Ep. 554 Why Digestive Rest Matters in Menopause with Cynthia Thurlow, NP | Menopause, Perimenopause & Fasting

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. This is the start of a new Thursday series called The Midlife Minute that is really designed to address listeners' questions in a little bit longer length of time and or deeper dive into topics. Ideally, we're going to keep these podcasts under 20 minutes. Occasionally, we make over to 30, but I'm trying to reinforce some key concepts and ensure that I'm addressing listeners' questions in a way that's really helpful. So the questions that I will be addressing topics are going to be items that I'm being asked over and over and over again. I hope you enjoy this series. Please share with your friends. And as you know, you can always send your questions to support at Cynthia Thurlow.com. I appreciate each and every listener. Wow, wow, wow. You all have spoken. You want me to be doing more solo, dedicated podcasts. So today, I wanted to unpack a little bit of research, a little bit of science around not only digestive rest, but also intermittent fasting. This is kind of a nuanced conversation because whether we are going unfed for 12 to 13 hours or we're going unfed for 20 hours, there's a lot of nuance to this conversation. Obviously, I'm known for intermittent fasting. I always say like that was unexpected. And so I very humbly sit back and say what works for me now might be different than what worked for me five years ago, 10 years ago. I think it's important for transparency. So I unpack a lot of the research, a lot of the information around this. I talk about specific things that can be triggered in the body when we are in an unfed state. And I hope you can take away from this conversation. A degree of nuance about how to approach how long you go without eating what makes the most sense for you at this time in your life. And really honoring where you are in time and space. If you are trying to build muscle, then probably 12 hours of digestive rest is great. If you are trying to lose body fat and you are really struggling with metabolic health, then some degree of intermittent fasting might be a better choice in a very targeted fashion. So I humbly leave you with my most recent solo podcast diving into digestive rest and how that differentiates from intermittent fasting. Enjoy and let me know what you're interested in me diving into next. Well, these solo podcasts have turned out to be quite popular. And I like to give my listeners what they are interested in receiving. And so today, we are going to talk about the value of digestive rest and how that is different than traditional intermittent fasting and for full disclosure, I have been an avid intermittent faster over the last 10 years. And everything changed last summer. And I think for many listeners, you know, why this changed. It really has been a valiant effort to put muscle mass on my body. And in order to do that, I've needed to have a wider feeding window. So let's dive into some of the science between digestive rest, why I think it's so important and how I think that can be, you know, very helpful. It's not to suggest that I don't still believe in the value of intermittent fasting. I do think it is a powerful strategy when used serendipitously and appropriately and judiciously, just like any other or medics stresser. So let's go back to 2019. When intermittent fasting was the most googled food related topic globally, that is probably why that second headaches I did went crazy viral. And when I say crazy viral at this time, it still has more than 15 million views. It's a little hard to wrap my head around that. But there is a lot of value in this as a strategy. I know it's not new or novel. This is something that dates back to biblical times. It is part of all of the major religions. Certainly as I was growing up, Roman Catholic in my house, the expectations were that during lint adults would fast on Fridays during lint. So with that being said, let's talk about how intermittent fasting and digestive rest are different. So a lot of its formality or even semantics and, you know, it's really, both practices are really about giving your body an opportunity to take a break from eating, right? And when I use the term digestive rest and it's the term I use in my new book, the menopause gut. The menopause gut is really speaking to healing and easing digestion versus I think I look at intermittent fasting as a little bit of a sharper sword. It's a little bit more calculated, a little more precise. I think about intermittent fasting as a metabolic strategy, you know, especially when we reflect on the poor metabolic health that most Westernized countries are dealing with right now. And so when I think about fasting, I think more about overall health, promoting fat loss and enhancing longevity, you can do both. But for purposes of this conversation, I'm really going to try to help differentiate between these terms so that