FirstPublishedin2016byVictoryBeltPublishingInc.

Copyright©2016Dr.JasonFung&JimmyMooreAllrightsreservedNopartofthispublicationmaybereproducedordistributedinanyformorbyanymeans,electronicormechanical,orstoredinadatabaseorretrievalsystem,withoutpriorwrittenpermissionfromthepublisher.

ISBN13:978-16-28600-01-8

Theinformationincludedinthisbookisforeducationalpurposesonly.Itisnotintendedorimpliedtobeasubstituteforprofessionalmedicaladvice.Thereadershouldalwaysconsulthisorherhealth-careprovidertodeterminetheappropriatenessoftheinformationforhisorherownsituationorifheorshehasanyquestionsregardingamedicalconditionortreatmentplan.Readingtheinformationinthisbookdoesnotcreateaphysician-patientrelationship.VictoryBelt®isaregisteredtrademarkofVictoryBeltPublishingInc.

BookdesignbyJustin-AaronVelascoIllustrationsbyJustin-AaronVelascoFoodphotography(recipes)byTomEstreraFoodpreparationandstylingbyLuzvimindaEstreraPrintedinCanadaTC0116

CONTENTS

Introduction,byJasonFung,MDNotJustAnotherF-Word:MyExperimentswithFasting,byJimmyMooreMeettheFastingAll-Stars

PARTI:WHATISFASTINGANDWHYISITGOODFORYOU?Chapter1:WhatIsFasting?FastingSuccessStory:SamanthaChapter2:ABriefHistoryofFastingChapter3:BustingtheMythsofFastingChapter4:TheAdvantagesofFastingFastingSuccessStory:ElizabethChapter5:FastingforWeightLossChapter6:FastingforType2DiabetesFastingSuccessStory:MeganChapter7:FastingforaYounger,SmarterYouChapter8:FastingforHeartHealthChapter9:WhatYouNeedtoKnowAboutHungerFastingSuccessStory:DarrylChapter10:WhoShouldNotFast?

PARTII:HOWTOFASTChapter11:KindsofFastsandBestPracticesChapter12:IntermittentFastingChapter13:LongerPeriodsofFastingFastingSuccessStory:Sunny&CherrieChapter14:ExtendedFastingChapter15:FastingTipsandFAQs

PARTIII:RESOURCESFastingFluids24-HourFastingProtocol36-HourFastingProtocol42-HourFastingProtocol7-to14-DayFastingProtocol

RECIPESBerryParfaitBulletproofCoffeeEssentialBoneBrothGrain-FreePancakesMiniFrittatasSimpleHomemadeBaconGrain-FreeCauliflowerPizzaChicken“Breaded”inPorkRindsChickenDrumsticksWrappedinBaconChickenStuffedBellPeppersGameDayWingsHomemadeChickenFingersSteakFajitasArugulaandProsciuttoSaladPearandArugulaSaladwithPineNutsStrawberryandKaleSaladTomato,Cucumber,andAvocadoSaladAvocadoFriesMustardGreenBeansRoastedCauliflowerRice

INTRODUCTION

byJasonFung,MD

IgrewupinToronto,Canada,andstudiedbiochemistryattheUniversityofToronto,whereIalsocompletedmedicalschoolandmyresidencyininternalmedicine.

Aftermyresidency,Ichosetostudynephrology(kidneydisease)attheUniversityofCalifornia,LosAngeles,mostlyatCedars-SinaiMedicalCenterandWestLosAngelesVAMedicalCenters(thenknownastheVAWadsworth).Eachfieldofinternalmedicinedrawsitsownpersonalities,andnephrologyhasthereputationofbeinga“thinker’sspecialty.”Kidneydiseaseinvolvesintricatefluidandelectrolyteproblems,andIenjoythesepuzzles.In2001IreturnedtoTorontotostartmycareerasanephrologist.

Type2diabetesisfarandawaytheleadingcauseofkidneydisease,andItreatmanyhundredsofpatientswiththisdisease.Mosttype2diabeticsalsosufferfromobesity.Bytheearly2010smyinterestinpuzzles,combinedwithmyprofessionalfocusonobesityandtype2diabetes,hadledmetofocusondietandnutrition.

HowdidIgofrompreachingconventionalmedicinetoprescribingintensivedietarystrategies,includingfasting?Despitewhatyoumightthink,nutritionisnotatopiccoveredextensivelyinmedicalschool.Mostschools,includingtheUniversityofToronto,spendabareminimumoftimeteachingnutrition.Therewereperhapsahandfuloflecturesonnutritioninmyfirstyearofmedicalschoolandvirtuallynoteachingonnutritionthroughouttherestofmedicalschool,internship,residencyandfellowship.Outofthenineyearsspentinformalmedicaleducation,IwouldestimateIhadfourhoursoflecturesonnutrition.

Asaresult,Ihadnomorethanapassinginterestinnutritionuntilthemid-2000s.Atthetime,theAtkinsdiet,promotinglow-carbeating,wasinfullswing.Itwaseverywhere.Somefamilymembersofminetrieditandwereecstaticwiththeresults.However,likemostconventionallytrainedphysicians,Ibelievedtheirarterieswouldeventuallypaytheprice.I,alongwiththousandsofotherphysicians,hadbeentaughtandcertainlybelievedthatlow-carbohydratedietsweresimplyafadandthelow-fatdietwouldprovetobethebest.

