Alcohol Sleep and Metabolic Troubleshooting

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. Today I had the honor of sitting down with friend and colleague Craig Emrich. He's an international bestselling author. He is an electrical engineer and he works closely with his wonderful wife Maria, Em irich. He's helped thousands of clients regain their health and by Tally with a strong focus on the science of human nutrition. He has been keto for over seventeen years in carnivore for over six to help treat his chronic l yme and chronic inflammatory response syndrome . Today we spoke about principles of metabolic health, the role of ultra processed foods and bliss point , as well as the loss of nutrient density , midlife changes with regard to metabolic health and changes in body composition, why metabolic flexibility is critically important and the impact of adequate protein intake , why body composition is the only metric we should be considering as opposed to the scale, how he determines carbohydrate tolerance, research specific to the gut microbiome. The insulin fat cell relationship as well as insulin resistance , fasting and protein sparing modified fast as specific strategies for weight loss , the impact of leptin resistance as well as alcohol , how cortisol and sleep impact the hormone cascade . And last but not least, troubleshooting with specific challenges for midlife women specific to HRT hydration electrolytes and body composition shifts . I thoroughly enjoyed my conversation with Craig. He has a new book out that he co authored with his wife called The Art of Metabolic Health that for those of you that are interested in having a deep dive into the science around metabolic health, it's done through a really beautiful and thorough lens. Craig, excited to have you with me. Welcome to Everyday Wellness. Thank you so much for having me on Cynthia . Yeah, you know, I think so much of the work that you and Maria both do is really deeply rooted in helping educate individuals about the role of metabolic health. And from your experience , both as a former individual who worked in the health and wellness space, now firmly rooted in the space that you're working in, talk to me about some of the changes that you've seen in metabolic health in terms of awareness and a greater emphasis on helping people understand why this is so critically important . Yeah, you know, we've been in this space for a very long time . You know, Maria's probably pushing twenty five years of helping people with these kind of lifestyles . And myself herself over twenty five years pushing thirty years of just eating this way herself . Me, it took me a little longer to come around. I was a strong German background, so I like to brew my own beer and I didn't have any health issues at the time. So it took me about five or six years after her to come fully around, but even I've been at this for over probably close to twenty years now. And what we having that much time in this space and that entire time helping people and being one on one with actual people and actual results , you really see a lot that, you know, some in some of these spaces in this community, people may not see if they're not really working one on one for extended periods. And so it's kind of evolved over the years a little bit. Some of our core princi ples that we find are just really good for anyone, no matter what approach , things like, you know, sticking with whole foods. Don't do, you know, in the keto space, don't do the keto products on, you know, processed stuff. And you know, some of these core principles prioritizing protein, you know, always have a good amount of protein because there's so many we could dive into that deeper later, but so many reasons why that's such an important thing . And through it all we kind of did that. But we've personally we did try not to get too dogmatic about anyone approach. You know, there's a lot of different tools out there, a lot of things that work for different people and different methods that work that may not work for somebody else. And so you have to be open to some of these different methods, keto carnivore, protein sparing, all of those. Well, and I think being open minded is really key. I would say rigid dogmatism really has no place. And so I sometimes when I'm navigating social media I have to put my blinders on because there are people that extrapolate that be just because Kito worked for them or just because Carnivore worked for them, that means what everyone should be doing. And I think this very bio individual approach is so important . I'll give you an example. So I have always been drawn to leaner proteins. That has been my entire life . And it wasn't until a few years ago where I did a cholesterol balance test and I was talking to my integrated practitioner and he said, This makes so much sense because you hyper absorb cholesterol. So for you to eat a really fatty rib eye, you probably didn't feel good because your body just the way it's designed, you hyper absorb all this cholesterol. You probably felt nauseous. And inevitably, someone would say, It's your gallbladder and I was like, No, I just think it's what works for me. So to your point about really looking at health and wellness through a very broad lens and identifying that nutrient dense whole foods might look a little different for you than it does for me and for someone else, but still really the emphasis on eating whole food s . What do you think kind of sets people up for the lack of success that they're seeing when we're looking at these conventional ultra processed foods? Because we know that now we're looking at seventy percent of the population is consuming ultra processed foods. We've convinced people that cooking is too hard and that the processed food industry has all of the solutions that we need, but yet you and I both know that's very far from the truth. Yeah, absolutely. It's kind of this environment of engineered food that really and in our book, we kind of dive into that a little bit of how there's this whole process and industry set up to make this environment that makes you overeat and makes you I mean literally they have food scientists at these companies who sit and think from a chemistry standpoint , how can I make this food more hyper palatable so that they eat more and they consume more and that's more profits and that's more value of our product, right? So I mean you add that all up and that's their whole focus is profit. And so to do that, you make them eat more . And so they design the food to be hyper palatable . And then, you know, there's this kind of this, you get this ultra process food dominance and then what do you do? You start supersizing things, you know, the whole supersized kind of environment. You get the extra large fry and the extra you know large shake with the, you know, my value meal or whatever it might be and then the portion sizes get bigger and bigger because they're hyperpalatable and you eat more. And then a lot of times they'll end up in this cycle where they're also do things like I mean one of the things when you hype hyperprocess is you're automatically reducing them out of nutrient density, right? So our bodies really crave a couple of things. I think they crave enough protein . And in that and