How Fasting Can Support Hormones, Muscle, And Heal The Body

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Doctor’s Farmacy with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Introduction: Coming up on this episode of The Doctor's Farmacy.

Dr. Mindy Pelz: If women just looked at those two hormones and used fasting in the right place of the cycle, they started to see all of their hormones balance out.

Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman, that's Farmacy with an F, a place for conversations that matter. And if you're a woman or no a woman, which most of you do because you usually had a mother, you should be interested this podcast because we're going to be talking with Dr. Mindy Pelz about hormones and women and the challenge they face throughout their life cycle and how to actually address these problems in a coherent way that gets the root cause of so much of the suffering that women have that's totally needless, PMS, fibroids, PCOS, infertility, perimenopausal symptoms, menopausal symptoms, all of it. Sexual dysfunction, brain issues, sleep issues, and weight issues, we're going to talk about all of it and how hormones play a role and what to do about it.
Mindy is a renowned health expert. She's one of the leading voices in educating women about their hormonal health and she's empowered hundreds of thousands of people around the world to tap into their bodies innate healing ability through her five-step approach, which we'll talk about, fasting, personalized nutrition, stress management, and chemical detox, as well as lifestyle changes to optimize health and slow the aging process.
She's on a mission. This woman is on a mission to start a women's health revolution. She has a private coaching group, the Reset Academy, teaching women how to sync a fasting lifestyle with their hormones. She's the author of three bestselling books, The Menopause Reset, The Reset Factor, and The Reset Kitchen. She's got a Resetter collaborative on Facebook with over 50,000 active members and they do a fast training week. And she has a new book Fast Like a Girl. I like that title, which is a definitive guide for women everywhere to harness the benefits of fasting while making sure they're supporting and caring for their hormones throughout different stages of their cycle and through perimenopause and menopause and post-menopause. So welcome Mindy.

Dr. Mindy Pelz: Oh, thank you for having me, Mark. I'm excited to be here and have this conversation with you.

Dr. Mark Hyman: Oh, it's so great. Years ago I was working at Canyon Ranch as a medical director and they're pretty much, the women were between 40, maybe late thirties and early sixties. And that was the majority of our guests and clients and patients. And so I got to be very experienced in dealing with all sorts of hormonal problems that were being poorly treated or actually mistreated by the conventional medical system. And it was just striking to me how the answer for everything before menopause was take the birth control pill and the answer to everything after it was take hormone replacement therapy. And then of course the data came out that hormone replacement therapy, Premarin and Provera specifically, which are not human hormones, one is a horse hormone and one is a synthetic progesterone, ended up having more serious consequences for women who took them like heart attacks and strokes and cancer.
And so everybody, overnight, boom, 50 million women stopped taking hormones, which created a huge catastrophe for them with no answers in sight. And here we are, gosh, that was '98, so over 25 years later, still women are struggling and trying to figure it out and doctors are confused. So I wrote an article years ago called The Life Cycles of Women talking about how to use a functional medicine approach to address women throughout their life cycle and the issues that they're suffering from that they really don't need to, that are, I would say, optional if you know what to do. So talk about how you have focused on this, why this is such an important area to get clear for women and how we really had it wrong and what we need to do to figure out how to get it right.

Dr. Mindy Pelz: Oh wow. That's a loaded question. There's a lot in that. So let me start with the first part of that question. The biggest challenge we have right now with hormones is that we are hormone illiterate. So this is women, this is doctors, this is men. We just don't understand our hormones, both men and women. But for women, this is a massive problem because our hormones run and regulate everything from our menstrual cycle, obviously, but also our appetite, our moods, our sleep. Everything is driven through hormones. In fact, when you actually look at the word hormone, it comes from the Greek word meaning to excite. It actually is what will initiate chemical reactions within the cells. So you have to have your hormones in balance in order for your cells to do the job they were meant to do. But when we look at the collective societal way that we approach female health, nobody's being taught how to live a life that works with these hormones.
So my passion started when I started seeing my own patients suffering with perimenopause and menopause. I started having my own experiences. And to your point, when you opened up this conversation, there was really only one solution. Well, there was two, and that was don't do hormone replacement, it's very scary, and take the birth control pill. But there was no education about what our hormones were and what lifestyle we should be using to match to the hormonal fluctuations that happened to us, not only monthly but also throughout our lifetime. So it's really the lack of knowledge that has us in the place that we are at as far as women's health goes.

Dr. Mark Hyman: Yeah, I like that concept of hormone illiteracy because I really think it's true. I just am shocked at how even endocrine experts, they know what they know about what they know, but in terms of how do we impact hormones without using drugs, it's kind of like what? And I think it's really one of the most gratifying parts of my practice and of functional medicine is seeing the power to transform women's lives from painful periods, from heavy periods, from irregular periods, from PMA, from fibroids, from infertility, from perimenopause, from menopausal symptoms, all of it, sexual dysfunction, libido issues, weight and metabolism changes, all these things are not inevitable parts of being a woman. And I think about it, I joked, 75% of women have some form of PMS, was that just a design flaw or is something actually going on here that we can address and get rid of it?

Dr. Mindy Pelz: Yeah. So on that note, you bring up such a good point. There are two major issues that are going on for women. One is this illiteracy problem. I can't tell you how many women that I've talked to that don't even understand when estrogen comes in during their cycle, when progesterone, most women don't know that they get testosterone in a big way only at one point of their whole cycle. So we have this lack of knowledge, not only with women, but doctors like you said as well. But then we are in an evolutionary mismatch with our hormones. So we have more physical stressors, emotional stressors, chemical stressors. The world is packed, as you know, with endocrine disruptors. And so the hormonal problems are getting bigger and bigger and bigger because the world is getting more and more toxic, not just from a chemical level, but from an emotional level. And then we don't understand ourselves. So we have this mismatch that's happening and it's creating this hot mess for women.