Thenstudiesonthelow-carbdietstartedtoappearinthemostprestigious

medicaljournalintheworld,theNewEnglandJournalofMedicine.RandomizedcontrolledtrialscomparedtheAtkinsdiettothestandardlow-fatdietthatmosthealth-careprovidersrecommended.Thesestudiesallcametothesamestartlingconclusion:thelow-carbdietwassignificantlybetterforweightlossthanthelow-fatdiet.Evenmorestunningwasthatalltheimportantriskfactorsforcardiovasculardisease—includingcholesterol,bloodsugarlevel,andbloodpressure—werealsomuchimprovedonthelow-carbdiet.Thiswasapuzzle,arealconundrum.Andthatwaswheremyjourneybegan.

FiguringOutWhatCausesObesityThenewstudiesprovedthatthelow-carbapproachwasaviableone.But

thisdidn’tmakeanysensetomebecauseIwasstillsteepedintheconventional“caloriesin,caloriesout”(CICO)approach—theideathattheonlywaytoloseweightistoconsumefewercaloriesthanyouexpend.DietsbasedontheAtkinsmethodology,forexample,didnotnecessarilyrestrictcaloricintake,yetpeoplewerestilllosingweight.Somethingdidn’taddup.

Onepossibilitywasthatthenewstudieswerewrong.However,thatwasunlikely,giventhatmultiplestudiesallshowedthesameresult.Furthermore,theyconfirmedtheclinicalexperienceofthousandsofpatients,whowereallreportingweightlossontheAtkinsdiet.

Logically,acceptingthatthestudieswerecorrectmeanttheCICOapproachhadtobewrong.MuchasItriedtodenyit,therewasnosavingtheCICOhypothesis.Itwasdeadwrong.AndiftheCICOhypothesiswaswrong,thenwhatwasright?Whatcausedweightgain?Whatwastheetiology—theunderlyingcause—ofobesity?

Doctorsspendalmostnotimethinkingaboutthisquestion.Why?Becausewethinkwealreadyknowtheanswer.Wethinkthatexcessivecaloricintakecausesobesity.Andifeatingtoomanycaloriesistheproblem,thenthesolutioniseatingfewercaloriesandburningmorethroughanincreaseinactivity.Thisisthe“eatless,movemore”approach.Butthere’sanobviousproblem.“Eatless,movemore”hasbeendonetodeathoverthepastfiftyyears,anditdoesn’twork.Forallpracticalpurposes,itdoesn’treallymatterwhyitdoesn’twork(althoughwe’lllookintothatinChapter5);thebottomlineisthatwe’vealldoneit,anditdoesn’twork.

Theunderlyingcauseofobesityturnsouttobeahormonal,ratherthanacaloric,imbalance.Insulinisafat-storagehormone.Whenweeat,insulinincreases,signalingourbodytostoresomeofthisfoodenergyasfatforlater

use.It’sanaturalandessentialprocessthathashelpedhumanssurvivefamineforthousandsofyears,butexcessivelyandpersistentlyhighinsulinlevelsresultinexorablyinobesity.Understandingthisleadsnaturallytoasolution:ifexcessiveinsuliniscausingobesity,thenclearlytheanswerliesinreducinginsulin.Boththeketogenicdiet(alow-carb,moderate-protein,high-fatdiet)andintermittentfastingareexcellentmethodsofreducinghighinsulinlevels.

InsulinandType2DiabetesHowever,inmyworkwithtype2diabetics,Irealizedthattherewasan

inconsistencybetweenthetreatmentofobesityandthetreatmentoftype2diabetes,twoproblemsthatarecloselylinked.Reducinginsulinmaybeeffectiveinreducingobesity,butdoctorslikemewereprescribinginsulinasacure-alltreatmentfordiabetes,bothtypes1and2.Insulincertainlylowersbloodsugars.Butjustassurely,itcausesweightgain.Ifinallyrealizedthattheanswerwasreallyquitesimple.Weweretreatingthewrongthing.

Type1diabetesisanentirelydifferentproblemthantype2.Intype1diabetes,thebody’sownimmunesystemdestroystheinsulin-producingcellsinthepancreas.Theresultinglowinsulinlevelleadstohighbloodsugar.Therefore,sinceinsulinlevelsarelowtobeginwith,itmakessensetotreattheproblemwithsupplementalinsulin.Andsureenough,itworks.

Intype2diabetes,however,insulinlevelsarenotlowbuthigh.Bloodsugariselevatednotbecausethebodycan’tmakeinsulinbutbecauseit’sbecomeresistanttoinsulin—itdoesn’tletinsulindoitsjob.Byprescribingmoreinsulintotreattype2diabetes,wewerenottreatingtheunderlyingcauseofhighbloodsugar:insulinresistance.That’swhy,overtime,patientssawtheirtype2diabetesgetworseandrequiredhigherandhigherdosesofmedications.

Butwhatcausedthehighinsulinresistanceinthefirstplace?Thiswastherealquestion.Afterall,wedidn’tstandachanceoftreatingtheunderlyingdiseaseifwedidn’tknowwhatcausedit.Asitturnsout,insulincausesinsulinresistance.Thebodyrespondstoexcessivelyhighlevelsofanysubstancebydevelopingresistancetoit.Ifyoudrinkexcessivealcohol,thebodywilldevelopresistance,uptoapoint—weoftencallthis“tolerance.”Ifyoutakenarcoticssuchasheroin,yourbodywilldevelopresistance.Ifyouuseprescriptionsleepmedicationssuchasbenzodiazepines,yourbodywilldevelopresistance.Thesameholdstrueforinsulin.

