Fasting Q&A with Megan Ramos: Fasting With a Low BMI, Healing PCOS, Night Shifts, and More.

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Progesterone is an appetite-driving hormone,
where estradiol is an appetite-suppressing
hormone.
So, by day three, our progesterone's
down, our estradiol is up.
We are hormonally programmed to be
very effective at doing fasting.
We also, emotionally, feel better at
this particular time, so there's less sort of

(00:21):
emotional eating drivers.
And, at this particular time, we're also the
most insulin sensitive in our cycle
as well.
So this is a great time to further enhance
that or support that, especially if there are
some insulin-resistant issues going on.

(00:41):
[music]
Hi, everyone.
It's Megan Ramos here with another episode
of The Fasting Method podcast.
Today, I'm going to answer your questions.
We're going to tackle topics such as why
it's best to do extended fasting during
the first week of your cycle,
is it safe to fast when you
have hypothyroidism, and

(01:03):
what about BMI?
How much does that factor into whether or
not you should be fasting?
All right, so we're going to kick it off with
that last one.
Beth from North Carolina says, "I've
heard Dr. Fung mention that he does not
recommend fasting for people with
a body mass index (or BMI) under
20.

(01:24):
My BMI is under 20.
I recently lowered my hemoglobin A1C
from 6.2 to 5.5%,
but I would like to lower it further, or
at least maintain it.
Would IF or OMAD (which
is one meal a day) be okay to
do?".
This is a really great question.
It's really important that individuals

(01:47):
are not malnourished
when they are fasting.
So someone who generally has
a lower BMI, we assume they don't
have a ton of body fat, not a
lot that's gonna sustain them when they're
fasting.
But what we do know is that body mass
index, or BMI, is not a really

(02:08):
good measurement of anything.
So if you are on the lower side
of your total weight, there's
a few things that I would recommend doing
before you decide whether or not you're going
to start fasting.
The first one is have a DEXA body
composition scan.
Do you hold excess body

(02:28):
fat? Visceral fat, that unhealthy fat
in and around your organs?
Subcutaneous fat?
Are you what we call a TOFI, someone
who's thin on the outside and fat on the
inside?
If your DEXA body composition does show
that you have an unhealthy amount of body
fat and you have a subpar
amount of lean mass in your body, meaning

(02:49):
that you might have weaker brittle bones
or that you might not have very much muscle
mass or deteriorating muscle mass,
something called sarcopenia, then
this is where I move on to step two.
So if you do your DEXA body composition scan
and it shows that you do have a higher level
of body fat than lean mass, go on
to level two here and get some blood work

(03:11):
done. Make sure all your nutrient stores
are good, and, if you have any
nutrient deficiencies, then take
care of them, recheck in a few months,
and then begin your fasting journey.
But sometimes when we
have a little bit too much body fat
and we don't have enough lean mass,

(03:31):
the answer isn't always necessarily
losing more body fat.
Sometimes the answer is putting on good lean
mass, fixing those brittle
bones if your bone-mass density is low,
getting on some good muscle mass,
so putting on a little bit of weight,
but healthy weight.
So not all weight is unhealthy.

(03:53):
I often share that, throughout my
journey, I hit a low of 97 pounds,
but I had more body fat at 97
pounds than I did at 120 pounds.
How can that be?
Well, I did have to lose a little body
fat, but I mostly gained good weight.
Gaining the good weight, increasing the
ratio of good weight, muscle mass, and

(04:14):
bone mass (which I didn't have very much of
at 97 pounds), that's what brought my
weight up. And bringing my weight up
in a healthy way lowered my
body-fat percentage down significantly.
So when I weighed 97 pounds and
my body percentage was around 37%,
the goal wasn't to get to 60 pounds.

