207. Cynthia Thurlow: On Women’s Health, Intermittent Fasting, Protein Intake & Hormone Therapy

Join my FREE 3-Day Water Fast Challenge - October 15th. It's the exact protocol I use with pro athletes and Fortune 500 CEOs to flush inflammation and kickstart autophagy. Sign up here! http://bit.ly/4nTILPt The supplement aisle isn’t just reserved for bodybuilders anymore. Specific nutrients become non-negotiable for women navigating hormonal changes. Cynthia Thurlow shares why creatine monohydrate deserves a spot in every woman's routine for optimal health, the protein threshold required to stimulate muscle protein synthesis (hint: it’s more than what you’re eating), and why body composition matters infinitely more than the number on your scale. Join the Ultimate Human VIP community for Gary Brecka's proven wellness protocols!: https://bit.ly/4ai0Xwg Get Cynthia Thurlow’s book, “Intermittent Fasting Transformation“ here: https://bit.ly/46PrboI Pre-order Cynthia Thurlow’s book, “The Menopause Gut“ here: https://amzn.to/3WpMMz7 Listen to "Everyday Wellness: Midlife Hormones, Health, and Science for Women 35+" on all your favorite platforms! YouTube: https://bit.ly/4mQjcgY Spotify: https://bit.ly/3IRdptM Apple Podcasts: https://apple.co/4nZo5oU Connect with Cynthia Thurlow: Website: https://bit.ly/4nJWOHE YouTube: https://bit.ly/47blItA Instagram: https://bit.ly/3KDxMLt TikTok: https://bit.ly/4oay4bi Facebook: https://bit.ly/3IXptcO X.com: https://bit.ly/4nGN4xN LinkedIn: https://bit.ly/4pVMuNV Thank you to our partners H2TABS: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa EIGHT SLEEP: SAVE $350 ON THE POD 4 ULTRA WITH CODE “GARY”: https://bit.ly/3WkLd6E COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp WHOOP: JOIN AND GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW MASA CHIPS: 20% OFF FIRST ORDER: https://bit.ly/40LVY4y VANDY: “ULTIMATE20” FOR 20% OFF: https://bit.ly/49Qr7WE AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn CARAWAY: “ULTIMATE” FOR 10% OFF: https://bit.ly/3Q1VmkC HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S BIOPTIMIZERS: “ULTIMATE” FOR 15% OFF: https://bit.ly/4inFfd7 RHO NUTRITION: “ULTIMATE15” FOR 15% OFF: https://bit.ly/44fFza0 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC GENETIC TEST: ⁠https://bit.ly/3Yg1Uk9 Watch the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8fo X: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps 00:00 Intro of Show 03:01 Cynthia’s Health Journey 06:48 Topic of Perimenopause on TED Talk 14:43 Intermittent Fasting and Protein Intake for Women 30:41 Creatine Monohydrate Benefits 36:48 Gut Health for Women 55:24 Hormone Testing and Therapy 1:12:21 Connect with Cynthia 1:12:47 What does it mean to you to be an Ultimate Human? Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions. Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation. Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered promotional in nature. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  One thing that I think I probably have not overemphasized enough is how critically important a woman's menstrual cycle is. It is as important as blood pressure, pulse, temperature. If a woman loses her menstrual cycle and she's not pregnant, guess what? That is a sign that her body is under too much stress.

• 0:15Gary Brecka?

  I noticed that women did not fit the common mold when they were menstruating. Some of the worst endocrine disasters that I ever saw were women that ate in a very narrow feeding window.

• 0:27Speaker 00

  We have been part of a culture that has really sent a very damaging message to women that thin is what we want to attain.

• 0:33Gary Brecka?

  If you don't feed the body, it starts to survive on less and less food, and it does that by slowing down the metabolism.

• 0:40Speaker 00

  Fasting is one of many strategies, and I think that most of us eat too frequently, and most of us eat too much of the wrong food.

• 0:47Gary Brecka?

  There's an intermediary between the food that we're consuming and the body's ability to utilize that food, and that has to do with our gut microbiome.

• 0:54Speaker 00

  The way that we need to think about it is that everything affects the gut, and everything about the gut impacts every other choice that we make.

• 1:00Gary Brecka?

  I'd love to go through your three broad categories: menstruating, perimenopause, menopausal. And a lot of women listening to this podcast are like, I want to go down the intermittent fasting journey. How do I decide if I'm a candidate or not?

• 1:11Speaker 00

  What women do not understand is that...

• 1:26Gary Brecka?

  Hey, guys. Welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything: anti-aging, biohacking, longevity, and everything in between. And today, we're coming to you live from London. I have a very, very special guest. Women, you are going to want to pay attention to this podcast. Welcome to the podcast, Dr. Cynthia Thurlow.

• 1:46Speaker 00

  Oh, thank you. I'm a nurse practitioner, not a doctor, but thank you.

• 1:49Gary Brecka?

  Nurse practitioner, sorry.

• 1:49Speaker 00

  Thank you. I want to make sure I make that clear.

• 1:51Gary Brecka?

  Well, you can actually practice independently in a lot of sites, like in Florida.

• 1:55Speaker 00

  I actually can in Virginia as well.

• 1:56Gary Brecka?

  Practice without supervision.

• 1:57Speaker 00

  I can hang a shingle. Yep.

• 1:58Gary Brecka?

  Nevada, same thing.

• 1:59Speaker 00

  Yeah. I mean, independent practice is an important part of advanced practice nursing, for sure.

• 2:04Gary Brecka?

  And, you know, you guys do all the work anyway, so sorry, docs. So they should have the right to practice independently. You know, there's, there's a common theme that I find, and it's, it holds so true in your case. That runs through a lot of my podcast guests. I find that some of the most impactful, passionate, purpose-driven people are in that position because they solved the problem in their life. And before the podcast, and I've seen this before, I'm watching you on a number of media channels, you were a nurse practitioner, or a nurse practitioner, and you were in the emergency room, you were wired to adrenaline and the adrenaline rush, until there was a

• 2:46Gary Brecka?

  time that you started to struggle metabolically, probably also emotionally, physically, and you pulled up the bootstraps and said, there's something different for me. Can you just tell my audience about that journey?

• 3:01Speaker 00

  Yeah, so I worked in clinical cardiology for over 16 years. Prior to that, I was an ER entrominist. So yeah, I am definitely an adrenaline junkie. And I think as my kids were starting to get a little bit older, and by that I mean elementary school age, I had one with severe life-threatening food allergies, and it really got me zeroed in on nutrition and how nutrition plays a role in our health. And, you know, that then evolved into wanting to focus more on lifestyle as medicine, which as you can imagine, in traditional allopathic medicine.

• 3:31Gary Brecka?

  This is what, how many years ago?

• 3:32Speaker 00

  Uh, 20 years ago.

• 3:35Gary Brecka?

  Oh gosh, lifestyle medicine 20 years ago? That's quackery.

• 3:37Speaker 00

  No, no, they, they thought I was, they were like, oh, we have this nurse practitioner and she likes to talk about food. And, and, and I would say my peers who were about my age were always very supportive. The older docs were generally, they thought I was crazy. And so they would support me and facilitate this interest. But over time, I was getting increasingly disillusioned with the concept of writing prescriptions for lifestyle-related issues. And I got to a point where I was telling my husband, I was having a harder and harder time. I would go to work and I would toe the party line and I would do my job and excelled at my job. But concurrently, I was also in the throes of perimenopause, but I didn't fully appreciate that until I was weight loss resistant, I wasn't sleeping well, I had brain fog, I

• 4:22Speaker 00

  was anxious, I'd never been anxious before in my life, even probably bordering on a bit of depression, just out of frustration, like all the things I tell women to do aren't working for me and what's going on. And so I think it was both a catalyst and also the realization that I felt like I can make a larger impact by leaving traditional allopathic medicine and the own, my own journey of figuring out for myself, what are the things I need to change about my lifestyle, which wasn't too bad to begin with, but what are the things I need to do differently in perimenopause to ensure that I remain metabolically healthy, that I may, I ensure I have enough energy to take care of my kids, that I can contribute to my community in a way that feels

• 5:04Speaker 00

  affirmed and valued. And so for me, it was really this massive leap of faith on April 1st, 2016, when I left traditional allopathic medicine and I told my husband, who thought I was having a midlife crisis.

• 5:17Gary Brecka?

  I guess he was already, he was going through perimenopause with you, trust me.

• 5:21Speaker 00

  He was like, I, I think you're having a midlife crisis. And he said, I give you two years, two years, and then you have to figure this out. And so within that two years, I had landed my first TED Talk. And, and the irony is, to be totally transparent, almost instantaneously, I was attracting one-on-one clients and created group programs. It was very clear to me that many women felt the same way that I did. Their needs were not being addressed in a proactive manner. They didn't feel seen or heard. They were generally, and I use the, and I use this term very delicately, but when a woman comes to a provider and says, I've gained weight, and their response is, you're X age, and this is just the way things are.

• 6:05Gary Brecka?

  Yes.

• 6:06Speaker 00

  That for me was so unbelievably frustrating because I said, F that. That's not the way. That's not going to be what I'm going to accept for the next 30, 40, 50 years of my life. And so that was a powerful impetus, but that then evolved into a couple TEDx talks, a podcast, a platform where it was very affirming that my husband was like, okay, this isn't a hobby. You really are making an impact.

• 6:32Gary Brecka?

  Yeah.

• 6:32Speaker 00

  And so, you know, for me, it's, you know, life kind of comes full circle. And I'm like, I can't imagine my life any different than the way it is right now. Like, I was meant to be an entrepreneur. I just didn't realize it.