closely tied to that, enough vitamins and minerals and nutrient dense food . And when you eat very low nutrient dense food, the body's like, I need more of these vitamins. Eat more. And so you don't get the saturated you would with the more nutrient dense food s. And that's tied closely with protein because protein is very very nutrient dense. It's one of the most nutrient dense foods for a wide range of vitamins and minerals that you can eat. And protein itself also drives a lot of satiety . And so when you hyperprocess, you pull all that natural body's feedback out and you just it's just a vicious cycle. No, it definitely is. And I think back to, you know, when I was a nurse new practitioner in the early two thousands and we were still bastardizing fats. We were telling patients to eat lots of heart healthy grains. We were minimizing the utilization of protein. We were really emphasizing like when you're looking at how many portions of carbohydrates you're eating a day, that should really take up the bulk of your plate and we weren't necessarily talking about fruits and vegetables . So I think that we're at the pendulum. I think everyone has gotten the memo about protein, which I think is great , I still find that women in particular really struggle with getting sufficient amounts of protein in. And this is where that loss of insulin resistance or excuse me the insulin sensitivity that starts to kind of unwind both for men and women, but much, much more so for women north of forty when we're losing anywhere from three to eight percent of our muscle mass, which we know muscle is this massive glucose reservoir to me about some of the things that you're finding for your midlife clients, so men and women that they start to struggle with. If they have maybe been able to get away with the ultra processed foods in their twenties and thirties, I think about my sons who are now twenty and eighteen, so they're both being college as of August . And you know, what they can get away with at eighteen and twenty is very lean athletic young men is not the same as what most people get away with in their forties, fifties and beyond . Yeah, probably by far the biggest clientele group that we have is the post mental woman . That's by I think probably eighty, ninety percent of what we see. And I think, you know, there's so many components to that. Obviously, the hormonal side and you know, you know that in detail. But there's also many factors too that, you know, you have to deal with which changes in the body. And one of those is the body composition piece, which you're alluding to. And if so many women find it hard to get that enough protein , and there's two and back up a little bit, you know, talking about metabolic flexibility and metabolic health, you're really talking about two things maximizing storage space for glucose and for fat . And that really drives metabolic flexibility, lowers insulin resistance. Those are the factors that are super key. And so how do you do that? Well, shrink fat cells. So make sure your fat cells stay small and not full of fat, so lose some body fat. And then the other side is to build or maintain your muscle. And that gives the like you said, the reservoir to store glucose . The more of that you have, the more metabolically flexible you are and less and more insulin sensitive. And as you get over a certain age, get a little bit of biochemistry here. You know, there's you want really complete, not just enough protein, but really complete proteins because proteins are made of amino acids. These are like the building blocks for your hair , your skin, your nails, things that are replaced every day . And on top of that, you know, building and repairing muscle and other tissues , you need a steady supply amino acids. And if you have complete ones, which means they have all the building blocks, all the different amino acids , and critically leucine, which is kind of the trigger, if you will, of telling the body, I have enough complete protein here to start building muscle. And so if you get enough leucine, you can build muscle. But here's what happens with anybody, but especially post menopausal women. As we get older , the amount of leucine you need to start that process, the threshold , goes up . So as you get older , not only do you need even more just to start that process, you need even more protein just to maintain your muscle, much less build it. And that's why I think it gets to be a challenge for a lot of women. Yeah, that's interesting because over the course of the past six months of the book launch and for my listeners, I have a podcast coming out that is solely dedicated to this. How did I maintain muscle in the setting of a lot of business travel , not being able to eat as often as I normally do at home, which is only two to three males. Let me be clear. I wasn't eating like min es. How did I maintain muscle working out less because of the travel and the just the exposure of book writing and book publication . And for me, you know, filling in the gaps and I have no problems and I talk very openly about this, whether it's essential aminos, whether it's getting some way protein in, talk to me about how that's part of the conversation because what I find is obviously people still know of me because of intermittent fasting. And over the past two years, I really have backed off on fasting and really doing twelve to thirteen hours of d igestive rest for specifically that purpose because I can't skimp on the protein piece. I think for a lot of women, they have a desire to change body composition, they have a desire to move the needle on the scale, proverb ally and figuratively . But the other side of that is at the expense of losing muscle, a lot of women are very fixated on the number on the scale, not understanding that muscle is currency. It is so important to maintain a build up . Yeah, the scale lies about body composition. I mean gaining muscle makes the scale go up, but that's a good thing and everybody should want that. So yeah, it's very important to focus as much as possible more on body composition and those changes. But you know, I look at it too is, you know, at any stage in life you can focus on this. And you know, especially if you don't if you are in your thirties and forties , make building extra muscle maybe more than you think you might need at that time because of what you're going to lose or struggle to hold on to when you get older. It's kind of like a, you know, you're depositing on your future vitality by gaining some extra mus cle when it's easier to do it. And I think something for a lot of women out there they worry about getting bulky, but there's no woman with a normal amount of testosterone or no more hormone levels that's going to get like you see these women you know on bodybuilding and all those kind of things. It muscle is not easy to build. It's not like something you're just starting lifting weights and suddenly got these big biceps like building a pound two pounds of muscle takes a lot of time, a lot of effort . So and it's all good, but what I'm just pointing out is, you know, some women will get worried about bulking up too much and you're not. You're just gonna get stronger, your clothes are going f toit better . The scale might be the same or even go up a