Excessiveinsulincausesobesity,andexcessiveinsulincausesinsulinresistance,whichisthediseaseknownastype2diabetes.

Withthatunderstanding,theproblemwithhowdoctorstreattype2diabetesbecameclear:wewereprescribinginsulintotreatit,whenexcessiveinsulinwastheprobleminthefirstplace.Instinctively,mostpatientsknewwhatweweredoingwaswrong.Theywouldsaytome,“Doctor,youhavealwaystoldmethatweightlossiscriticalinthetreatmentoftype2diabetes,yetyouhaveprescribedmeinsulin,whichhasmademegainsomuchweight.Howisthatgoodforme?”Ineverhadagoodanswerforthis.NowIknewwhy.Theywereabsolutelyright;itwasn’tgoodforthem.Aspatientstookinsulin,theygainedweight,andwhentheydid,theirtype2diabetesgotworse,demandingmoreinsulin.Andthecyclerepeated:theytookmoreinsulin,theygainedmoreweight,andastheygainedmoreweight,theyneededmoreinsulin.Itwasaclassicviciouscycle.

Wedoctorshadbeentreatingtype2diabetesexactlywrong.Withthepropertreatment,itisacurabledisease.Type2diabetes,likeobesity,isadiseaseoftoomuchinsulin.Thetreatmentistolowerinsulin,notraiseit.Weweremakingthingsworse.Wewerefightingthefirewithgasoline.

Ineededtohelpmyobesityandtype2diabetespatientslowertheirinsulinlevels,butwhatwasthebestapproach?Certainly,therearenomedicationsthatdothis.Therearesurgicaloptionsthathelp,suchasbariatricsurgery(commonlycalled“stomachstapling”),buttheyarehighlyinvasiveandhavemanyirreversiblesideeffects.Theonlyfeasibletreatmentleftwasdietary:reducinginsulinlevelsbychangingeatinghabits.

In2012,IestablishedtheIntensiveDietaryManagementProgram,whichhasauniquefocusondietasatreatmentforthetwinproblemsofobesityandtype2diabetes.Atfirst,Iprescribedlowandverylowcarbohydratediets.Sincerefinedcarbohydrateshighlystimulateinsulin,reducingthesecarbohydratesshouldbeaneffectivemethodofloweringinsulin.

Igavemypatientslengthysessionsofdietaryadvice.Ireviewedtheirfooddiaries.Ibegged.Ipleaded.Icajoled.Butthedietsjustdidn’twork.Theadviceseemedhardtofollow;mypatientshadbusylivesandchangingtheirdietaryhabitswasdifficult,especiallysincemuchofitrancontrarytothestandardadvicetoeatlow-fatandlow-calorie.

ButIcouldn’tjustgiveuponthem.Theirhealth,andindeedtheirverylives,dependeduponreducingtheirinsulinlevels.Iftheyhadtroubleavoidingcertainfoods,thenwhynotmakeitassimpleaspossible?Theycouldsimplyeatnothingatall.Thesolutionwas,inaword,fasting.

NOTJUSTANOTHERF-WORD:MYEXPERIMENTSWITHFASTING

byJimmyMoore

Inthecomingpages,youwillreadallaboutthetherapeuticusesoffastingandhowtoimplementitinyourownlifeinordertoexperienceitsamazinghealthbenefits.Butyoumightbewonderingwhattheexperienceoffastingactuallylookslike—perhapsparticularlyforsomeonewhowasextremelyskepticalaboutfastinguntilhetrieditforhimself.That’spreciselywhatI’llbesharingwithyouinthischapter.MynameisJimmyMoore,andI’mtheinternationallybestsellingauthorofTheKetogenicCookbook,KetoClarity,andCholesterolClarity,aswellasthehostofthelongest-runninghealthpodcast,TheLivin’LaVidaLow-CarbShowwithJimmyMoore.WhenIdiscoveredDr.JasonFung’sincredibleworkonfasting,Iknewweneededtocollaboratetogetcomprehensiveinformationaboutfastingintothehandsofasmanypeopleaspossible.ButIwasn’talwayssuchanexuberantfanoffasting.

“ThisHasGottoBeaJoke,Right?”WhenIfirstheardaboutfastingaspartofimprovingyouroverallhealth

overadecadeago,itmightaswellhavebeendescribedas“theotherf-word.”Whyintheworldwouldyoupurposelystarveyourself?Howcouldanyonepossiblythinkthatdeliberatelybeinghungrywouldeverbeagoodthing?Thishasgottobeajoke,right?Believeme,Iknowmanyofyoureadingthisbookhavehadsomeoftheseexactsamethoughts.Andbackin2006,Ididn’tfullycomprehendthepositivebenefitsfastingwouldsomedayprovideme,includingitsamazingeffectsonmycholesterolandbloodsugar.

IfirstheardabouttheconceptofintermittentfastingfromDr.MichaelEades,authorofthebestsellingbookProteinPower.In2006,Dr.Eadesbeganwritingaboutthegreatsuccesswithweightlossandotherhealthbenefitshehadseenwithsomethingcalledintermittentfasting,orIF.Itwasanewideaatthetimetogoperiodsoftimewithouteatinganythingatall,onaregularbasis,andthewayhedescribeditseemedrelativelydoable:stopeatingat6:00p.m.andthendon’teatagainuntil6:00p.m.thenextday.Soyoustillgottoeateverysingleday,butthisstrategyforcedyourbodytogowithoutfoodfortwenty-fourhoursatatime.