• 6:44Gary Brecka?

  Right. And you had two TEDx talks. What was that first talk about?

• 6:48Speaker 00

  Perimenopause. And in 2018.

• 6:51Gary Brecka?

  Nobody was talking about it in 2018.

• 6:52Speaker 00

  I was so embarrassed. I got on that stage and I was telling someone this today. I remember being so embarrassed to talk about perimenopause because women are shamed into not aging. We're told to shut up and not talk about what's happening with our bodies emotionally, spiritually, physically. And I got up on a stage and I was like, if I didn't know what was going to happen, how could I expect any of my patients to know? And I trained at arguably one of the best medical institutions in the country. And I'm like, if it wasn't part of my education as a clinician, how could I expect my patients to know what they should be anticipating? And so it was incredibly freeing to do that. And as an introvert, absolutely terrifying.

• 7:36Gary Brecka?

  Yeah, you know, I think that, you know, women's health has always been treated the same as all health, right? So men's health, women's health, you know, we go down the road of intermittent fasting, one size fits all, cold plunging, one size fits all, diet, one size fits all. You should be on carnivore because your husband's on carnivore. Your husband eats in a narrow feeding window. You should eat in a narrow feeding window. You know, he's weight training. You should weight train. It's these, these one size fits all, especially when we talk about women, are not applicable in many cases. And I found this out the hard way. I had a similar trajectory. I was in the mortality space, decided to end that career and get into the functional medicine space. I'm only a human biologist, so I'm actually not licensed to practice medicine. We started a functional medicine clinic and

• 8:22Gary Brecka?

  In treated hundreds of thousands of patients and had some amazing practitioners. But I noticed that women did not fit the common mold. And they didn't fit the mold at different times of their life when they were menstruating. Some of the worst endocrine disasters that I ever saw were women that ate in a very narrow feeding window, like their husband was really into CrossFit. So then they got into CrossFit and that was fine. But then while they were doing CrossFit, everyone was intermittent fasting and then sort of the shorter the window, the better the window. And some of these young women that were eating in these four hour windows or six hour windows,

• 9:05Gary Brecka?

  their cortisol, their cycles were just a follicular stimulating hormone, luteinizing hormone. And so they were actually gaining weight, eating in a narrow feeding window. Their husbands jacked is pissing them off. And then their sleep would go out the window. So I'd love it if we would talk, maybe open the conversation about with intermittent fasting. Cause I love what I've seen you say on other media outlets. And I think it's so good for women to hear this and get some relief that maybe, maybe all intermittent fasting is not good for every woman.

• 9:45Speaker 00

  Yeah, I mean, I would say bio individuality absolutely rules. And, and when I say this, whether it's peak fertile years, 35 and under, perimenopause, 35 to 50, or menopause, 51 and older, I would say that each individual really has to look at it from their own lens. So a 24 year old who is lean and athletic has no business doing a lot of intermittent fasting. Now, if someone is 24, they're obese, they have polycystic ovarian syndrome, or they're type 2 diabetic, probably some degree of time restricted feeding is probably a good idea for a variety of reasons. But one thing that I think I probably have not over emphasized enough is how critically

• 10:29Speaker 00

  important a woman's menstrual cycle is. It is as important as blood pressure, pulse, temperature. And respirations. And if a woman loses her menstrual cycle and she's not pregnant, guess what? That is a sign that her body is under too much stress. And so when a woman says to me, I started fasting and I then skipped a couple of cycles. I'm like, timeout.

• 10:50Gary Brecka?

  Yep.

• 10:51Speaker 00

  Stop what you're doing. And I would be the first person to say that I think a lot of women benefit from some degree of digestive rest and men too, frankly, that could be 12 or 13 hours of not eating. That is not formal fasting, but I think in many instances, that can be very beneficial. You know, the other side of intermittent fasting is that, you know, there's a time in a woman's cycle when she should fast and there's a time when she should not.

• 11:15Gary Brecka?

  Right.

• 11:15Speaker 00

  And what I find is in my perimenopause and menopause patients, because they are so frustrated with weight loss resistance, because they are frustrated with body composition changes, and we can certainly unpack this, they think of a little bit of fasting as good, more is better. So whether it's the CrossFit, the fasting, the carbohydrate restriction, the overemphasis of protein, and protein is very important, the overemphasis on hormetic stressors, whether it's infrared sauna, whether it's cold plunging, whether it's high intensity interval training, it is taking things to an extreme. In a body that is conditioned to respond to stressors, we don't need as much stress.

• 11:52Gary Brecka?

  Right.

• 11:53Speaker 00

  To create hormesis in our bodies. And so when I'm talking about intermittent fasting, I always say, I feel like I have to apologize because I didn't emphasize this enough before. And so now I feel like I want to undo perhaps some of the unclear messaging. Fasting is one of many strategies. It is not the only strategy. And I think that most of us eat too frequently and most of us eat too much of the wrong food. So if you change the food frequency, and it could be that you still eat three meals a day and you're doing it in 12 hour windows, that's great. That is far better than what the average American is doing. And so I think the messaging is important to actually talk about women, how attuned our bodies are to stressors, how we probably don't need as much stress on our

• 12:38Speaker 00

  bodies as men can tolerate. And I would say menopausal women, there's also a special group there because we're not dealing with the hormonal fluctuations that we once dealt with, you know, day to day, week to week, throughout a menstrual cycle.

• 12:51Gary Brecka?

  Yeah, you know, I noticed that in a lot of our young menstruating females, so menstrual years, fertility years, that we would notice that as they narrowed the window, their thyroid metabolism would drop almost universally across the board. I'm sure there were some outliers that I don't remember, but you know, so nothing's more frustrating to a young woman than restricting her eating and when she's restricted eating very good, you know, working out in a fasted state, going hammer down at Orange Theory 55 minutes, three, you know, five days a week, and then retaining water.

• 13:29Speaker 00

  Yep.

• 13:30Gary Brecka?

  It looks like fat while their spouse is just loving life.

• 13:35Speaker 00

  Yep.

• 13:35Gary Brecka?

  And one of the things that we would notice is, you know, when, when the hemoglobin A1C, that, that, that three month average of, of blood sugar would get very, very low, 4.8, 4.9, 5.0, meaning they're spending a lot of their time hypoglycemic, that almost universally, you would see the thyroid say, hey, let's slow down the metabolism. We're not getting enough nutrients, so let's slow down the metabolism. It's almost like what happened on The Biggest Loser.

• 14:05Speaker 00

  Yep.

• 14:05Gary Brecka?

  If you ever watched the documentary afterwards.

• 14:07Speaker 00

  I did. It was fascinating. Disturbing.

• 14:09Gary Brecka?

  Very disturbing.

• 14:10Speaker 00

  Very disturbing, very fascinating.

• 14:12Gary Brecka?

  Um, I mean, the transformations were shocking, but nearly every single one of these contestants not only gained back the weight that they lost, they ballooned to catastrophic new weights. And when you peel back the layers of the onion, it's hard to outsmart your human physiology, right? I mean, a lot of our biology is there to protect us. So if you don't feed the body, it starts to survive on less and less food, and it does that by slowing down the metabolism.

• 14:43Speaker 00

  Well, look at all these patients that have whittled themselves down to one meal a day. And I, this is. I don't ever get as much hate as I do when I talk about one meal a day. So OMAD, how many women have said to me, the way I lost 50, 60, 100 pounds is that I now eat one meal a day. And I remind them, how much protein are you eating in that very narrow window? And they'll tell me and I, and I talk about why body composition is so important. I was like, yes, you might be a size X, Y, or Z. However, you probably have lost quite a bit of muscle. Muscle is our metabolic currency.

• 15:20Gary Brecka?

  Yes.

• 15:21Speaker 00

  You've lost, you've lost your metabolic currency and now you're eating 600 or 700 calories a day and you're wondering why you've either plateaued or you're stuck. And so I think that-

• 15:31Gary Brecka?

  Or you're exhausted and your sleep's off.

• 15:34Speaker 00

  Yeah. And, and, and I, I anger people when I say you are not eating enough food. And so, you know, whether it's getting people into this kind of reverse diet, which I think can be controversial, but saying, okay, we, we're going to add a hundred additional calories of protein a day and we're going to monitor body composition and we want you to be lifting weights. But more often than not, you know, we have been part of a culture that has really sent a very damaging message to women that thin is what we want to attain. The thinner the better, often at the expense of losing muscle mass. And we know how-

• 16:06Gary Brecka?

  And the GLP-1s don't help that.

• 16:08Speaker 00

  If you're not lifting and eating enough protein, absolutely. That is a huge piece of it. So I always say like the body composition, it's like, let's really dial in on what's your fat free mass? How much muscle mass do you have on your body? Because more often than not, and I'm constantly working on this myself, very transparently, I am thin, but I am constantly trying to fine tune, like adding a little bit of muscle. It is a hell of a lot harder at this stage of life, even with hormone replacement therapy and with lifting, it is still challenging.

• 16:37Gary Brecka?

  If you want protein to build lean muscle, but without the caloric impact or need to cut, you need Perfect Amino. It's pure essential amino acids, the building blocks of proteins in a precise form and ratio that allows for near 100% utilization in building lean muscle and no caloric impact. So we build protein six times as much as weight, but without the excess body fat we normally get during bulking. This is the new era of protein supplementation and it's real. If you want to build lean muscle without having to cut, you need Perfect Amino. Now let's get back to the Ultimate Human Podcast. Now, how about peptides? Where do you fall on peptides?

• 17:15Speaker 00

  I love peptides.

• 17:15Gary Brecka?