little, but you're going to look better in the mirror. Your clothes are going to fit better and you're going to feel better. Yeah, it's interesting. I have to remind women sometimes that physiologically we are, not going to get like some of the extreme bodybuilders. Let me be really clear. There's a key differentiator. When you're taking anabolic steroids, that's going to give you a very unique look. You are not going to get that from lifting weight and taking physiologic dosing of testosterone. That's just not going to happen. And I think for many women, especially in our generation, because we were conditioned to believe thin is in sk,inny is where you want to be, and I remind women all the time, what they're not thinking about in their forties or fifties or even their sixties is that if you don't build and maintain muscle, what that leads to is frailty . Frailty leads to fall s and falls lead to a loss of independence. And that's what I think of as a clinician because I would sometimes ran on the hospital, you know, I was shocked. I would see people that weren't much older than me that couldn't get off a bedside commode, a bedside toilet. And I was like, if they're in the hospital, I understand they're sick, they may not feel well, they're weak. That might be the reason why . But that's actually a poor prognostic indicator for later frailty and falls. Yeah, for sure. And there's some real key points in there too that you point that when you point that out, it doesn't, you know, people think maybe when you get older overall, you sort of get this slow decay of muscle mass, but it actually kind of happens in jumps . And the reason for that is exactly what you point out is the they fall. So suddenly they fall and now they're immobile for a period and they have a big loss in muscle mass because of that immobility and so you back that up , having the muscle to maintain that balance and strength , but also the bones. The bones are basically a matrix of protein filled in with calcium. And there's been a lot of studies on this. They'll take people with osteoporosis or osteopenia and they'll give them calcium supplements and then they vary the amount of protein they were taking in. One group they were below the RDA, which the RDA is already low. Like that's not going to die. That's not thriving protein level. That's the you won't get deficient in some, you know, amino acid or something . But if they were below, didn't matter how much calcium supplements they took, they still had muscle or bone los s. If they're at the RDA , they kind of maintain bone status. And if they're above the RDA, they regained bone density. And so that just shows you that protein is such an important part for the bones as well. And so you put those together , not only the protein for the bones and the bone strength, but the protein for the muscles around them and their strength to stay active and mobile. So key . Something I hear constantly from women in our community and something I understand personally is this nothing about your effort has changed and yet our bodies are responding differently. Your mid section feels different, your blood sugar is much less stable , and your cravings may have shifted. And let's be honest, your energy probably isn't what it used to be. As a nurse practitioner with over twenty five years of experience , I want to be completely transparent with you about why. Estrogen is one of the body's master regulators of metabolic health. It influences how we store fat, how our tissues respond to blood sugar changes, and how efficient ly our metabolism functions at the cellular level. As estrogen shifts during perimenopause and menopause, the same lifestyle choices, diet, exercise, sleep genuinely do not produce the same result s. This isn't a failure of effort. It's a precise biological transition , and most solutions don't address the root causes. That's why I want to tell you about might acute hormonal metabolic control. It's formulated with SEQL, which is a highly bioavailable phyto estrogen that supports healthy estrogen signaling. We know that eighty percent of women cannot produce SEQL naturally because it requires specific gut bacteria most of us just do not have. This formula bypasses this entirely. It also includes a particular bacterial strain Breva, which works via the gut hormone access to support estrogen path ways and help ease occasional bloating and chromium to support healthy blood sugar balance. This is a targeted cellular support for the transition we are all in and is designed specifically for women in perimenopause and menopause and built around what actually is effective . Go to w ww mitoque dot com slash cynthia and get ten percent off your first order . Again, that's MIT OQ dot com slash cynthia to get ten percent off your first order . We've talked before about why skin really stands out as a skincare company. It's not hype or just fancy packaging. It's real science. And listeners of this podcast know how much I value that. The founding team are longevity researchers who asked a decept ively simple question if many visible signs of aging like wrinkles, fine lines, and loss of elasticity are driven by so called zombie cells . What if you could actually reduce those cells to slow the aging process down instead of just covering it up. That research led to OS one , OneSkin's proprietary peptide. It's the first ingredient proven to switch off those damaged senescent cells actually slowing skin aging directly at the source. This is serious science that fits easily into my existing skincare routine and every time I use one skin, I'm giving my skin a clear signal to repair dam age cells, support collagen and strengthen my skin barrier I have been using the eye cream facial cleanser for the past eighteen months and I recently swapped in the lip mask. I absolutely love them. It's simple. The products last a long time, so it is very cost effective . And for me , being science oriented, I love knowing that I'm actually helping to reverse visible signs of aging and doing so in a way with a really clear , clean option. And this isn't just my experience. OneSkin's products are backed by extensive lab and clinical data, including four peer reviewed clinical studies to validate their efficacy and safety on all skin types. Plus, they've got over ten thousand five star reviews. Born from a decade of longevity research, OneSkin's OS peptide is proven to target the visible signs of aging, helping you unlock your healthiest skin now as you age . For limited time, try One skin with fifteen percent off using code cynthia at oneskin dot c slash cynthia . That's fifteen percent off one skin dot co with code cynthia. After you purchase, they'll ask you where you heard about them. Please support our show and tell them we sent you . Yeah, that's interesting. You know, as I was writing the book because I devoted a whole chapter to talking about bones and the microbiome and helping people understand that if your microbiome is not optimal, that will actually worsen bone loss. So I think women think about bone loss in the perspective of yes, as I'm losing hormones, I potentially am losing bone, but I remind them, you know, leaky bone, you're going to be dealing with leaky gut. And so it kind of goes back and forth. And this is where