Ihavetoadmit,Ihadnevergonethatlongwithouteatinginmyentirelife,andIwasextremelyskepticalaboutthewholeideaoffasting,evenonanintermittentbasis.Why?BecauseIliketoeat,asevidencedbythefactthatIonceweighedinatawhopping410pounds.Ofcourse,atthatweightIwasconsuminglotsofprocessedjunkfoodandsugarysodasliketherewasnotomorrow.Growingup,incollege,whenIgotmarriedinmytwenties,andintomyearlythirties,Ihadterribleeatinghabitsthatcontributedtosomeprettysignificantmetabolicdamage.Thankfullyin2004Icameacrossinformationaboutthelow-carbdiet,whichenabledmetolose180poundsinoneyearandcomeoffofthreeprescriptionmedicationsforhighcholesterol,highbloodpressure,andbreathingproblems.IhadtoshareabouttheincrediblehealthsuccessI’dfoundonthatdietwithothers,andIwentontogrowahugeplatformonlinecalledLivin’LaVidaLow-Carb,whichIusetoeducate,encourage,andinspireothersintheirownpersonalhealthjourneys.Iwritebooks,givetalksaroundtheworld,andspeakwithsomeofthemostinfluentialandintelligentpeoplemakingwavesinnutrition,fitness,andhealth.It’sbeensomeofthemostgratifyingworkofmyentirelife,andI’mprivilegedtobeabletodowhatIdoforalivingnow.

Despitemydietturnaround,though,Ididn’tstopenjoyingeating!Hencemyskepticismaboutintermittentfasting.IwasintriguedbywhatDr.Eadeshadtosayaboutit,though,andIdidmyhomework.OnethingIlearnedinparticularmademesitupandtakenotice.In2009,IinterviewedBostonCollegebiologyprofessorThomasL.Seyfried,whohadbeenresearchingalternativetreatmentsforcancerpreventionandtreatment,includingusingacalorie-restrictedketogenicdiettotreatbraincancerandothercancers.Oneofthemoreinterestingandmemorablenuggetsfromthathalf-hourinterviewcameattheveryendofourconversation,whenDr.Seyfriedmadetheboldassertionthatanannualseven-toten-daywaterfastcouldbeausefultoolforpreventingcancer.WOW!ButasskepticalasIwasaboutintermittentfasting,aone-weekfastfreakedmeoutevenmore.Whocouldactuallydothat?

ButbythatpointI’dheardenoughtoconvincemetogivefastingatry.Needlesstosay,IhadtogetmyheadaroundIFbeforeIevendaredtryamultiple-dayfast,andbeingthenothing’s-too-hardadventurerthatIwas,Idecidedtotryit.Boyohboy,whatwasIgettingmyselfinto?!

MyFirstAttemptatFastingOkay,beforewegettothegoodstuffaboutfasting,Ihavetobehonest

aboutthebadstuff,andallIhavetosayaboutmyfirstattemptatalternate-dayintermittentfasting—fastingfortwenty-fourhourseveryotherday—isugh,ugh,andUGH!Itlastedexactlyfourdays,nineteenhours,andfifteenminutes.Butitfeltlikeaneternity!Ididsomethingswrongthatmadethisattemptmuchmorepainfulthanitshouldhavebeen,butbeforeIexplainwhatsothatyoucanlearnfrommymistakes,here’swhatIlearnedaboutmyselfduringmyfirst,unpleasantexperienceofattemptingIFin2006:

1.Iwasprettyaddictedtocaffeinestill.ThatfirstdayoffastingwaspainfulbecauseIhadamassiveheadacheformostoftheday.Bythesecondday,though,theheadachehadsubsided.

2.Ihadn’tfelttrulyhungryinalongtime.Afterlosing180pounds,myphilosophyhadbeentoneverallowmyselftogethungrysoIdidn’tslipbackintothoseoldeatinghabits.(Ironically,duringmylow-fatdietingdays,allIdidwashavehungerpangs.)Now,listeningtomybodyisbeneficialbecauseIdon’thavethesamefoodtemptations.

3.Beingravenouslyhungrymademeovereat.Attheendofmysecondfastingday,mywifeChristineandIwenttoSteak&Alefortheirall-you-can-eatprimeribspecial.Theywerebusy,sothesteakstooklongertocometothetablethantheyusuallydo.IwassohungrythatIateawholeplateofsaladinminutes,devouredthefirstprimerib,waitedtwentyminutesformysecond,andkilledthatone,too.Thenmyserverbroughtmeanotheroneaboutthirtyminuteslater(aftermyfoodhadsettledabitinmystomach)andIstartedtoeatit—butwhenIgothalfwaydone,whoaNelly,Iwasfull!Notjustfull,butreallyreallyfull!Asin,ithurtsomuchIhadtotakesomeTum-ta-Tum-Tumsandliedownforabitwhenwegothome.Iwasquitetheravenousbeast!

4.Eatingenoughfoodtofuelmydailyworkoutsreallywasimportant.Onday1ofmyfast,Itriedtokeepupthesameresistanceandspeedonmyellipticalworkout,butitjustdidn’thappen.WhileIusuallyhavea13resistanceat8.5mph,Ihadtobackoffto7resistanceat7.0mphtokeepmyworkoutaslongasusual.Ofcourse,Iburnedfewercaloriesaswell.WhatwasworsewasthatevenonthedaysIdideat,theverynoticeablelackofenergypersistedanddidnotcomebackuntilIendedmyIFexperiment.Ittookmeseveralweekstogetbacktofullstrengthandendurance.

