>> Hi.

I'm Lewis Howes, New York Times best-selling author and entrepreneur.

And welcome to "The School of Greatness," where we interview the most influential minds in the world to inspire you to live your best life today.

And in this episode, Cynthia Thurlow, a globally recognized expert in intermittent fasting and women's health, shares the transformational benefits of fasting.

We discuss optimal digestive health, the importance of sleep, and how intermittent fasting can lead to a more balanced life.

Tune in for practical tips and empowering knowledge to optimize your overall well-being.

I'm so glad you're here today.

Now let's dive in and let the class begin.

♪♪ ♪♪ What is the science showing us when we do a 24-hour fast and a 48-hour fast?

what is actually happening to our bodies?

Is it healing our body?

Is the autophagy settling in or starting at 24 hours?

What is the science that happens after 24 hours of water-only fasting?

>> Well, first and foremost, congratulations on, you know, being almost two days into a fast and you feel fantastic.

>> Thank you.

>> But I think that when we're talking about fasting, I think most people think about intermittent fasting.

So the shorter intervals.

But with longer episodes of fasting, you really get into deeper autophagy, which is this waste and recycling process that goes on behind the scenes when we're in an unfed state.

And this is particularly important, you know, given the last 2 1/2 years, where we've had a lot of illness and concerns about illness.

We get upregulation and, you know, other principles.

Stem-cell activation over, you know, two to three days' worth of fasting.

I think a lot of people don't even understand that giving ourselves that period of digestive rest can really help heal the gut.

I mean, how many of us have leaky gut and autoimmune disorders?

And so I think, on a lot of levels, there is this improvement in biophysical markers.

We know we get, you know, lowered insulin levels, which allows our bodies to be much more efficient and be able to use different types of fuel substrates.

So, not only fatty acids but also glucose, and getting into a point where our bodies can use ketones.

That's why you have so much energy, you have all that mental clarity, because your body's really just functioning on optimizing your health, as opposed to, you know, the chronic eat every two to three hours, and you know, kind of the kind of traditional methodology.

But the longer we fast, we're really looking at upregulation of autophagy, reduction in inflammation, improvement in biophysical markers.

If you fast long enough, usually closer to four to five days, you're getting stem-cell activation.

>> Really?

>> Yeah, and for a lot of people, that's a huge benefit that they're looking for.

You get improvement in telomere length, which is some of the key anti-aging benefits of fasting.

And so I think, on a lot of levels, people think about intermittent fasting as these shorter intervals.

But there are benefits from doing longer fasts, as well.

Kind of shaking things up.

>> What -- Is there different benefits for for men and women?

You know, 24, two days, three days.

Does it hurt the other gender, the longer you go?

Does it affect hormones?

How does it all work for men and women?

>> Oh, it's a great question.

I think men and menopausal women -- so women who have not had a menstrual cycle for more than 12 months -- they're in unique categories.

There's not just -- not as much hormonal fluctuation.

So they can generally fast when they want to.

Whereas younger women, especially when they're under the age of 35, still at peak fertile years, I'm a little more cautious.

I always say, fast for your menstrual cycle.

So there's times in your menstrual cycle when you can get away with fasting, times you should back off.

And then perimenopause is kind of this nebulous time.

You know, that's 10 to 15 years before women go through menopause.

It can be a time when women have to be a little more careful about their lifestyle.

>> So, after 35, when should women fast, and for how long?

>> It's a good question.

I think it's really dependent on the individual.

So, typically, I say, if you're, you know, late 30s early 40s, and you're in the follicular phase -- so for the time for when you start bleeding until ovulation -- women can get away with quite a bit of fasting.

>> So you can fast during that time?

>> Fasting during that time is generally not an issue, but you got to dial in on sleep and stress and right types of exercise, anti-inflammatory nutrition.

So it gets a little more nuanced and complicated.

And I think, for a lot of women, as they're getting older, they start to realize things aren't working quite as well.

>> Like what stops working as well?

>> You know, as we're getting fluctuating amounts of, like, our ovaries aren't making as much progesterone, so our adrenal glands are kind of stepping in to help buffer that.