  I do too, because I've seen that, you know, a lot of women do very well on these growth hormone peptides, not growth hormone. I think that would be very dangerous. But the growth hormone peptides, the GHRPs and GHRH is CGC, Dole 95, ipamorlin, sermorlin, tesamorlin. And we have experienced in our clinic, you know, women seem to do very well on those. Also helps their circadian cycle if they take it the proper time at night. But I'd love to, so I'd love to unpack that, but I'd love to sort of go through your three broad categories of women, you know, menstruating, perimenopause, menopausal. And, you know, a lot of women listening to this podcast are like, well, I'm, I'm, I want

• 18:00Gary Brecka?

  to go down the intermittent fasting journey. How do I decide if I'm a candidate or not?

• 18:04Speaker 00

  Yeah, I mean, I would say kind of broadly, if you're not sleeping, if you're not managing your stress and that's not five minutes of meditation once a day, if you're just not, if you have a distorted relationship with food already and this is just going to feed the machine, you know, I see a lot of that on social media as well. It's people that have latent eating disorders like anorexia and they'll just say, oh, I'm just intermittent fasting.

• 18:26Gary Brecka?

  Yeah.

• 18:27Speaker 00

  No, you just don't eat.

• 18:28Gary Brecka?

  Right.

• 18:28Speaker 00

  No, you're not intermittent fasting, you just don't eat. So I think when I'm, when I'm looking at the appropriateness, it's like, how is your lifestyle to begin with? And then how can we tweak and kind of determine whether or not this is right for you? Again, if you are very lean and exercise a lot, I would actually argue that you can put yourself in what's called the red. It's, it's relative energy deficiency. And this is where a lot of very athletic women or very active women can just have themselves in a caloric deficit in perpetuity and that can be harmful. So that's number one. I think it's being honest with yourself, like where do you fit in? And, and I am certainly not an athlete. I don't pretend to be an athlete, but I am an active, middle-aged person.

• 19:11Speaker 00

  I think, you know, really looking at, can you sleep through the night? Do you fall asleep and stay asleep?

• 19:16Gary Brecka?

  Right.

• 19:17Speaker 00

  Sleep is foundational. And if a woman irrespective of what age she is tells me I don't sleep well, I'm like, that is the first thing we have to address because sometimes when you start reducing the amount of food you're eating, that can worsen the sleep piece. And especially because

• 19:32Gary Brecka?

  The cortisol response.

• 19:34Speaker 00

  It can be a cortisol response. Some people are much more sensitive to carbohydrate intake. And so at the very beginning of my intermittent fasting journey, I was very much into carbohydrate cycling. Never was I ketogenic, transparently. But I think many people took from that that I'm anti carb. I'm not anti carb. I just like smart carbs. Like, let's eat the non-processed varieties. I think carbohydrates can be very important for many people. And so really kind of dialing in the sleep piece, addressing the stress. Like, don't add in fasting if you're going through a divorce, you lost your job, you're in the midst of a big move, someone in your family's sick. That is not the time to add this additional stressor. So really kind of looking at, you know, what is your feeding or the amount, like the hours in which you are eating now? And how could

• 20:18Speaker 00

  we compress that and maybe see some improvement? And even it could be from, you have a 12-hour feeding window, maybe we compress it to 10.

• 20:25Gary Brecka?

  Yeah.

• 20:25Speaker 00

  Can you get enough protein into that feeding window? That is always my question now. If the answer is, I cannot get at least 100 grams of protein in a day, then the answer is your feeding window is way too compressed.

• 20:37Gary Brecka?

  Right.

• 20:37Speaker 00

  And so I like to work with numbers. I'm very quantitative. And so I will sometimes say, you know, if you have two meals a day and you get 100 grams of protein in, that's not bad.

• 20:46Gary Brecka?

  Right.

• 20:47Speaker 00

  There's probably some room for improvement.

• 20:48Gary Brecka?

  Two meals and 100 grams of protein, that's

• 20:50Speaker 00

  That's 50.

• 20:50Gary Brecka?

  That's pretty good. I mean, that's a lot of chicken.

• 20:54Speaker 00

  But most women, what they're doing is, when I ask them to track their macros, because I'm like, let's build awareness, like, chronometer, I have no affiliation with them, but it's just an easy way to track macros. How much protein are you eating? More often than not, it's 50 grams total.

• 21:09Gary Brecka?

  Wow.

• 21:10Speaker 00

  And again, we're talking about, not only are we undergoing, you know, it's, men go through underpause, women go through menopause, but We go through this entire, whether it's our thyroid, it's our adrenals, every single endocrine organ takes a hit during this middle age transition into menopause. And so helping people understand, we have to recalibrate everything. You know, my 17 year old and my 20 year old can probably sneeze and stimulate muscle protein synthesis. Like truly, their, their bodies are so anabolic right now.

• 21:43Gary Brecka?

  Right.

• 21:43Speaker 00

  We know as we're getting older, we need more protein, not less. Sometimes in some instances, three or four times as much as we did when we were younger. So at a bare minimum, building awareness around, what does 30 grams of protein look like? Cause you need at least that to stimulate muscle protein synthesis. And I would actually argue you need more. So really helping them build awareness, because what I find is, oh my God, that's so much protein. I can't eat that. Well, maybe you go from four ounces to five ounces of fish, steak, chicken, et cetera. We're not looking to stuff you, but we want you to build awareness around what is a proper portion of protein look like?

• 22:20Gary Brecka?

  That's why, you know, I'll often recommend that women will take the essential amino acids too, because I think a lot of the protein equivalent, we always equate protein to muscle, which is true, but, but it's not just muscle. It's your natural killer cells. It's your connective tissue. It's collagen, elastin, fibrin. I mean, there's so many structures that are built from these amino acids because that protein is broken down into amino acids. And then those amino acids go out and build all kinds of structures, not the least of which is muscle, but certainly not the only thing. So we, I think women, you know, it's like creatine, and I want to unpack that too. You know, I've always considered creatine a bodybuilding supplement. And, and it was, I mean, the nineties, it was a big rage, you

• 23:02Gary Brecka?

  know, like BCAAs, which are considered to be sugar water. Just really expensive lemonade. But, um, you know, I think it's important to highlight that, you know, protein is going to become amino acids, which are the building blocks of not just muscle, but so many other structures in the body, which is why when you're protein deficient, you can start to see this myriad of issues starting to happen.

• 23:27Speaker 00

  You become very catabolic. Like I always like to use the example, and sometimes my podcast community is like, yes, Cynthia, we've heard this story, but I use it to kind of demonstrate. In 2019, I spent 13 days in the hospital. I was incredibly

• 23:39Gary Brecka?

  It was an appendicitis, right?

• 23:40Speaker 00

  That was, yeah, that was that fun 13 day journey of every complication.

• 23:44Gary Brecka?

  So it must have burst, I mean.

• 23:46Speaker 00

  So, so what's interesting was my husband and I accompanied my husband on a business trip. First time I'd been able to do that, we get home, I'm like, damn, I got food poisoning. So I'm up, I'm vomiting, I have diarrhea, I feel terrible. The next day, my husband's like, you don't look so good. And I was like, I don't feel good. And so I spent the whole day in bed and touch base with my internist who I was friends with. And she was like, you know, you need to go to the hospital because you still aren't feeling good, right? Like, I want to make sure that's clicking in your brain.

• 24:13Gary Brecka?

  Yeah.

• 24:14Speaker 00

  And so by the time I get to the ER, it was the worst abdominal pain I'd ever had. And I was like, I looked at my husband and there's something

• 24:20Gary Brecka?

  I've heard people describe.

• 24:21Speaker 00

  The impending sense of doom. And so when a patient says to you, I think I'm going to die, you take that really seriously. And I looked at him, I said, if they don't figure out what's wrong with me, I'm going to die. Like, I just knew it without a question because I could not get comfortable. It was worse than labor pain. And they kind of papooed me because I didn't look particularly sick. And then they, they ran blood work and the ER doctor came in and said, something's wrong. You've got a massive white count. So my massive white count over 20,000, I mean, way high, sent me for an emergency CAT scan and they were like, I couldn't even put my arms above my head. I was in so much pain. I had an idea of what might have been wrong, but I had such diffuse abdominal pain and they were like, well, you have a ruptured appendix and you have

• 25:04Gary Brecka?

  Ruptured appendix.

• 25:05Speaker 00

  Ruptured appendix and you have pancreatitis, which means the entire length of my colon was, was inflamed and angry. And the surgeon came in immediately and said, I want to take you to surgery tonight. We're going to take your appendix and we're going to take your colon. And I was like, no.

• 25:18Gary Brecka?

  Yeah.

• 25:18Speaker 00

  Timeout, I need my colon. She's like, no, you don't. I was like, yeah, I do.

• 25:22Gary Brecka?

  Yeah.

• 25:22Speaker 00

  I'm just asking you to give me 24 hours, 24 hours. And if, and if I, my white count goes down, my fever goes down. So that started a 13 day hospitalization.

• 25:32Gary Brecka?

  Wow, they did go in and fix the appendix, right?

• 25:34Speaker 00

  Oh, no, the story gets better.

• 25:35Gary Brecka?

  I was going to say, because a ruptured appendix is

• 25:37Speaker 00

  Yep.

• 25:38Gary Brecka?

  Septic emergency.