Dr. Mark Hyman: So talk about this, talk about why are women's hormones so screwed up? And by the way, men's are too. I see 20 and 30 year olds with testosterone levels of 80 year olds, and I'm like, what is going on here? But a lot of it's due to poor metabolic health. So let's talk about women because it's a little more complicated with women. It's not just about bad diet, it's about a lot of things that are influencing their hormone function.

Dr. Mindy Pelz: Well, I mean each hormone's going to have a different thing that's messing it up, is the way that I look at it. So I think the best place to start this conversation is to realize that men are really driven by one hormone, which is testosterone. And testosterone is made in the outer layer of the testes, goes up to the brain and converts to estrogen. Women, we've got testosterone, progesterone, and estrogen made in not just the ovaries but the adrenals and some of the peripheral tissues. So we have to really a address different lifestyles when we're looking at these different hormones.
So when we look at why women are struggling right now, a large part of that is there's a one size fits all approach to healthcare. I walk into my doctor's office, I have high cholesterol, I have high glucose or high insulin, and we're never asked what part of our cycle we're at. So we have a real challenge just being able to get medical care that can bring in this hormonal picture. So more women are suffering. I don't know if you saw the New York Times article on menopause recently, but one of the things that really stood out to me is that there was this line where they said that we have a societal acceptance of women suffering with their health.

Dr. Mark Hyman: Yes, 100%. 100%. I'm like, you don't need to suffer, absolutely.

Dr. Mindy Pelz: So a woman, when she's suffering, goes into the doctor's office and they're given a one size fits all approach. So we have that issue.
The second issue we have, and this is a big part of what I'm trying to teach women, is that when you look at your menstrual cycle, estrogen has vastly different qualities and lifestyle habits she wants us to live by, whereas progesterone completely wants us to do something different. So let's just use cortisol as an example. Estrogen's pretty forgiving of cortisol. If you decide to run a marathon or do a really long fast, when estrogen is coming in, it's not going to really affect estrogen too much. But progesterone that comes in the week before your period, it does not like when cortisol shows up. When cortisol goes high, progesterone goes shy, she's out, she's not going to make her appearance. So then we start to see women losing their periods or having really difficult periods once they start because of the lack of progesterone. And that's just with cortisol alone. We can do the same thing with glucose, insulin. I mean you can take exercise, we should be exercising according to our cycle, but we have to look at these three hormones through the lens of our lifestyle to get them back in balance.

Dr. Mark Hyman: Yeah, it's so important. And I think there's a lot of other things that affect women's hormones too, obviously the stress, sugar in our diet, alcohol, environmental toxins, sedentary lifestyles, all these things affect our hormonal balance. And there are things that we can usually do something about. Toxins in the environment, we can reduce our exposure. It's a little harder, but pretty much everything else, whether it's smoking or caffeine or alcohol or sugar or how we manage stress or sleep, all these are things that are within our control. And I've seen so many patients just recover from years and years of misery and thought they just had to live with PMS or thought they had to live with all these menopausal symptoms. And it's important to realize that you actually can fix it.
Let's sort of start the conversation with your five step program and talk about fasting because it's really an unusual framework to think about managing hormones with fasting. I think I'd sort of love to hear your perspective on that, what you've learned and how it works?

Dr. Mindy Pelz: Yeah, I love this question because what I just stumbled into understanding fasting for women because this was about over 10 years ago when we saw Dr. Ohsumi's work come out into the world talking about this concept of autophagy. We started to see this big wave of people fasting and so many people were getting incredible results. And I always call them Oh matters. They became the one-meal-a-dayers that are like, I'm just going to eat one meal a day and I'm going to do that forever.
And I was actually out, I have a popular YouTube channel and I was educating people on the science behind fasting and I started to see that there was a really clear difference the results women were getting and the results men were getting. And when I started to dive into that a little deeper, I realized that women got great results at certain points of their cycle. But if they continued to do one meal a day over and over and over again, they actually destroyed their hormones and they started gaining weight, they started-

Dr. Mark Hyman: Oh really?

Dr. Mindy Pelz: ... they started losing their hair, they started having menstrual problems that were pretty severe. If you were in perimenopause and you weren't paying attention to wear to fast, all of a sudden you started to see women that were going into menopause way too early.
So what I started doing is tweaking and looking at, okay, if I look at estrogen, I look at progesterone, they have vastly different requirements. Estrogen likes to have glucose be low. Estrogen likes insulin to be low. Progesterone, we actually need to bring glucose up, we go into more of an insulin resistant state the week before our periods. So I started timing like different fast and different foods to cater to these two hormones. And what I saw was not only in my clinic, myself, but now it's been millions of women on my YouTube channel, is that it just balanced their cycles out completely. And it was everything from PCOS to perimenopause symptoms to infertility, we started to see if just those two hormones, if women just looked at those two hormones and used fasting in the right place of the cycle, they started to see all of their hormones balance out.

Dr. Mark Hyman: Interesting. And how would you manage someone throughout that process?

Dr. Mindy Pelz: Yeah, in the current book, I wrote something called the Fasting Cycle, and it was actually something I created for my patients because I was trying to show them, hey, the first 10 days you can lean into some longer fasts. And when we hit ovulation, we're going to want to shorten our fast because you have so many hormones coming in. When you come out of ovulation, you can go into some longer fast and then the week before you want to stop fasting. So it really became working with a woman's lifestyle and teaching her A, are you tracking your cycle? So it's interesting because a lot of the younger generation is doing this. My son is-

Dr. Mark Hyman: Yeah, with the apps, right?