5.Formeatthetime,goingwithoutfoodfortwenty-fourhourswasnotrealistic.OnthefirstdaymyheadwashurtingsomuchfromthecaffeinewithdrawalsthatIbarelynoticedhowhungryandlight-headedIfelt.Butonmysecondfastingday,IfeltlikeIwasfloatingaroundmyofficereadytotipoveratanymoment.MybodywaslethargicandIfeltdissociatedfromeverything,asifIwasn’tinthelivingworld.MycoworkerskeptaskingmeifIwasokaybecauseIwasn’tmynormalchipperself.

CallmeawimpfornotmakingitthroughevenonewholeweekontheIFexperiment,butitwasjustnotforme.Andthereareafewreasonswhy.

First,Iwasstilldrinkingdietsodasduringthefast,andthatstokedhungerandcravingsthatIwouldn’thavehadotherwise.Second,Iwasn’tgettingenoughsaltduringthefast,whichledtofatigueandenergydrain.Betterthanthosedietsodaswouldhavebeenbonebrothwithseasalt,whichprovides

much-neededelectrolytesandissatiating.Andfinally,Ijustdidn’thavetherightmindset.Ididn’tanticipatejusthowtoughitwouldbeatthebeginning,andIwasn’tpreparedtohandlethehunger—bothrealandimagined.

AfterthisattemptatIFcrashedandburnedinablazeofglory,Ididn’tthinkI’dtryitagain.Butthenin2011,aftersomegentleproddingfrompeoplelikeRobbWolfandotherIFadvocates,Idecidedtogiveitanothergo.

SuccessonIF,andaGrowingAmbitionDuringthissecondattempt,Igavemyselfeighteentotwentyhoursbetween

meals,anditwasmuchbetterformethangoingtwenty-fourhoursbetweenmeals.Infact,itwasquiteeasyeatingamealinthemorningaround9:00a.m.andthenanotheraround2:00p.m.asthetotalityofmyfoodintakefortheday—soIfastedbetween2p.m.onedayand9:00a.m.thenextday,aboutnineteenhours.Ievensometimesmixeditupandpushedmyfirstmealtoaround12:00p.m.andthenthesecondmealat5:30p.m.forashorterfeedingwindow.Ifeltverycomfortabledoingthisanditbecameverynaturaltome.

Ihadn’tforgottenabouttheideaofanextendedperiodoffastingasawaytoboostmyhealth,though.WhenIinterviewedDr.ThomasSeyfriedonmypodcastin2009,hewasadamantthataone-weekfastwouldbebeneficialasanannualcancer-preventionstrategy.Ofcourse,mostpeoplecan’t(or,morerealistically,won’t)dosomethinglikethis.Butwhatwoulditbeliketoactuallytryitformyself?OnceIFstartedtocomemorenaturallytome,in2011,Idecideditmightbetimetopushthetotalfastingtimetoanentireweek.WouldImakeitthroughalongerfast?Ididn’tknowatthetime,buttodayI’msogladIputasidemyfearsandgaveittheoldcollegetry.

InadditiontomygrowingeasewithIF,twothingsgavemetheconfidencetotryanextendedfast.First,oneofmyblogreaders,whohaddonethreeone-weekfastsoverthespanofayearonthesuggestionofhisdoctortohelpwithsomeprostateissues,sharedsomethingwithmethatputthingsintoperspective.Here’swhathesaid:

Thewayyouexperienceyourselfphysicallywhenyouarefastingispracticallyidenticaltothewayyouexperienceyourselfphysicallywhenyouareeating.Thereasonthisissoimportantisthatwhenyouthinkyouexperiencehungerwhileeatingnormally,thatsameexperienceofhungerispresentwhenyouarefasting.Inotherwords,thehungersensationsinfastingarethesameaswhileeatingnormally.Youthenhavetoaskyourselfhowyoucanbehungrywhenyouhaveeatenthreehoursagowhenitisthesamehungersensationwhenyouhavenoteatanythingatallforaweek.Whatwethinkishungerisnotreallyhunger.Thatimpulsetoeatcannotbetakenseriously.

Wow!Soifwecanlearntoviewhungerintherightway,thenwecanbe

Wow!Soifwecanlearntoviewhungerintherightway,thenwecanbemoreresistanttothetemptationsthatinevitablybefallsomanyofusduringfasting.Asmyreadersosuccinctlyputit,“fastingallowsyoutoreclaimyourhungerforwhatitis[so]itnolongerdictateswhatyouputinyourmouth.”Nowthat’samessageIthinkwecanalllearnsomethingfrom.Bytheway,theseriesofone-weekfastsmyreadercompletedwere“tremendouslysuccessful”intreatingthoseprostateissueshehad.Thishelpedconvincemethatfastingreallyisapowerfultherapy.