(04:35):
That was not the goal.
That, of course, and a bit unhealthy.
The goal was to put on healthy weight.
And I did have a little bit too much
visceral fat, according to my DEXA
body composition scan, so I did have
to lose a couple of pounds.
So, when someone comes to me who is very
slender, we look at these things...
Are you a TOFI? (Are you someone who's thin
on the outside, fat on the inside?) How

(04:57):
much visceral fat is that DEXA scan
saying that you have?
If it's under two pounds, then I'd
say, "You know what? Therapeutic fasting
really isn't for you You can do 12
or 14 hours regularly, you can
do 16, 18 hours.
You can focus on really good time-restricted
eating protocols, but really try to get
in some good protein, and just focus on

(05:19):
building some lean mass.
Now, when someone has a little bit too much
visceral fat, okay, let's do
some intermittent fasting.
We would be very gentle, just doing 24
hours of fasting, not every day,
two or three times a week to target that
visceral fat.
24 hours of fasting is actually very
effective at targeting that visceral fat.

(05:42):
You don't need to do 36, 42, 48.
You don't need to do three days or five days
to target that visceral fat.
Subcutaneous fat can be a little bit more
stubborn and sometimes we benefit from doing
longer fasts for that, but visceral fat
we can pretty much obliterate in a
good 24-hour, consistent fasting pattern.
With this individual, again, if we

(06:02):
did have that higher visceral fat, we would
do those 24s two to three times a week,
we would anywhere from 14 to 18
hours of fasting on the other days,
really prioritizing protein and a
nutrient-dense diet just to
help aid in the development of
some healthy weight, good bone-mass density,
good muscle mass, and the goal would to

(06:24):
actually be to increase lean
mass, so increase your total weight
while losing a little bit of fat mass.
So we would want the scale to actually
go up kind of in the end but
being reflective of healthy weight.
It's important to remember the scale only
tells you your total weigh but it doesn't
tell you what that total weight is.

(06:45):
Is it mostly fat or is it mostly muscle?
Now I'm five foot three and around
120 pounds (when I have
little fat and more muscle
and more strong bones) is a really good spot
for me. But if I weighed 120 pounds,
and I had a lot of fat, and I had osteopenia
or osteoporosis and sarcopenia,

(07:05):
so my lean mass was really low, then I'd be
unhealthy and I'd be at risk of all kinds
of metabolic concerns.
So this is where the
total number on the scale can be really
misleading. It's important to know your
body composition, and a DEXA body composition
scan can tell you all of these
departments so you know what to do.

(07:27):
And then going for micronutrient testing.
You can do standard micronutrient testing at
almost any lab.
If you're in the United States, Genova
and Spectrocell do some more in depth,
detailed micronutrium testing.
I personally have alternated between
using both, depending on just
sort of what's going on at each company -
when I could get faster results, what

(07:49):
my doctor's preference was (because I'm in
California and do require a doctor to order
it for me).
They're both really great tests; they're ones
that I also recommend to people that I
work with. And then we want to make sure that
we've tackled any of those nutrient
deficiencies.
Most importantly, you need to get your
healthcare provider on board.
You should never fast without having

(08:10):
a cooperative and supportive physician
or healthcare practitioner giving you the
thumbs up.
Now, again, we would sort of cap it at 24
hours. We would add in some strength and
resistance training.
We would really try to focus on optimizing
the nutrients and the protein in the diet to
help gain some good weight.
So we can't always necessarily go

(08:33):
by BMI, but BMI does
pop up a little bit of a flag where we
need to assess these things before we can
determine whether or not it's safe.
When someone has an A1C of 6.2
and they're on the lower side of things,
chances are they are a bit of TOFI.
We know that we want to optimize our
A1C. An optimized A1C

(08:55):
is 5.2 or below, so,
at 5.5, there could still be a
further bit of optimization.
I wouldn't be surprised if this individual
does have a little bit of visceral
fat, but they probably don't need
to lose body fat, maybe half
a pound, if that, and it's about putting
on some healthy weight.

(09:15):
So as long as we follow all the proper
protocols, we have that healthcare provider
on board, then we would transition
into some strategic fasting
strategies.
With that being said, in this particular
set of circumstances, it would be most
advisable to work with a coach who can
navigate this with you safely.

(09:35):
So this is one of those instances where I
would really recommend connecting with a
fasting coach.
You can learn more about coaching over
on thefastingmethod.com [music]
[promotion] Have you ever thought, "I am my
worst enemy when it comes to weight-loss
or health goals?" If so,
you are not alone.