you will be able to use them comfortably. I have not trademarked the term digestive rest. It's just my way of explaining 12 to 13 hours of not eating per day. And I jokingly will say I used to have teenagers. Now I have a teen and a young adult, but technically they're both adults. Now my youngest is now 18 years old. And I talk about the fact that even they as very athletic, muscular, young men can go 12 hours without eating. So let's talk a little bit about key benefits of intermittent fasting. I know we've talked about this a lot impacted a lot on the podcast. It can help change body composition. I would argue there's lots of things that can do that. But it's one of my favorite ways when I'm talking to patients or clients or speaking on stages, helping people understand it can be very helpful, especially again, for those who have poor metabolic health. We know it can promote gut health as well as a healthy microbiome. Creates metabolic flexibility so that our bodies can effectively utilize both stored fat and stored carbohydrate. Enhances might accondrial health. And after the age of 40, we know that most of us are experiencing some degree. Might accondrial dysfunction and decline. And that's a byproduct of aging, but it doesn't have to be. Also, it upregulates a topogy. It's not the only thing that upregulates a topogy, but it is one of the benefits that we can get rid of disease and disordered mitochondria and organelles. It can be helpful for boosting brain health, reducing inflammation, which is one of my favorite things about intermittent fasting. If you use appropriately can support immune function, my book, we spent an entire chapter talking about what changes in immunity and our ability to fight infections as we navigate the parimenopausic menopause transition. And then for some people, the reason why they enjoy doing intermittent fasting is a lot to do with spiritual awareness. That's why it's incorporated in so many of the major religions. I think a great deal about the gut microbiome. And obviously this is a passion project of mine. I think the more stool testing I did and the more conversations I had with women, the more I realized that the gut was kind of this really missed and lost piece of the parimenopause and menopause conversation. And so the role of the microbiome is complex. It's a very expansive ecosystem made up of trillions of microorganisms, including bacteria, viruses, fungi, and protozoa that are important for eating and digestion, producing chematabolites like short-chain fatty acids and maintaining the immune system. We know that this takes a major hit as we are navigating this middle-aged transition, especially with the loss of estrogen, estradials that predominant form of estrogen in our bodies. And as we are losing estrogen, we have some immune modulating properties that we are losing, especially if we are not utilizing hormonal replenishment therapy. And we know that these microorganisms have many effects, but they can be both protective metabolic, they can be structural, and they can help us break down food and actually synthesize nutrients like B vitamins and vitamin K. These are different types of fat soluble vitamins, vitamin K in particular. They can improve bile acid bio transformation. So our ability to break down and emulsify fats and ferment the fiber into short-chain fatty acids. This is why I am a huge proponent of fiber being so important for us in the conversations around middle-aged health is that fibers are a friend, fiber is not something to be feared. It's very bio individual. How much fiber we actually tolerate. And as I've talked about before, when I came out of the hospital, after being on antibiotics that saved my life and antifungals, I couldn't tolerate fiber for a long time. And I'm grateful to be able to be able to do that now and really push the lever, but understanding the role of fiber in the gut microbiome, we know that our microbiome impacts our mood, impacts how we perceive things and impacts how we think. And there's this wonderful bi-directional relationship between our gut and our brain. And that's the Vegas super highway. It's the longest nerve in the body. It's called the wanderer for good reason. And research has shown that the composition of the gut can vary significantly from person to person. So if we were to take samples from every single person listening, there's a degree of bio individuality because each one of us experience our lives in different ways, our perception of stress, how much sleep we get, what types of food we eat, what our hormones are doing on that day. And we know that men and women have very different microbiomes, gut microbiomes when they're born that differentiates further. They're very similar at first. They differentiate further in puberty and for women, then pregnancy, if we become pregnant and then parimenopause as well. And that's called the microgenderome. And if we're getting really granular about the gut, and this is my intention