and I'm not sure what your thoughts are on fiber, but it's interesting the research is very clear that fiber is actually bone protective because of we consume fiber, it goes through our digestive system, gets a large intestine, it gets fermented. And from that our body will produce short chain fatty acids. But one in particular helps to stabilize bone loss, which I find fascinating. I know the carnivores don't like to hear this, but I will remind them I'm like, you know, I think for menopausal women, it's important at least have that conversation about how fiber can be very bone protective. It's not just about the loss of estrogen. It's the increase in osteoplastic activity with that bone loss, which progesterone is responsible for that. But when you go through that transition from perimenopause to menopause, it starts to accelerate the bone breakdown effects. Yeah, definitely. And we're not, like I said, not dogmatic on any approach. And we actually talk a little bit about carb tolerance levels in this book. We have sort of a spectrum of diets and and going back to what we kind of talked about with the silos of you know, carnivores think that because it worked for them, everybody has to eat carnivore. Everybody will get cured if they eat this way. And that's just not true. And what's every single diet out there, the number one failure lack of compliance. They can't stick to the diet. And if you tell a lot of people you can only eat beef and salt the rest of your life, not a lot of people are going to stick with that for the rest of their life, right? There might be some and all the power to them, but you know, you gotta find your carb tolerance level so that you don't start gaining weight or get certain a lot of people we work with, they'll start if they introduce too many carbs of certain type, they'll start getting cravings and issues that will kind of snowball. You gotta watch that. But if you can find a place with some fiber and with that you get to a higher carb point , but you're maintaining and you feel great and then you can stick with it for life. That's what really matters. Yeah, I know. We're very much in alignment on there. And walk me through your process of how you approach carbohydrates, because when I say that I'm anti processed carbs . I think most of us are anti processed carbs. We're really talking about nutrient dense whole foods. Preferably I tell patients, I actually want you to have three vegetables a day to one piece of fruit because here in the United States, we love sweet, we love sweet things. And so kind of approaching carbohydrates from a very bio individual lens , but I think also the utilization of continuous glucose monitors or glucometers to really get a sense of what works for your body or what works against it. Yeah, and this is very much context based, you know, there's no one size fits all and you really have to look at what are the goals of the individual person because it can vary widely, you know, based on that. In general , we'll if somebody's main goal is weight loss, we will keep the carbs pretty low. We'll keep them probably twenty grams or less and stick and most of that's probably fiber type sources, vegetables and whatnot. And it will adjust that based on goals. And it really depends on the situation. Like Maria is trying to gain muscle and gain weight. She's actually introducing quite a bit more fruit in this situation because for her, not only is it helping, it's you can actually look at carbohydrates on the other side of this in this community, especially people really like to talk about there's no essential carbohydrates and that's true. Your body can make all the glucose it needs from protein . But that also means that some carbohydrates are protein sparing because your body doesn't have to turn it in the protein into glucose anymore if you get a certain amount. And so if you're in maintenance or you're an athlete or you're trying to build a muscle or increase weight , you a some carbohydrist can help with that, right? Because you don't have to take that protein now in the diet and turn into glucose. You can use it to build more tissue, hopefully muscle. So it's really very, very context dependents. And we just start with their goals and their body composition situation, then you start building off of that. And some of it's trial and error. You know, if they start getting lots of more sugary type fruits, like you said, maybe that starts to drive some cravings for other sweets. So then they have to back off on that, maybe more vegetables like you're saying. But yeah, all in the context of whole foods , you know, no processed anything. Yeah, it's interesting because I think about , you know, in twenty nineteen, I was in the hospital for thirteen days, had six weeks of antifungals, antibiotics. My gut microbiome was decimated. I was full carnivore for nine months 'cause that was the only thing I could eat. And you better believe I was dreaming of vegetables by the end. And it took me a period of time. Oftentimes when patients say to me, I don't tolerate fiber, I'm like, there's something more to what's going on in the gut microbiome that is a reflection the inability to actually process these otherwise healthy foods. And to your point about this personalization piece, which I think is so important for patients to understand that the power of the end of one, you know, the exploration, I think for so many patients they've, been told what to do for so many years that it scares them to think about doing a degree of experimentation. Has that been your experience that when you're encouraging clients to find their carb threshold or experiment with low carb or high carb, are they is there a degree of apprehension about altering their diets significantly? Definitely, you know, definitely and with certain people they'll have some trouble with that. And we just tell them to go slow. And you know, part of what you just described as well is probably a little bit of adaption phase too. You know, the gut microbiome is pretty incredible, really. If you look at how adaptable and how quickly it can adjust and adapt, there's one randomized controlled trial that I really love that you're probably familiar with it. It took two groups. One went to straight vegan and the other one went to carnivore and they looked at the gut microbiome. It was a good study too. They it was whole foods. There wasn't like, you know, sometimes they'll do a carnivore or a keto and they're having like liquid fat and all this no, it was whole foods. And the gut microbiomes shifted within twenty four hours to the new diet. It's just this rapid change. But the types of gut bugs kind of stayed fairly consistent. There's just certain ones went up, other ones went down. And so there is adjust very quickly, but with certain things like fiber or other types of plants, if you're been carnivore for example, reintroducing those can be a little bit of an adjustment to that, you know? Just like our bodies will stop creating certain enzymes like for protein if, you'd stop eating that, it's just it's not going to make something it's not using. And so it might be a little ramp up period where you start digesting those things better. But I'm very similar to you in this and I have Lyme disease from I was diagnosed probably