Cynthia Thurlow
SUMMARY KEYWORDS
people, eat, fasting, patients, cynthia, started, talk, protein, nurses, medicine, clinical medicine, day, phil, thought, women, feel, physicians, hear, husband, cardiology
SPEAKERS
Jack Heald, Cynthia Thurlow, N.P., Dr. Philip Ovadia
Jack Heald
Welcome back, everybody. This is the Stay Off My Operating Table podcast with Dr. Philip Ovadia. I'm your cohost, Jack Heald, and joining us today is somebody that I bet I started following you 18 months ago on Twitter, Cynthia Thurlow in pee, and I love that in pee. Welcome. We're glad to have you.
Cynthia Thurlow, N.P.
Thank you. And I love that you've been following me on Twitter, you get to see a whole other side of my personality, depending on my, depending on my day, I can be a little snarky at times.
Jack Heald
This is literally the only side of your personality that I know. So for all I know, that's, that's all there is. So Phil, tell us why you invited Cynthia, to be on the show.
Dr. Philip Ovadia
Yeah, I was, I would say, um, I guess more fortunate than New Jack and that I probably came across Cynthia a few years ago. I think it was even before the it was probably between the first and the second TED Talk. And the second TED Talk, of course, has become legendary. But we have a common background, Cynthia's background in allopathic medicine and cardiology. Certainly,
Jack Heald
I want to, I want to stop you right there. Because for people I know there's a lot of people out there who do not have probably never even heard the word allopathic. Somebody define that for us. I know what it is. But that's just because I've been working with you for a while. So
Dr. Philip Ovadia
yeah, allopathic medicine is just basically that you have MD or do or np after your name, and you sort of tradition, the traditional what people think of when they go to the hospital, or they go to their mainstream medical practitioner.
Cynthia Thurlow, N.P.
I also would dovetail and say that when I think about traditional allopathic medicine, it's very symptom focused. So if you come in with a cough, we're going to address the things to get rid of your cough, we may not be thinking about root cause and so on a lot of levels, I always say I'm very grateful that we have the quality of care that we do have in terms of emergency and urgent care medicine. It's the prevention and the chronic disease management that I really struggle with. And one of many reasons why I needed to leave clinical medicine to feel like I could make a larger impact on my patients.
Jack Heald
All right, so allopathic medicine, is practiced by those who have received their medical certification through what are the normally, probably the first certification bodies that people think of when they think about a doctor of the American Medical Association says you're a doctor if you've had this particular type of, of education. So it implies a particular type of education, which necessarily also implies probably doesn't have another kind of education, which I hope we'll get into that. And practices a particular has a particular model of human health, but certainly not the only model. Okay. There you go, folks, your Word of the Day allopathic medicine, carry on,
Dr. Philip Ovadia
I think that's a great part, a great point to actually start the conversation because Cynthia and I think have come to a similar realization that allopathic medicine leaves a lot to be desired. And we spent all our time and I still spend a lot of my time just focusing just chasing those symptoms and just trying to alleviate those symptoms, and not looking at the broader issue and not looking for root causes. And so I'd love to hear Cynthia's thoughts on that frustration, and how she became aware, I guess, that there was more.
Cynthia Thurlow, N.P.
Well, I think for me, I started I spent 16 years in cardiology, and prior to that, it was er medicine, so 20 years total and clinical medicine. And for me, I just kept seeing patterns. I kept saying, Yes, I can address my patients angina, or chest pain. Yes, I can send them for a cat. Yes, I can send them for surgery. Yes, I can slap a statin on them. But um, they're not actually getting better. It's like we're just stabilizing everything. We're just kind of keeping everything calm. And I think for myself having a child with life threatening food allergies, shifted everything that changed everything. You know, I felt like I couldn't. I couldn't protect him enough. And the more I read and the more I understood and quite frankly, the more I thought about nutrition being the basis for all of our health or disease, the harder it became to go to work and write those scripts. Because when I was in the hospital and I was in clinic, I was toeing the party line, it was all evidence based medicine, I worked for a very dynamic cardiology practice. And most of my colleagues were pretty supportive. They thought I was the cute MP that was focused on nutrition because I always tried to talk to my patients about lifestyle medicine. But as you can imagine, when I'm dealing with the sickest hospital follow ups just making sure they can breathe poop, pee, and like move is important. And there was never enough time to really talk to him, like, we need to focus on sleep with clean up your nutrition. I mean, there was almost a hesitation on the part of the patient that they were just like, this isn't the way things are supposed to be, just give me the pill. And I would charge just about any angle I could get. And I started getting to a point when I got into my late 30s, early 40s, where some of my patients were younger than me. And I would say how old are your children, I was always looking for an angle to encourage them to take better care of themselves. And so for me, I just out of utter frustration got to a point when it was evident to me that there were so many limitations on my time. And I didn't want to compromise the quality of care I was providing, because I took I still take great pride in being an excellent, smart, astute nurse practitioner. But I just felt, and I know, this sounds perhaps naive. And I'm married to an engineer, finance guy, I literally got out of bed one morning and said, I can't do this anymore. And he was like, what, and without a business plan, I gave my notice at work. And I just leaped, and I was very fortunate that very quickly, I was able to create programs. And there were a lot of women who wanted to come to me and talk about exactly all the things I talk about now. But I think on a lot of levels, it is very hard for many, I don't use the word woke, but I'm going to use the word woke healthcare providers who are seeing that there are limitations with our current medical model to prevention and chronic disease management. Because we just aren't given the tools and our training, we either have to go back and get more training, or we have to do a lot of education beyond where we started from to be able to provide the degree of breadth and experience to what we oftentimes feel is most important to that lifestyle piece, I think for so many of us that are in this space, whether it's a low carb ketogenic lifestyle, lifestyle medicine, so many of us recognize that as oftentimes the most important thing we should be teaching our patients, but that's not what they're conditioned to believe they want the pill. In fact, I had younger patients that were like, I'm not going to stop smoking, I'm not going to get physically active, I'm not going to change my diet. So just give me the pill, Cynthia. And I, of course would oblige. And I would document what we talked about. But we have really conditioned our patients for pharmaceutical agents as opposed to lifestyle medicine. And I want to just add that it is much harder for a patient to change their lifestyle. And I wish I could snap my fingers and make it easy. But lifestyle changes are hard. And they're not meant to be easy. But we are always I think we as a culture are always looking for a quick fix. And so you can appreciate why sometimes that it may be when someone gets ill, or they have a family member that gets sick, or there's some powerful impetus that all of a sudden they want to change. And we're always supportive of that. But there are definitely limitations to when I was practicing. And that was an endless source of frustration.