to kind of touch on this and then wrap it back up to digest of rust and intermittent fasting, the microgenderome is established at birth and influences by birth method. So if you are, if you are vaginal delivery versus a C section, you're going to have a different microbiome, infeating method. So whether or not your mother breast fed you or you were bottle fed age, genetics, environmental exposures. We know early environmental exposures can be quite significant. And then also immune status, zip code and even diet and medications. And so it's really interesting to see we get this imprinting. Obviously we have zero control over how we are born, right? Whether we're vaginal delivery C section, both my boys were C sections because they were both breach. They were both breast fed, but there are other people that are vaginal deliveries. And then their moms can't breastfeed. Maybe they have to bottle feed. So I look at it as we are imprinted at birth. We are imprinted through our early infancy and childhood. This is not naming or blaming anything on our parents. This is just facts. We know that there's a critical role of the microbiome in sex hormones and it's highly relevant to disease susceptibility, which is why again, as we are navigating the parimenopause to menopause transition, we may be more susceptible to opportunistic infections. We may be less responsive to vaccines. I'm 54 years old and every time I go to CVS to pick up a prescription, I'm offered vaccines, flu vaccine, shingles vaccine. I think they offered me the pneumococcal vaccine. The last time I was there and I was like, no, no, and no. And this is not an anti vaccine message. I just know that at the stage of life that I am at, I am less responsive to vaccines. And that is a byproduct of changes in the immune function as I am navigating middle age. There's also this bi directional relationship between the microbiome our hormones and immunity as well as the endocrine system. And as I mentioned, the three Ps puberty, pregnancy, parimenopause. Most of us do all three. Some of us just do two of those. And these differences remain up until menopause when our microbiomes start to look more like men. So it's like we come full circle, truly full circle. And then, you know, we talk about digestive rest and fasting. And as hypocrite has said, all disease begins in the gut. And I do fervently believe that our health is intricately linked to this complex ecosystem of microbes in the gut and nutrition as well as meal frequency, whether it's digestive rest or fasting, have the greatest impact on the gut microbiome of all I believe. So we talk about improved microbial diversity. Why that's important. If you're in parimenopause or menopause and are feeling more fatigued, dizzy, lightheaded, struggling with headaches or noticing your workouts feel harder than they used to, electrolytes may be part of the missing piece. As estrogen declines, we lose some of the fluid regulating and vascular protective effects that hormones once provided. That means blood pressure regulation can shift. Quarters all can run higher and many women become more sensitive to dehydration, especially if you're strength training, walking more intermittent fasting or reducing process foods. That's why I love element. It is my favorite electrolyte formulation. And I've exclusively used their products for the past six years. Element contains a science backed ratio of sodium, potassium, and magnesium without sugar, artificial ingredients are unnecessary fillers. It supports hydration at a cellular level, helps reduce muscle cramps, improves energy, as well as recovery, and can even support better stress resilience. This is particularly helpful in midlife when we're prioritizing metabolic health and muscle preservation. I personally use element throughout the day and it's become a staple in my routine as well as my household. If you'd like to try it, go to drinkelement.com. Slash, Cynthia, to receive a free sample pack with any purchase. Stay hydrated, stay strong, especially in midlife. If you're women in midlife or beyond, you're probably noticed those changes in energy, strength, and recovery just don't feel like they used to. And what's frustrating is that for many women, this happens even when you're eating well, lifting weights, prioritizing protein and doing all the right things. You're not lazy, you're not unmotivated, and you're not doing anything wrong. A big part of what's changing actually starts inside your cells. As we age, our mitochondria, the energy producing structures inside our cells, become less efficient. And when mitochondrial function declines, it can show up as lower energy, slower recovery, reduce muscle strength, and feeling less resilient overall. This is a normal part of aging physiology, and it's one of the reasons midlife can feel so different. And that's why I've added my pure gummies from timeline nutrition into my daily routine. Might appear as the only clinically proven form of