eight nine years ago and I've been treating that for a long time and part of that was carnivore because it helped with my pain and I was having like eighteen months of some three high powered antibiotics simultaneously for all nine, eighteen months and just destroyed my gut. So I had to kind of go into carnivore for a while and now I've all the protocols I've been doing, I've been able to build back more and more vegetables and plants and very welcome as well to have some more of that flavor in the diet. Yeah, it's interesting. To this day, there's certain foods and for me, I don't believe I'm no longer oxalate sensitive. I no longer I know that there are people out there , but I always say that when you're sensitive to a particular food, the question is always why? Because I don't think those plant defenses aren't designed unless you're just seeing copious amounts. Like if you're eating all the almond meal and almond crackers and almond muffins and almond pancakes and all those things binished smoothies where you get high concentration. Yeah, the celery juice phase that everyone went through. So I think for a lot of individuals it's, tankering with this end of one. Like I know for myself, I really miss Brussels sprouts, but of course when I started eating them again, I wasn't smart about it. I didn't eat a quarter cup. I ate probably two cups . And that just was a horrific experimentation , but over time, we build it back up just like a muscle. And so if someone's listening to the podcast and they themselves, you know, they just went through, whether they were treated for a tick borne illness, they were hospitalized, whatever the reasoning is, they were appropriately prescribed antibiotics , what are some of the things that you , what are some of the things you did to help with your microbiome re establishing your microbiome health post antibiotic use, especially eighteen month s because that is a concerted amount of time. Yeah, yeah. There's a couple different products I use, supplements restore, which is a product that helps restore the gut . It took some probiotics, kind of pulse those on and off. I didn't take them, you know, extended period of time. Those are two of the main ones and then just starting to slowly reintroduce some of those things that feed those gut flora or the plants and the different foods that will help out reestablish that in the gut . And it was, you know, took a while for me to really tolerate certain things well again. But yeah, just go in slow and, you know, and keep introducing new things that you want to include in your diet. Yeah, no. And I think for a lot of people, they kind of get to a point where they believe that just because they don't tolerate something right now, it means it'll be a forever problem. And I remind them that as an example, I just did a microbiome test earlier this past month and I said to the provider, you know, I don't tell her any inulin. It doesn't matter what it is. If it's in Lily's dark chocolate because I'm deciding to have a piece of dark chocolate . Don't tolerate it all. Sure enough, what does my microbiome need inulin? And so we had to walk through this protocol of how to slowly introduce it into my diet because my microbes actually need it. The irony being it's the one thing that I was like clearly I don't tolerate and they're like over time you will get to a point where you tolerate it again. Let's pivot a little bit and talk about getting back to insulin resistance because I think this is part of a much larger conversation . You know, walk us through the insulin fat cell relationship in plain terms because I think for a lot of people , when they're trying to understand how does insulin resistance develop I thinkment. we hear this term. We understand fundamentally what the hormone does, but how do our cells actually become insulin resistant over time? Yeah, this is really interesting. One of my areas of passion . When I was younger, I remember as a teenager , I think it was , I learned that most people, the vast majority of people, they don't make new fat cells as they're older. They just they fill up and empty the ones they have . And didn't think of anything of it a long time ago, but now it's come full circle where I really understand the mechanisms of this and this is really the root cause of insulin resistance in the body. And what happens is as we're young, most people will build up a certain amount of fat cells and then after a certain age, like when we're toddlers, the vast majority of people stop creating new fat cells. And we just fill up what we have and empty what we have and that's how you gain or lose body fat. But the fat cell itself, it's got a membrane on the cell and the cell can only stretch to a certain it's kind of like a balloon. Stretch it so far and now it's going to burst if it gets any bigger. So the cell itself rejects any more fat being stored into it. And it says, Nope, I'm done, I'm full , no more in this cell, use a different cell . And the cells, the fat cell s themselves, as you get lots of these fat cells on the body that are in that state , what's going to happen now with the fat coming in the diet? There's no place to put it, right? And so fat will accumulate in places, it shouldn' t, like the bloodstream, sky high triglycerides, fatty liver, fatty pancreas , full metabolic syndrome, insulin resistance. That's the root cause of why that's happening. And this also explains why you can have somebody, you know, we've had women one hundred and ten pounds that are typed to be diabetic and they're inflammatory resistant because they have a small number genetically, a small number of fat cells. And so they get they get stuffed quick ly and you don't see a lot of physical gain of fat, but the cells are stuffed and they're not happy. And then the complete opposite of this, you can have people with a hundred pounds overweight or even more , and they look totally fine metabolically. Insulin fasting insulin's low, their glucose is low. They look totally normal metabolically. And to take that to the absolute extreme, this is a Tyler's case study I have in our book here. He actually went to high school with Maria and he came to us and we started working with them pro bono just because we wanted to help any way we can. And I was really curious and so I sent them this test that tested a bunch of metabolic markers . It tested his fasting glucose, fasting insulin, triglycerides. He was six hundred forty five pounds. So we had to have him do this test. And if you had somebody six hundred forty five pounds come into your office , what would you think their metabolic markers would look like? I would think their triglycerides would be through the roof. I think their fasting insulin would be high. I mean , yes. Totally. Probably gonna say it was the opposite. Yep. So I said earlier , almost everyone stops making new fat cells as they get older. There are genetic variants. So there are some people who continue to make new fat cells so the fat cells always stay small and they don't get too stuffed. And his case, his fasting on this test it was his fasting glucose was fifty. He wasn't sure why it was low, but normally it's ninety. His fasting insulin three point five , his triglycerides seventy seven, HDL forty two , A one C five point