Jack Heald
Phil, do you mind? I want to ask a couple of questions that actually are going to look back. Cynthia in your career, and I have this sense that there's an awful lot of people out there, like me, not medical professionals who have a perception of what being a medical professional is that is entirely wrong. I'm thinking of Brian Linkous who we talked to three weeks ago. I mean, that was just a kind of a thing. So is that okay, if I, you okay with if I just kind of drill down into that with CYNTHIA Yeah,
Dr. Philip Ovadia
I think will be great. You know, I over the past few weeks. Cynthia, we've had Brian Lenski, us and we've had William Davis. And we seem to Pete keep coming across this story of the system is broken, and we need to get out of the system. And so I think exploring your perspective on that a little bit would be great.
Jack Heald
So let's just give us a feel for a day in the life of Cynthia Thurlow nurse practitioner back in the day. Yeah, just Well, what was a typical day for you?
Cynthia Thurlow, N.P.
Um, well, I can tell you that the time my husband did a lot of international travel, and so my kids were younger, and so it was oftentimes me scurrying to get them on the bus. I get in my car, I drive to the hospital. I would start seeing patients
Jack Heald
that were You were you hospital basis. Do you have an office and then you had rounds?
Cynthia Thurlow, N.P.
I did both. I did both. Although I started transitioning more to output addition because it was more predictable, I could get out on time if I needed to grow up my kids. And that's really what it that's what it came down to. And actually, to be completely fair, I am an adrenaline junkie I do like sick patients, but I was much more autonomous in the clinic than I was in the hospital. Because in the hospital, my doc was always around. If I had a problem, I had someone to bounce ideas off of. In clinic, you screw up, I mean, you send someone home, that's a problem. So more often than not, I would start rounding in the ICU. You know, I was on the floor, usually by 737 45, ICU er consults, then you would start rounding and I was there to put out fires. And so my doc might have been in the cath lab, my doctor, specialty, cardiology, okay. And so again, that gravitating towards sicker patient medically very medically complex. And the practice I work for allowed the NPS to have a lot of autonomy, we did have a tremendous amount of autonomy, if I needed to call a chopper, if I need to arrange for surgery, I mean, I could do all of those things. And the one thing I oftentimes tell people is that when you work in more urgent Acute Care Medicine, you can't afford to screw up. I mean, you could be rounding and someone to two doors down, you they call a code and you're there, you're running a code, you're resuscitating a patient, you're calling the ICU, I mean, there's just a tremendous amount of pressure to make sure that you're 150% and all the time. And for me, I'm incredibly conscientious, almost to the point of being a little OCD. And generally I could manage the stress that I was experiencing day to day, and I loved what I did. I love cardiology, everything about the heart. I find it utterly fascinating, but I was starting to see several things that were happening one, almost all of the specialty practices. Now in the hospital. The real hardcore specialties are usually cardiology, nephrology, so kidney, pulmonary, pulmonary critical care. And those three specialties tend to eat interweave all the time. And for me, when I saw those specialties, I generally knew we were all kind of managing similar issues, but I always felt very confident. But what I was hearing from all of my physician colleagues was how frustrated they were, they were being forced to see more patients, they weren't able to spend as much time with their patients as they wanted to. Because in the back of their mind, they had to see X number of patients per day to be profitable. Nurses felt overworked, overstressed there the volume of patients they were responsible for, even in more critical care areas were going up, everyone just felt constrained. And it was stressed that all of us were experiencing. And I don't think most people go into health care without really genuinely wanting to serve others. So you can imagine something that you that you initially gravitated towards, because you wanted to help others you suddenly feel constrained by. And so I felt the one thing I started on
Jack Heald
that word constrained by constraint. There's a lot, there's a lot contained there.
Cynthia Thurlow, N.P.
Yeah, I mean, you're frustrated, because you can't deliver the kind of care you want. You're frustrated, because you have a bean counter over your shoulder telling you that you didn't use the right CPT code or the right code for what you were doing. Because you have to create you're doing billing all day long, like you're keeping track of how acutely sick was this patient that you rounded on? How much time did you spend on this console? How it's like every minute of the day, you were accounting for what you were doing based on acuity. And you'd have bean counters over your shoulder, or you didn't document this one metric, or we didn't check off aspirin for your cardiovascular patient. I'm like what you'd have technical issues. You know, I started in medicine in the 1990s, way before electronic medical records. And all of a sudden the wave of EMRs, electronic medical records came about, and there were a lot of benefits to that. But you get the call from the bean counter telling that you didn't check off one box, and they wouldn't process an order. And you'd have to stop what you were doing to go to a computer to fix the one bean counter request to go back to what you were doing.
Cynthia Thurlow, N.P.