Dr. Mindy Pelz: ... Yeah, exactly. My son's 20, my daughter's 23 and they know this. My son's like, "Oh yeah, all my friends track it," my daughter's tracking it. But as a 43-year-old woman and she's like, "Oh, I'm supposed to track my cycle?" So there's a little bit of a generational gap there. But you got to start tracking and you got to know what hormones are coming in when, and then you got to know what these personalities of these hormones are. So it's really getting into the nuance of what's happening at different parts of your cycle and helping women understand the lifestyle to pair to that. That's how we started, that's how we start to repair. It's not going to be in a fancy supplement. It's not going to be in us beating the conversation to the ground about HRT. It's going to be what are we doing for these women's lifestyles so that they can match their lifestyle to their hormonal needs.

Dr. Mark Hyman: Incredible. And how does fasting work to regulate hormones? I mean, what is the mechanism of action? How does it actually do that?

Dr. Mindy Pelz: Well, okay, so if we start and we look at what happens, I think this is the best question is what happens when we fast? So the way that I look at fasting is that you have two energy systems, one that comes from sugar and one that comes from fat. And so when we learn how to metabolically switch into this fat burning energy system, we are not just making what we call ketones, and I know there's been a lot of great discussion about the healing power of ketones, but we start to see many healing aspects exist within this fat burning system. So the longer that you're in a fasted state, the more healing mechanisms show up. So for example, we can see testosterone raise, we only have, this is another huge elephant in the hormonal room, which is we have a lot of studies on men. We have a lot of studies on men and women. We don't have a lot of studies on women alone.
But when we look at testosterone in a man, when he fasts 13 to 15 hours, he can raise testosterone by 1300%. He goes to 24 hours, he gets that testosterone level up to around 2000%, according to the science. A woman, it's going to take her 24 hours to even start to see a little blip of increase in testosterone. But what we do appear to know is that it starts to rise about 24 hours. So now can we teach her how to start to train her body maybe one day a week, maybe one day a month to start to move into some longer fast to get testosterone coming up?
The other thing that we see is that when we start to stimulate autophagy, which comes in around 17 hours. Well what autophagy is it's where that intelligence goes within the cell and it starts to repair the cell. Well guess what's very, very susceptible and highly influenced by autophagy is your hypothalamus and pituitary and the ovaries. So now can we teach a woman how to dip into a little bit of a longer fast so she can start to clean up these areas that might be packed with toxins. In the book I write six different length fasts and each one has a hormonal impact. But that sort of gives you a big picture of why we can use it therapeutically. I'm not talking about this as a fad diet, I'm talking about this as a therapy tool that everybody can afford to do.

Dr. Mark Hyman: Interesting. And so what is the different types of fasting and how do they each differ?

Dr. Mindy Pelz: Yeah, so the six different ones that I lay out are intermittent fasting, which is 13 to 15 hours. And just so we're clear, fasting to me is time restriction. It's not calorie restriction. And we can talk about what to eat in your fasting window, which I'm sure you've talked about ad nauseum.
But when we look at 13 to 15 hours, that's where we start to see growth hormone. We start to see that the body brings down glucose and insulin. We see that the body starts to make ketones. Autophagy fasting is 17 hours, I mentioned that where the cells start to clean themselves up, toxins get pushed out of the cell. 24 hours of fasting, we start to see that actually the whole gut microbiome repairs, which this is also key because estrogen is broken down by a set of bacteria in the gut called the estrobolome. And so we actually have bacteria that needs the help and of something like a fasted state to start to thrive so we can break estrogen down. When we look at like 36 hours, the research is showing that you can start to tap into more fat burning. 48 hours, we get the whole dopamine system starts to reboot. And then Valter Longo brought us the 72-hour fast, which is really resetting your whole immune system. So each one of those pieces has a different implication for both men and women, but especially for women.

Dr. Mark Hyman: So fasting up to 72 hours are a long time. How do those work that are different than just let's say time-restricted eating where you're eating within an eight-hour window?

Dr. Mindy Pelz: So 72 would be literally going without food for 72 hours. So you're staying in that fat burner state for 72 hours. So as daunting as that sounds, I've seen some of the greatest healing happen to people. Have you ever done a three-day water fest?

Dr. Mark Hyman: I have. I have.

Dr. Mindy Pelz: Yeah. What'd you notice?

Dr. Mark Hyman: I mean, it was hard. I was hungry. But then after the first couple days I got really clear, energetic, felt light. It was quite a liberating experience to sort of disconnect from food.

Dr. Mindy Pelz: Yeah. And insight. A lot of people get a lot of great spiritual insight because the brain calms down.

Dr. Mark Hyman: Well. Yeah, it's a method of spiritual quest often is fasting for a long fast, longer fast has been used forever.

Dr. Mindy Pelz: Yeah. So the 72, a woman's may be going to do that once a year. One of the things that we know, and I'm sure you've studied this and looked at this especially in relation to your new book, but a 72-hour fast is going to get rid of senescent cells, those aging cells. And so it wipes out the cells that are slowing the process down, speeding aging process up, but turn making the body more, not only insulin resistant but hormone resistant, sometimes vitamin D resistant, which is really important for hormonal health. So we can look at a 72-hour fast as, again, therapeutic, we could dip into it to get rid of the cells that are no longer serving us.

Dr. Mark Hyman: How often should someone do something like that?