Thesecondthingthatpropelledmetodoaone-weekfastwasthatI’dbeenlearningalotaboutallthebenefitsofbeinginastateofnutritionalketosis—andfastingandketosisgotogetherperfectly,likebaconandeggs.Whenyoueatalow-carb,moderate-protein,high-fatdiet—aketogenicdiet—itbecomesmucheasiertofast.Thecarbohydraterestrictionandproteinmoderationhelpstokeepyourbloodsugarandinsulinlevelsundercontrol,andconsumingadequateamountsofhealthysaturatedandmonounsaturatedfatskeepsyourhungeratbay.Andhere’sthekeytowhyketoissogreatforfasting:beinginketosisteachesyourbodytoburnfatforfuelratherthansugar,andsincethat’swhatyourbodyhastododuringfasting,ifyou’realreadyinketosis,yourbodyisalreadyusingfuelthewayit’ssupposedto.

Thinkofitthisway:Youhaveatleast40,000calories’worthoffatonyourbodyrightnow,butonly2,000calories’worthofsugar.Ifyou’reafat-burner,whenyoustartfasting,yourbodysimplycontinuestousefatasitsprimaryfuel.Ifyou’reasugar-burner,though,yourbodyburnsthose2,000caloriesofsugaruntilit’sallgone,andthenittriggershungeruntilit’sadaptedtousingfat.Asasugar-burner,you’llfeeltheeffectsofhungerduringafastmuchearlierandmoreintensely.Thisiswhygoingketo(coveredindetailinmybookKetoClarity)isagreatfirststepforfasting,bothIFandextendedfasting.

Iwasn’tquiteinketosisyetmyselfwhenItriedtheone-weekfast,butIhadbeeneatinglow-carbforalongtime,andIwasreassuredthatmybodycouldhandleanextendedfast.

ExtendedFastingTake1:AWeekWithoutFoodOntheeveningofApril10,2011,Iconsciouslychosetodooneofthemost

unlikelythingsI’deverdoneinnearlyfourdecadesofliving:Iembarkedonaone-weekfast—onpurpose—justtoseehowIwoulddo.

SomanypeopleaskedatthetimeifIwasdoingittoloseweight,andtheanswerwas,notatall.Anyweightlossonacompleteextendedfast(unlikeonaregularIFroutine)wouldnotlikelystaycompletelyoffoncefoodwas

reintroduced.That’snottosayafewstubbornpoundsoffatwouldn’tfindawaytoleavemybody,andthat’sneverabadthing.ButmyprimarypurposewastomonitorhowIfeltgoingwithoutanyfoodforaweek.

IlearnedsomuchmorethanIcouldhaveeverimagined.

ThephysicalexperienceofthefastThefirstthreedaysweresomeofthemostdifficultbecausemybodywas

screamingatmetoeatsomething.Ifeltspaceyformuchofthetime,asifeverythingaroundmewasrunninginslowmotion.Butatthesametime,mythoughtswereclearandIwasfullyfunctioning,despitehavinghadnofood.Andhonestly,Ifeltgoodformostofthetimethroughouttheentirefast.Days4and5werethebestofthesevenasIexperiencedthebigwhooshofrenewedenergythatIhadheardsomanypeoplesharewouldhappen.Onday6,though,Istruggledearlyonwithastrongdesiretoeatagain,andbyday7,whenIwasatchurchandtookcommunion,Ifeltabsolutelyhorrible,likemybloodsugarhaddroppedtoalevelthatzappedmeofallmyenergy.WhenIcheckedmybloodsugarlevelandsawareadinginthe50sandcouldbarelystanduparound2:00p.m.onthefinaldayofthefast,Iknewitwastimetobreakit.

EffectsonbloodsugarandweightIdidn’tmeasuremybloodsugareverysingleday,butthefewtimesIdidI

sawreadingsinthe60s.Sure,thiswasbelow80,thelevelIgenerallysawonmyhealthylow-carblifestyle,butthat’swhathappenswhenyoudon’teatanyfoodatall.Controllingbloodsugarandgivingyourpancreasaweektorestfromproducinginsulinisanexcellentreasonforattemptingafastlikethis.

ThefirstfewdaysIlostaboutapoundaday,andthenondays4to7Ilostseveralpounds.WhileIwasn’tdoingthistoloseweight,itcertainlyproducedasizabledroponthescale:thirteenpoundsinoneweek.Ilearnedlaterthattheweightlossonaone-weekfastlikethisismostlywaterweightbecausethefastingprocessdepletesglycogenstores.

ExercisingBelieveitornot,Idecidedtokeepupwithmyexerciseroutineduringmy

fastingweek,andIdidawholelotbetterthanIthought.Iknewnottopushittoohard,andItoldmywifethatifIstartedtofeeldizzyoranything,Iwouldstop.Evenstill,IplayedcompetitivevolleyballtwiceanddidacoupleofPilates/yogaclasseswithnoproblems.AlthoughIwasspaceyonthevolleyballcourt,Iwasabletoperformquitewell,running,jumping,andblockingspikesinthefront

abletoperformquitewell,running,jumping,andblockingspikesinthefrontrow!

ThebathroomYes,Iknowit’sgrosstotalkabout,butit’sapartofthefastingexperience.

Iexpectedtovisittheporcelaingoddessfrequentlyinthefirstcoupleofdaysorso,butwhenIwasstillseeingmassiveamountsof“stuff”comingoutlateintheweek,thatwasprettyfreaky—afterall,Ihadn’tconsumedanythinginmanydays,sowhatwascomingout?Itremindedmethatthere’salotmorewasteinthebodythanweevenrealize,anddoingthisfastmayhavehelpedcleanagoodbitofthatout.