(09:56):
But this barrier does not need to keep
holding you back.
I'm offering a Self-Sabotage Workshop
that can end this pattern of
defeat.
Together, we will explore the root
causes of your self- sabotage and
create strategies to overcome the
thoughts and behaviors that have been
preventing you from feeling the success

(10:18):
that you are seeking.
You will learn to proactively avoid
the pitfalls that have kept you feeling
stuck and develop new responses
to triggers that have served as roadblocks
for years.
Join me at TFM for my Self-Sabotage
Workshop that begins in May.
The links are in the show notes.

(10:39):
You can also enjoy 10% off
any of the workshops and masterclasses we
are offering from now until November
on the TFM website.
This includes the 3-pack and 6-pack
bundles, as well as the All-Access
Pass, using the coupon code
PODCAST10.
[music]

(11:04):
The next question says, "I have been doing
therapeutic fasting to address my polycystic
ovary syndrome (or PCOS) and
hopefully get my period back.
Do you have any recommendations for a
preconception plan for fasting and nutrition?
Is there anything I should be doing before
trying to conceive?
How will I know my body is healthy enough?"

(11:27):
Oh, my friend, I could probably do a whole
podcast series just on this alone.
If you've been following my journey, when I
was young, I had PCOS.
I was able to correct it in my 20s
by targeting and treating the insulin
resistance first, and then optimizing
my sex hormones later.
But because I developed PCOS so young

(11:49):
and had it for about 15 years
before I was able to treat it, before
I knew what to do, before I even knew
that I could treat it, I had burned through
a lot of my ovarian reserves.
So I was 38, trying to
get pregnant, and I didn't have much in terms
of ovarian reserves.
Knowing that I wanted to have a couple of

(12:10):
kids, and my second kid
would probably be born in my 40s,
if I was lucky, I ended up doing three
rounds of IVF to bank embryos
just to guarantee that I could
likely, hopefully, have a second baby
as I got older because in my early
40s I wouldn't have these ovarian reserves.

(12:31):
So I feel like, since I was 14 years
old, and I am going to be 41 soon,
I've spent a lot of my personal
health focus on treating these
things. Now, I never lost my period
with PCOS.
I always did have a regular period
with PCOS, but so many
women that we work with don't.

(12:52):
So one of the best things you can do
is, if you're looking to try to conceive,
regardless of whether you have PCOS
or not, is get that micronutrient
testing. Build your nutrient stores
back up, take a pre-methylated
folate.
The brand of prenatals that I use is
WeNatal. I have no affiliation with

(13:14):
the brand. I have talked to the founders
of the brand and they have occasionally sent
me some samples, but I do pay out
of pocket every single month.
They also have an egg-optimization supplement
that recently came out, and they have
a DHA supplement.
Now, I have all my embryos
on ice, so I still take their prenatal

(13:34):
because it's got that pre-methylated folate
in it, it's got choline in it.
But the most important thing you can do,
as soon as possible in your preconception
journey, is to test your micronutrients
and bring them up to where they
need to be, to those optimal levels.
And once they're there,
then that's when I would begin trying

(13:56):
to conceive.
I, in my own journey, ahead of
doing IVF, I knew that it
was coming up and I spent a solid
three months, because the egg lifespan is
three months.
I spent three months making sure that I was
optimizing every single one of these every
day, either through nutrition,
first and foremost, always through nutrition,

(14:17):
or, if there were some obvious deficiencies
in your nutrition, through supplementation,
and monitoring this very, very
closely. It's the most important thing
that you can do.
Again, PCOS or not, whether you're
22 years old or 42 years old,
or anywhere in between, looking into trying
to conceive, you want to get

(14:38):
a head start on this.
And if you can give yourself six months to
do it, even better.
Now, I was in a unique position because, when
I did my initial baseline micronutrient
testing, I was almost optimal across the
board. Obviously, I know a little bit
about nutrition and for many years had been
working on optimizing things.
But if you're just starting, you want to give

(14:59):
yourself six months.
It will make a world of difference.
And, ladies out there, I know how
eager it can be to want to be a mama,
but this six months just totally,
radically sets a foundation for your kid's
future. It's the most important thing that
you'll do.
All right, now back to the whole fasting
[laughs] topic,