Dr. Mindy Pelz: So 72, again, it's personal preference, but I always say twice a year is a great opportunity to get rid of the cells that no longer serve you and reboot your immune system. I personally recommend to my community that we do it January and September, and largely because January is when we come out of the holidays, everybody's overdone it. And then September, if you're living in our hemisphere, summer, now we overdo it in summer. So it's a really good reset to just make sure that you didn't veer too far off your health habits.

Dr. Mark Hyman: And for me, for example, I'm scared about doing it a 72-hour fast again because I have 10% body fat. I'll lose weight very fast. Even if I don't eat enough in a day, I'll lose weight in a day. I probably shouldn't say that in public. I'll get death threats in my house. But I mean I'm concerned about someone like me. Is it still useful? Is there harm? Will I lose too much muscle? How do I prevent that? What are the downsides?

Dr. Mindy Pelz: Such a great question. So here's the thing around the fasting conversation that I don't think we're having enough. So when you're in the fasted state, all of this healing is happening. And so part of that is a breakdown of muscle. There's a lot of studies that show your muscle shrinks while you're fasting, but guess what? Your muscles breaking down when you're lifting weights too. So when we exercise certain ways, we are breaking muscle down, and we know that we're breaking it down so that we can build it stronger. So when we look at the fasted state, there may be a small amount of breaking muscle down because the body's going to go find glucose where it needs to find it. And if you don't have a lot of fat, it's going to find it in the liver and it's going to find it in the muscles.
But here's the really cool opportunity is that when you reintroduce food, that is going to actually be a game changer for building muscle, we've seen it be a game changer for the microbiome. So you would want to come in, and it depends on the length fast you would do, but let's say you do a 72-hour fast and you're like, whoa, my gosh, my muscles have completely shrunk. That is completely temporary. And if you come in with something like protein cycling where every couple hours you are doing 30 grams of protein or more, you're actually going to build up mTOR and you're going to start to see that those muscles start to actually grow stronger. Same thing happens with the microbiome. We see total change in microbiome that looks like the good and the bad bacteria start to go away in a fasted state. But when we reintroduce food, if we start to bring in the polyphenol, the probiotic, the prebiotic foods, now we actually are starting to regrow that microbiome to a whole new level.
So to answer your question, the answer is absolutely, and you're going to really need to be mindful of what you break that fast with because when you reintroduce food, you have an opportunity to take your health to a whole new level.

Dr. Mark Hyman: So essentially it's the refeeding process that activates all the sort of rebound benefit. So yes, you will have a loss of certain things like muscle perhaps, but you'll also have cleaned out all these senescent cells, this deep cleaning. So the deep cleaning you're talking about is about killing the zombie cells, which are these one of the hallmarks of aging which produce these secretory inflammatory products that are spewing them out all over the body and accelerating aging in every possible way. Are there other benefits besides the autophagy and the killing of the senescent cells that happen with a prolonged fast versus an eight-hour time window every day of eating like a daily time restricted eating?

Dr. Mindy Pelz: So Valter Longo brought us the whole resetting of the white blood cells. His original research was looking at patients going through chemotherapy and found that it decimated the immune system. But what he saw was at that 72 hour mark, it got rid of the bad white blood cells and fresh new ones regrew and it re-stimulated the whole immune system. So we also have evidence that the dopamine system gets completely rebooted at about 48 hours. So new dopamine receptor sites will emerge, so now when you enter back into food, you're going to start to enjoy your food a little more

Dr. Mark Hyman: Interesting. Right.

Dr. Mindy Pelz: Each one of these has a different healing mechanism, and then you pair that with good food and now you've created the two amazing healing states without, again, anything other than using your own body as a tool for healing.

Dr. Mark Hyman: That's amazing. So you actually accelerate your immune function and you create a reset of your dopamine receptors. Now dopamine for those people who are listening is the sort of pleasure molecule. It's what we eat sugar for or smoke or drink or take cocaine or heroin if we're unlucky. And those are the things that activate these pleasure sensors and they become saturated. And so we need more and more stimulation to achieve the same benefits. So if you haven't eaten sugar for a month and then you have a bowl of ice cream or a cookie or something sweet, it's going to be having a big intravenous hit of cocaine and you're just going to go, whoa. But if you're eating it all the time, you need more and more just like an alcoholic needs a lot more alcohol. I can drink one glass of wine and I'm a little tipsy. Other people who are heavy drinkers may need a half a bottle of whiskey to get the same benefit, meaning benefit, which is not the same benefit.
So I think this is really fascinating. So both shorter term time restricted eating and longer periods of fasting, you recommend, not just a sort of daily timer restricted eating. And should we do this every day? Should we do time restricted eating every day and eat only in an eight-hour window or 10 hour window? What's the optimal dose for doing this?

Dr. Mindy Pelz: Yeah, before I answer that question, I want to go back to one interesting comment about the alcoholic and the drug addicted person. So one of the things we know about people who are obese is that they're not getting the same pleasure out of food as somebody who's more dopamine sensitive, their dopamine receptor sites get saturated. And so now they have to eat more food to get the same pleasure and it's just like the alcoholic has to keep drinking more and more to get the same dopamine response. So what I loved about that 48 hour fast and why we do it as a community so much is that it resets that system. So now you're getting more pleasure from your food, you're not needing as much because you're feeling the dopamine effects much quicker. So I just want to point that out because I think that's something that's just not talked about enough.
As far as frequency. This is the big part of Fast Like a Girl, is that I want women to move in and out of different fasts according to their menstrual cycle using those six different fasts as their tool of they can do anything from 13 to 72 depending on what they're trying to accomplish with their bodies. For men and for post-menopausal women, I think same thing, but in a weekly amount, we want to move in and out of different length fasts. So I'll give you an example. I recommend a what I call a 5-1-1 where five days a week you're intermittent fasting, super easy. One day a week, you want to push that fast, just make it a little uncomfortable. There's a thing called, as you know-

Dr. Mark Hyman: What's pushing it? What would that be?