NutritionalsupplementsIdidnotstoptakingmyregularsupplementsforthedurationofthefast.I

continuedwithmymultivitamin,vitaminD3,magnesium,probiotics,andothervitaminsthathavebeenapartofmyhealthylow-carblifestyleforyears.PerhapsIcouldhavegiventhisroutinearestforaweek,too,butIdidn’t.

HowImadeitthroughThiswasmyfirstattemptatfastingforlongerthanaday,soIdidn’thave

anyideawhattoexpectbeyondwhatIhadheardfromothers.OneofthechallengesIfacedwashowtowardoffthesymptomsofnoteatinganything—thelight-headednessandlethargyI’dexperiencedonmyfirstfast.Iwasguzzlingalotofwater(veryimportantforanyonewho’sfasting),butIdecidedIwantedmore.SoIaddedinsomedietsodastohelpgetmethrough.WhileInolongerdrinkdietsodas,theyweresomewhathelpfulingettingthroughthefast.(Yes,Iknow,Dr.Fungadvisesagainstthis—seehere—andthey’reprobablyabigreasonwhymyfirstattemptatfastingwassotough.It’sajourneyweallneedtotake.)Ialsoincludedbouilloncubestohelpwithelectrolyteimbalance.I’vesincelearnedthatabetter,healthierwaytogetthesehelpfuleffectsistodrinkkombuchaandbonebrothwithseasalt.

Otherpeople’sreactionsWhenIstartedsharingmyfastingexperienceonsocialmedia,thereactionI

receivedwasprobablythemostsurprisingpartoftheentirefast.Itranallacrossthespectrum,fromencouragingwordsfrompeoplewhothoughtthiswasagreatideaandcheeredmeonallthewaytopeopletellingmeIwaskillingmyselfandunderminingtheverylow-carb-lifestyleprinciplesIpromote.SomeoftheresponsewasasifI’dusedtheotherf-wordinchurch!

responsewasasifI’dusedtheotherf-wordinchurch!

WhatwouldIhavedonedifferently?IhatetosayI’dchangeanythingaboutmyfirstexperiencetryingaone-

weekfast.Theexperiencewaswhatitwas,anditwaseye-opening.Atthetime,Iplannedtoeatsomecoconutoilifthehungerbecametoomuchtobear,butitneverdid,andnowIcan’thelpbutwonderiftheadditionofcoconutoilorotherstrategiesmighthavemadeadifferenceinthewayIfelt.Addinginthesethingsmighthavestokedsomehunger,butmaybenot.Itgotmethinkingabouthowtotweakandimprovemyfastingattemptsinthefuture.

Afterthefastended,Idecidedtowritetothemanwhoinspiredthisone-weekfast—Dr.Seyfriedhimself—whomIhadmetinpersonthatyearatanobesityconferenceinBaltimore,Maryland.WhenItoldhimwhatIhaddone,hesaidhewashappytohearI“survived”myfastingexperience.HesaidthevitaminsItookandotherthingsIaddedtomyfastmayhavesent“mixedsignalstothebody,”makingthefastmoredifficult.Dr.Seyfriednotedthatacancer-preventingfastshouldprobablybedoneusingdistilledwateronlyandnothingelse.HealsolamentedthatIdidn’tmeasurethelevelofketones—byproductsofthebodyburningfat—inmyblood.(Iwouldlearnmoreaboutthatandstarttestingthemoneyearlater.)Hesuspectedthatmybloodketoneswereelevated,whichhelpedmeendurethefastfortheweek.

Dr.Seyfriedwassoimpressedbymyexperimentthatheincludeditinhistextbookoncancer,CancerasaMetabolicDisease:OntheOrigin,Management,andPreventionofCancer.Here’swhathewrote:

Mr.JimmyMoorealsodescribedhisexperiencewithaseven-day,mostlywater-onlyfastinapodcastvideo.Mr.Mooreisawell-knownbloggerforthehealthbenefitsoflow-carbohydratediets.Hewasabletodocumentthephysiologicalchangesheexperiencedduringthefastinnontechnicallanguage.AlthoughMr.MoorefollowedmostofwhatHerbertSheltonwouldconsiderstandardpractices,Mr.Mooreincludedbouilloncubesinthefast.Chickenandbeefbouilloncontainsomecaloriesandsalts,whichmightpreventglucosefromreachingthelowestlevelsneededtoputmaximummetabolicpressureontumorcells.However,Mr.Moore’sbloodglucoselevelsdidfallwithintherequiredtherapeuticrangesfortumormanagementduringhisfast.Furtherresearchisneededtodocumenttheinfluenceofbouillonandotherlow-calorieandlow-carbohydratefooditemsonbloodglucoseandketonelevelsduringfoodfasting.Nevertheless,itisimportantforcancerpatientstorecognizefromMr.Moore’spodcastthatfastingisnotharmful.

CombiningFastingandNutritionalKetosisFast-forwardto2012,whenIbeganmyone-yearexperimentwith

nutritionalketosis.Byeatingalow-carb,moderate-protein,high-fatdiet,Iwas

abletoswitchmybodyfromprimarilyburningglucoseforfueltoburningfat.Aspartoftheexperiment,Istartedkeepingtrackofmybloodketones,asDr.Seyfriedhadsuggested.