• 25:39Speaker 00

  What they've learned, though, is that if they can If they can manage it, because right now your appendix ruptures and then it spills all this putrid content into your peritoneum, which is a bad thing because you can get peritonitis, which is life threatening. And so on day two, I developed small bowel obstruction. I think on day five, the surgeon was, I mean, they were really worried. I had all these specialists coming to see me. They were like, Cynthia, we don't know what's going on. Your fever's going up. I've got an ENCH tube down. I mean, I'm really sick. And I had a, what I would describe as, I've had patients tell me where they have experiences where they, they perceive that either God or spirit comes to them and gives you an option. You know, do you want to fight? Or do you not want to fight? And I was like,

• 26:24Speaker 00

  I've got two young kids at home. I can't not be there for them. But it turned out I had retroperitoneal abscesses.

• 26:30Gary Brecka?

  Oh my gosh. So I had to go interventional radiology. All of these things have, that's just pain on top of pain.

• 26:35Speaker 00

  Yep. So interventional radiology came in and put tubes in to drain them. And then I developed a fistula. So I had a communication between the appendix and my cecum. And so I was so sick that I was discharged to home 15 pounds lighter. So you want to talk about catabolic, my muscle, I had no muscle. And I was too sick to take my appendix out. So my appendix came out six weeks after my hospitalization, 10 days after I did that second TED Talk.

• 27:02Gary Brecka?

  But now it's already ruptured?

• 27:04Speaker 00

  It's ruptured, but it was encapsulated.

• 27:07Gary Brecka?

  Ah, so it actually didn't spread?

• 27:09Speaker 00

  It did.

• 27:09Gary Brecka?

  But you had an infection, but just it was localized?

• 27:12Speaker 00

  Yep.

• 27:12Gary Brecka?

  And IV antibiotics, the whole?

• 27:14Speaker 00

  IV antifungals. I mean, it just decimated my, my gut. So when I say to people, if you don't actively work at building muscle, your body will actually break down the muscle you have. And that's catabolism. And so that's what happened to me. So I jokingly say, I lost 15 pounds of muscle six years ago. And it'll probably take me 10 years to put that muscle back on, if at all.

• 27:38Gary Brecka?

  Wow.

• 27:39Speaker 00

  So I, I talk about, I don't say this to sound extremist or to sound, you know, like I'm trying to garner sympathy because I processed it all. But I think, you know, protein is so important. And I, to your point about essential aminos, my younger son got mono in January and he bodybuilds and he's, does mixed martial arts. He's very athletic. That kid did not lose muscle during mono, even though he did not lift for four months because he was using essential aminos every single day.

• 28:11Gary Brecka?

  Huge fan of that. And I'm so glad you said that. You know, I take them every day. I take all nine of the essential amino acids because a lot of the protein that we put in our body, like collagen, is just not a complete protein.

• 28:21Speaker 00

  Correct.

• 28:21Gary Brecka?

  You can't even build muscle from collagen.

• 28:23Speaker 00

  Hair, skin and nails, it's great for that.

• 28:24Gary Brecka?

  Yeah. Um, hair, skin and nails, it's good for, but so are all the essential amino acids. You have the same amino acid profile to build that as you would need to build muscle. And you have the extra benefit of building muscle and, and not maybe turning into sugar or, or fat. So I, I, I think Dr. Gabrielle Lyon, she, if you're watching this, Dr. Lyon, she's, she's fully on board with your, oh, she's a good friend. She's a, she's a good friend of mine, too. She's, she's amazing. And she's been the champion, I think, um, at least the, the female champion of, you know, you need to get more protein, you need to get more amino acids and you need to be weight training. If you want to live a long time, start lifting weights.

• 29:03Speaker 00

  Do you want to, the first conversation I ever had with her, which was in 2020, we both spoke on a panel together and we connected instantaneously. And during the course of our first few conversations, she said, um, you're probably not eating enough protein. And I was like, a what? And, you know, I, I give her full credit for opening up my mind and impressing upon me how critically important it is to consume adequate protein and why we need more with aging and not less. Cause I think a lot of people are like, oh, I'm thin or my body composition looks fine. If you are not doing body composition readings

• 29:43Speaker 00

  at least quarterly, or at least twice a year. So at least two to four times a year, you don't know. You don't know. Cause I just had mine done and my VO2 max. And dang, it's like, you know, it's like every time we're just trying to fine tune like, okay, still gotta put on a little bit more muscle.

• 30:02Gary Brecka?

  Yeah. So, so protein for sure, but um, let's start unpacking creatine because I think it's, it's making headway now. And I think it's returning to a core supplement for a lot of women. Um, I put the vast majority of my female clients that are over 40 on, on creatine, uh, HCl, um, or monohydrate. Sometimes they bloat on HCl, but very rarely do they do that. Where do you fall on creatine? I think the science is, is pretty astounding. Actually, higher levels than I would have ever thought, like 20 milligrams to, or 20 grams to cross the blood brain barrier and really bathe the brain. But where, where do you fall?

• 30:41Speaker 00

  Yeah, I'm, I think that it's a foundational supplement. So creatine monohydrate, not just for muscle strength, but also for neurocognitive benefits. And there's evolving research about bone health, anywhere from eight to, you know, 10 grams a day or more. Um, I think the quality is important. So I always say that the research is really done around creatine monohydrate. Um, but the quality is certainly important because what I hear from a lot of people, including family members, oh, when I take creatine monohydrate, I get bloated. You don't want to buy the crap from China. You want to buy Creapure. It has to be licensed through, I believe I'm saying this properly, uh, I, we license ours through Germany. Uh, and you, and it costs a little bit more, but it's actually there, as the Germans are,

• 31:26Speaker 00

  they're very organized, methodical about the way that they manufacture, um, products. But I think what's exciting and evolving is the research around brain health. And you're right, you do need more to get across the blood brain barrier. Blood brain barrier is designed to be protective. What's ironic is most of us don't have a healthy blood brain barrier because most of us also have concurrent leaky gut. And it's always like leaky gut, leaky brain. So you have these permeable membranes that are designed to protect us. But helping people understand, like, when I am traveling, like, right now, we're in London. I'm doing 20 grams of creatine monohydrate daily.

• 32:01Gary Brecka?

  Wow.

• 32:01Speaker 00

  I start three days before.

• 32:03Gary Brecka?

  Do you take it in powder or liquid?

• 32:04Speaker 00

  I do it in powder.

• 32:05Gary Brecka?

  Okay.

• 32:05Speaker 00

  And I just dump it into my water along with my electrolytes and I'm good to go.

• 32:10Gary Brecka?

  Yeah.

• 32:10Speaker 00

  But I will do that preceding three days, preceding travel, especially with time zone changes and three days after. And I've come to find that I sleep better. We know that creatine monohydrate can be very helpful for brain support if you are jet lagged, but also if you just have a crappy night of sleep. And occasionally, that even happens to those of us who pride ourselves on having good night's sleep. So I think creatine monohydrate for both men and women is very important. But I think the science is evolving. And what's interesting, because I have some patients that are still getting menstrual cycles. And it's like, if you look at a broad section, there are times in a woman's cycle where we need more and less creatine. And so we have 70, 80% less endogenous creatine stores than men do. So that's why supplementation is so beneficial.

• 32:55Speaker 00

  But if you look at kind of a cross section of women, there's times in the cycle when we can actually benefit from more. That's why I think taking it daily is very helpful. Sometimes people will say, I'm not lifting today. I don't need creatine.

• 33:06Gary Brecka?

  Right.

• 33:06Speaker 00

  And I always say, there's so many other reasons other than muscle strength.

• 33:10Gary Brecka?

  I agree.

• 33:10Speaker 00

  I think it's really, really helpful. And it's an, it's one of those easy, like, straightforward, you know, it doesn't have to be fancy.

• 33:18Gary Brecka?

  Yeah.

• 33:19Speaker 00

  I think it can be an easy thing. You can mix into a smoothie or you can just consume in water. Good quality creatine will dissolve pretty easily in water.

• 33:27Gary Brecka?

  I totally agree with you. You know, you bring up the gut. I remember Dr. Perlmutter, David Perlmutter, wrote a book. And I forget if it was Gut-Brain Connection or Grain-Brain came first. But I read both of his books. And the first one was so eye-opening to me. I mean, he was.

• 33:43Speaker 00

  He's brilliant.

• 33:44Gary Brecka?

  Yeah, he's very brilliant. He's a Naples resident. I was living in Naples at the time. We ran in the same sort of friendship circles. And I read, and I forget which one I read first. It was either Grain-Brain or Gut-Brain Connection that he, that he wrote first. It was the first time that someone had so eloquently articulated the connection between the gut and the brain. He called it the second brain. And he, he also talked a lot about menopause and perimenopause and how.

• 34:14Gary Brecka?

  We're not actually eating, which was the way that he phrased it was so amazing. We don't eat to feed ourselves. We eat to feed our gut bacteria. That's the only reason why we eat and our gut bacteria eat to feed us. So there's an intermediary between the food that we're consuming and the body's ability to utilize that food. And that has to do with our gut microbiota. And I think even in gastrointestinal GI circles, they didn't really put much emphasis. There was emphasis on pathology. Oh, you have diverticulitis, you have ulcerative colitis, you have Crohn's disease, you have irritable bowel syndrome, which is sort of just a name for a collection of symptoms.

• 34:51Gary Brecka?

  And those were widely considered to be things that were just happening to you, right? Not happening within you. And talk about the importance of gut health for women. And, and you know, I think so many things are foundationally rooted in the gut. You talked about for your first time, and this is very common for women. Here you are, this ER nurse practitioner, and you're experiencing anxiety and anxiousness for the first time. And that's frightening because you've gone your whole life not being this anxious or having to deal with anxiety. And all of a sudden, you just have these sensations of impending doom out of nowhere.

• 35:31Gary Brecka?