your lip and a compound shown in human clinical trials to support mitochondrial renewal. In simple terms, it helps your cells do a better job of making energy. And when your cells have more energy, your body is able to support strength, endurance, and recovery as you age. What I appreciate most about might appear is that it's foundational, not flashy. This isn't a stimulant or a quick fix. It's a daily habit that supports how your body actually works at the cellular level. And the gummies make it easy. They're just two sugar-free gummies per day. They're vegan and cleanly formulated. They're independently tested and certified for quality. And if supporting your energy, muscle health, and overall resilience, as you move through parimenopause and menopause is important to you, might appear as worth considering. You want to go to timelinenutrition.com slash Cynthia and use code Cynthia Thurlow for 20% off your order. Again, that's timeline.com slash Cynthia and use code Cynthia Thurlow for 20% off your might appear gummies. If you're in your 40s and 50s and feel like your body suddenly stop responding the way that it used to, you're not imagining it. Bloating, waking, sleep disruptions, food sensitivities and unpredictable energy are incredibly common in parimenopause and menopause. But here's what most people aren't told. Your gut microbiome is changing right alongside your hormones. And those changes can influence everything from how you store fat to how well you sleep, to how your body processes estrogen. That's exactly why I wrote my new book, The Menopause Gut. In this book, I walk you through the science of how the microbiome, metabolism, immune system and hormones are all connected during midlife. But most importantly, I give you practical, realistic strategies. You can start using right away without extreme diets or complicated protocols. You'll learn why the same diet that worked in your 30s may not work now. How your gut influences hot flashes mood and weight, the truth about fiber, protein and blood sugar in midlife and the daily habits that help your body feel safe, stable and resilient again. If you're tired of blaming yourself for changes that are actually biological, this book will help you understand what's really happening and what to do about it. You can pre-order the menopause gut wherever books are sold. And when you do, be sure to check out the special pre-order bonuses I've put together for you. Again, you can go to www.synthethorlo.com. You'll click on the banner. It'll take you to multiple options for where you can order the menopause gut in pre-sale. Improved beneficial bacteria. So some studies suggest that intermittent fasting can promote the growth of beneficial bacteria in the gut. Again, it's a fine tooth sword. It's like this very fine, delicate balance between a little bit of stress, but not too much. This happens because fasting gives the digestive system a break, obviously, allowing the gut to repair itself and maintain a balanced microbial environment. Bacteria such as acrimoncya, which I've done a whole podcast with Dr. Colleen Cutliff dedicated to this. Arsis, it was good gut health and have shown to increase with fasting. So acrimoncya is not just about overall gut health. It's about endogenous GLP1 production. It's about the mucin lining, the mucous lining, which I know sometimes people think that's kind of a gross concept, a very important for protection of the one cell layer thick of the small intestine, also very, very important for short-chain fatty acid production. And then we talk about production of short-chain fatty acids. So things like propryonate, butyrate, acetate, are synthesized via fermentation of dietary fibers. Again, I go back to why I think it is so important to consume some degree of fiber in our diet. We know that we can see some improvement in gut health, fasting can lead to a reduced inflammation in the gut with fewer inflammatory responses, the gut lining may heal, creating a better environment for diverse bacteria to heal. And this can strengthen the layer preventing harmful substances from leaking into the bloodstream. I think I've talked about this on multiple podcasts, but if the very delicate one cell layer thick of the small intestine gets breached either by toxins or inflammatory substances, those little tight junctions can open up and you can leak particles, you know, food particles into the bloodstream, which can lead to inflammation. This is why so many women will suddenly become sensitized to particular types of foods, maybe things that they've never had an issue with before. Like dairy became something I was incredibly sensitive to gluten, you know, for me alcohol, a lot of these things I, I no longer consume. I can consume a teeny tiny bit of dairy, maybe one or two days a week, and that's it. And then we know the gut microbiota for men, amino acids in conjunction with bile acid. So the synthesis of vitamins in the control of motor and immune systems of the gut