And I felt like in a lot of levels. Because I had been trained in emergency medicine. And because I was always given a lot of autonomy as a nurse and a nurse practitioner that I expected. The team that I worked with to have the same concerns, critical care, thinking etc. And I just started to see that some of the people that were going into, and it could be any designation after their names could be a respiratory therapist. I mean, it could be anybody that people were getting so bogged down and all the extra work that they had to do that some people just stopped caring. And that was disheartening to me really disheartening that there was almost like this hard shell that people would develop in response to the added pressures that they were experiencing, so much so that they were no longer really being effective in their job role like yes, they were a physician or a nurse or respiratory therapist, but they weren't really connecting with their patients. And so that, to me was sad to see as well. Because I would imagine that when those people or those individuals started in their careers, they felt very differently. And more often than not, the joke was, and Phil, I don't know if this is what you've heard from other colleagues who's going to take care of us when we get old, because so many people were leaving clinical medicine. And again, I go back to in the hospital, the people that are like dealing with the sickest patients other than surgeons, kidney, pulmonary cardiology, and I'm like, some of the people I worked with are so smart, unlike we don't want to lose these people, to other occupations. This has a profound net impact on all of us. And unfortunately, my greatest concern, now I have teenagers, neither of them wants to go into medicine, none. Neither of them wants to do that. And largely because they're like, Mom, we see how hard you worked. And we know how hard we have a lot of physicians in our family. And so the degree of physician dissatisfaction nurse, and P, add in any title in the medical community right now, people feel like they're fighting an uphill battle. And so many of my colleagues during the beginning of the pandemic went and went to New York City, a lot of my anesthesiologist friends, nurse anesthetist friends. And in many ways, I think the pandemic has really made it even harder for health care professionals to feel valued and appreciated. And what I'm hearing from my colleagues scares me, quite frankly, because I don't know what kind of care we're going to have. As we get older, given the fact that I have colleagues that are leaving in droves, like my gastroenterologist, who was brilliant, she was like a Hopkins trained gastroenterologist, she was tough as nails. And she said to me, after a year and a half being in the pandemic, she said, Cynthia, my husband, and I talked and even though she's in her 50s, she's like, we just decided enough is enough. Like, I'm leaving medicine, and I said, you can't replace people like that. So when I when I think about on the ground, things that are hard to discuss with people that perhaps don't understand the amount of pressure that healthcare providers are under, on a day to day, minute to minute basis. You know, it's, it's interesting, because I think this is the first time I've really talked about that in probably four or five years, but I'm so glad that I am, because I hope that people understand that all of these health care providers really want to do what's best for our patients, we're just so constrained within the current system. And we really want we don't want it to be that we're outliers, that when we look at who's metabolically flexible, who's healthy, you are becoming an outlier. Most Americans are so incredibly metabolically unhealthy. And that's not getting better. And so I think, on a lot of levels, the frustration that so many of us are experiencing, Brian, Phil, I mean, so many people that I know, within the healthcare community is a large byproduct of the realization that the current model is not sustainable. The other pieces if you're healthy, and you're in this model, your insurance premiums just continue to jack up, even if you see the doctor once a year or an MP once a year. I mean, I'm in a super healthy family. We only go to the doctor when it's necessary. And my husband was telling us what our premiums are every month. And I said, that's a direct reflection of how unhealthy the general population as you know
Jack Heald
There're so many places I want to go with that. Go ahead, Phil.
Dr. Philip Ovadia
Yeah, one of the biggest concerns I have around the future of medicine, and you sort of touched on this is that the system is selecting out. independent thought it is actively discouraging, independent thought and we see it starting now in in medical school, and the whole educational system for practitioners of all sorts, that you need to stay within the guidelines, you need to be checking all the boxes, and anyone who starts to say, well, this isn't working quite right for this patient, and we need to start thinking differently about this can actually get punished for it discouraged for thinking like that. So not only do I share your concerns about just having enough practitioners to take care of people moving forward. I really get concerned about what is the quality of care that those people are going to be able to deliver when they're not allowed to question and think about things.
Cynthia Thurlow, N.P.
Well, I know even over the last few years, my team, I've told them, we don't talk about the pandemic. We don't talk about vaccines, we don't talk about the virus largely because I don't want the blowback and I have colleagues that have said to me, if I see a traditionally trained provider speaking out against X, Y, or Z, I will report them to the Board of Medicine. And when my colleagues said this to me, I shall I shuttered I thought, oh my gosh, we're in a, we're being censored, like, as a licensed healthcare professional, and I'm still fully licensed,
Jack Heald
you are not allowed to publicly express a belief that falls outside of the accepted narrative.
Cynthia Thurlow, N.P.
And I think it's very tricky on social media as one example, I've had people in my DMs that have said, I know you won't talk about it outside the context of this conversation, what are your thoughts, and I always say, I'm only comfortable sharing what I have chosen for myself and my family. That's I'm not giving any medical advice or guidance, as much as I would love to be able to do that. I'm just not in a position where I can do that, because I'm just not willing to get the blowback. And I think it's so unfortunate I think not only was I raised by parents who encouraged me to question everything. I was trained at a university that encouraged us as nurses to question everything. And now I'm in a situation where I can't verbally question the way I want to in a thoughtful manner. I was even told recently by a friend of mine, who's a physician who has been on a lot of news outlets talking about the past two years. And he and I politely disagree to disagree, which was fine. But he was saying, Don't he's like, you probably don't want to talk about that on social media. And I was like, Oh, I know not to because I'm, I'm genuinely concerned. And it's also not on brand is not what I talk about, I'd rather talk about diabetes, and metabolic flexibility, I seem to navigate a whole lot easier, talking about other subjects.
Jack Heald
But I personally am sorry, Phil, I, I apologize for dragging us down that path. But I'm I've become more and more aware of how many people there are, who care about their health, and yet are utterly ignorant about why what their health care professional tells them to do, doesn't work. And so I feel like one of the things that we're being able to do on this show is educate people, not just about metabolic health, but about why if you're dependent on an allopathic health care provider, to give you to, to put you on the path to health, you're doomed to be disappointed. So
Dr. Philip Ovadia
all right, yeah. And the, the problem becomes what, Cynthia, and I and many others deal with every day is that this extends to all areas. So it's certainly not limited to the pandemic. And when you start talking about things like maybe not eating all day long might be good for your health. You know, maybe cholesterol isn't the one and only thing that we should be worried about around heart disease. And we start to see that blowback. And I'm sure Cynthia has experienced that, as well, when you start to talk about these alternative ideas around nutrition and health.
Cynthia Thurlow, N.P.
Well, and I've even had people tell me that I'm propagating eating disorders, that I don't understand what it's like to have an unhealthy relationship with food. And I always think, Gosh, I've taken care of patients for so many years. And as a middle aged woman, for the first time in my adult life, I struggled with the hormonal flux of perimenopause. And so I take such great offense when people are so triggered when I'm really just trying to provide education and inspiration for people to move the lever, like maybe you aren't ready to fast but dang, you should, you should not eat for 12 hours a day, like really, that should be the gold standard. Maybe not my teenagers, because they seem to have a voluminous appetite. 24/7 But for all adults, we should not be eating so often, like my mom is Italian. And I always tell people like my mom was like, well beyond her years in terms of we ate organ meats, as much as we didn't like it. My mom didn't allow us to snack, we had vegetables at every meal, my mom cooked everything from scratch. And so, for me, we've gotten so off base from instilling in our children or instilling in as a virtue of learning how to cook for ourselves, not eating as often like things that are so benign and they're so much more aligned with, you know how as a species, we've evolved as human beings that to me a lot of when people get triggered, it's really a reflection of them, and things that they're not they're not ready to do the work on.
Jack Heald
Well, let's follow up on this a little bit. What does you use the phrase that I'd like you to expand on? What does metabolic flexibility have to do with be healthy? Why is a trained allopathic nurse practitioner talking about metabolic flexibility? And what's all this stuff about fasting? If you're a nurse, why stay in your lane. Cynthia, help us understand here.
Cynthia Thurlow, N.P.