We go through something called adrenal pause, of all things, where we're just not as stress-resilient.

It doesn't mean we can't manage stress.

We just have to be much more diligent about that.

We're having, you know, imbalances between those two key sex hormones, progesterone and estrogen.

And so we suddenly become weight-loss resistant.

We are struggling with breast pain, we're having heavier cycles.

>> Really?

>> And this is all things that we don't talk enough about with our patients, and certainly not amongst other women.

So a lot of women get into that age, and all of a sudden, they're like, "What in the world is going on?

Everything I used to do no longer works."

And that's when I think fasting can really -- if practiced properly, can really be a fantastic strategy.

>> So, what are some of the challenges that you've had, I guess, or the changes you've had, where fasting has supported, you know, not hurting you as much or supporting you in ways?

>> Well, I think, you know, we've taught our patients for so many years, "Eat snacks, eat mini meals, stoke your metabolism."

I'm here to tell people that our bodies intrinsically are designed to go longer periods without eating.

And so when we're looking at women north of 35 or menopausal ages, all of a sudden, you know, the calories-in, calories-out model doesn't work.

And the eating with all that frequency and eating heart-healthy grains and following MyPlate is really putting us at a disadvantage.

So I think, on a lot of levels, eating less frequently, combined with having more protein, eating less processed carbs, maybe drinking less alcohol, all of a sudden, women are sleeping better, they're less inflamed, they're losing weight.

And so I think, for a lot of women, it's figuring out what's the right recipe, if you will, to allow them to continue to, you know, age in a way that is aligned with their -- the way they want to live their lives.

>> So, you're a mom, you got two teenage boys.

What is the fasting practice that you do in your life at this season of life?

>> Yeah, I would say, for me, I fast consistently, but it's -- I'm not doing a lot of long fasts.

I did that before, and I always say -- >> Multiple-day fasts.

>> I used to do that, and then I had a hospitalization, and then I said, "I will never fast like that ever again."

>> Really?

>> Yeah, that was -- That whole process of going through that, I said, "I've checked the box, I've done some very long fasts."

>> What was the longest?

>> Willingly?

That I wanted to fast?

>> Yeah.

>> Probably five days.

And then, you know, when I had a 13-day hospitalization and didn't eat, I just said, "I've done that.

I don't need to do that again."

So my typical -- >> Did the hospitalization start because of the fast?

>> No, I had a ruptured appendix.

>> Oh, wow.

>> And the ruptured appendix led to, you know, one complication after another.

>> You didn't eat for 13 days.

>> No.

>> So, you're the fasting person, but you did it not wanting to do it?

>> No, no, no.

>> At that point, yeah.

>> And you know, I had a slew of complications, but I was so sick, I lost 15 pounds in 13 days.

And so I came out of the hospital looking like a skeleton.

>> Bones.

>> Yeah, but it was -- >> When was this?

>> 2019.

>> Oh, wow.

Okay.

Is this before the TED Talk?

>> This is what preceded that talk.

>> Okay, so, what did you learn from this hospitalization?

>> Oh, gosh.

Well, there's nothing more humbling than being a healthcare provider and then becoming a patient.

>> Oh, man.

>> And I recognized the first week I knew how sick I was.

And I had a fantastic team of doctors and a fantastic team of nurses.

But there's something to be said for even the most positive person suddenly becoming despondent and depressed.

And I felt, five days in, I was so depressed because my surgeon kept saying, "We don't know why you're not getting better.

We don't know why you're not getting better."

And I knew that if they didn't figure out why I wasn't getting better, then there was not going to be a positive outcome.

>> Oh.

>> And so I always say that whether it was a spirit, the universe, something came to me and said, "You have a choice.

What's your choice?"

And my choice was, I wanted to live.

I wanted to get home to my kids and I wanted to live.

And so, from that point forward, I said, "I promise that if I get out of this hospital and get out of this bed, I'm going to -- there are specific things I'm going to focus on -- my family, I want to do this talk."

I missed every milestone for this TED Talk because I was in the hospital.