and then this promotion of circadian clocks. So we know that the loss of estrogen impacts our circadian biology impacts these internal clocks. And so the gut microbiome has this beautiful natural gut rhythm, unless we're traveling, unless we are on a different time zone, the gut clocks, the circadian clocks actually adjust. They can be influenced by when and what we eat and fasting in many instances, and even a degree of digestive rest can help synchronize these rhythms, allowing certain bacteria to benefit and to flourish, which can contribute to better gut health as well as diversity. And then the piece about metabolic flexibility, we talk about this a lot, shifting between a fed in a fastened state can improve metabolic flexibility, being able to use different types of fuel substrates for our health, both utilizing stored fat as a fuel source as well as stored glycogen. And again, this can be facilitated by having longer periods of time when we are not eating. Now, the improved microbial diversity can happen even with 12 hours of digestive rest. It can get amplified if you're not overdoing it when you're doing longer periods of fasting. As I mentioned, this improved gut barrier function is really important, especially because we have very specialized cells, they're called interocytes and goblet cells, the goblet cells are responsible for secreting mucus. The intestinal lining is crucial for preventing harmful substances like toxins, whether it's lipopolysaccharides, whether it's something you've ingested and pathogens for mentoring the bloodstream, if anyone's ever had bad food poisoning, which is happening me a couple times. I think the most notably when I was in Morocco and that started the whole chain of events that led to a very likely hospitalization. Thank you, Georgia, that I picked up while I was there. We know that intermittent fasting can help strengthen the integrity of the small intestinal barrier, reducing the risk of leaky gut. It doesn't mean it will prevent it, but it will help reduce it and can help promote a reduction in inflammation, reduce some food sensitivities and susceptibility to autoimmune conditions. As I've mentioned before, even autoimmune condition, you have had a leaky gut at some point. And by promotion of the production of these healthy keystone bacteria like acrimoncia, intermittent fasting can help maintain the gut lining and prevent inflammation. So the keystone bacteria, which I won't get into much of a tangential conversation, these are foundational bacteria in our gut that we really want to foster and kind of in our modern day lifestyle. Sometimes they can get forgotten about. Let's talk about circadian rhythms and the gut microbiome. We know that there is a center for this in the brain. It's called the super chiasmatic nucleus that coordinates peripheral clocks, the clocks outside the brain from the intestines, the liver, the pancreas to food intake and regulates metabolism. Clock change regulate our circadian rhythms over a 24-hour period of time. And depending on the input, like if I'm traveling, if I go west three hours, if I go five or six hours east, my circadian clock is working over time to adjust for that. And sometimes when I travel, even if I work diligently on sleeping really well and eating the right foods, it can take my body a couple days to kind of catch up. It's almost like it gets a hiccup, it gets a reset and you want to get back on track as quickly as you can. We know our gut bacteria have their own circadian rhythm, which is fascinating. And Dr. Sachin Panda has been a proponent. I'm actually looking at his research right here has been a proponent of time restricted eating. This approach aligns eating patterns with the body's natural circadian rhythms, potentially enhancing health outcomes. Research from his lab suggests that time restricted eating can improve glucose regulation, as I've mentioned, reduce inflammation and mitigate the risk of various chronic diseases. And his paper is called time restricted feeding prevents obesity and metabolic syndromes in mice, lacking a circadian clock. He also has some really excellent resources on lawn and strives to make his information very accessible. There's also something called chrononutrition. And it's the study of how timing and meal frequency impact metabolism, digestion and overall health based on our body's natural circadian rhythm. So calorie distribution is important. So chrononutrition suggests that consuming a larger portion of daily calories earlier in the day, a K A at breakfast and lunch and fewer calories at dinner, improves metabolic health outcomes. So we know we are less insulin sensitive as the day goes on. So that's not the time to eating massive meal and try to go to bed. We know that late night eating is associated with poor metabolic health. If it's something you're doing chronically, and that includes weight gain and impaired glucose regulation studies suggest that eating earlier in the day can help