(15:21):
which most of you are here for.
PCOS is a form of diabetes of
the ovaries, essentially, diabetes of
the ovaries.
The advice that Jason and I have always given
has been quite different from those of
other functional, female-hormone specialists.
Our peers, who we respect so much,
they often really try to optimize

(15:42):
the sex hormones as much as possible
through nutritional strategies,
and, over time, see the insulin
resistance improve.
And these strategies are a little bit
different than what we would do with insulin
resistance, so a little bit less
fasting during the second half of the cycle,
a little bit more carbs during the second

(16:04):
half of the cycle.
But when someone has insulin
resistance and that's causing PCOS,
Jason and I have just always found it being
so much more successful to
treat the insulin resistance first,
obliterating the insulin resistance, and
then optimizing those sex hormones
secondary.

(16:25):
What I'm talking about is we would treat
you just like a diabetic.
We would focus on doing a very low-carb
or ketogenic diet, depending on
sort of your adrenal needs.
Someone who has some adrenal issues
going on, if it's on the lower end
of the side of things, more sort of
adrenal fatigue or insufficiency,

(16:46):
HPA axis dysfunction, we
would be sort of more of a moderate to
liberal low-carb diet.
If someone's got more cortisol issues in sort
of the opposite direction, or
is cortisol healthy, you know, then we focus
as lower-- a low-carb or
a ketogenic diet to help.
And then we would do therapeutic fasting.
The first week of your cycle is actually the

(17:08):
best week to do extended fasting.
Extended fasting, for you at the start of
your journey, might look like something from
24 to 48 hours.
As your journey progresses, it might look
like something like 48 hours, three days,
or five days, but usually around
day three of your cycle is
when you plan extended fasts.

(17:28):
Even for myself, today's day and age,
I always calendar (pencil in) any
extended fasts I do to be starting on day
three of my cycle.
Why is that? It's the most hormonally
easy time to do an extended fast.
As day one of our cycle happens,
our progesterone levels are coming down
quickly and our estrogen levels

(17:49):
are shooting up very quickly.
Now, by day one of your cycle, your
progesterone levels have kind of
dipped already.
Progesterone is an appetite-driving hormone,
where estradiol is an appetite-suppressing
hormone.
So, by day three, our progesterone's
down, our estradiol is up.
We are hormonally programmed to be

(18:11):
very effective at doing fasting.
We also, emotionally, feel better at
this particular time, so there's less sort of
emotional-eating drivers.
And, at this particular time, we're also the
most insulin sensitive in our cycle
as well.
So this is a great time to further enhance
that or support that, especially if there are
some insulin-resistant issues going on.

(18:32):
Once ovulation happens, we do
notice that the appetite starts to bump up
a little bit.
In that particular time, we start to see
estradiol come down over the next seven
days and progesterone go up over the
seven days.
And then, that week before our cycle is when
we struggle the most with fasting.
So, during week one of a woman's

(18:53):
cycle, we tend to do extended fasts,
or whatever that might mean for you.
As we approach ovulation, we still try to
stay in that therapeutic range of 24
to 48 hours.
As we go just post ovulation,
24 hours, and then, that week before
the period, we focus on just good

(19:14):
time-restricted eating.
And if we're trying to conceive, we do add
more carbs.
Root vegetables, I'll be specific,
not just all carbs.
Root vegetables we start adding in after
ovulation to support progesterone.
But when you are
first starting out with this and you don't
have a period, you don't have a cycle to even

(19:34):
know because the insulin resistance is so
bad, then we just fast as
much as we can, tolerate as much of
this fits into our schedule, and we keep the
carbs down. Once you start getting a
regular period and a regular cycle, then
that means you know we've done a good job
tackling a lot of the PCOS issues, and
then we move into supporting those sex

(19:56):
hormones by breaking down the cycle week
by week and talking about targeted
fasting and nutritional strategies per
week. So I hope that that helps.
I'll say that, for most women, it takes
about four to six months to get
their period back on a regular cadence.
And then, after that, we see a lot
of people get pregnant in the six months

(20:17):
following that.
So I would be very optimistic.
We have an amazing person on our team (she's
actually just taking some time off for
personal reasons) - Dr. Nadia Pateguana.
We called her the Baby Whisperer!
In about a year, a lot of women [laughs] got
pregnant working with her.
She'll be back doing some coaching in the
fall. There's a new program that we're going