six, home IR zero point four , completely insulin cell s. That's six hundred and forty five pounds. And that's because the fat cells, if you keep them small , they aren't insulin resistant the metabolism, the body's pretty much happy from a metabolic standpoint. Now, I'm not saying this is, you know, healthy at any size . He's got, you know, the pressure on his organs and his joints and he's got, you know, he's working hard to lose weight, but from a metabolic standpoint, looks normal. And what was your approach to help him, you know, in terms of coaching, given the fact that he was insulin sensitive, which was surprising given all the information that you provided earlier. Yeah, so what we did, so one of the things I mentioned earlier is protein sparing modified fast. And kind of tying back to some of the fasting stuff you're talking about. Let's separate fasting into two groups . Intermittent fasting or time restricted eating. And then you have your extended fasting where you're eating nothing for more than twenty four hours. You know, two day fast, three day water fast, that kind of thing. Clinically they found and when they're doing studies on this, you know, extended fasting works extremely well for rapid fat loss , but they found you also lose protein. You lose some lean mass and a chunk of that's going to be musc le. And again, back to the insulin resistance, you want to maintain or grow muscle while shrinking fat because otherwise if you lose muscle, you got less place to store the glucose and not as much metabolic flexibility. So they came up with protein sparing modified fast where you modify the fast , the extended fast to spare the body's protein . And basically all this is you get enough protein for your whatever your protein goal is , almost no carbs and only like twenty or thirty grams of fat for that day . So it's just really lean protein and that's it. Generally we say they're pretty low calorie days. We'll generally say one to maybe three of these days per week if you want to do them, it's not something you do all the time and you kind of you wouldn't do a water fast all the time. So you kind of replace a water fast with something like this basically . But that's also a very individual approach , individual not a one size fits all as well. And somebody like Tyler because, he has so much body fat to tap into , he actually was pushing protein spraying even more frequently because his body had that. But we would break that up with some overfeeding days, basically a day eating at maintenance calories , keep that metabolism on us, keep it from metabolic adaptation from happening, but he could really push it . And what I refer to this as kind of like a tube of toothpaste. If you've got a lot of body fat, it's kind of like that full tube of toothpaste. You squeeze it, you're probably getting more out than you really wanted . When the tube of the toothpaste is pretty empty, it's hard to get that last bit out. And the same thing your fat cells when they when you don't have a lot of body fats, it's hard to get enough out to use for the body. So we 'd usually say if you're within like ten pounds of gold weight , don't do protein sparing days, just do weight loss macros, focus more on body composition than the scale and kind of shift your perspective. If you're one hundred pounds overweight, you can do it more often. Yeah, no, it makes a great deal of sense. I think the nuance here is for a lot of people that are within five, ten pounds of their bowl weight , when they're doing a lot of fasting over time. This is what started to happen for my patient population was that over time they were losing muscle at the expense of trying to fast. And so since we know muscle is such an important currency , especially as we're getting older , a lot of my patients now do twelve or thirteen hours of digestive rest, especially if they're close or at goal weight , just to ensure that they're not at risk for further muscle loss. Yeah, for sure. And I'm personally, I mean , generally speaking for most people, as long as you hit enough complete amino acids for the day, whatever your protein goal is, you'll be fine. But I'm personally especially if you're trying to gain muscle, I like that first meal to be at least thirty grams of complete protein it kind of sets the tone for the day and really kind of the next twenty four hours almost . The body gets enough Lucine says we're going to start building today. Let's say you have a lunch that's a little smaller and maybe not thirty grams of complete protein . You're probably still gonna gobble those up because the process already started. And the body sort of has a halo, if you will, of once it starts, it's going to be in that mode for a while . And so you can have a little more flexibility in the other meals. But if that first meal has got for sure at least thirty grams of complete protein , I think that's beneficial. What are some of the most common nutritional mistakes you see in this post menopausal population? I would imagine like you and I can just rattle these off , but it's very affirming when listeners hear it from someone other than myself. But since this is a large portion of the work that you and Maria do, what are some of the most common things that you see them that are that they're doing that are hampering their des ire to lose body fat or to change their body composition. Yeah, so I'm going to go kind of into the silos in this space that we do with so much. We probably get almost daily, but for sure weekly, we get people that come to us coming from the high fat carnivore space and they're almost always post menopausal women and they're either not losing weight when they have a significant amount of body fat to lose or gaining weight . And sometimes it's two, three years of not losing any weight . And it's this there's a lot of these silos they think it's a one approach. You eat just the fattiest cuts of meat until comfortably full and then everything will work itself out. And there's a problem , as you know with post menopausal women, there's a lot of other stuff going on that can affect this. And the one factor that we find very often is somebody who's got history obesity or are obese , you've naturally got some level of leptin resistance . So leptin's the hormone that let fall while eating. Well, if you're following this, eat all the fattest cutis until comfortably full, you're overeating because you're not getting the signal when you should because of the excess body fat on the body. You've got some left and resistance there. And so you really got to approach it in a different way and for us, it's always about prioritizing protein. We cut the carbs down, and then we moderate the fat down a bit. And you bring it down. It doesn't have to be protein sparing level, you know, only twenty grams in a day, and you wouldn't want to do that every day anyway, but just moderate it down. Don't you know, a lot of these spaces, you know, it's not just a fatty rib eye, but it's tablespoons of butter on top of that fratty ribeye. And you know, just cut out the added fats and a lot of times, you know, somebody's eating two fatty cuts , switch one of them to a leaner cut. Still have the fatty ribby in the evening if you want or whatever. In the morning, have a tenderline or some