with weight management, blood sugar regulation and reducing the risk of chronic metabolic health issues like type 2 diabetes, liver disease and also cardiovascular disease. And since we know the number one killer of women is heart disease, this is something to genuinely take seriously. And so the fasting piece and meal frequency, a lining intermittent fasting or time restricted feeding with circadian rhythms can further enhance the benefits. For example, fasting during evening and nighttime hours when the body's metabolism not only slows down, but also we lose a degree of insulin sensitivity is important. This doesn't mean that digestive rest is negating these benefits. It also is encouraging people to eat earlier in the day. So if you break your fast at 8 o'clock in the morning and you close your fast or maybe of your third portion of protein, maybe it's just a piece of protein as your last meal of the day, you're kind of shutting it down within three hours of bedtime. There's another study looking at the timing of breakfast, lunch and dinner, the effects on obesity and metabolic risk, eating late versus eating early. This was looking specifically at BMI and body fat percentages and the importance of bio individuality and distribution of calories prior to melatonin peak. So high melatonin can impact glucose variability, meaning melatonin is peaking in the evening. So it becomes more challenging for your body to process a bowl of food when melatonin is high, like when your body is supposed to be asleep. So just something to kind of keep in mind, it just reaffirms why it's important to not be eating too close to bedtime. There's another study looking at diurnal transcriptome, landscape of a multi-tissue response to timer-stricted feeding and mammals. This is looking at mice, so mice are not humans, but we can extrapolate some of these concepts. The researchers found that time-restricted eating align their circadian rhythms of multiple organs in the body. By changing the timing of food, we're able to change the gene expression, not just in the gut or in the liver, but also in thousands of genes in the brain. So this is Dr. Pandas research, nearly 40% of genes in the adrenal gland, hypothalamus and pancreas are affected by timer-stricted eating. And circadian rhythms are everywhere in every cell, so they're not just in the brain, they're not just in the gut. He found that timer-stricted eating synchronized their circadian rhythms to have two major waves, one during fasting and another just after eating. And he suspects this allows the body to coordinate different processes. Getting back to some key aspects of Dr. Pandas' work, he talks about their circadian rhythms and timer-stricted eating, emphasizing that circadian rhythms regulate processes such as digestion, metabolism and hormone production. And by aligning food intake with these natural rhythms, he discovered that human health can be significantly improved. In one notable study of his patients who limited their eating to a 10-hour window, aka digestive rest, saw reductions in body weight, improved sleep quality and better energy levels without necessarily changing what they eat. He also is demonstrated that disruptions in circadian rhythms, and I think this is important, such as those caused by irregular eating or sleep schedules can lead to metabolic disorders like obesity, diabetes and cardiovascular disease. His research shows that eating late at night, like I think about my college-age son, or during times in the body, circadian rhythms are not primed for digestion, such as during sleep, can increase the risk of metabolic syndrome leading to waking and insulin resistance. And in his book, the circadian code, which I highly recommend, he outlines how modern day-lifestyles characterized by prolonged exposure to artificial light, eating at erratic times and disrupted sleep, misaligned the body, circadian rhythms, and how this leads to chronic health issues. So he talks a great deal about time-restricted eating, which I really think of in the context of how he defines it as really digestive rest, proper light exposure, so getting sunlight in the morning, getting blue blockers on in the evening, regular sleep schedules, aka don't stay up and binge the diplomat on Netflix, like my husband and I did over the course of a couple days, and physical activity are also very, very important. And then lastly, about Dr. Pandas' work, he also talks a lot about the gut microbiome, and he shows that circadian rhythms influence gut bacteria, which are critical for digestion, immunity, and mental health, and disruptions in the circadian rhythms themselves, such as eating at erregular times, can alter the gut microbiome in ways that promote inflammation and disease. So kind of getting back to how important it is to have regular schedules in place, not just about sleep, but about how we're eating as well. And he talks a lot about light exposure and how blue light in particular, especially at night, can