  And you know, your spouse or your family members are throwing the typical lines at you. There's no reason for you to feel that way. There's nothing for you to be afraid of. Why do you choose to act like this? And the truth is, it's not a choice. And you've heard those. So let me tell you about something that's been a total game changer for my sleep and my stress levels. Buy Optimizers Magnesium Breakthrough. Here's the thing most people don't know. Regular magnesium supplements only give you one or two forms, but your body actually needs seven different forms to function properly. That's why you might be taking magnesium and still feel tired or stressed or having trouble sleeping. Magnesium Breakthrough is the only supplement that combines all seven bioavailable forms in just a single capsule.

• 36:14Gary Brecka?

  Within just a few days, I noticed I was falling asleep faster, staying asleep longer, and waking up actually more refreshed. Plus, my post-workout muscle recovery has been incredible. If you're ready to finally get the deep restorative sleep you deserve and feel more relaxed during the day, head to buyoptimizers.com and use the code ULTIMATE to save on magnesium breakthrough. Trust me, your body will thank you. Now let's get back to the Ultimate Human Podcast. So talk about the, you know, the importance of gut health and for women that are starting this journey, like, how do they evaluate it? Like, where do they start? There's so much information out there on gut health.

• 36:48Speaker 00

  No, you bring up so many good points. I mean, I think that what we now understand about the gut microbiomes, let's unpack that, is exponentially more than any of us were trained with. So when I trained back in the 90s and early 2000s, we weren't talking about the oral microbiome, the vaginal microbiome, the gut microbiome, the lung microbiome, none of that was discussed. I think now we're understanding how critically important our health is interrelationship with these microbiomes. So we have trillions of bacteria and protozoa and fungi that are all beneficial to us in the microbiome, in our guts. And it intersects not just with neurotransmitter production, it intersects with how well we can fight

• 37:30Speaker 00

  off infections, whether or not we make things like short chain fatty acids, which are critically important, how well we feed the colonocytes, which are the cells in the colon that are so important for creating these short chain fatty acids. It's also very important for understanding that there are, there are axes throughout the body. So it's the gut lung axis, the gut bone axis, there's the gut ovarian axis, there's the gut gonadal axis, and it goes on and on and on. So nearly every organ system in the body is intricately connected to the microbiome. And whether it's a function of our modern day lifestyles, where we are super stressed out, we are not supporting our circadian biology, we are

• 38:14Speaker 00

  eating ultra-processed food-like substances, we eat too frequently, we drink too much, you know, we over-exercise, we don't exercise, we have fulfilling relationships, we don't have fulfilling relationships. The role of the evolving research on adverse childhood offense and the effects on the gut, it's, the way that we need to think about it is that everything affects the gut, and everything about the gut impacts every other choice that we make. So those bacteria, fungi, et cetera, influence how our moods are, they influence the way we perceive the world, they influence.

• 38:50Speaker 00

  Our ability to break down different types of macronutrients, they influence, you know, how well our body fights infections. And for women in particular, we know estrogen plays this incredible role in immune system functioning. And so it is involved as well as progesterone with how easily do we have a leaky gut?

• 39:10Gary Brecka?

  Yeah.

• 39:10Speaker 00

  And so I think for a lot of individuals navigating that perimenopause to menopause transition, there's a lot that goes on that makes us much more susceptible to opportunistic infections, that diversity changes. And the irony is before a woman goes into puberty, a young girl and young boys' microbiomes are very similar. The influence of sex hormones, and really now we're trying to think of them not just as sex hormones, but estrogen, progesterone, testosterone, change the microbiomes of young women and young men in puberty. And then the irony is when a woman goes into menopause, our microbiomes start to resemble men's again.

• 39:47Gary Brecka?

  Wow.

• 39:47Speaker 00

  That's how vastly evolved they are. So life comes full circle. And so when we're having these kinds of conversations, I think it is so helpful for people to understand that although we cannot see this, this, all these microorganisms, their, their health is as important as our health.

• 40:05Gary Brecka?

  Trillions of them, yeah.

• 40:06Speaker 00

  Yes. And there's literally nothing that we do in our day to day lives. Like right now, my circadian biology is shifted a bit because I'm on a different time zone, as is yours, all of your team. And so the things and the decisions that we make when we are in the state of hormetic stress, shift the microbiome. So it's like that those bacteria are trying to shift to accommodate all of these changes. And it's fascinating to me, you know, depending on what time you eat, depending on what time you wake up. I mean, those bacteria are constantly shifting in response to our lifestyle. So.

• 40:40Gary Brecka?

  You know, what's interesting, I have a tip that I tell people when they travel, and this has been a game changer for me. And I've never heard anybody else talk about it. And that's, you know, on the East Coast. I'm roughly in bed around 10 o'clock, 10:30, and I'm roughly up by 5, 5:30, maybe 6 o'clock. So that's the timeframe that I'm normally sleeping and I'm pretty consistent about that. I find that if I travel and I eat during my normal sleeping window, so we're five hours ahead here. I would normally be up by 6 o'clock in the morning. So, but if I eat at what would be 1 a.m. or 2 a.m. my time or midnight my time, that wrecks my, it makes my jet lag 5x worse.

• 41:24Gary Brecka?

  And, but if I just preserve that eating window, meaning I, I don't eat when I would normally be sleeping. So if I'm normally awake at 6 a.m., then here I wouldn't start eating before 11 a.m. Just that little shift has made a huge difference in my ability to adapt to time zone changes, and I'm pretty militant about that. And now that you're bringing up a good point, it's very likely tied to, I'm going to refer to it as a term that probably doesn't exist, but the circadian rhythm of my gut microbiome.

• 41:55Speaker 00

  It's a real thing.

• 41:56Gary Brecka?

  So at least I'm feeding them at the same time.

• 41:59Speaker 00

  They like consistency. The body thrives on consistency.

• 42:02Gary Brecka?

  That's why you've been good to me. Yeah.

• 42:03Speaker 00

  Well, and the other thing is when you're jet lagged, you just regulate your glucose, which means your fasting glucose goes up. It means, you know, you have this down toward effect. And, and this is when, when people are jet lagged or sleep deprived, you generally don't make good food choices. You generally will probably drink more alcohol. You probably won't exercise. And so like today, as an example, you know, my friend went and did a bunch of stuff. She's like, if you want to go shopping, I was like, nope, I want to walk around outside with no sunglasses.

• 42:31Gary Brecka?

  Yeah.

• 42:31Speaker 00

  I did that for an hour and a half. I was like, it's really important input for sunlight on my retina, no sunglasses. I have light eyes. Sometimes that can be challenging in the middle of the day. But I did that for 30, for an hour and a half, I grabbed some lunch while I was out. I grabbed a salad, went back to my hotel room and I felt instantaneously better just with that one input. And to your point about when I eat. Maybe it was a little earlier than I normally would eat, but it was roughly around the time that I might be breaking my fast traditionally in the morning. And so I think that as much as we can stay kind of attuned, depending, I mean, if obviously in Asia would be more challenging, but you know, being five hours ahead, it's, it's a little more conceivable that I can get away with that.

• 43:14Gary Brecka?

  Yeah, I go to Australia next week. So I'm like worried about it because I'm like, they're exactly, I think they're 14 hours. So I'm gonna have to do some math on that one.

• 43:22Speaker 00

  Yes, you're gonna be a little bit upside down for sure, for sure.

• 43:25Gary Brecka?

  Yeah. And it's only five days. So it's not enough to jump on that time zone and just deal with it and get through it and change. So, so I'm going to do my best to preserve my feeding window. But of all the things I've done, and I do the same thing you're talking about doing, getting sunlight into my eyes first thing in the mornings. I was dragging ass a little bit when we woke up here and I just put my jogging shorts on and my running shoes and I did like a fast walk and then I worked into a nice light jog. It's kind of hard to jog in London because I'm always about to get hit by a bus coming from the wrong direction.

• 43:55Speaker 00

  And that's, I was gonna say, I have to catch myself. And actually, the cab driver, when I took my cab over, he was like, ma'am, you're gonna get hit. You need to be on the opposite side of the road. And I was like, I know, I know.

• 44:06Gary Brecka?

  Have you seen the look right and look left arrows that are at every one of the crosswalks? They must've wiped out a lot of the Yankees because, because as soon as you come to the crosswalk, there's these big white letters that say, look left and or look right. Cause we're just not used to seeing traffic, you know, instinctively.

• 44:22Speaker 00

  So I tend to stop and wait. And if there are other people that are clearly have inhabitants of London, I let them move first.

• 44:29Gary Brecka?

  Yeah. You're like, just do what they do. I do the same thing in New York.

• 44:31Speaker 00

  Assimilate.

• 44:32Gary Brecka?

  So, you know, we know the, the importance of the gut microbiome, but so for women that are suffering from those conditions that we know are, have a strong link to the gut microbiome. You know, one of the things we didn't talk about was the immune system, which about 70% of it is sitting right there. I think that's because that's where all the action is. But they're having anxiousness or anxiety or, you know, the classic gas, bloating, diarrhea, constipation, irritability, cramping. They can't seem to link it to the food that they're eating. They're on a relatively clean diet. I've had a lot of female clients like this. Where do they start on the gut microbiome bandwagon? They're like, okay, I want to pay attention to the gut.

• 45:16Gary Brecka?

  I want to test it somehow. And I want to fix it or feed it.

• 45:21Speaker 00

  Yeah, I mean, so I think it's very bio individual. So when I'll give you an example, when a patient says to me, I don't tolerate fiber. I'm like, then you really have some disruption in the microbiome. And remember, I mentioned the story of my hospitalization. I couldn't eat a vegetable for almost 18 months.