Dr. Mindy Pelz: ... It depends. If you want to repair your gut, you're going to go to 24 hours so you can get that gut reset. If you want to detox and get rid of some senescent cells, then make sure you get at least to 17 hours. If you want to get burn some more fat, try going 36 hours. So it really depends on what you're going to do. And then one day a week, don't fast. Skip the fasting and actually feast. So when you go back and you look at our primal ancestors, they were feast famine cycling. They would go long periods without food and then they'd feast once they made a big kill. So we're so far from that now and that's why the variation is getting us back to how we're genetically designed like our primal ancestors.

Dr. Mark Hyman: Yeah, that's true. I remember being in Africa on a safari and we were out there a number of times in the same area and there was this one big lion, was a male lion and he just looked so emaciated and skinny. He just looked terrible. And then the next day we saw him and he looked like he was nine months pregnant and he literally probably killed something and ate the entire thing. So it's that fasting and that sort of feasting cycle that we do. But is it good to feast like that or how do you kind of reenter food? Because I think it's important not just to, like you said, how do you reintroduce protein? What are you eating? Are you eating two grams of protein per kilo a day or more when you reintroduce food? How do you manage that?

Dr. Mindy Pelz: So in the book, I mapped out what I mapped out three different ways that we should be reintroducing food so that we can get the healing effect to continue and it sort of stops that desire to just keep eating. So the three different ways are... And you can combine all three of these, they don't have to be in silos. So one is fat, you want to make sure you have a lot of good fat, that's going to kill the hunger hormone. So avocado, one of my favorite things to break a fast with is a big avocado and then I'll throw some sauerkraut on it, put some nuts, some seeds, and you're pretty satiated after that. Or a big salad with all of that on there. So if we use fat as like a break for the desire to eat, you're not going to go boomerang as much, but as you know, it's got to be good fat.
Then we can look at protein. And protein, I'm sure you've had this conversation on your podcast, but it is a conversation that needs to continue, which is we're just not giving protein enough credit. And what most people, especially my menopausal women out there, I just want to emphasize that when you are eating protein, it's another way of building muscle, especially if you're getting at least 30 grams. But what protein also does is it creates, the more muscle you have, the more insulin receptor sites you're going to have. So now you're going to be more insulin sensitive, so make sure you're going big on protein. And then the third one is what I call the three Ps, and this is polyphenol, probiotic and prebiotic foods. So repair your microbiome, get the green leafy vegetables in, get the nuts and the seeds. And if you want to combine all those together in one meal, fabulous. I promise you you're not going to be hungry after that because this is good quality therapeutic food that is going to make sure that that hunger hormone stops and the healing continues.

Dr. Mark Hyman: And are there people who shouldn't be fasting or who shouldn't do this?

Dr. Mindy Pelz: Yeah, and it's a great question. So the first group that I always say is, if you have an eating disorder, you need to be really coached through fasting. You don't want to go down that journey by yourself. So if you have a psychologist or a doctor that can work with you, fabulous. So just be mindful that it doesn't trigger any old patterns for you.
The second group that I really can't emphasize enough is pregnancy. This is not your tool. This is not the tool that you want to use. You can support a healthy microbiome. There's a lot of other great tools while you're pregnant, eat more protein, fasting's not your tool.
And then the third one is the nursing mom. I just don't want her fasting longer than 15 hours because the minute she goes into autophagy, now what's going to happen is she's going to start to see some of these, we talked about the senescent cells that are dying off, but there's another process called apoptosis where you're going to see dysfunctional cells that are packed with heavy metals and toxins. They're going to die off and go directly into her breast milk.

Dr. Mark Hyman: So how do you deal with the detoxification process that happens with fasting? Because as a physician, I'm very aware of the biological aspects of detoxification, the requirement for nutrients for phase one and phase two detoxification, the need for fiber for elimination, the need for amino acids for a lot of the phase two pathways of detoxification. So how do you navigate that? Because I always wonder about what happens when you just eat nothing. And is that a stress that you're not actually taken care of by actually providing the raw materials for your body to process everything that gets metabolized, everything that gets released from your fat tissues, all the toxins you're exposed to that then get actually activated while you're fasting? How do you address that?

Dr. Mindy Pelz: Yeah, it's such another great point. And what I really am trying to get people to understand, both men and women, is that you got to make sure your detox pathways are open. So this is making sure that the lymph that's pulling the toxins out of your or internal organs are completely open. So this is where the dry brushing, this is where the infrared saunas, this is where just sweating in general, this is where the breath work. All of that comes into play. Making sure you have bowel movements while you're fasting, which is fascinating, a three-day water fast, we'll see people still having bowel movements the third day because they're just-

Dr. Mark Hyman: Really?

Dr. Mindy Pelz: ... yeah, their body's just getting rid of everything. So just using some of those natural ways to detoxify and opening up those pathways will make it so that when the body goes into that detox date, it can do it really efficiently.

Dr. Mark Hyman: Interesting. And so basically making sure you're drinking plenty of fluids, you're saying sweating and dry brushing, you don't need to take the nutrients, you don't need to take the amino acids, you don't need to take all the cofactors for detoxification is what you're saying?

Dr. Mindy Pelz: Yeah, I mean, you can. So let's talk about that because there are certain things that you can have in your fasting window and one of them is minerals. I really recommend that a lot of people, especially when they go into the longer fast, that they've got some sodium, magnesium, potassium in some water and they're just drinking that.