(20:38):
to be launching in the fall, but we
have an incredible, incredible team that's
fully able to support you if you're in this
journey. You're not alone.
You'll find a lot of Community members that
are trying to conceive, and tackle PCOS, and
get regular cycles as well.
So The Fasting Method would be a great tool
for you, my friend.
And I want to give you all the hope in the

(20:59):
world. At 14 years old, I
remember a doctor telling my parents
that I probably wouldn't be able to have
kids. And I'm a 40-year-old
mom to a really wild, wild
17-month-old healthy, baby boy.
So there's a lot of hope.
Even though I didn't have to do IVF for
infertility, I had to do it to

(21:20):
bank embryos because of my past fertility
issues in my 20s and teens,
science is super cool.
So, between lifestyle and science, I wish
you the best of luck.
I think there's a lot to be positive about.
All right. The next question is
from Miggy from the Netherlands.
Miggy is asking, "Can you wreck your thyroid

(21:42):
by fasting too much or is this
not true and can you heal it with fasting?
Mine was subclinical hypothyroidism
but returned to normal when I stopped fasting
without meds.
I am back to alternate-day fasting now
because I love fasting so much."
This is a big thing to unpack, Miggy,
but, in general, fasting is perfectly fine,

(22:05):
you just have to do what you can tolerate.
So we would want to look into, one, why
do you have subclinal hypothyroidism?
Is it because you have reverse T3
hypothyroidism?
If that's the case, we would begin your
fast after breakfast.
This actually helps prevent the conversion
of free T4 into reverse T3,

(22:26):
driving it into the form of free T3
and sort of course-correcting some
of that subclinical hypothyroidism
just by changing the meal timing.
And then we would start our fast at breakfast
and we would end it at breakfast the next
day, and we would just see how the body was
doing.
Often, that helps in those cases
of, say, reverse T3 hypothyroidism.

(22:48):
When someone says that thyroid
function has gotten worse while
fasting, are you checking your
thyroid levels while you are fasting?
We never, ever, ever want
to do hormone blood work or lipid
blood work while we are fasting.
The numbers are all going to be temporarily

(23:09):
thrown off.
So people will be halfway through a
42-hour fast, a 48-hour
fast, or they'll be three days into a fast,
and they'll go get blood work done,
and this blood work is not going to be
representative of your hormone levels at
all. The advice I give for
hormones (so when anyone that I'm working
with at The Fasting Method) is to

(23:31):
not fast for more than 14 hours a
day, for two to three days before doing any
hormones. Whether that's thyroid hormones or
whether that's sex hormones, we want to
stop fasting for at least two days.
For lipids, at least three days.
And most people are doing all these at the
same time, so it's three days.
I always tell people book your labs on

(23:52):
Monday, eat Friday, Saturday, Sunday,
then Sunday evening you can begin your fast.
And you can launch into a 24,
42, 48, three-day
fasts, whatever, at that point, because
you're going to do your labs the following
morning at 12 to 14
hours fasted, and that is the
best time. So sometimes people look

(24:13):
at their labs when they're deep into
these therapeutic fasts and they think
that the numbers are not ideal.
They're not going to be ideal.
There's lots going on in the body when you're
fasting. So you do want to
stabilize a norm here and then
have your levels checked.
So, if you came into a consultation or

(24:34):
were in one of our community groups, that
would be like the very first thing that I
ask since you are checking your labs in the
morning without medications, were you
fasting and how fasted were you?
How long had you stopped fasting before doing
these particular labs?
There are instances, a lot of my colleagues
in the low-carb space do believe

(24:55):
that fasting helps lower inflammation
in the body and it's cellular inflammation
that causes subclinical hypothyroidism,
and that, when that cellular inflammation is
reduced, then the subclinal
hypothyroidism goes away.
So I actually have a lot of colleagues in the
low-carb space that won't even bother trying
to treat subclinical hypothyroidism

(25:16):
with any type of medication, especially if
it's not too far off, because the
fasting will lower that inflammation,
improving and correcting this issue.
Dr. Fung and I also have a Facebook group.
It's a free community.
It's like the wild, wild west, [laughs] to be
honest. I spend a lot of time in our
Community forum, but, every now and then, I

