on it, any other show with any other person, but you never know when it's going to land. You never know when that person's going to really be ready to not only listen, but to hear.

01:32:14 - Cynthia (Guest) Well, I always say when the individual is ready, the teacher arrives.

01:32:18 - Chase (Host) Yeah, when the student's ready, the master will appear.

01:32:20 - Cynthia (Guest) Yeah, and that's what I remind myself of when I'm like I've talked about this 595 times.

01:32:26 - Chase (Host) I just want to be like go look at the last five years. Actually, don't go back to the first two years. I don't like to promote those. I was still very new, but I guess that's the beauty of having evergreen content, right, you always? Have a resource for somebody.

01:32:38 - Cynthia (Guest) I always tell people, Mike, don't listen to the first 60 episodes. Yeah, definitely not the first year for me.

01:32:43 - Chase (Host) I was such a noob, I was messing up everything. One other question here before I get to my final question, and again I just want to say thank you for coming on the show. It's so great to connect with you. Have you ever been wrong and if so, what did you do to correct it, particularly in your healthcare career?

01:33:00 - Cynthia (Guest) Oh God, yes, absolutely. There were a lot of things that I reflect back on, especially in cardiology, things that I learned and have now unlearned. I would say one of the biggest things was in 2015, probably timeframe there was a study that came out that was talking about how patients that were taking Lipitor were losing insulin sensitivity they were more likely to become diabetic and, as a practice, we talked about this. You know what patients are going to come to us. You know we have very educated population. They're going to come to us ask us. You know what we think of this and, um, I didn't read the study because my kids were still little and whatever the physicians wanted us as a nurse practitioner service to say is what we did. Now I'm really dove into all the research surrounding statins and loss of insulin sensitivity and this year I brought on Peter Attia's lipid specialist. We did a five series podcast talking about lipids.

01:34:04 - Chase (Host) Five series podcast on lipids, yep, and it was one of the most downloaded of the year.

01:34:08 - Cynthia (Guest) Like he's amazing. And then I brought on Dr Dave Diamond and we talked about the research around statins and insulin sensitivity and I was like this is my acknowledgement of what I didn't know and I get chills when I think about it, because I wrote thousands and thousands and thousands of statin prescriptions over 16 years Thousands, tens of thousands, probably hundreds of thousands.

01:34:33 - Chase (Host) And you feel like those were collectively unnecessary those were collectively unnecessary.

01:34:43 - Cynthia (Guest) Well, if you look at the guidelines for uh, ascvd, so our uh atherosclerotic cardiovascular disease and you look at, you know, standard of care for statins and um, myocardial infarctions, heart attacks. It is standard of care, it is evidence-based medicine. What I don't agree with, what pains me enormously, is that how many of those patients became diabetics? How many of those patients became diabetics and I didn't do enough to help them? That's what I think about.

01:35:12 - Chase (Host) You could probably find that data.

01:35:14 - Cynthia (Guest) I'm sure somehow yeah.

01:35:16 - Chase (Host) That would be interesting.

01:35:17 - Cynthia (Guest) That's what weighs heavily on my heart. So that's why I did this lipid series and dedicated it to all those patients I took care of. I was like, no better do better. Oh, that's incredible, yeah, that's incredible. So for me, I take that kind of stuff really seriously. I'm like we used to say things like we should put statins in the water. Wow, yeah, wow.

01:35:38 - Chase (Host) Yeah, well, okay, maybe to your defense, devil's advocate a little bit. Isn't that the nature of science? To some degree, we go off of the best information, correct With the best clinical, hopefully ethical and pure processes as possible at that time. It's not uncommon for us, you know, five, 10, 20 years later to go, oh, with new science, new evidence, no.

01:36:05 - Cynthia (Guest) Yeah, I mean and let me be clear like this was evidence-based medicine, but it still weighs heavily on me because you know the concept of know better, do better, and it would have been medical malpractice in those circumstances not to appropriately prescribe statins, given the guidelines as they were at that point in time. But I think that statins are not benign and that's the point I was trying to make. Having said that, if you understand physiologically the way that they work and now really look at the research, you can see how, essentially, it's like robbing Peter to pay Paul.