Yeah, no I in fact, I was told recently by a registered dietician that I had no business giving nutrition information to my patients. And I said, That's BS. So when we talk about metabolic flexibility, what we're really talking about is our bodies being aligned with utilizing either carbohydrates or fats as a fuel source. What's happened in our kind of over harried, highly processed hyper palatable food lives is that we've been conditioned that we need to eat frequently to stoke our metabolism, the breakfast is the most important meal of the day. And really, what we've done to our patients is that we have created so much blood sugar dysregulation and insulin resistance by encouraging them to eat a heart healthy whole grain diet, and very little protein and too many of the wrong types of fats and way too many carbohydrates and too much meal frequency. So when I talk about metabolic flexibility, it's about getting back to a position where you have normal blood pressure, where you don't have insulin resistance, by eating less often, you're going to allow your body to tap into stored fat. And even if you're thin, you have plenty of stored fat in your body to utilize as a fuel substrate. But most people here in the United States and most westernized countries eat so frequently that your body never has an opportunity to burn through the stored carbohydrates or glycogen. And so what ends up happening is that I was I always give the example my father likes to top off the gas tank. So he gets to a three quarters of a tank and wants to fill it up again. Well, it's the same premise people more often than not have lost the concept of what your intrinsic hunger feels like they just don't eight o'clock, they breakfast, they have a snack at 10, they lunch at 12, they have a snack midday, and then they dinner and then they might eat again in the evening. And if you look at the research of Sachi Panda, he had a research article that came out in 2021. Talking about meal frequency, people are eating anywhere from six to 10 times a day. And that never gives your body an opportunity to keep its insulin levels lower or to tap into those fat stores. So when I talk about metrics related to metabolic flexibility, it's some of the ones that Phil talks about blood pressure, waist circumference, HDL, triglycerides fasting glucose, and I always say fasting insulin should be one of the first things that we're checking on our patients. And these are metrics that are covered by insurance. They're not woowoo they're not integrative medicine or functional medicine. These are straightforward labs or metrics that you yourself can monitor and follow. But we're not doing a very good job metabolic syndrome has been around for a long time. But I actually was reading a paper today that was talking about that visceral adiposity should be like the first marker that we're really focusing on and do we talk to our patients the apple shape patients where they have visceral fat around their, their major organs that's really concerned is very different than a woman being frustrated with adipose tissue around her hips or her thighs, that's much, much different that subcutaneous tissue. So I remind people that the whole concept of metabolic flexibility is how we've been able to get from dating back to Biblical times till now, because our bodies were accustomed to going through periods of feasting and fasting. And so now we're just over eating all the time, and our bodies are really getting more and more, we're becoming a less healthy population.
Jack Heald
Well, that's one of the things that Phil hammers on. 88%, that's the number that that
Cynthia Thurlow, N.P.
88.2% From that UNC Chapel Hill study from 2018. That was pre pandemic. And if you look at the research, I just presented in Salt Lake, if you look at the research, I mean, people gained anywhere from 15 to 50 pounds, and a lot of it's mediated by alcohol use and sleep. So that number is probably higher, it's probably low 90. So you really are an outlier if you're metabolically flexible now. But that doesn't have to be our destiny.
Jack Heald
So you are, you've gone a different direction. You're still caring for patients, you're still providing health care guidance, you're still providing the things that we think of an allopathic healthcare provider able to do, but your practice is different. How has it changed?
Cynthia Thurlow, N.P.
Well, I now see myself as a purveyor of a different level of care. So I more often than not, I'm partnering with physicians and other advanced practice nurses they do they take care of the big stuff, but I'm very specialized. I'm very focused on women in middle aged, so perimenopause and menopause, because we as a medically focused group, we focus on women with contraception, pregnancy postpartum. And then it's like women go off to pasture. And to me, in many ways women need care at that stage of their lives, it's been 40% of their lives and menopause. So for me, I develop programs and, and one on one work with patients. And then went on to do a lot of speaking because I felt like women of this age group were really forgotten about and so it was a much needed service to women. And now I get to really talk about things all day long talking about lifestyle, peace, and gut health and hormones. And if someone has an issue that crops up that's beyond what I want to deal with, I send it back to their internist or their GYN. And it's been a beautiful relationship, because the allopathic train, people don't have the time to do that kind of work. And I always feel like if someone needs something urgently, urgently, etc, it's like those days of me having to worry about emergencies are long behind me. But I do provide a significant level of care that I wish I had been able to do before, but now I have the flexibility to be able to do so.
Jack Heald
So why do you have that flexibility?
Cynthia Thurlow, N.P.
Well, I mean, there's a couple different things. I mean, when I left clinical medicine, I had a spouse who is supportive, but cautious. And so he gave me a bit of time to start creating it. And it was like, within a year, I was profitable. So group programs, one on one work, a podcast sponsorships, and things that have been able to fill in the gaps a book deal, all that have kind of come out of public speaking things that I've done. So the way I look at is I get to impact women at a whole other level. And I can talk to more people. So to me, it's the blessing of all blessings is that my desire to do clinical medicine was able to help more people. Now I am able to do that. And I do it on my terms, like I it would be very hard for me six years out of my traditional kind of job that I had before, to ever go back like during the pandemic, at the peak of the pandemic, I had. My old practice called me, the hospitals call me they're like you have a very specific skill set, you could run the you could be in the ICU, helping them manage patients. And I said I don't think that's what I want to do anymore. I'm much more content, coming downstairs in my pajamas and getting in a full workday and doing other things. So I'm very blessed. I mean, I am grateful every day that I have the opportunity to do this. But I do get to impact more people now than I ever did before. And I'm an introvert, which people are always surprised to hear, I am not someone who I did the I did the TEDx talks, just to challenge myself, I was like, Okay, what's really scary to get up in a big room full of people and execute a talk and commit it to memory that was pretty scary, which makes me laugh now. But the point being is that I feel very fortunate that as a nurse and a nurse practitioner, that I'm in a community now where I feel that a lot of the people that that Phil and I interact with, were in a wonderfully supportive environment where we're able to support one another, and do it in a way that we all have an understanding of what everyone is, is struggling with right now. But the really interesting thing is, it seems like so many of my peers are gaining the courage to be able to stand up in the face of what is not working and try to be a remedy for change. I mean, that's the really powerful thing. The one thing that I found interesting was that my alma mater, reached out and wanted me to, I did some lectures, they asked me if I was willing to teach a class in the fall, because they said, We want more nurses to be able to do what you're doing. And so I look at it as we're inspiring a whole generation of other health care professionals to not feel like you're so constrained in a box, you do have options, that your message is really valued and appreciated, and that we can impact change. Like, we don't have to feel like I always felt like I was almost like a canary in a cage. I kept squawking I was like, trying to explain like, the system is broken, this is not working. And now I get an opportunity to help more people and that that is incredibly gratifying.