• 45:40Gary Brecka?

  Wow.

• 45:41Speaker 00

  Because my gut had been so decimated, my microbiome, because I had all these antibiotics.

• 45:45Gary Brecka?

  Oh, IV antibiotics are brutal.

• 45:47Speaker 00

  So I think I was full carnivore for nine months. And my tell, and I'm watching my husband go through this right now. We may talk about his story, but my tell is that when a patient tells me I cannot tolerate fibrous foods of any capacity, I'm like, all right, we need to kind of take 10 steps back. So therapeutically, I like to look at stool testing, and I do think that's important. If someone is, if we've done like a whole 30 and they're still having gas and bloating and diarrhea or constipation, I'm like, all right.

• 46:18Gary Brecka?

  Whole 30 stool, stool test.

• 46:19Speaker 00

  Yeah. So a whole 30 is actually a kind of a broad based elimination. It's gluten grains, dairy, soy, alcohol, sugar. If we pull all those things out and they're still having symptoms, okay, maybe move on to food sensitivity testing.

• 46:32Gary Brecka?

  Okay.

• 46:32Speaker 00

  There are a lot of different stool tests that I like to work with, but I would say stool testing plus food sensitivity testing. And then getting really nuanced about, do they have micronutrient deficiencies? If we're really kind of digging deeper, you know, oftentimes women need a personalized set of recommendations for them. So it could be, you know, maybe they don't have enough digestive fire. Maybe they have, you know, not enough hydrochloric acid to help break down their protein. Maybe their digestive enzymes, which we know as we get older, we just make less of them. It's kind of like everything else. It's like tires that are worn out on a car. So sometimes you have to change out the tires or maybe add some supplementation. So digestive fire issues that can contribute to gas and bloating, underlying food sensitivities

• 47:16Speaker 00

  that can contribute, and that can be very bio individual. I think most women, by the time they're in their 40s, probably are not tolerating gluten, potentially grains and possibly dairy and certainly alcohol. People don't like to hear that because they like their fun foods and I get it.

• 47:33Gary Brecka?

  Right.

• 47:33Speaker 00

  People may find when they travel outside the United States, they can eat bread in Europe, but they can't eat bread at home.

• 47:38Gary Brecka?

  So true, the full of acid, seed oils.

• 47:40Speaker 00

  Yeah, different, different type of dwarf wheat, which is what we have in the United States, which is less likely to spoil versus some of the artesian wheat sources they may use here. When I'm looking at it from a higher level perspective, it's like, are you eating standing up? Are you eating in your car? Are you eating on the go? Are you chronically stressed out? Are you not in a parasympathetic state? Like something that seems so simple, but most of us are not relaxed when we eat because we're rushing, we're eating off our kids' plates, we're eating in the car. We don't eat healthy food. I mean, there's a lot of things. So it's, it's like really getting down to the nuance of that. Certainly when I was rounding on patients in the hospital, I was lucky if I got to go to the doctor's lounge to eat. Like that was, that was unusual.

• 48:23Gary Brecka?

  Yeah, most ER nurses don't pee for 12 hours.

• 48:25Speaker 00

  So what did I do? I was eating crappy protein bars and rounding because I needed to get through rounds and I needed to see the patients in the ICU and consults in the ER and wherever else we were seeing patients. And, you know, we were an interdisciplinary team of, of providers. But now that I have the luxury of being able to slow down a little bit, this is when I'll say to women, okay, what is your, what are you doing when you eat? So that's another piece that can contribute. And, you know, it's also this loss of estrogen and progesterone can definitely impact how quickly we can move food through the digestive system. We know estrogen and progesterone both play a role. We know that when we are more prone to leaky gut, we are more prone to amplifying these

• 49:10Speaker 00

  food sensitivities. We know that we are more likely to be dealing with, you know, It could be a pathogenic. I see a lot of E. coli. I see a lot of salmonella occasionally. We see a lot of dysbiosis, which is an imbalance of beneficial to non beneficial bacteria in the gut. And so that's just a starting point for ground zero. But I find if women are open minded enough to do a little bit of testing, try some elimination diet, add in some digestive fire. And that's not a technical term, but that's just how I choose to explain it to patients. So they understand like that is very personalized. I don't need to take hydrochloric acid, but I do take digestive enzymes. I need that for me personally.

• 49:48Gary Brecka?

  Yep.

• 49:49Speaker 00

  And then the other piece of it is, you know, what's your sleep like? If you're not sleeping, you are not going to make good food choices. When I don't sleep well, I do not crave chicken and broccoli. I'm going to crave, even though I don't eat gluten, I'm going to crave, you know, chocolate. That's usually my vice in life. That's like my one vice.

• 50:06Gary Brecka?

  It's not really such a bad one. I mean.

• 50:08Speaker 00

  But it, but it becomes one of those things. I'm like, hmm, why am I thinking about the chocolate? Oh, it's because I haven't slept well. That is definitely contributing. So I think there's a multi layered, you know, issue that can kind of be apparent, but those are kind of the broad level things that I start to consider that are contributory. And then, again, that loss of estrogen and progesterone. So women that are on HRT are generally having less bloating, gas, constipation, diarrhea.

• 50:33Gary Brecka?

  Very true.

• 50:34Speaker 00

  And to tie up the constipation piece, because I think it needs to be said, constipation is not normal. Full stop. If it's brand new, it needs to be evaluated. If you are someone who is a non public pooper, we have a lot of those in the world. They like to, they have their bathroom at home and they don't feel comfortable in a, you know, in an airport or a hotel room or at their loved one's home. They have to go at home. So they will constipate themselves because they are not relaxed. I think a lot of people that have chronic constipation, some of it is psychological in the sense that their body doesn't feel safe. So whether it's a squatty potty, setting aside time to go. But when a woman says to me, I poop two or three times a week. I'm like, that is a problem.

• 51:16Gary Brecka?

  Huge problem.

• 51:16Speaker 00

  Huge issue. And especially. What women don't realize is that we have this estrobolome in the gut, and that is designed to help us process and recycle excess estrogen. And yes, you can be in an estrogen deficit and be recirculating estrogen that you're exposed to in your environment, personal care products and food. And so helping people understand that estrobolome is a very important facet of having a healthy digestive system, packaging up and processing estrogen. And how do we package it up and process it? Usually it is, you know, there's a, Dr. Carrie Jones always calls it a present, but there's a way that we can package it up and poop it out. And so if you're not pooping every day, and I have to just be blunt, that is not normal.

• 52:01Speaker 00

  Like, we should be going at least once or twice a day.

• 52:03Gary Brecka?

  If you've ever tried water fasting, you know it can be powerful, boosting energy, lowering inflammation, and even supporting detox. But most people jump in unprepared, and within hours, they're hungry, tired, and frustrated, thinking fasting just isn't for them. That's why I created this free three-day water fasting challenge. From October 15th through the 17th, I'll guide you through every step of the way, answer all your questions, and give you the tools, mindset, and motivation to succeed so you can finally experience the benefits of fasting without the struggle. Sign up now using the link below and join me on this transformative journey. Let's make this your easiest and most successful fast yet. Now, let's get back to the Ultimate Human Podcast.

• 52:47Gary Brecka?

  And for those people that have regular issues with constipation, where does their journey start? Magnesium, do you start with supplementation? Do you start with gut microbiome testing?

• 52:57Speaker 00

  Well, I think, I think it depends on the patient because some people are like, before I even think about paying for testing, let's do the basics. Do you need to set aside time? Do you need a squatty potty? Because we know it can lift the knees, that can make things easier. A lot of people are just chronically dehydrated, and that's why they can't poop. I mean, it sounds silly, but our bowels will reabsorb water in the colon. And so when someone says to me they have hard stool, they have publey, you know, pebbly stool, they have hemorrhoids, they really have to strain to go, that's a sign that it could be a hydration issue. Now, if this is brand new, like you all of a sudden are constipated, and it's problematic, that needs to be evaluated by a licensed medical provider because it could be another underlying issue. But in most instances, I would say things like Trefala, which is Ayurvedic, magnesium glycinate or biglycinate can be helpful.

• 53:44Speaker 00

  I think some people benefit from just doing some abdominal massaging. Not that you're sitting there for hours, but sometimes just moving.

• 53:52Gary Brecka?

  Like that.

• 53:53Speaker 00

  Yes, and that kind of clockwise direction can be very helpful. But I feel like I get really good results with Trafala, magnesium. My other trick is usually to do, you know, raw salads can be helpful. But a tablespoon of fresh ground flax and a tablespoon of chia seeds together. Brilliant.

• 54:12Gary Brecka?

  Wow. Tablespoon of chia seeds, tablespoon of fresh ground flax. You put them in a blender?

• 54:16Speaker 00

  You can put them in a blender.

• 54:17Gary Brecka?

  And does it become oily?

• 54:19Speaker 00

  The chia seeds don't need to be ground, but the flax, you know, you want to grind it down. So it's not so kind of chalky. You can put it in a smoothie. And I mean, a tablespoon isn't too much.

• 54:30Gary Brecka?

  Right.

• 54:30Speaker 00

  But I find for a lot of people, like those are simple things. And then, you know, if that doesn't work, we go to aloe vera juice, which doesn't taste great. You know, chlorophyll, I mean, those kinds of things, you can kind of start amplifying it. I'm not a fan of resorting to stimulant laxatives. If you're constipated. I just think there's a lot that can be done. And I find for most people, those kinds of tips are life changing. Like I have women that will travel with, you know, they, they put it all together. They have their chia and flax and they take their tablespoon out every day. And they're like, I don't care if I have to stick it in water. I just know this is what helps me stay regular. And I think that's, and it's, we've gotten conditioned to suppress our urge to go, which is another thing.