Dr. Mark Hyman: So electrolytes?

Dr. Mindy Pelz: Electrolytes, yeah. And then aminos. So here's a really interesting thing on aminos. Aminos can really help make fasting a lot easier. So to your point, they support the detox pathways and they make those symptoms that can show up that are really uncomfortable. They can make them a lot better. But here's the question that nobody's been able to answer, and I just don't think we have any science on it, is what we know stops autophagy is 20 grams of protein or more. So if you're going to do aminos, is that going to stop autophagy? It won't stop ketosis, but is it going to stop autophagy? And that's the million dollar question. I haven't seen anybody be able to answer any research on it. So having said that, I'm a huge fan of minerals and aminos in your fasting window.

Dr. Mark Hyman: Yeah, that's interesting. I think that that's always the thing I wondered about and worried about. In terms of women, we sort of got back to this. I kind of like to talk about how do we decide when you need to use hormone therapy, what ways that we can use lifestyle that actually work better than hormone therapy, whether it's the pill, premenopausal or hormone replacement after? What are the things you're finding as you're helping women through this process of regulating their hormonal dysfunction with food and lifestyle?

Dr. Mindy Pelz: So my philosophy is always lifestyle first. Do lifestyle, clean up your lifestyle and then see if you need the medication or you need the hormone therapy. So that's my approach. Now, what is a big challenge that we have right now is that I strongly feel as our hormones start to decline around the age of 40, that our lifestyle has to dramatically change. And this is another piece of education that's not getting out to the world. And so there are five things that I recommend women over 40 start to do. Fasting is one and cycling their fast. Going in and out of high carb, low carb and making sure that-

Dr. Mark Hyman: Really?

Dr. Mindy Pelz: ... Yeah. So going into low carb so we can balance estrogen and then going into higher carb so we can keep the thyroid happy and we can keep progesterone happy. And then making sure you're eating enough protein for sure.
And then the third one is most women when they get into their forties, they've got to repair their microbiome. They've been on birth control for decades, they've been on multiple rounds of antibiotics and steroid use. Their microbiome is in bad shape. And you need that as you move into those perimenopause and menopausal years. And then you mentioned it, detox is another one. We got to start teaching women how to look at all their beauty products and what are they doing for detox in general. And then the last one is what was actually a phrase coined by Dr. Libby Weaver and it's called rushing woman syndrome. We got to bring in more mindfulness tools, we've got to learn how to chill out a little bit more.
And so we got to start with those five steps first. And then, if that's not course correcting, now you can go in with more success. Whether you choose bioidenticals or hormone replacement, it's up to you, but we've got to stop looking at those tools as being this, I'm going to absolutely do it or I'm not going to do it because as we go along the journey, there may be a time you want to pull it in, but you're still going to have to fix your lifestyle.

Dr. Mark Hyman: Yeah, there's no way around that for sure. I think a lot of people just don't realize how powerful it is. And it works better than most medications. And I can't tell you how many women I've helped with all sorts of hormonal disorders from menstrual issues, PMS, heavy bleeding, painful periods, cramping to really more serious issues like fibroids and infertility and PCOS. And it's just amazing when you start to apply these principles that a lot of women out there who struggle with these issues can get better and not using hormonal therapy.

Dr. Mindy Pelz: Right. And I know this is a hot debate right now, especially amongst women's health groups, is really this idea of should I do hormone replacement, should I not? I know we're looking at it a little different. But what we have to realize about hormones is that there is the production of a hormone, then there is the breakdown of a hormone, and then there's the hormone being able to get into the cell. So if all you're doing is focusing on the production of a hormone through a medication or through a hormone therapy, you still got to have a good microbiome to be able to break that down, you still got to have a great functioning liver to break it down and you got to still detox so that hormone can get into the cell. So this is why doesn't matter if you're going to do it or not do it, it's a personal choice, but those five steps have to be considered. Otherwise, you're going to end up in one of those situations where you're like, I took it, it's not working. And women, as women, unfortunately, what we do is we start thinking it's our problem. We start shaming.

Dr. Mark Hyman: Yeah, it's our fault, right.

Dr. Mindy Pelz: It's our fault. We did something wrong. And that has to stop as well.

Dr. Mark Hyman: Totally. Amazing. So where do women start? How do they start thinking about working on this for themselves? How do they begin a strategy? What are the steps they should take? You have this five step program, walk us through what it would look like?

Dr. Mindy Pelz: Yeah, so the first place, it depends on your age. So this is the other complicated thing about talking about women's hormones is that we've got women that are in their fertile years, the twenties, thirties, teens, twenties, thirties. We've got the perimenopausal years, the forties, and then we have the postmenopausal. So the first is you got to know where you are and what your hormones are doing. If you have a cycle, make sure that you're tracking your cycle. I'm also a huge fan of a urinary hormone test so that you know where your hormones are at, highly recommend that. Because then what you need to work on. And you can get to know these, this is why I call them the personalities. We got to get to know the personalities of these hormones and when they're showing up. Progesterone's going to make you really hungry and crave carbs. And estrogen's going to make you very verbal and want to go out and put your party hat on and be out socializing all night long. And testosterone's going to spike your libido and increase your motivation and drive. So get to know these personalities because they're coming in and out every single day.
Once you know that, now how do you pair your lifestyle? And this is the five steps that I wrote, I actually wrote that in a book called The Menopause Reset. And so that was my book before Fast Like a Girl, it's all written out there. But start to take these five steps and ask yourself, am I fasting? Am I varying my foods? Am I working on my microbiome? Am I detoxing? And am I slowing down? Start there. That could be a decade, that could be a long time working on that.
And then from there you can start to figure out, do I need to supplement? Do I need to go into more hormone therapies? From that point you can navigate. And it's not a linear absolute approach. And this is perhaps why we have been giving women one size fits all. Because it's much easier for the doctor to say, "Your cholesterol's high, your blood pressure's high. Take this medication." Than, "Hey, you're going to need to eat different. You're going to need to very your fast. You need to stop stressing, repair your microbiome and detox." Most women are like, what? I have to do that?