Dr. Philip Ovadia
Yeah, the community thing I think is a big part of this because you and I have started going to different types of medical meetings now. I know you were at Quito Salt Lake and a for me recently, I was just at the metabolic health summit, and it is very enlightening, very encouraging, to see that community that is building and we are all on the same mission. And we are all helping each other and the traditional medical conferences that I'm sure you went to just like me are oftentimes not like that, and they're very much about promoting yourself and competing and, and then it would just be the same people up there giving the same message all the time. So I have certainly found, I would say renewed vigor for going to meetings and interactions like that.
Cynthia Thurlow, N.P.
Well, and it's really neat to meet some of these people like I got to meet Dave Feldman and Brian Lewinsky's out in Quito Salt Lake, and my husband was with me. So he had heard about these characters and got to meet them in person and got to meet Brian's wife and so many other really lovely people. And he said to me, I know I know, I understand I get it, I really get it. Because obviously, leaving clinical medicine was a really hard decision for me. I mean, I think I cried every day that I worked for, like two weeks, because many of these physicians and these nurses had become such close friends. But I realized that I was so strangled by the circumstances I was in that I couldn't really practice the way that I wanted to. So to me to be around people that are like minded and supportive, incredibly supportive, is really nice, because in many ways, initially, they thought I was crazy. And I say they might my fellow nurses and nurse practitioners, but now they're like, I want to do what you're doing. So I feel in a lot of ways, you're inspiring other surgeons and doctors, and I'm certainly inspiring nurses to, to recognize like we were really capable of doing incredible things we can use our training in different ways, doesn't have to be in that kind of, you have to practice in a hospital or in an office or in a surgical suite, when there's so many other ways that you can utilize your training that will help benefit more patients.
Jack Heald
I want to ask an uncomfortable question of both. Brian Linkous said the same thing I've heard you say he and I don't remember if he gave the ratio. But he'd said he'd had patients come through the office. And he tried to talk to them about metabolic health. And they kind of roll their eyes and say, just give me the pill doc. And he realized when he left that kind of practice, those people didn't care whether he was prescribed prescribing the pill to them, or somebody else was prescribing the pill to them, because the only thing they were interested in was give me the pill. But on the other hand, there was a small number of patients who wanted what he had to give, and those are the ones who went with him. So my question, I guess it's the Pareto Principle. You know, 80% of our problems come from 20% of our customers 80% of productivity comes from 20% of the producers, and on and on and on. And I don't want you to throw anybody under the best bus. But there are patients there's, there's some percentage of patients who are just aren't willing to do the work to get well. They want symptom mediation or remediation. Do you see the same type of thing in the healthcare professionals that you've worked with? Is there just some percentage that there's nothing that's going to happen, that's going to get them off of this? Treadmill? Because they're perfectly happy to be on it?
Cynthia Thurlow, N.P.
Well, I think there's a few things. So I was privy to starting in medicine, when it was still very, very profitable occupation to be in now. It's like specific specialties are largely insulated from a lot of what my colleagues were dealing with. But when I started in clinical medicine, it wasn't unusual to see a cardiologist making 500 to 750 $1,000 a year. That wasn't what it was when I was leaving. And so I think there's a degree of cognitive dissonance about comfort for people leaving if they, they've, I lived in a very affluent part of the United States, and a lot of the physicians lived in the most affluent cities around where we worked, where a mortgage could be two or $3 million. And I was thinking God on how they're affording that. And so I think sometimes people get a get accustomed to a certain kind of lifestyle, and therefore they, they're, they don't have the option to be able to leave their circumstances. So I think there's some of that, and I want to be sensitive to that. I think some of it's just cognitive dissonance. People just don't want to see what is in front of them. And I'm of the belief system that once I saw I could not unsee and then it was it just it was almost like an itch that couldn't get scratched. I couldn't scratch the itch enough. It just persisted until I moved, I had to do something. So I think there's a variety of different things. I would say more often than not now. What I hear from my colleagues, it's just it's just potentiate it like now people are really unhappy. And this is both nurses and pas other advanced practice nurses, physicians, etc. The people are really fed up. You know, in the six years since I've been out of like a traditional environment. Everyone's waking up, my friends are waking up Many of them are just trying to squeak through till they maybe they've got a metric of how much money they have to have in the bank. A lot of people are just getting by, like, I have one colleague who's a nurse anesthetist. And her way of getting around a lot of this is that she started doing travel nursing, which she really loves, actually, but allows her to see what's going on in different hospitals in different parts of the country. And it's not unique to any one geographic location. In fact if anyone's been living in a box the last couple years with the book dope sick and Hulu has a series about job sec, but I was watching. I was watching a special on ABC about fentanyl. And for anyone that's not familiar fentanyl, so synthetic narcotic, it's incredibly powerful. In fact, when I had my appendix out, they gave me too much fentanyl, and had to give me a couple rounds of Narcan to wake me up. But that, but I think the point of what I'm trying to say is that there have been so many, there's been so many different variables that have impacted people's quality of life as a health care provider over the last 20 years that I think there are some people who feel like they're pill pushers, I think there's some people who are just frustrated, they just they're biding time, like I had a big birthday last year, and I can tell you, I've colleagues, they're like, I just want to work five or 10 more years, and then I'm out. And that's their mentality, I want to get my kids through college that I'm out. And that's unfortunate, because you can't replace the knowledge of a well-seasoned physician or a nurse or nurse practitioner with five newbies, it takes a long time for people to accrue the confidence and the skill set to be really, really good at what they're doing.
Dr. Philip Ovadia
Yeah, the not being able to unsee what you've seen I think is one of the cruxes that I see, because you hear that from almost all the physicians and the practitioners that are kind of in the spaces that we are now. But you realize that a lot of people when they are faced with a sort of ground shaking realization just say, Oh, well, that just can't be true. And they just ignore it and, and put their head in their say, in the sand. And again I get back to the whole healthcare system has evolved to such a point that thinking outside the box and questioning these basic assumptions, is just not allowed. It's just not encouraged. And so people who have invested their entire lives most of the people who go into medicine that's what they always wanted to do. And they start down the path, and you just can't and you're 20 years into your career. And it's hard to think about that you might be able to construct a life in some other way. And even staying within medicine, but doing it different than the way that you've already always done it can be a tough, tough thing for people to say,
Cynthia Thurlow, N.P.