(25:36):
peruse the Facebook group, and I saw one
woman report that it had actually reversed
her hypothyroidism over time
as well.
We want to address any nutrient deficiencies.
We want to make sure that the adrenals
are in good shape.
We want to make sure we know what's causing
that subclinical hypothyroidism in the first
place. You know, maybe it's iron,

(25:56):
maybe its selenium, maybe it's iodine, maybe
it's the cortisol. So there's all these
little things that we can look at and that we
can easily address, either through food
or through some lifestyle modifications.
Then we are able to help further support
the thyroid and carry on
with ADF.
So those are things to take a look at.

(26:17):
I would make sure you get some blood work
done, know your morning cortisol.
That's best to do with a saliva test or a
urine test, though, over a 24 hour
period.
But get some selenium, iodine, and
an iron panel checked in the morning, too.
Get your reverse T3 levels checked as
well, so we have a better idea as to what
is the cause of the subclinical

(26:38):
hypothyroidism.
And then, yeah, just be mindful of
when you are doing your blood work.
The last question for today's Q&A
is from Susy in South Carolina.
Susy says, "I've been on a night shift
schedule at the hospital for the last 30
years, working 7pm to 7am.
I'd love to know the ins and outs, stay

(27:01):
as healthy as possible on nights,
and the best way to fast with that schedule."
Hospitala!
As someone who's spent most of her life
working in a hospital or just in a
hospital for family reasons,
they're like the worst places to eat
[laughs]. So, if you are going
to eat, bring in foods that you can have,

(27:21):
so doing meal prep, meal planning in advance.
As someone who's worked in a hospital,
sometimes having things on hand just in
case - a dozen hard-boiled eggs,
a pound of cooked chicken wings,
some bacon, keeping a
small bag of avocados around,
a bottle of olive oil to go along with those
avocadoes.

(27:42):
Those are all things that I always just
kept around in our staff room,
so I would have something if I needed to
that would help me stay away from some of the
temptation that's there, especially during
those really long and stressful days
when the fasting is not necessarily going
to happen.
So having good, healthy food to revert

(28:03):
back to, more of these fat-fasting
style foods, can be really
good just to help you stay
on track. And then, of course, doing as much
meal prep as you can so you're bringing
any of your particular meals
that you would eat during that time.
Usually on an eating day, we would eat two
meals. You'd have one at home before leaving.

(28:24):
I imagine you would eat, quote-unquote,
'dinner', which would be more like your
breakfast before you leave for the 7
p.m. start and the shift, and then you
would just eat once.
So making sure that, before you do go,
that you prep something, even if it's just a
duplicate of what you've eaten right before
you've gone to work and you've just made
extra.
That's what I found a lot of nurses and other

(28:45):
healthcare practitioners do that work night
shifts. They tend to have a bigger meal with
their family before they leave to go to work,
and what they bring for their next meal is
just extra from that particular
meal. And that's okay to do as long as
you have enough variety in your diet
throughout the week.
So if you have something like steak and
Brussels sprouts at home for dinner,

(29:07):
then you can bring it for your lunchtime at
work as well. You can just make an extra
steak, make extra Brussels sprouts,
bring whatever extra leftovers you have
from that meal.
And that's one of the easiest things to do.
It can be a little monotonous,
but you've just got to make sure you're
adding in enough variety throughout the week.
And most people find that to be very

(29:28):
sustainable.
Now, you get off work at 7 a.m.
and I imagine you don't go to
bed right away?
If you are going to eat, if you are going to
have your meal then, your second meal then,
that's okay to do.
You can have your second meal then.
You just want to make sure that the time
before your last meal and going to bed,

(29:49):
the window is at least three hours.
Optimal would be four.
So, if you can eat before you go
to work and then once you're at work, and
that way you're not eating at seven o'clock
in the morning, that would probably be
the most ideal for this particular
night shift schedule.
All right, everyone, thank you so much for

(30:09):
sending in such amazing questions.
We'll be back next week with another
episode.
Bye for now and happy fasting!

All Episodes

Episode Transcript

Popular Podcasts

Are You A Charlotte?

On Purpose with Jay Shetty

Dateline NBC