disrupt the production of melatonin, which is not just a sleep hormone, it's a master antioxidant, can lead to poor sleep quality and circadian misalignment. So there's probably many of you that are EMS or healthcare workers or people that work shifts, and Dr. Pandas' research on shift workers, who experience frequent circadian misalignment. I certainly experienced this both working as an ER nurse. One of my first jobs as a nurse practitioner reveals that these individuals are at higher risk from metabolic disease due to disrupted eating and sleeping patterns. His work suggests that even shift workers can benefit from time restricted eating. So irrespective of what day you are working, you stay to the same schedule where they limit their eating to a certain window, even if their work hours vary. And so it's also very helpful to promote healthy aging by eating an alignment with our circadian rhythms. So reducing inflammation by eating in terms of looking at digestive rest, tournament fasting, we know fasting has been linked to a decrease in pro inflammatory markers such as C-reactive protein, interleukin six, and tumor necrosis factor alpha. These markers are typically elevated in inflammatory conditions. In metaporemetabolic health, there's a cardiovascular disease, diabetes, an autoimmune disease, and by reducing these markers, we know the body can manage inflammation more effectively. We also know that these all tend to go a little bit haywire in middle age. So really working diligently on lifestyles, very important. There was a study published in obesity that showed that intermittent fasting as an example, reduced levels of CRP, and other inflammatory markers and obese individuals. And we know fasting triggers something called a topology, which I know all of my listeners are familiar as with that term, where the body breaks down and removes damage or dysfunctional mitochondria and organelles. And this helps reduce inflammation by clearing out cellular debris that has the potentiality to go on and create disease. It's interesting that in there's research in nature that highlighted that intermittent fasting can induce atophagy, which has anti-inflammatory effects. And it's interesting to note that it's not just intermittent fasting that can induce atophagy. It can be induced by polyphenols. It can be induced by certain types of exercise. For a lot of people, they're like, listen, I know that intermittent fasting doesn't work for me. Then do 12 or 13 hours of digestive rest. There's a lot of other things that we can do that can help support atophagy. And one thing that I think is really important, I do talk about this in my first book, the intermittent fasting transformation. There's this wonderful concept called the migrating motor complex or the MMC. It's a pattern of electrical activity in the GI tract that plays an important role in an unfed state. It helps clear the stomach and small intestine of undigested food particles, bacteria, and waste between meals. It's almost like a street sweeper. The MMC typically occurs during periods of being unfed. So if you eat breakfast and then you don't eat again for four to six hours, the migrating motor complex is kicked in. And it starts about 90 minutes or two hours after eating, as often referred to as the intestinal housekeeper. I like to think of it as a janitor. And so the MMC and digestive rest or fasting only happens when the stomach is empty. So if you are eating all day long eating snacks and many meals, guess what? You don't get the benefits of this little janitorial service. And during periods of not eating, the MMC helps clear out leftover food, bacteria, and waste in the GI tract, preventing bacterial overgrowth and keeping the gut healthy. This process typically stops when food is eaten again. And there's this little caveat. There's a role of motel in. So there's actually mechanism that works in conjunction with the MMC. The MMC gets disrupted when we snack or we eat small meals throughout the day. Like how many people listening were told by well-meaning healthcare professionals that they need to eat snacks and many meals. I was one of these people. I propagated that. And as I always say, no better, do better. And so disrupting the MMC can be problematic because it doesn't allow your body to have this beneficial break from working on processing food. We know that the MMC is not working properly. It can lead to incomplete clearing up the gut, which may contribute to digestive issues like bloating or bacterial overgrowth. If you've ever been told that you have SIBO, it is probably very likely that your migrating motor complex is not working optimally. We know that metabolism is complicated business, right? It's determined by a diversity of genes associated with the gut microbiota and the variety of intestinal flora. The body produces hormones like insulin and ghrelin based on circadian cues. Eating in sync with the body's natural hormone cycles can optimize energy utilization