And I said, "I'm so committed to doing this talk, I want to show my kids I'm okay.

I want them to know I'm okay."

And that was the intention I set, was that, "If I get out of this hospital, I'm going to do this talk to prove to my kids that I'm okay."

>> Wow.

Did you have this talk planned before the hospital?

>> Not 100%.

>> Okay.

>> I just knew the topic, and that was what we had agreed upon for this particular venue.

>> Wow.

>> And for me, the big message was, "Through adversity comes opportunity."

And so I, you know, 27 days after I left the hospital, I did that talk.

>> Come on.

>> 27 days, and I did it with a ruptured appendix.

>> Oh, my gosh.

>> Yeah, I was too sick to take to surgery.

I had so many complications, they just said, "If we can stabilize you enough, we'll send you home.

We'll do surgery later."

>> Did you eventually do surgery?

>> I did, 10 days after that.

>> Holy cow.

>> And so I went to -- I didn't feel bad once I got out of the hospital, and my mom was, you know, feeding, making sure I was eating anything, just to stay, you know -- stay alive.

>> Nourished, yeah.

So, what was the complication in the first place?

Like, what happened?

Do they know?

Well, I had -- So, it was the the ruptured appendix, but by the time I went to the hospital -- and it wasn't as if I ignored symptoms.

I thought I had food poisoning until I didn't.

And then, when I went to the hospital, they found out my entire length of my colon was inflamed.

>> Ew.

>> And they said, "If we take you to surgery tonight, we're going to take your colon."

I said, "Time-out.

I need my colon."

And they're like, "No, no, you don't need your colon."

I said, "No, I need my colon."

And so I said, "Please give me the time to save my colon," because if you don't have a colon, you wear a colostomy bag.

>> Oh, no.

>> And that was not how I wanted -- >> You didn't want to live.

>> No, and so then it turned into, on day 2, I developed a small-bowel obstruction.

I looked six months pregnant.

>> Come on.

>> And then, by day 5 or 6, they figured out I had -- they call them retroperitoneal abscesses, which means, in your peritoneum, which is your sterile cavity of your abdomen, I had developed abscesses, so infections.

So they had to call in an interventional radiologist in the middle of the night to put drains in.

>> Ew.

>> And then I developed a fistula.

So it was kind of like this domino effect.

And my surgeon kept saying this would only happen to another healthcare provider.

And there's nothing worse than knowing something's wrong with you and being in a position where you just fully have to surrender.

>> Ohh.

[ Sighs ] >> Maybe that's the bigger message, is that I had to just surrender.

I could not outthink anything that was going on.

And I remember my cousin, who's a physician, came to stay with me, because I told my husband to keep the kids out of the hospital, because they were so stressed.

And she kept telling me -- she was like, "You can't buck what they're trying to recommend."

You know, they gave me liquid nutrition in a bag.

And I kept saying, do you have any organic TPN?"

which is this total parenteral nutrition.

And my cousin's like, "You need to stop it."

>> "Just take whatever."

>> Yeah, exactly.

That was the takeaway, is just surrender to the process.

>> Wow.

How long were you fasting or trying intermittent or longer fast before this moment?

>> Oh, probably five days was probably my max.

>> I mean, for how many years before, did you start?

>> Oh, at least three or four, prior to that.

So I was definitely, you know, metabolically healthy.

And I credit the fact that I had a very different outcome than other people would have had, with the fact that I was so healthy.

I had enough reserve, not a lot, as evidenced by the fact that I lost so much weight, but my body was breaking my muscle down for food.

That's essentially what happened.

>> It's crazy.

>> It's hard to process.

>> So what do you think led to that?

What was, like, the root cause of that happening, do you think?

>> I've had conversations with a good friend, a mutual friend, Dr. Gabrielle Lyon.

And about six months before I got sick, I had been in Morocco.

My husband and I had gone to Morocco.

We were celebrating an anniversary, went to Morocco and Spain.

And in Morocco, I got the worst food poisoning of my life.

Like, to the point where I was like, "This is bad.

I don't want to be in Morocco and be sick."