chicken or some fish , something you know that',s a little leaner. And that alone can just really help with weight loss. How about alcohol? How does that enter the conversation ? Yeah, I would say if you're really serious about fat loss, you gotta cut the alcohol. So there's something in the body, a process called oxidative priority. And this is the process where the body you can kind of think of it one of two ways. Either it prioritizes fuels coming in in reverse order of storage space or in order of toxicity . So if you look at alcohol the order is pretty much and we'll take exogenous ketones out of it for now, but you have alcohol , carbohydrates , and fat are really the priority fuels. Protein isn't really used as a fuel. It's the building blocks for all the things you need it for. It only turns a little bit into glucose and it's a lot of it's based on whether you need glucose as well. It'll convert more to glucose if you need glucose. But if you just kind of take that out now and you got alcohol, carbohydrates, and fat. Alcohol, there's no place to store alcohol. Your body cannot store alcohol. That becomes a priority because too much alcohol can kill you, right? So you have to burn the alcohol. And if there's carbohydrates and fat also coming at the same time , those get down, you know, they're not at the priority, so they get stored away . And then so you go down the line and you have no storage space for alcohol, carbohydrates, a little storage, usually fifteen hundred calories or so in your glycogen, your muscle, other maybe four hundred in your liver , go down the next level. Fat is almost unlimited. I mean depending on your, you know, how many fats set your fat threshold, but you know, you could have easily even lean athletes, you know, that have ten percent body fat have like twenty or thirty thousand calories in fat stored on their body . So that becomes the big storage tank. That's easy to just stuff fat off into storage while it's dealing with the other fuels. And again, you know , a high glucose level can kill you as well. So it's got to focus on prioritizing that. And if you take alcohol out and just look at fat fat and carbohydrates, you're really kind of talking about the random cycle, which is that displacement property where the more carbohydrates you eat, the less fat you burn or oxidize. The less carbohydrates you eat, the more fat you burn and oxidize. So it was really all tied together in that priority. And so if you really are serious about burning fat , cutting the alcohol is definitely going to help. When we talk about perimenopause and menopause, the conversation often focuses on hormones . And let me be clear, hormones absolutely matter . But one thing I think we don't speak enough about is muscle . Women can lose significant muscle mass and strength during the per imenopause to menopause transition , and that loss impacts far more than just our appearance . Muscle influences metabolic health, insulin sensitivity, mobility , healthy aging, and more . And the good news is there's so much we can do about it. Strength training and adequate protein intake are critically . And increasingly, we're learning about the role mitochondrial health plays in maintaining muscle quality as we age. That's why I've been paying attention to the science behind Mitopure from Timeline . Mitopure contains Urelithin A, a clinically studied nutrient that supports mitochondrial renewal through a process called mitophagy. Think of it as supporting the energy systems that help keep your muscles functioning at their best . For women who want to remain strong, capable and resilient for decades to come , this is an essential area of research worth knowing about . Visit timeline . com and use code Cynthia for twenty percent off your order. Again, that's timeline dot com and use code Cynthia for twenty percent off your order. This is one of my foundational supplements that I never miss. Yeah, sometimes I will talk about the mommy drinking culture and certainly, you know, when children are younger and moms are trying to, you know, decompress after a busy day, maybe they work outside the home, maybe they don't. And they put the kids to bed at seven o'clock and they're like, Oh, one glass of wine becomes two . And so in medicine, whatever the patient tells us they drink, we usually double it. So if someone says to me, they have two glasses of wine at night. I'm like, they're probably having a bottle of wine a night. And there's no judgement, I'm just saying from your clinical experience, whatever they're telling me, it's probably twice the amount . But to your point about if anyone's serious about wanting to lose and shift body composition, one of the first things that we have to talk about is the relationship with alcohol. It doesn't mean that maybe you don't have a glass of wine on a celebration or anniversary , but if it's something that you're doing on a daily basis or most days of the week, it is probably contributing to weight loss resistance. Yeah, and it's not just the oxidative prairie or the hormonal effects of alcohol, which, you know, there's the whole aspect there. There's also just the calories. I mean, if you're sitting if you're having three glasses of wine, how many calories is that? four, five hundred calories? Yeah. And you can't just add five hundred calories of food to your day and not expect it to impact your weight loss. Absolutely. Let's talk about sleep . Where does sleep enter the conversation? I always talk about how sleep is absolutely foundational to our health. For so many people, the sad fact is that many hormones go down in midlife , but cortisol is one of the ones that goes up and how cortisol can contribute to poor metabolic health and why sleep becomes such a larger part of the conversation . Yeah, you know, when back to kind of the mistakes that people make, overdoing the fat is a big one. The next one we typically look at is are you eating dairy? Dairy end or nuts? Dairy nuts are one of the things that across the board, you cut those out , you see better weight loss results. So two of the foods, even though they're mostly whole foods that don't drive satiety as well as other whole foods. And so they become an issue for a lot of people. After that, next one sle ep for sure. You know, people , you know, you can see it in yourself. A lot of times when we come back, we spend a few months in Hawaii in the winter and then we come back, it's an overnight flight and I never get more than an hour or two sleep on that flight . And so I get here and man that next day I could eat everything in sight. Like my hunger is through the roof that whole day. I never really get satiated with what I'm eating and you just got to fight through it and get a good night of sleep and get recovered. And so it drives the hunger, it drives there's lots of hormonal issues I could describe. One of the things Maria points out a lot is that you don't want to eat any calories. You want to completely shut down calories at least three hours before bed human growth hormone, which is so important for a lot of reasons .ik Sesp short ly after you fall asleep and insulin's an antagonist to that. So if you eat a snack something right before bed, now insulin's up and you don't you suppress human growth hormone. Another