Well, it's funny, even my father still talks about my father still, to this day, keep saying I can't believe you got the education you got. And you still left. And I said, Dad, I know you don't understand this. But once you see you cannot unsee I said I would not have been I wouldn't be who I am the if you raised me to be a certain kind of person. I wouldn't be the daughter that you raised if I just sat back and sat there passively and didn't do anything. So
Jack Heald
I want to I want to ask about your practice. Now in particular, I am not a woman or menopausal. So these are things that my interest in it is relational rather than personal. Talk about I guess the I'm looking at this poster book or whatever it is on the on the credenza behind you fasting transformation. What is fasting have to do with caring for pre-menopausal and menopausal females.
Cynthia Thurlow, N.P.
So this is a good story. So, six years ago, seven years ago, eight years ago, I hit the wall of perimenopause. And for anyone that's listening, if you're not familiar with that term, it's anywhere from five to 15 years prior to menopause, and I was gonna be
Jack Heald
who's married to a woman? Yes. Yes. Guys, who? Yeah, this one? You want to listen to this one, maybe more than your wife wants to do?
Cynthia Thurlow, N.P.
Yeah, no, no, I mean, for the for the first time in my adult life, I had gained five to 10 pounds seemingly overnight, I couldn't sleep I was exhausted all the time. And you know, I had a very demanding job. I had a husband who did a lot of international travel. I had young kids, I was probably not eating enough food during my day to day existence, because I was taking care of these sick assisting people. And over time, intermittent fasting just kind of came to me as potentially a straw Did Jr can utilize to get my health back in line. The irony being the strategy that I use to get myself back on track is something that literally bled into all the work I was doing like with every person I worked with one on one and every person I worked with in a group program or anytime I got on a podcast, I would talk about intermittent fasting, of course, not realizing that that was a foreshadowing to several years later. And so for me, for a lot of women in particular who are struggling with weight loss resistance, all of a sudden the game changes in perimenopause, the things that used to work in your 20s and 30s don't work anymore, you don't sleep as well, your body isn't as stress resistant, as it once was foods that used to not bother you suddenly do and so you have to change what you're doing. And for a lot of people, they would rather they would much rather try to make lifestyle adjustments and live a fervent and inspiring middle age life. And then you got to call people who they're rigidly dogmatic and they don't want to give up their alcohol and they don't want to change. They're over exercising. And so fasting gave me back my vitality. And that's why I'm so passionate talking about it. Now, the irony is for full disclosure, when I did my first TEDx, it was about perimenopause, no surprise, right. You know, when I was offered my second, I was planning on talking having a gender neutral discussion, but it was the organizers that asked me to do a gender slanted discussion. And so, voila, that is now what I'm known for is talking about women and intermittent fasting. But up until that point, I talked to men and women about it all the time. But in a lot of ways, when you think about fasting as a strategy, it's very aligned with ancestral Health Perspectives we went through food scarcity, if our bodies weren't able to adapt to having periods of food scarcity, we wouldn't have survived as a species. So when people send me DMS and tell me that I'm advocating for starvation, or I'm advocating for eating disorders, who it really demonstrates to me that they really don't understand what intermittent fasting is, but to me, it's a really powerful tool that both men and women can utilize. And certainly there are people shouldn't do it. But I'm pretty vocal about those that should exclude it from their lifestyle, but more often than not, I mean, even if you just do 12 hours of digestive rest, we're doing tremendous benefit for your health, and we just don't talk enough about that we just keep it's like this. You know, it's like on autopilot, we just keep saying fat is bad sugars, not bad, eat all these heart healthy grains don't eat enough protein, eat the wrong types of fats, not realizing it's just make us making us more obese and more sick.
Jack Heald
So intermittent fasting, quick definition for us.
Cynthia Thurlow, N.P.
Eating Less often, it is that easy, eating less often. And that there's so much flexibility to when you choose to eat when you choose to fast. Some people like to make it complicated, and I remind them all the time, intermittent fasting should not be complicated, we make it complicated, because we overthink it. So eating less often is really the way to think about it. And it could look very different. For each one of us. We all have flexibility about when we fast, how long we fast, how short we fast. Women obviously have the confounding variable of menstrual cycles. And so women that are still getting a menstrual cycle, need to fast at certain times during their cycle. And this is the only time you'll ever hear me utter this phrase. menopausal women and men have less limitations on fasting than younger women do. And so that's the only time you'll make I'll make that comparison, say men and women, postmenopausal women and men are more aligned with more stable hormones. I'm just gonna say stable as in stable, quote unquote, stable.
Jack Heald
So does that mean every day? Here's I actually had a thought that occurred to me. And I've had this question in my mind for 40 years, maybe? Seriously, um, for reasons that don't matter. When I was a freshman in college, right back after Jesus was born. I decided to fast 24 hours a day, once a week. And I did that for I think my entire freshman year. So for like 36 weeks, I ate six days a week and fasted the seventh and then I let it go. And I've wondered if that practice did something for me at the time that also bore long term fruit. And in the same way that that if a 17 or 18 year old or nine year old boy gets serious about weightlifting and does weight training and is committed to it for a while, it also will bear long term fruit that lasts for decades. Is there damp? Any insight on that? I'm not that I'm advocating that people do that. But I've wondered, because I've never, I know I've never had an adversarial relationship with food at least as long as I can remember. And I've wondered if it goes back to that? I don't know. Anyone? Bueller?
Cynthia Thurlow, N.P.
Sorry, you were you're breaking up, I just wanted to make sure I didn't miss a nugget of what you're trying to share. Yes, I mean, I do think that even a 24 hour fasts a week has benefits. For a lot of my patients who are not ready to do daily fasting, sometimes we'll just have them do 20 to 24 hour fasts a week. And that can be very beneficial. And if you look at the technical like a five to five slash to, in some instances, a five two is five days a week of your normal eating pattern two days a week of fasting, versus five days a week of your normal eating pattern, and then two sub caloric days, but I don't believe in counting calories, that's not my focus. But for men, it's under like 600 calories for one meal out of the day. And for women less than 500. But I do think that having periods where you're not eating longer periods, can for many people help with cravings, it can certainly help with boosting certain biomarkers like growth hormone, etc. It invokes deeper levels of autophagy, which is the waste and recycling process in the body. So, I do think that there can be benefits to doing that. And certainly men, because they're not constrained by menstrual cycle and the fluctuations of estrogen and progesterone and testosterone, generally have a long, generally seem to have an easier time implementing a 24 hour period of not eating every week. And we can talk about the law of diminishing returns. I know Ted naman is very big on talking about fasting and thin people and not doing too long of fast, which I do agree with, to some extent, how about you feel? What do you think?