And so we suspect that probably started a cascade of events, because I picked up a parasite.

And our working kind of hypothesis is, that was probably the starting point that that just kind of got things rolling.

But I feel so fortunate that I was having the ruptured appendix in the United States... >> Right.

Oh, my gosh.

>> ...where I could get a certain degree of care.

>> So, you don't think the fasting -- the extreme fasting to five days -- was any effect -- or had any effect on this?

>> No, and I didn't do really long fast with any frequency.

I mean, there's certainly a law of diminishing returns if you're lean.

>> You're not going to lose more weight, just going to lose the muscle.

>> And so I'm very proactive about not losing muscle.

So, for me, it was definitely not that I had been doing too much fasting.

I just suspect it was the timing.

I'd literally just gotten back from a trip with my husband.

I accompanied him to Hawaii.

He had a business trip.

And I was like, "Oh, I'm going to practice.

I'm going to start writing my TED Talk" while I was there.

And so I just think it was -- I'm grateful I didn't have a ruptured appendix on the plane.

You know, the things I think about, coming all the way from Hawaii, all the way back to the East Coast, which is a pretty long leg -- >> Long.

>> You know, for me, I just say I'm grateful that it happened in a hospital where I knew the doctors, I knew a lot of the nurses, I know I got exemplary care.

There's no question.

>> Right.

So, what have we learned, then, about the metabolism?

Because you mentioned about how people have been thinking -- or the latest trends in the last 10, 15 years is, like, have small meals every two, three hours -- you know, little snacks, six meals a day, whatever it is, because that speeds up the metabolism, I think, is what has been said.

What is the research or the science saying about, you know, that not being the case and actually having less meals, in your mind?

>> Well, I mean, I really am very aligned with this whole Carb-Insulin Model for metabolic health.

And so, when we're telling our patients and we're telling the general public, "Eat to stoke your metabolism," breakfast is the most important meal of the day.

I'm here to tell people that eating so frequently and eating a lot of carbohydrates is keeping your insulin levels higher than they should be, which is going to make it virtually impossible to lose weight, because you need your insulin levels to be low, to actually free up fatty acids, stored fat, to be able to use as a fuel substrate.

And so I think we have really done a tremendous disservice to the public.

I think, a lot of, you know, what we see coming out from the federal government, whether it's MyPlate or a lot of the plant-based narrative.

And I don't want to be inflammatory, because I'm respectful of people's choices.

But I think a lot of the information that we've been sharing with patients has been disproven on a lot of different levels, that we need to eat less frequently, more protein, right types of fats, right types of carbohydrates.

I'm not anti-carb, but for the bulk of the population, when we look at studies, I mean, 7% to 8% of the population is metabolically healthy, coming out of this pandemic.

We've got to change what we're doing.

We have to course-correct.

And so, you know, looking -- leaning into the research that's looking at, you know, these low-carb ketogenic diets, more protein, helping with satiety.

Think about it.

When we're eating snacks and mini meals, were you ever satiated?

No.

Your blood sugar goes up, it comes back down.

And it's, you know, this roller coaster of constant hunger, lack of satiety.

So you're eating more foods.

I mean, I think about the fact that I have teenage boys and, you know, their running mantra in our house is, "Where's the protein?"

They're like, "Mom!"

And they'll have -- You know, they'll sit down and I'm like, "I don't mind if you have the pasta.

You're a growing athlete.

This is different."

>> You're running around for three hours a day, you can have a bowl of pasta, >> Right, and you can have rice.

But where's your protein?

And so that's always the conversation.

>> Interesting.

>> So if you really look at a lot of the metabolic health research that's being done -- people like Ben Bikman, who's an insulin researcher and is really talking about the role of insulin, that at the basis of all chronic disease right now is insulin resistance.

>> Really?

>> And so high blood pressure, obviously diabetes, polycystic ovarian syndrome, a lot of these neurocognitive disorders that we're starting to see, like early-onset dementia, Alzheimer's, Parkinson's.

All at the root cause, at the base, are a lot of these insulin disorders.

And so -- >> You get, you know, your, I guess, your insulin spikes just when you're eating.