01:36:41 So your cholesterol and lipids are looking great, but now, potentially, you're a diabetic and women are at greater risk for developing diabetes while on statins, and that's the kind of stuff that weighs very heavily on me. So again, know better, do better. And that's why I feel like the lipid series I'm actually bringing on me. So, again, no better, do better. And that's why I feel like you know, the the lipid series I'm actually bringing on another. He's a, a Harvard Oxford guy. He's like brilliant that he's coming on. He's a Harvard med student right now, but just really brilliant and progressive and we're going to have some really good conversations. Because to me, I look at it as you know, new better, do better. I got my mom off of statins in conjunction with her physician. Let me be clear, I'm not telling anyone to stop their meds. Didn't get my dad off, but you know he was like very tunnel vision and wasn't willing to accept an alternative perspective.

01:37:31 - Chase (Host) And that's a whole other area we didn't get into. Um, you very you know, comfortably share that information and you know your father recently passed away and you know comfortably share that information and you know your father recently passed away and you know you seem to think that it was because of, or there are a lot of reasons you think that you could have maybe helped make that not happen.

01:37:48 - Cynthia (Guest) Yeah, and yeah, it's those kinds of things that you know. Ultimately he's no longer suffering and that's the most important thing. But you know, as someone who is a clinician and a human being, it's like there's a lot we could have done differently.

01:38:02 - Chase (Host) Yeah, it really reminds me a lot, unfortunately, of Casey's situation Dr Casey Means and her mother.

01:38:10 - Cynthia (Guest) And that was rapid yeah.

01:38:12 - Chase (Host) From yeah, fine to not, yeah, not, and for a lot of potentially preventable, or at least we could have been aware of things and done a lot more to not get here, at least not so quickly.

01:38:25 - Cynthia (Guest) Exactly.

01:38:27 - Chase (Host) Well what you're phrasing. And no more, say again. You were saying no more, do more.

01:38:34 - Cynthia (Guest) Yeah, no, no better, do better no better do better, ever forward.

01:38:38 - Chase (Host) I'll piggyback on top of that. What are those two words mean to you, Cynthia?

01:38:44 - Cynthia (Guest) Oh gosh, I mean I'm. I'm someone that's always looking for, you know, the bright side in any situation. You know that's just, that's my like practical optimism, that that's just part of who I am as an individual, that I take, whatever the circumstances are, and I'm always looking ahead to see how is this going to help benefit me, someone else in the future. You know never being, never fretting about the journey, understanding that you know things all kind of fall into place ultimately, but I'm never looking back, I'm always looking forward.

01:39:20 - Chase (Host) And, like we also share, you're exactly where you're supposed to be right.

01:39:23 - Cynthia (Guest) Exactly, no doubt.

01:39:25 - Chase (Host) Well, where can my audience go, besides the show notes and the video description box, to kind of check out more of your content? Website podcasts, all that. Where are you hanging out the most online? Where can they go to learn more about you?

01:39:40 - Cynthia (Guest) Yeah, thank you so much. So, wwwcynthiatherlocom, you can get access to everyday wellness, which is my podcast, which is my favorite thing I do in my business. It's the best right, it's the best, it's my favorite thing I do, I would say probably most active on Instagram, but I'm slowly growing YouTube, so definitely check us out there. We post the full sessions of the podcast and that's that's been growing very organically, which has been nice. If you find me on Twitter, I may be snarky.

01:40:01 - Chase (Host) So I'll just be actively Isn't that what Twitter's for?

01:40:03 - Cynthia (Guest) I feel it is, but it's funny People will say but you're so sweet on Facebook and Instagram and I'm like occasionally, I can be snarky on Twitter.

01:40:10 - Chase (Host) That was Twitter, cynthia, okay, yes, I grew up in New Jersey.

01:40:13 - Cynthia (Guest) I can't help myself.

01:40:15 - Chase (Host) And speaking of if you're watching this video on YouTube. Thank you, make sure to smash that thumbs up button. Subscribe to the channel had so much growth over the last few months. Thank you all. So much for tuning in and continuing to check out the studio vibes here in Santa Monica. And Cynthia, thanks for coming in. Thanks for having me. For more information on everything you just heard, make sure to check this episode's show notes or head to everforwardradio.com