Dr. Philip Ovadia
Yeah I, Jack and I have talked much on the show one of the things that I always say is just eat in a way that makes you hungry less often. And I do agree that inter fasting of any sort intermittent fasting, and it takes all the different forms that you talked about. And one of the things I love about the book is that you are not dogmatic about this is the only way to do it. And you talk about the process to kind of prepare for it and make it a long term successful strategy. But I agree that there is probably a diminishing return, and it does get harder for very lean people to fast and there may not be the reasons that they need to fast. So, but what I do want to say about the book is that, although it's sort of geared towards women, I think there's a lot that men can learn from the book. I've learned a number of things from the book, and you can directly help yourself. And of course, you can also be helping the women in your life with the stuff that's in the book.
Cynthia Thurlow, N.P.
Thank you. Yeah, no, I think that one of the questions that I get most frequently is do I do really long fasts? And the honest answer is, three years ago, I spent 13 days in the hospital and almost died. And so I don't do really long fast because I had seven days of not being able to eat followed by TPN, which for anyone that's listening, it's total parenteral nutrition, which is probably what kept me alive. But I lost 15 pounds, and so I didn't fast for probably four or five months after that. So to me long, fast put me in a kind of a negative tailspin. I've done lots of work around this area. But I haven't done more than a 24 or 48 hour fast in the past three years, and I'm okay with that. I don't think that for myself, personally, that it does me any benefits, but I do like doing a 24 hour fast and probably do two of them a month. I do feel like it's a way of like getting myself back on track. The irony is I'm in a house with all men. And I say this, like my oldest is six feet tall. He's a football player, lacrosse player, my youngest is a competitive swimmer. And the amount of food that my kids eat is just unbelievable. So sometimes when I'm in a fasted state, and they're in the kitchen for the uptake of time, I'm just like, oh, enjoy your metabolism boys. I'm telling you, it's pretty incredible. I can just marvel I'm like, wow.
Dr. Philip Ovadia
In some ways, maybe you're kind of in the ancestral model that you actually have to fight for food. So times fasting becomes unintentional thing.
Cynthia Thurlow, N.P.
Yeah. Well, you my husband, my husband, so this is the funny thing. So when I transitioned from my nurse practitioner job to an entrepreneur, my husband, he was an engineer. And he's very kind of like very fiscally conservative. He started picking up meal prep. That was his job. That's what he wanted to do. So he does batch cooking for protein, which is really what we need two days out of the week. And last night, my husband grilled a bunch of shrimp for him. And he said to my boys, do not eat your mother's shrimp. Well, sure enough, I went to eat my dinner a little earlier. And I opened it up, they're probably like six shrimp in this thing. And I'm like, seriously? And my husband's like, yeah, my youngest wanted to make SUVs each day. And my husband was like, but they'll go through four or five pounds of meat. And just, I mean, like a day and a half. It's unreal. We call it first dinner. Second dinner, like just trying to the hobbits. I got it. Yeah, it's insane.
Jack Heald
Yep, I don't miss those date might have grown. I had, I had a bunch of had 10. I had eight boys between the ages of five and 13. In my pool all day, Saturday, fed them to meals. Wow, did we go through a lot of food. But they weren't big. These?
Cynthia Thurlow, N.P.
Well, and it's funny, my husband. So as smart as he is, he sometimes forgets how much the six foot tall 16 year old eats. And I'll say I don't understand. I said you need to make a pound more than whatever you think you need. Like, that's just the conditioning. And my son will sit down he'll eat a massive breakfast I'll have him because he's 16. And because he's very active. He eats rice and eats pasta because he can do it. And he had the amount of rice was the same as the amount of ground meat. I think it was ground bison. And ultimate said how do you eat that and go to school, I would want to take a nap. But he said no, this is great. He just he eats constantly. He can't eat. He can't eat enough. It's insane.
Dr. Philip Ovadia
Talk a little bit, Cynthia about, you know what, and you go into this in the book, but you know what to eat when you are eating because I think that's as important as the time spent fasting in order to I think make fasting sustainable and successful, you still have to focus on what you're eating when you were eating.
Cynthia Thurlow, N.P.
Exactly. And so I think the most important macronutrient in terms of satiety and muscle protein synthesis is protein. And we're talking about animal based protein and aiming for 100 grams a day. Now I find most women are probably getting by with 40 or 50 grams. And this is where I was saying earlier, we don't eat enough protein, what happens north of 40 That's important to mention, it's not a question of if but when sarcopenia which is muscle loss with aging. Insulin resistance starts in our muscles. So if you take this no other takeaways from this conversation number one, you need to strength chain number two, you got to need enough protein number three, you got to get good sleep. So protein centric meals, I always say if you're going to break a fast it's always with some degree of protein. I don't care if it's a little bit of bone broth to start and then you have a meal later. protein and healthy fats and healthy fats are not seed oils. They're not canola oil, soybean, sunflower, safflower, etc. Protein with healthy fats like avocado, olives, coconut oil, whatever it is that you enjoy butter, or you have protein with some carbohydrates. Now I'm not anti-car But I remind people non starchy carbohydrates are really should be the focus of the carbohydrates. We consume low glycemic berries of tart apple etc. Always consumed in conjunction with protein. And I find for most people, irrespective of gender, that doing it that way, make sure you're satiated. If you're satiated, your leptin and ghrelin are properly balanced, you can push your meal away, you don't want to go back in the pantry. Now. relator went back to the ghrelin. So there are two Yeah, there are two hormones. They are involved in appetite regulation and hunger. And one of the ways that you can help support leptin, which communicates between the brain and the stomach, is by eating that protein bolus. Now, obviously, there are people that are insulin resistant, who may also be leptin resistant. Leptin can help dysregulate communication, the communication centers in the brain. But I remind people over time, the way that you can work through that is the protein piece. I find for a lot of people that if you're hitting if you're eating enough protein, you're just too full to continue eating, you can push the plate away. And so animal based protein is superior to plant based protein amino acid profiles are not the same. This is this is a definitely one of those things that I have to do a lot of education around. There are people who feel guilty about eating, eating meat, and I remind people that we are designed to consume animal based protein and a cup of quinoa is for most of us is going to be profoundly detrimental to our blood sugar and insulin response as opposed to sitting down and having a steak. You eat a large enough steak, you're going to be full, you eat a cup of tea while I can probably guarantee you're still going to be looking for more food or beans or legumes or whatever you're eating But I find that those, those variables are very important how you choose to break your fast and what you choose to play your meals with. Because ideally, I want you to get from, let's say, you break your fast at 1030, from 1030, until your next meal should be four or five hours later, the way to get to that point to not have to have a snack in between is really to be hitting those protein macros. And for a lot of people, this freaks them out, they've been told to count calories for so many years. And I remind them, if you do nothing else, I want you to measure your protein. So you have a sense of what 3040 50 grams of protein in a meal looks like. And I want you to track your carbohydrates and not tracking net carbs. That's cheating. We want to track total carbs. To keep yourself honest, I always say net carbs is a byproduct of the processed food industry because they want you to eat more of their crap. So if you follow those principles, you generally will do pretty well. And there is a retraining, I always say there's a retraining, reframing people think they're going to die if they don't have bread and pasta. And I remind them, there are so many substitutions. One of my big things is if you can't moderate you eliminate so there are certain foods I don't have in my house, I don't care how much my kids want them. There are foods that I can't moderate like gluten free cookies, so we never have them in the house. But I do like dark chocolate. And I have a little bit every day because I can moderate.