So if you're eating less, then your insulin will go down.

>> Right, and so, in response.

So, we know that when we're looking at macronutrients -- so protein, fat, and carbohydrates -- we're going to have a more exaggerated response with carbohydrates than protein, than fats.

And so explaining to people that we're not -- I'm not anti-carb at all.

It's just understanding, you want to always be making sure that when you're having a meal, you want to blunt that response.

So we don't want these wildly exaggerated blood sugar responses.

We want to have a blood sugar response, of course, but we don't have to secrete so much insulin to bring that blood sugar back down.

>> Yes.

>> And so that's unfortunately what happens, is people have chronically high insulin, they're weight-loss-resistant.

And it's because their body can't go in and free up those fatty acids, because they're just constantly stoking this fire.

>> And if we never give our digestive system rest, what happens?

If it's like kind of, okay, every three -- two, three, four hours, there's something we're ingesting, and it's always working, what is happening to our gut, our brain, and our body?

>> No, that's a great point.

Well, there's lots of things, physiologically, that go on, that are unable to be optimized when we're chronically eating.

One example is there's something called the migrating motor complex.

It's kind of like the janitor in the gut.

It's kind of pushing things along, pushing food along.

And we need about four to five hours for that to kind of -- that sweet sweeper to come through.

And it's getting rid of debris and things that don't belong in the gut.

And so if you're eating all the time, it's like your gut just becomes really less optimized.

It doesn't get into a position where you'll actually be able to take the time to extract all the nutrients.

It's almost like you're -- It's like -- The best example I can give you is, my dad likes to fill his tank when he gets to, you know, three-quarters of a tank.

And it's like you're constantly topping off the tank.

You're never allowing your body to actually utilize the fuel that you've eaten.

You're just storing it because your body is never in this position where it's able to fully enjoy this.

So, what happens with your brain?

You've got high insulin.

If you've got high blood sugar, you're going to have brain fog.

You might get tired.

You know, think about all the people that want to take a nap after a meal.

That's not normal.

And that's because your body's, you know, trying to figure out how to manage this blood sugar response.

People will deal with constipation.

One of the first things people will say, when they're fasting is, "Oh, my gosh, I didn't realize I was meant to have a bowel movement once a day," and it's because they're constipated.

Their body is just literally backed up with a backlog of nutrients.

Yeah, so it's definitely -- There's a lot of things, from subtle changes.

Energy, cognition can be impacted adversely.

And just, you know, the other piece of it that I always explain to people is, people think it's normal to be bloated, people think it's normal to be constipated.

And a lot of it is, you're just not allowing your body to be fully optimized.

You're not allowing your body to get to a position where it's able to utilize what you fed it.

You're just continuing to top off that tank.

>> So, how many meals a day should we have?

Because Dr. David Sinclair says that he's now been doing kind of a one-meal-a-day approach and just having a longer fast almost every day.

And he's seeing benefits from that experiment for himself.

Should we be doing two meals a day?

How much time in between our meals, where you don't have the top-off feeling?

What's your beliefs on that?

>> Well, I obviously respect Dr. Sinclair's work enormously, but the longevity researchers, they're not meeting their protein needs.

So, to me, at a bare minimum, if we're looking at the changes that happen in skeletal muscle with aging, and that impacts our insulin sensitivity, I always say at least two meals a day.

Really depends.

I have some very athletic men that can manage to fit it.

>> Need more.

>> Right, they need those three meals to get at least their boluses of protein in, to help ward off sarcopenia, which is this muscle loss with aging.

So the right answer is bioindividuality rules.

I think most women can get by with two meals.

I think very active men probably need three.

I'm not a fan of OMAD as a sustained strategy.

>> What's OMAD?

>> OMAD is "one meal a day."

>> Only one meal a day?

>> Because you just can't hit your protein macros.

There's no way.

>> Especially if you're -- You know, I'm 6'4", 240 pounds, so I probably need 200 grams of protein a day.

>> Correct.

>> Especially if I'm lifting and running and, you know, physical.