Dr. Mark Hyman: Right. Right. It's a lot, right?

Dr. Mindy Pelz: It's a lot. But it's where health exists. I mean it's putting the responsibility back on us. And then the other part of that is all of us... I love this idea of women doing health as a community because when we are in community, we're raising oxytocin. And when you bring oxytocin up, you bring cortisol down. And when you bring cortisol down, you regulate insulin and now you can regulate your sex hormones. So women are so good at connecting in community, let's do it all in a community and learn from each other and share our stories with each other.

Dr. Mark Hyman: I love that. I love that. And I think it's really important because I think when people feel isolated, they feel on their own. They feel like they just have to figure everything out and that they're not getting the answers they want from their doctor. And I'm curious, why do you think it is that the medical system is just so blind to hormonal regulation for women?

Dr. Mindy Pelz: Well, I think the first part is that we look for absolutes in our healthcare system. You have this symptom, I'm going to give you this diagnosis and I'll give you this pill or surgery. So it's very linear like that. I call that more of a patriarchal or masculine approach to health. When we look at a more feminine approach, and I love this, I actually heard Sara Blakely speak last year and she was saying that one of her desires was to bring a feminine approach to business and be able to integrate the masculine and the feminine together in business. And she believes that that was one of the reasons why Spanx was such a huge success.
I would say the same thing needs to happen with healthcare, we need to bring the feminine back into healthcare. And what that looks like is us understanding our own natural cycles and then not giving our power away to the doctor and just saying, "Hey, here's my symptoms. Tell me what to do." But actually to start to collaborate with our doctors and say, "Tell me why this is showing up at this part of my cycle. Tell me what I can do that affects the different aspects of my cycle," and become educated and have an educated conversation with your doctor. So I really see an integration of the feminine, the masculine together that's going to change this conversation within the doctor's room. But what's happening is within the doctor's room, it's absolutes, it's guilt, it's shame, it's one size fits all, that has to stop.

Dr. Mark Hyman: And it's not their fault honestly, because I never learned about any of this in medical school. And I think one of the things I sort I'd love you to talk about a little bit is hormonal testing. Because I think we don't know how to manage hormones through testing, whether there's saliva testing, you mentioned urine testing, blood testing, what's the best way to get handle on hormones? There's the DUTCH test, there's urinary estrogen metabolites, there's blood work that you can do to look at hormone levels. Talk us through some of that.

Dr. Mindy Pelz: So if you're a cycling woman, a blood test is not that helpful for you. I think that your door in is more a DUTCH test. I'm a huge fan of the DUTCH test. In fact, I don't know what your feelings are on the DUTCH test, but I feel like if we could get a DUTCH test into every woman's hands somewhere around in her thirties and her forties, she could really start to see if her lifestyle was working for her or against her.
And one of the reasons I love a urinary DUTCH test over a blood test is that it can tell me the estrogen metabolites. And the estrogen metabolites are how is your estrogen breaking down? So you can go and get a blood test and your doctor might say, "Oh my god, your estrogen is so high." It's probably coming from toxic estrogen, maybe an endocrine disruptor. But when we look and compare that to a DUTCH test, which we've done a ton in my clinic, we start to see, well maybe it's high because you've been eating really well and you actually have a lot of the good protective estrogen and not as much of the bad estrogens. So the DUTCH just gives us so much more than a blood test.

Dr. Mark Hyman: And that's a saliva test? Or is that urine?

Dr. Mindy Pelz: It's a urine test. Yeah. It can be both. Saliva's really for adrenals a lot, tells us a lot more about adrenal function, which is also important for hormonal health.

Dr. Mark Hyman: Yeah, I mean it doesn't test so much, just all the cortisol hormones it attests, the sex hormones. It gives you a really pretty good picture of where things are. And it depends on where you do it in your cycle if you're premenopausal, right?

Dr. Mindy Pelz: Yeah. So that's the other thing is DUTCH will have you do it somewhere between day 17 and day 21 so that we can see what progesterone's doing, which is really, really important. You also get like DHEA levels, you get a organic acids test with it now so you can see dopamine and norepinephrine. These are things you just don't get on a blood test, you're just getting a big broad picture. Whereas DUTCH is giving you the details.

Dr. Mark Hyman: And so what exactly does the DUTCH test look for that's different than you'd get on a regular panel of hormones that your doctor would check like FSH, LH, estrogen, sterol, progesterone, testosterone. How is it different and why is it better?

Dr. Mindy Pelz: The way that I look at it is I think the DUTCH is a more functional. So remember if we go back to this idea that hormones need your gut, they need your liver, they need the support of the other hormones. So when we just look at LH, FSH and we just give it a big broad picture, we're not really looking at the supporting actors. Let's put it this way, if estrogen, progesterone and testosterone were the stars, we need to know what the adrenals are doing. We need to know what the liver's doing. We need to know what the thyroid's doing to affect that. And that is what the DUTCH gives you as opposed to a blood test.

Dr. Mark Hyman: And it measures different things too, it measures different kinds of sex hormones, not just the ones we typically look at, right?