Jack Heald
But if your workload is the hill above which I will die, yes,
Cynthia Thurlow, N.P.
I told my kids. I told my kids that I have a little bit every day probably with some salt and macadamia nuts. And that makes me very happy. But I think it's important for people to also understand the concept of good, better best we're talking about food. So Phil mentioned he was just recently traveling, I was certainly doing a lot of traveling. When I do a lot of business travel, I do longer fasts until I can get to where I want to eat. But when you're in a pinch, you can get a naked burger, I can't tell you what country city I'm in, I can almost always get a naked burger on the lettuce wrap. And I do just fine. Or I just get a big steak. If I'm in a city, I'm like, I can have my big steak and have my broccoli and I do really well. But I think it's important for people to understand that. we don't live a life of deprivation. We've just learned to retrain our thought processes and to reframe a lot of our thoughts like I tell my kids all the time that I've traveled all over the world, and I have rarely been in a circumstance where I can't get something that's aligned with my nutritional paradigms. I do feel I'm curious now if you do, I do travel with certain foods, like just in case I get stuck in a layover. I always have olives like prepackaged olives, I always have beef jerky, and I generally have salted macadamia nuts. And if I have those things with me, I can my husband knows I mean, worst comes to worst. If I'm in a situation where I can't get something to eat. I'll do I'll be just fine. I just fast longer, right, one of those things, and I do just fine.
Dr. Philip Ovadia
Yeah I certainly I basically use fasting as my emergency backup plan. You know, if I'm in some travel situation where I'm stuck, then I'm just gonna fast for a little longer. And knowing that you can do that, it I find is very empowering. You know, one of the one of them, I think things that fasting kind of teaches you is that you can go without food. And like you said, it's strange that we think that that's a strange concept, because that was the basic assumption for most of our existence as humans that there were going to be times that we went without food. But now we see that going without food for four hours is considered abnormal. And so that's part of the that's certainly a big factor in the mess that we find ourselves in. But I think fasting for me has basically taught me that if there isn't good food available, then I'm just gonna go without eating for a little while. And there's, there's no problem with that. So I kind of used my emergency plan. I travel a lot as everyone knows I'm on the road constantly. And I would say that the strangest thing I traveled with is my cast iron pan. So wherever I am, I can grab some grab some meat and throw it in a pan and be able to eat good food instead of being stuck with takeout stuff.
Jack Heald
That's regularly get yanked out at the security check at the airport.
Dr. Philip Ovadia
Well, that has to go in the check bag.
Jack Heald
Well, Cynthia, I love this. I'm having so much fun. I would love to ask you another four hours of questions. But this is the point where we need to say you need to kind of wrap it up. Tell us you've got a book. What's the name of the book? Where to folks get it out of folks connect with you Let's get all that information.
Cynthia Thurlow, N.P.
Yeah, thank you. This has been most enjoyable. So, my book is called "Intermittent Fasting Transformation."
Jack Heald
That's what's behind you, okay?
Cynthia Thurlow, N.P.
Yes. And it was published in March of 2022. It's doing very, very well, for which I'm very grateful. You can find it on most bookstores, Amazon, target Barnes and Noble, your local bookstore. I always encourage people to go to their local bookstore because our brick and mortar businesses have really had a tough time the past two years. You can find me on my website, www dot Cynthia thurlow.com. I have an amazing podcast, Dr. Phil has been on there, called everyday wellness. I really am very fortunate. It's been probably one of my favorite ways to network within my incredible community. I am on Instagram, very active on Instagram, I am on Twitter, Be forewarned, I can be snarky. And I do have a free Facebook group called intermittent fasting lifestyle, backslash, my name, there are men and women in that group. It's a very supportive, nurturing anti drama environment. I have zero tolerance for drama. But that's probably the easiest way to connect with me. But I always say that the podcast probably gives people the best sense of a lot of my philosophies and a lot of my area of focus. I just had a podcast out yesterday talking about leptin resistance with a leptin expert, because I've gotten so many questions about leptin, but it's a fascinating hormone.
Jack Heald
So that's everyday wellness. All right, very good everyday wellness with Cynthia Thurlow. This has been yet another one of those great ones, I get to work through the transcript from the show. And I was working through last weeks before the show came on. It just was wow. I just feel so blessed that I get to sit here and listen to you smart people talk about all this stuff. It's changed my life for the better. All right, Phil, we good for the day.
Dr. Philip Ovadia
I think so another enjoyable conversation saying Thank you, Cynthia, and look forward to maybe having you back on again some time to continue it.
Cynthia Thurlow, N.P.
Absolutely.
Jack Heald
All right. Well, you guys who listen know the drill, but for those who don't know the drill, this is the staff my operating table podcast, Dr. Philip Ovadia. You can reach him on the web at Ovadia Heart Health dot com. Take his metabolic health quiz at IFixHearts.co, I recommend everybody do that. Find out if you're one of the 12% or the 88%. And finally, I highly recommend you follow him on Twitter @IFixHearts. He's a good follow. You hit that subscribe button. We drop a new podcast episode every Tuesday at midnight. And we'll talk to you next time.