• 55:11Speaker 00

  You know, people like when my kids were little, they would, you know, rush home from school because they refuse to go to the bathroom at school. I'm like, you know, you're setting yourself, if you complete, continue to suppress the urge to go, that in and of itself can be a problem.

• 55:24Gary Brecka?

  Yeah, I would totally agree with that. And then there are the women that want to take a dive into their hormones, right? Into their cycling. And this is a wide open area. We gravitated from doing blood testing for hormones to using almost exclusively the Dutch test. And our clinic director was a, or is a board certified OB GYN. She was such a Dr. Sarda, shout out to you, was a big fan of this Dutch test. I learned to read these easy on, early on. And I, I found that it was so much easier to get to the root cause of their hormone deficiency or hormone excess, their dominance.

• 56:06Gary Brecka?

  By looking at the ratio of these hormones throughout this 24 hour period, it's 24 hour urine test. So where do you fall on hormone testing? Do you use the Dutch test? Do you like that one? Are there other ones that you like? And are you a fan of in menopause hormone therapy? Because I will just tell you anecdotally, it was life changing for my wife's age. And for me too.

• 56:33Gary Brecka?

  We've been very open about it. Yeah, I was wrong a lot, did a lot of apologizing for things I didn't do. But you know, just as a human biologist, as she started, I started seeing these symptoms. And she is lean, fit, you know, eats very clean, exercises with a trainer, you know, does all the things. And when all of a sudden, the wheels started getting loose on the wagon.

• 57:00Gary Brecka?

  You know, and she was around that age, you know, late 40s. We took a deep dive and I will tell you, life changing what's happened to her. She had the frozen shoulder. I mean, if it was a menopausal symptom, she had it.

• 57:12Speaker 00

  Poor thing.

• 57:12Gary Brecka?

  The brain fog, sleep disruption, you know, mood imbalances. She would just, I would walk into the room and she would say, I am furious with you. But I know that I have no reason to be furious with you. You may just want to give me some space.

• 57:26Speaker 00

  I would say that would be the loss of estrogen irritability. Yeah, for sure.

• 57:31Gary Brecka?

  And she's like, I don't even know why. And, and then things that were not catastrophic, she would think about it and it would just make her cry. And I was like, babe, this is not you.

• 57:46Speaker 00

  Yeah.

• 57:46Gary Brecka?

  And, and it was relatively rapid onset. But after the Dutch test and supplementing for those deficiencies, we cleared up a COMT gene mutation. Issue that she had mood, sleep, energy, workouts, mood swings, you know, I would say 90% resolved.

• 58:08Speaker 00

  That's great.

• 58:09Gary Brecka?

  And she's so much more comfortable in her body.

• 58:13Speaker 00

  That's great.

• 58:14Gary Brecka?

  But where do you fall on that for menopausal women, you know, getting on hormone therapy? Because there were some scary data out there early on. Most women don't know that the, the study that implicated hormone therapy and breast cancer, unimplicated it later as they continued the study. And that one stigma of hormone therapy, breast cancer, you know, I think has a lot of women frightened to even start.

• 58:41Speaker 00

  Yeah, no, no, I mean, we feel only 5% of US women are on HRT. So that statistic is significant. So number one, I like testing and I like a combination of blood testing. I do saliva testing and I do use the Dutch specifically because I like for certain women, I want to know what's your estrogen metabolism, like how well are you breaking down these metabolites? I do like the Dutch for looking at distribution of cortisol over a 24 hour period of time. I think that's really valuable.

• 59:10Gary Brecka?

  That's really cool too. Yeah, it shows you the.

• 59:11Speaker 00

  Yep, and DHEA. So I think those are certainly important, but I would say that I'm, I'm a combination. So I've always got my allopathic hat on as well as my functional hat to kind of decide what are the tests this patient needs us to run? Now, if someone is still in perimenopause, their hormones are all over the place.

• 59:29Gary Brecka?

  Right.

• 59:29Speaker 00

  And, and it becomes more challenging. Now, some women will say, I know if I look at an FSH or an AMH, the anti-malarian hormone, I might have a sense of where I am on the trajectory of, am I getting, am I knocking on the door of menopause or am I not? And so that can be helpful, but we do know that, you know, our estrogen, as an example, is 20 to 30% higher in perimenopause than it is at any other time in our lives, which is why women have so many symptoms.

• 59:57Gary Brecka?

  Right.

• 59:57Speaker 00

  You know, this relative, and I hate the term estrogen dominance, but we have, our ovaries are making less progesterone, the adrenals are kind of stepping in to be a backup quarterback, and we have this relative estrogen dominance because we have 20 to 30% higher levels for a period of time and then it drops off, kind of like everything else.

• 1:00:15Gary Brecka?

  But that's when the water retention shows up and. They're retaining water for no apparent reason, no change in diet, no change in lifestyle habits. I mean, that is super frustrating.

• 1:00:25Speaker 00

  Yeah, oh, totally.

• 1:00:26Gary Brecka?

  When a woman just starts retaining water out of nowhere.

• 1:00:29Speaker 00

  And I think some women are more sensitive to that because

• 1:00:32Gary Brecka?

  I think so, too.

• 1:00:33Speaker 00

  Some people are just like even with, and I am pro hormone replacement therapy, which I will get to.

• 1:00:39Gary Brecka?

  That's what I wanted to get to.

• 1:00:39Speaker 00

  But I think that progesterone in some women, like it doesn't cause me any fluid retention. But when I was pregnant years ago, when I was put on progesterone in my first trimester, I recall like I was incredibly bloated, but it was probably more a function of the pregnancy than it was the progesterone. So I'll just go without saying that. The study that you are referring to is the Women's Health Initiative that was published in 2002. So I was a baby nurse practitioner. And even though I was not prescribing hormones, I was in cardiology and I had patients coming into my office who were crying, who were upset, who were devastated. They were taken off their hormones. Now, we have some good data from that study, but we also have a lot of information that was misinterpreted, you know,

• 1:01:24Speaker 00

  just to give kind of broad strokes, it was largely an older population, people that were more than 10 years into menopause. Many of them were former smokers. Many of them were obese. Many of them had underlying hypertension, high blood pressure, you know, in some instances, probably not metabolically healthy. And they extrapolated that information. They were looking at progestins, so non-bio-identical progesterone. They were also looking at conjugated equine estrogen, which is Primorin.

• 1:01:48Gary Brecka?

  Yep.

• 1:01:49Speaker 00

  So they weren't looking at bio-identical hormones. And actually, you know, the research certainly suggests if you pull all the research out of that study, we know that estrogen has some very protective effects for the breast. There's a book called Estrogen Matters, written by an oncologist, Dr. Avram Bloming and Dr. Carol Taver. She's a researcher. Excellent resource. That's usually what I recommend to people if they really want to understand what the WHO did wrong. Again, now things are coming full circle. We're talking more openly about the fact that these were not body identical or bio identical hormones. They were extrapolating a lot of, we know that progestins are not particularly helpful for women in terms of,

• 1:02:32Speaker 00

  there's no equivalency to body identical or bio identical progesterones. Same thing with conjugated equine estrogen, you're getting like 40 different estrogen metabolites. It's not the same as estradiol, which is the predominant form of estrogen our bodies make up until menopause. So I am very pro HRT if that is the right choice. It is a shared decision-making. What I find is people are still scared.

• 1:02:55Gary Brecka?

  I agree.

• 1:02:55Speaker 00

  They are worried that hormones equal cancer. And so we have to have those conversations. I'm like, listen, you're still going to get your mammogram. You're still going to get pelvic exams. This month is actually gynecologic cancer awareness month. And so there are five major gynecologic cancers. So I tell everyone that's why getting a pelvic is important. Because, you know, unfortunately ovarian cancer, there's very little signs that happen. But for most women, it's important to get a exterior, to get your exterior hardware checked out by your GYN or your internist or whoever's doing that exam. So when we're talking about hormone replacement therapy, we're talking about progesterone, we're talking about estrogen, and in most instances, we're also talking about testosterone. I would

• 1:03:38Speaker 00

  actually argue that whether that's thyroid replacement, we're talking about DHEA for people who need it, pregnenolone, which is so important for memory, really, really important.

• 1:03:48Gary Brecka?

  It's a precursor for so many downstream cortisol's.

• 1:03:52Speaker 00

  And very important for maintaining memory. So I tell everyone that's something that I check on my patients, just to kind of see where we are. But I find for most women, if we're starting with a hormone, we're probably starting with oral progesterone. Oral progesterone, you know, I sometimes will hear, well, my doctor said that my uterus was taken out, so I don't need progesterone. I'm like, no, no, no. These are not just sex hormones. They are hormones that nearly every receptor in the body uses. We have progesterone receptors on bone in our brains. It is so, so important. So generally progesterone, because a byproduct of that is a neuro steroid, allopregnenolone, that is so important for sleep, inducing sleep. Are there people that are sensitive, intolerant, or even allergic to progesterone?

• 1:04:35Speaker 00

  Yes, but most people do just fine. Usually start with progesterone, then I usually will move on to estrogen, then testosterone if that's needed.

• 1:04:43Gary Brecka?

  Yeah.

• 1:04:45Speaker 00

  This is my personal feeling. I, I am probably a little more conservative. I am not a pellet fan because it can be wildly unpredictable. I've had women who insist they know their testosterone levels are low because they went from feeling awesome to then they feel terrible. And it turns out their testosterone is three times what it should be.

• 1:05:03Gary Brecka?