Dr. Mindy Pelz: Yeah. So it looks at major ones are estrogen, progesterone, and testosterone. It looks at cortisol. It also will tell you your cortisol pattern, which is super cool because you can see if your pattern of when cortisol comes in is actually in regulation with the circadian rhythm of the day, what is actually supposed to happen. We've read thousands of DUTCH tests in my clinic and one of the biggest things we see is that women will have high cortisol at eight o'clock at night and very low cortisol when she wakes up in the morning and no wonder she can't sleep and she needs coffee to wake up in the morning. So it's really helpful for showing you that pattern. And then it also will show you methylation pathways. So we can see are you able to detox efficiently or is your body working really hard to detox? Or maybe it's been exhausting because it's been detoxing too much. I mean, I could go on and on, there's so many nuances in the DUTCH test that you just don't find anywhere else.

Dr. Mark Hyman: It's powerful. And it's not easy to interpret, there's a lot of numbers on there and the average doctor will have trouble.

Dr. Mindy Pelz: Are you familiar with DUTCH test?

Dr. Mark Hyman: Yeah. Yeah. We use it in our practice for sure all the time. And I find it very, very helpful as an addition to the overall picture. But what's really quite encouraging for me and hearing you talk is how powerful a lifestyle is and how things that are within our control without even hormone therapy can make such a difference. And that there are such simple ways through this basic five step program that you've mapped out with fasting, personalized nutrition, stress management, detox and lifestyle changes that can basically optimize women's health, men's health too, by the way, and basically slow the aging process.
I love this idea of sort of personalization and customization, essential to functional medicine. I also love talking about how we can use fasting in different ways at different times for different results. We covered, for example, just basic time restricted eating as a way to optimize metabolism and hormone balance, but also deep cleaning fast, which are three to five or maybe longer fasts. 72-hour fast is something I want to try again, but I get nervous because at 63 I don't want to lose too much muscle. And so I think that there's always that kind of balance. And I think we do need a time to give ourselves a rest from food. And then we need to refeed, as you said, to optimize our metabolism.

Dr. Mindy Pelz: Yeah, let me know when you go into 72 hour fast, call me, I'll coach you through it. I'll make sure it successfully. But I want to really highlight this idea around lifestyle. And I so appreciate that that is so much of your message because I feel like we have lost the art of healthy living. And we can say that it's causing all kinds of chronic disease problems, but when we bring the conversation of hormones to the surface, we have to start with lifestyle. Otherwise, we've got women that are chasing down supplements that are great, I'm not opposed to them. Or we have women that are either so scared of hormone replacement or they're like, it was the greatest thing of my life. Or we've got women that are taking thyroid medication and they're not seeing any results, but their doctors saying, "But your thyroid tests are completely normal." It's because we're missing lifestyle. We have to come back to lifestyle. So thank you for saying that, it's such an important piece.

Dr. Mark Hyman: Yeah, so key and your work is so great. I think your new book Fast Like a Girl: A Woman's Guide to Using the Healing Power of Fasting to Burn Fat, Boost Energy, and Balance Hormones is a great guide. I think your other books are great too for women who have menopause and want to learn how to reset, you really have provided a whole wealth of great resources for women to become empowered around taking charge of their own health.
And it always was a pet peeve of mine, and I think I saw this so much when I worked at Canyon Ranch, and even over the last 20 years too, my practice, women just struggle with being kind of the yellow canaries for all of our poor lifestyle habits. They are more susceptible, they're more sensitive, they're more connected to the things that actually affect them, whether it's dietary changes, whether it's stress, whether it's environmental toxins, they're way more likely to be impacted adversely. And our healthcare system has sort of ignored that as a whole thing. And I think the amount of suffering that's needless and that can be easily fixed with some simple practices is quite amazing. And it's been a very gratifying part of my practice. And even young women who struggle with things like painful periods or PMS, it ain't that hard to fix. I mean, I hate to say it. If you know what you're doing and you know how to apply lifestyle and certain supplements and sometimes even the bioidentical hormones, you can have remarkable results. And most people can do really, really well.

Dr. Mindy Pelz: I 1000% agree. And I don't know if you know this statistic, but they're saying right now that the most common time for women to commit suicide is from 45 to 55. And when I look at that statistic, what I know is we have no understanding of our hormones. And you're dealing with a decade of women that are not understanding why they're depressed, why they're anxious, why they can't sleep. And so when we look at this hormonal literacy issue that we have going on when they're in these dark states they turn with that on everybody else, they turn on their husbands, they turn on their partners, their friends. They think it's external, and they don't realize there's so much they can do to adapt to these hormones. That is how powerful lifestyle can be.

Dr. Mark Hyman: It's really true, and I think your work is a testament to that. I loved having you on the podcast. There's so much more to talk about. I think if people want to learn more, they can go to your website, DrMindyPelz.com. And Instagram channel, Dr.Mindy... Miny or Mindy?

Dr. Mindy Pelz: Mindy, yeah. Don't you remember, Mark and Mindy? It's like Mark and Mindy.

Dr. Mark Hyman: Yes, I do. I do. I do. And your podcast, The Resetter Podcasts, great for people to listen to if they want to learn more. There's just so much here, but I think you're diving into this deep end of the mess of women's hormones in our society and how to fix it is a huge gift to all of us. I encourage people to check it out and learn more about your work, and hopefully you love this podcast. And if you did, please share it with your friends and family. They'd love to hear, I'm sure, how to fix hormones because it's a big problem for all of us. Comment on how you've used various techniques and lifestyle, maybe fasting to help regulate your hormonal function and subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Farmacy.
Closing: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.