important factor when it comes to weight loss and health. So yeah, sleep is massively important . I even remember a study a while back I saw they took Army Rangers and they cut their sleep in half so eight hours to four. That's the only thing they changed. And at the cellular level their insulin resistance doubled just from that loss of sleep. So a lot of important factors when it comes to sleep for sure. Yeah, I think, you know, the research that I always quote is that if you're sleeping less than six hours a night, it dysregulates your blood sugar by about sixty percent. And to your point about, you don't make good food choices when you're sleep deprived. You're not craving chicken and broccoli. You're very likely going to consume the hyper processed carbohydrates and hydrogenated if they're even still around seed oils, all the things that we don't want to consume in an effort to push that satiety mechanism. Now I, think for a lot of reasons , you know, when I think about areas of traditional allopathic medicine that tend to be problematic for midlife women, of course thyroid health is huge on the list. What has been your experience working with your clients and helping them kind of navigate discussions around thyroid markers because if you're looking through a traditional allopathic lens, it can be very limited and I, probably made that mistake in the hospital more than a few times, but now I know better versus this kind of integrative approach that's looking a bit more broadly. Yeah, you know, I'm not a thyroid expert by any means myself either, but yeah, they're mine. There's definitely a lot there though that and Maria is a little more versed on that than I am. But I think in some situations, adding certain carbohydrates can be helpful as well if you've got a lot of problems going on there . But yeah, it's a big piece of the puzzle. That plus HRT, as you know, are two of the biggest levers outside of food that I think you can start to focus on and optimize that can have such massive impact on health, especially post menopausal women. Maria will talk for days. I'm sure you can as well on HRT and vaginal estrogen and all the importance of these things herself. She was having chronic UTIs, and what do they do? They put you on antibiotic after antibiotic, after and you're wrecking your gut microbiome as well in the process and she started vaginal estrogen and didn't have another UTI since and it's been years . That's amazing. And it's such an inexpensive intervention. And to your point , when you touched on, there are definitely people that are very s ensitive, not just for thyroid conversion reasons, but also sleep when they go really low carb. I have a very athletic eighteen year old and so he's going to the beach with his friends and he was trying to shift his body composition just a little bit. And we were having a conversation yesterday and he said, If my carbohydrates fall below one hundred grams, my sleep is racked. And I said, That actually happens to bigger adults too. But I thought it was very interesting that you touched on that. And so this is again that bio individual piece of experimenting if you suddenly go ketogenic or very low carb and your sleep doesn't work quite so well or you feel like you can't get through your workouts, it could very well be that you've adjusted your macros in a way that's not allowing you to utilize stored fuel effectively . Yeah, and there's a couple other levers to pull in there too, if that's happening too. One is electrolytes. Make sure you're getting dehydrated. And another one is progesterone. We do find that a lot of times women they'll get an imbalance when they go low carbonate they need a little more progesterone one of the things one of the clearest signs of low progesterone is you fall asleep okay, but then at like two AM being you're wide awake and you can't fall back asleep that's a classic sign of low progesterone and we find that adding progesterone can help with that as well. But yeah, it's another lever you have to pull and find what works for you. Yeah, no and it's interesting. I always say progesterone helps us fall asleep, estrogen helps us stay asleep and why that's so important . In terms of , you know, if someone's listening and they're, you know, they're overwhelmed, which can happen when we listen to podcasts, what are three things that you think are really important to focus in on as initial steps if we're wanting to improve metabolic health. You know, it depends where you're coming from. If you're coming from a standard American diet , step one is eat whole foods and I don't even care what diet it is. You're going to see improvements. You know, personally, I don't think, you know, there's a lot of approaches that can be very valid and work well. I personally don't think vegan is good for anybody long term because you just it's just so hard to get enough complete amino acids to do all the things we've described . But yeah, just starting with whole foods can be so massive. And you know, another thing outside the diet that people lose sight of or don't focus enough on is neat, non exercise activity thermogenesis. It's basically that movement that you do without really it's not a workout. You're not at the gym , but it's all those things that can really add up. And there's been lots of studies on this , like just showing people that fidget. So people that like tap their foot all day or do that kind of thing have better weight loss results than people that don't. It's that little things that can add up, you know, and when you're cooking the whole foods, guess what? Instead of going through the drive through, sitting in your car not moving while you get the food, eat the food in the car and you didn't move hardly at all, going to the grocery store, walking through the grocery store to get the food , coming home, chopping the ingredients, cooking the food, cleaning up afterwards . These are all little movements that can add up and you know you go to the gym and you power workout for thirty or forty five minutes and all the time you commit to that to make sure you get that thirty minutes. Well, you got to like fourteen other hours that you could be doing little things that really add up to a lot more than that thirty minutes of exercise. Yeah, I think it's so important to understand that all these little small efforts that we make do ultimately add up and I'm laughing because I'm the type of person that's not necessarily fidgeting, but I'm usually kind of scooting around in my chair as a podcast host . Is there anything about your new book that we didn't address that you feel like is particularly relevant or important for my community? Well, two sections that I think are super relevant and important, but Maria wrote them , not me, so you could go into detail of that with her. But of course, the HRT section in hormones , she has a deep dive on that in this book, as well as peptides. She ' as whole chapter on peptides. She has been researching those for about six, seven years now and she's got a ton of info on that. I think both can be great tools in the right situations for women, especially postmenopausal women, of course. I'm not the expert in those , but I think they're super important things to have in us. I mean, it's almost four hundred pages. We put