>> Yeah, and I think that's where I always -- It's interesting, during, you know, the height of, like, the book-launch press that I was doing, I got that question a lot, and I would say, "I am not aligned with some of the longevity researchers, in the respect that I'm far more concerned about maintaining skeletal muscle then I am worried about restricting calories to a point where you're chronically going to be in a state of not enough stability.

>> Because if you're 60, 70, 80, and you fall and you can't push yourself up, then that's another issue.

>> Yeah, that loss of strength.

>> So it's learning how to stay flexible and strong as we age, not just, you know, having minimal calories.

>> Right, and I think that's an important distinction, because I inherited a -- I now co-host another podcast.

And one of the things that I differentiated with the prior podcast host was, I'm not a big fan of OMAD, and let me tell you why.

I said, I'm not saying, if you're on vacation, you overate, the next day, you're like, "I need to get back on track just have one meal."

But as a sustained strategy, I don't think most men and women are going to be able to get their macros.

And that's a greater concern because I see what starts happening to people when they're less metabolically flexible, when all of a sudden, they start becoming more insulin-resistant.

And the bulk of the population, it's like we have to have those frank conversations to say, as a clinician, we have to do better, and the way we do better is having those frank discussions, "You must maintain insulin sensitivity."

>> How much protein should women be having on a daily basis?

>> I would say, at a minimum, 100 grams.

>> No matter your size, your age?

>> It's a good benchmark starting point, because I find most women are probably eating 40 or 50, and then they're wondering why "I can't get gains in the gym.

I lost all my muscle strength.

What's going on?"

And I'm like, "Well, your sex hormones are fluctuating.

That's number one.

That's contributing, but then you're making it worse because..." The best example -- Like, I love analogies -- is, like, young people's muscle looks like a fillet.

Older people's muscle looks like a rib eye.

So that fat and that marbling is what starts to change in the muscles themselves.

And so although rib eye is delicious, we don't want to be a full rib eye because that's going to make us much less metabolically flexible.

>> Yeah.

>> And so I think that analogy makes people go, "Oh, yeah, I want to eat a rib eye; I don't want to be a rib eye."

>> Interesting.

So, 100 grams of protein a day for women, on average, is a good benchmark.

For men, I guess, 150 to 200, depending on your size and your... >> I think that's reasonable.

And I think also, like, as an example, like, you know, you are still at a stage where you're still -- you've got your testosterone where it should be.

I think most younger men absolutely want to be shooting for more protein.

You know, I would say, men 50 and above might -- might need a little bit less, but it probably depends on what they're doing, in terms of, are you lifting.

Are you hitting that muscle protein synthesis, which is certainly really important.

I feel like it's really been -- you know, my life's work is now to help make information accessible so that people can take action.

>> I love it.

Check out the podcast, the website, the book, everything.

A final question for you.

What is your definition of "greatness"?

>> I think, on a lot of levels, greatness comes from within.

You know, it's really your own journey into determining what makes sense of, you know, your gifts.

Like, each -- all of us are given gifts, and it's what we choose to do with them.

>> Mm!

>> So, you know, from my perspective, greatness is really leaning in to the gifts that you were given, even if they aren't entirely, abundantly clear to you at the time that you go through them.

I feel like, on a lot of levels, you know, I started as pre-law, got into law school, didn't go, became a nurse, became an N.P.

Like, all of those things didn't make sense to me until I got to a point, after being so sick, that I was like, "Oh, this all now makes sense."

>> Right, right.

>> So, like, really leaning in to what makes you special and unique.

And each one of us have gifts that we should lean in to.

>> Absolutely.

We hope you enjoyed this episode and found it valuable.

Stay tuned for more from "The School of Greatness" coming soon on public television.

Again, I'm Lewis Howes.

And if no one has told you lately, I want to remind you that you are loved, you are worthy, and you matter.

Now it's time to go out there and do something great.

If you'd like to continue on the journey of greatness with me, please check out my website, lewishowes.com, where you'll find over 1,000 episodes of "The School of Greatness" show, as well as tools and resources to support you in living your best life.

>> The online course Find Your Greatness is available for $19.

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