and hunger regulation. So again, we go back to melatonin. This very important master antioxidant, everyone thinks of it just as a sleep hormone. It is far more impactful. We know it rises at night, signaling our bodies to go to sleep. And eating late in the evening may interfere with melatonin secretion and disrupt sleep, which can impact metabolism and appetite regulation the next day as well as blood sugar. So practical applications, how do we go about determining how to view both digestive rest and intermittent fasting? So number one for men, they've got it pretty easy in terms of they don't have as much hormonal fluctuation week to week day to day, month to month as women do. And so whether women are premenopausal, so 35 and under, which I affectionally refer to as peak fertile years, or perimenopause, five to 10 years preceding menopause, or menopause is highly dependent on what variable we should be concentrating on. I think that it's important just to mention who should avoid intermittent fasting, children and teens without question. Even if your child is obese or teenager is obese, there's a lot of other things that can be done. I do not recommend that children or teens who are still growing have a degree of food restriction. I think there's a lot of other ways to address metabolic health. If you're elderly, frail or malnourish, this is not a strategy I recommend for elderly frail patients. If you have a disordered relationship with food, and if it's an ongoing one, whether it's anorexia bulimia or binge eating, any chronic illnesses, unless in conjunction and in conversation with your prescribing provider, anyone who's under too much stress, if you're going through a divorce, you just lost your job. You're experiencing a lot of situational stressors, not the time to add in a hermetic stress. This is where I would argue that digestive rest works for everyone. Intermittent fasting does not. If you're pregnant, trying to conceive or nursing. So the question is always, how long should you go without food? Digestive risk really speaks to 12 to 13 hours, which is very gentle. There's obviously a whole constellation of different options. If you're intermittent fasting, whether it's 16 hours fast with an 8-hour feeding window, or you're doing omad, which I don't recommend, or you're doing multi-day fast for specific purposes. And so I think that it always comes down to, when we're thinking about talking around whether it's digestive rest or intermittent fasting, I always say that if you've gone a long period of time without eating, you want to break your fast with something light. So if you've done omad because you came back from vacation and you just decided that you over ate or you just feel inflamed, breaking your fast with something light like bone broth or yogurt or salad is probably very reasonable. Obviously, if you're doing 12 or 13 hours of digestive rest, it's not an issue. I think macros are important. We always want to be protein-centric when we consume our first meal the day, protein plus or minus, non-starchy carbohydrates with some fiber, and then deciding what does not break a fast. I know this can get very nuanced. I know that talking about what breaks a fast can get exceedingly nuanced. Generally speaking, if you think it breaks a fast, it probably does. Now, I think it's important to not get obsessive about this. I think that perhaps unknowingly, we have propagated a situation where people then become paranoid eat anything because they're worried it's going to break a fast. I think if you are metabolically healthy and you decide to have some electrolytes in your water that are sweetened by stevia, it is probably not going to be a deal breaker. But if you were someone who is not metabolically healthy, those things over time, multiple things that you're consuming in an unfed state could potentially add up over time. So I think you have to have an honest conversation with yourself. Think about anything that's going to provoke an insulin response is very likely technically breaking a fast, but don't overthink it and don't overstress it. And then it goes with that saying, if you are in an unfed state, whether it's 12 to 13 hours of digestive rest or a more formal intermittent fasting regimen, you kind of stay hydrated. Like, be smart. Hydration, electrolytes, whether they're flavored, unflavored, just be smart. You may need to add in more electrolytes, especially if you are sweating, exercising, et cetera. Anyway, I so love these conversations and I so value my community. I would love to hear from you what are the things you would like me to do a deep dive into. I hope that I've been able to kind of identify some of the key benefits of what goes on in our bodies in an unfed state, whether you embrace 12 to 13 hours of digestive rest, which is really what I do at this stage. That's great. If you are intermittent fasting occasionally or daily, just make sure you are taking care of you. That's what it's all about.