  Right.

• 1:05:04Speaker 00

  And so I was-

• 1:05:05Gary Brecka?

  And you're stuck with it very often. If it's overdosed, you're stuck for that. And if you're underdosed, you might be stuck too. Um, um, yeah, if you're underdosed, you might be, might be stuck too.

• 1:05:15Speaker 00

  Yeah.

• 1:05:15Gary Brecka?

  I, I, you know, I think the sublinguals, we use a lot of sublinguals patches because if you make a dosing mistake or metabolism mistake, you just, you can, you can correct it. I'm glad to hear we're on the same page with that. I just, you know, I wanted to undistill some of the fear because I think, you know, it's, it's like the old Time Magazine article on saturated fat. I mean, we're still trying to undo the war on saturated fat.

• 1:05:42Speaker 00

  Well, and what's interesting is it goes, this is so cardiology and lipids were my like pet interest and, and passion for years. And I remind people, the bio-individuality piece is important. And it's important to understand that what is happening with estrogen. So women will say to me, I'll give you an example. I'm 55, I'm 45, I'm 60, whatever age they are. I don't need hormones. I feel great. And I would be the first person to say, and I respect that. And I think I, I am all about women's right to choose with shared decision-making.

• 1:06:14Gary Brecka?

  Right.

• 1:06:15Speaker 00

  But what women do not understand is that as we are navigating this perimenopause to menopause transition, there is a lot of inflammation that is below the surface. And I'm going to give you one example. Estrogen is intricately tied into nitric oxide production. Nitric oxide is very important for the endothelial lining in our blood vessels. So as estrogen's going down, as we are making less nitric oxide, our blood vessels can't dilate and, and come back together and, and come back together the way they once did. It also sets up a lot of inflammatory pathways. And so women will say, I don't need estrogen. Yeah, you do. You know, the number one killer of women is heart disease.

• 1:06:54Gary Brecka?

  Yeah.

• 1:06:55Speaker 00

  Full stop. One in three women will die of atherosclerotic cardiovascular disease. So the things that I think about when I'm talking to a female patient about hormone replacement therapy is I just want you to understand what the research says about whether it's oral estradiol or a patch. And we could argue that for certain people, maybe oral estradiol in very low dose might be better and more heart protective than a transdermal dose. But that's, again, very bio individual. You start looking at how estrogen works mechanistically in the body. And so there's a class of drugs right now called PCSK9 inhibitors, Repatha. They're very expensive, but it's one of the few drugs that will drop LP little a.

• 1:07:37Gary Brecka?

  It does drop LP little a. I didn't know there was a pharmaceutical solution to it.

• 1:07:41Speaker 00

  So it's unfortunate because it's super expensive and not everyone can afford it. And what I say is like the kind of expensive, like thousands of dollars a month expensive.

• 1:07:49Gary Brecka?

  Wow.

• 1:07:49Speaker 00

  Like, most people can't afford that. And the traditional labs that are done for men and women, they look at a total cholesterol, they look at LDL, which used to be called ad cholesterol and HGL, good cholesterol, and triglycerides. So that's a standard lipid panel. We are still seeing providers that are only doing that and trying to prescribe a statin.

• 1:08:14Gary Brecka?

  Yes.

• 1:08:14Speaker 00

  Based on that alone.

• 1:08:16Gary Brecka?

  Just LDL. If it's above 99, statin.

• 1:08:18Speaker 00

  And so if your LDL is high, it's probably a sign that another lipoprotein, apolipoprotein B is probably high. And that is something we need to look at as well as LP little a.

• 1:08:31Gary Brecka?

  Yep.

• 1:08:31Speaker 00

  Why are they important? Because they are more impactful on our overall risk for developing heart disease. And I would argue most providers are not looking at these.

• 1:08:41Gary Brecka?

  I would argue that, too.

• 1:08:42Speaker 00

  LP little a is genetic. Mine is high. I got it from both my parents. And that's why I know so much about PCSK9s. What's interesting is estrogen acts like a PCSK9 inhibitor.

• 1:08:52Gary Brecka?

  Wow.

• 1:08:53Speaker 00

  So for someone who has a high LP little a, I would argue that estrogen replacement therapy is critically important.

• 1:09:00Gary Brecka?

  Wow.

• 1:09:01Speaker 00

  And so when I'm talking about whether it's heart disease risk, bone health risk, dementia risk, it's just important. And those are like the three big ones. But it also goes into like, are you more likely to have leaky gut? Are you more likely to develop neurocognitive decline? Are you more likely to develop, you know? Frailty issues. And so it really becomes this domino effect. So yes, I am pro HRT.

• 1:09:23Gary Brecka?

  Okay, good.

• 1:09:23Speaker 00

  Always with the context of what is your own biological risks? And so for someone who is not metabolically healthy, maybe has high, now, again, it's genetics, like you can't, sometimes we can't fix genetics. But it's helpful to understand, like, what are your specific risks? So APOB, LP little a needs to be drawn on everyone. And what's interesting is 20% of the population has a high LP little a. And if you're African American, it's 50%.

• 1:09:51Gary Brecka?

  Wow.

• 1:09:52Speaker 00

  And we know that most African Americans are not getting the kind of care they deserve to have. So I want to make sure I just say that in case you're listening, get it checked. If it's low, great. If it's not low, and more often than not, we see those numbers going up. APOB, LP little a go up in menopause.

• 1:10:10Gary Brecka?

  Yep.

• 1:10:10Speaker 00

  Not as dramatically, probably in andropause. The other thing that I'll just tie into this, I'm going to get off the lipids thing, my lipid soapbox, triglycerides. No, it's important because people don't talk about this.

• 1:10:19Gary Brecka?

  It's so important.

• 1:10:20Speaker 00

  Triglycerides. If your triglycerides are more than 70, you have work to do. I would argue that the traditional, you know, you should be less than 150 milligrams per deciliter. You're already dealing with some degree of insulin resistance.

• 1:10:32Gary Brecka?

  Yes.

• 1:10:32Speaker 00

  And not enough people are talking about this.

• 1:10:34Gary Brecka?

  Yeah. And the insulin resistance ties to the triglyceride. People that eat the most sugar have the highest blood fat.

• 1:10:40Speaker 00

  Yep.

• 1:10:40Gary Brecka?

  It's not people that eat the most fat have the highest blood fat. I think when you see triglyceride, you equate that to fat. So I reduce my saturated fat intake, which causes you to increase your carbohydrate intake. And then it gets worse and it doesn't make sense to you. In fact, when I, when I was doing labs on Dana White, and his triglycerides were critically elevated, I put him on a 10 week keto reset, just for 10 weeks, to bring his triglycerides down.

• 1:11:03Speaker 00

  How high were they?

• 1:11:03Gary Brecka?

  Um, 790.

• 1:11:05Speaker 00

  And a good risk for pancreatitis.

• 1:11:07Gary Brecka?

  Fasted.

• 1:11:08Speaker 00

  And it's, if you look at the labs when they're drawn, they're very fatty.

• 1:11:12Gary Brecka?

  Oh, yeah. The, the, I'll never forget, my, my daughter was a nurse that drew the labs on him. And, uh, you know, you lay the, the vials on the table, you wait 30 minutes to spin it. So she, she had him laying, uh, who's in his office. And she went around the corner where he couldn't see her and, and I could. And she was like, oh my God.

• 1:11:31Speaker 00

  Yeah.

• 1:11:32Gary Brecka?

  And she inverted the bottom and it was already beginning to coagulate.

• 1:11:35Speaker 00

  Someone like that, if you're over 500, they're at risk for pancreatitis.

• 1:11:38Gary Brecka?

  Yeah. So he was right on that verge. But Cynthia, this was like amazing advice. You're amazing. I want to touch on two other things real quick. You have a new book coming out, which I want to highlight. I'm going to put a link in the show notes so my listeners can hopefully get on a pre-launch list for you. What's the title of your new book?

• 1:11:59Speaker 00

  The Menopause Gut.

• 1:12:02Gary Brecka?

  She showed me the cover today too, and it's beautiful. So.

• 1:12:04Speaker 00

  No, it's gonna dive into all the things with the gut microbiome, all the things that change. And like I was mentioning earlier, when we go into menopause, how trauma impacts the microbiome, how a healthy gut impacts how well our bones stay healthy. I mean, it literally impacts every part of the body.

• 1:12:21Gary Brecka?

  And for my listeners that want to know how to find you, where can they find you?

• 1:12:25Speaker 00

  Probably easiest to go to my website, www.cynthiaThurlow.com. You can access to my web to my podcast, Everyday Wellness, and all my social media channels.

• 1:12:33Gary Brecka?

  Okay, great. I'm going to make sure we put that in the show notes. And I wind down every podcast by asking all my guests the same question. There's no right or wrong answer to this question, but what does it mean to you to be an ultimate human?

• 1:12:47Speaker 00

  You know, I think that the way that I would answer that, being an ultimate human is being like the ultimate example, not just to my family, but also my community. Because ultimately, I'm not saying I'm perfect, but I do endeavor to make sure that I'm living a virtuous, kind, thoughtful life and doing everything I can to live as healthfully as I possibly can. Because, you know, they talk about the marginal decade. I don't ever want that to be the case. So doing all the things I can now to forestall ever having to deal with that.

• 1:13:19Gary Brecka?

  That's such a great answer. Well, I'd love to have you back when your book launches and talk about how that's going for you. And my audience is going to eat that up. So thank you so much for coming on The Ultimate Human today.

• 1:13:32Speaker 00

  Thanks for having me.

• 1:13:33Gary Brecka?

  And as always, that's just science.