Ihadnointentionatalloffastingaspartoftheketosisexperiment.ButIquicklydiscoveredthatitjuststartedhappeningspontaneouslyandnaturally,especiallywhenmybloodketonelevelsexceeded1.0millimolar.Irememberthatearlyon,inthefirstfewweeksofmyexperiment,mywifeaskedmewhenthelasttimeIatewas.Afterlookingattheclockandthengoingbackthroughmyfoodlogs,Idiscoveredithadbeenabouttwenty-eighthours.Ihadtotallyforgottentoeat.Inlightofmyhistoryofeating,thiswasabsolutelystunning!

Oncemybodymadetheswitchfromburningglucosetoburningfat,theideaofeatingbreakfast,snack,lunch,snack,dinner,snack,midnightsnackjustseemedsilly.WhywouldIwanttoeatthatoftenwhenIwasn’thungry?MybodywasveryclearlytellingmeitwasokaythatIdidn’tthinkaboutfoodthatobsessivelyanymore.Wesimplyaren’tmeanttobeeatingasmuchorasoftenaswedoinmodernculture,andgettingintoketosisbyconsumingreal,wholefoodsonadietthatislow-carb,moderate-protein,andhigh-fat,withadequatecalories,willallowyoutospontaneouslyfastfortwelvetotwenty-fourhours.(ReadmybookKetoClaritytolearnmoreabouthowgoingketogeniccanmakeintermittentfastingacinch.)

AMYBERGERFASTINGALL-STARSIpreferformyclientstosticktoagood,nutrient-denselow-carbdietandgetfat-adaptedforawhilebeforeexperimentingwithfasting.Ithinkit’seasierandmorepleasanttofastwhenyourbodyisn’tstillscreamingoutforcarbohydrates.

MymainpointhereisthatwhenIgotintoastateofnutritionalketosis—whenIbecamemostlyafat-burnerratherthanasugar-burner—fastingbecamecompletelynaturalforme.Ofcourse,manyofyoureadingthisaren’teatingaketogenicdietorpursuingnutritionalketosis,andthat’sfine(althoughyoushouldbe!).Dr.Funghashadalotofsuccessusingfastingasatherapeuticapproachwithmanyofhispatientswhoaren’tinketosis.ButmyownexperiencewithfastinghasbeenthatitwasdifficultbeforeIgotintoketosis,andperfectlynaturalandeasyafterward.

Thatone-weekfastreallyshowedmethepoweroftheketonesinkeepingmecompletelyenergizedandcomfortableduringafast.EventhoughIwasn’tinketosiswhenIstartedthefast,duringthefastmybodywasburningfatandproducingketones,anditfeltgreat.That’sthebottomlinetoremember—onceyou’reaccustomedtofasting,ithappensverynaturallyandshouldn’tbeassociatedwithmuchhungerordiscomfortafterthefirstfewtimes.Andtheadviceinthisbookwillhelpyougetthroughthosefirstfewtimes,whichIadmitcanbetough.Buttoughdoesn’tmeanimpossible.Myfirstfastingexperiencewasterrible,butnowIcandoitonawhim,anditfeelsgreat.TheonlythingIcantellyoutodoistryityourselfandwatchwhathappens.It’sincrediblyfreeingtonotthinkaboutfoodtwenty-fourhoursaday,sevendaysaweek,365daysayear.Isitstillsoundinglikeanotherf-wordtoyounow?

Whathappensifyoudogethungryordon’tfeelgoodwhileintermittentfasting?Ummmm,hello,McFly?Youeatsomething!Thisisn’trocketscience,people.Whileit’snormaltohavesomehungeranddiscomfortforthefirstcoupleofdays,there’sadifferencebetweenminordiscomfortandtheI’m-going-to-literally-bite-someone’s-head-off-if-I-don’t-eat-somethingdiscomfort.Ifyourenergyisjustgoneandnotcomingback,oryou’renotfeelinglikeyourself,oryou’reinsanelyhungry,don’tpushthrough.Fastingshouldn’tbephysicallypainful.Endit,havesomethingtoeat,andtryagaininaweekorso.

Ofcourse,asmyblogreadershared,truehungerismuchdifferentthanwhatwehavecometoexpect.Thesadfactis,mostpeopledon’tlistentowhattheirbodyistellingthem.Instead,theyeatmoreoutofhabit,comfort,andboredomthananythingelse.Thisiscriticaltounderstandifyou’regoingtoattempttoengageinfasting.

Ifyou’veneverdoneIFbefore,thenatwenty-four-hourperiodwithnofoodcansoundabsolutelytorturous.Yourbodyisusedtogettingfoodatcertaintimesofthedayandwillsendnot-so-subtlecuesthatitistimetoeat.Iusedtothinkthatwastruehunger,butit’sreallynot.Instead,itissimplyyourbody’sinternalclocktryingtokeepyouonyournormal,familiarroutineofeating.Butdoesthatmeanwearesupposedtosuccumbtothedesiretoeatwhenthatfeelinghits?Iusedtothinkso,butthewisdomofexperiencehasnowtaughtmetheanswerisanemphaticno.Thefactisthatourstomachcanremainquitesatisfiedevenwheneveryoneelsearoundusischowingdownonfoodbecauseit’s“timetoeat.”

WhenIweighedover400pounds,priorto2004,IfeltlikeIwashungryvirtuallyallthetime,nomatterhowmuchfoodIputinmymouth.Gettingmyhungerundercontrolandrecognizingwhattruehungerfeelslikewasahugepart

hungerundercontrolandrecognizingwhattruehungerfeelslikewasahugepartofmyeventualsuccessandstillsustainsmealltheseyearslater.

Thereareplentyofpeoplelikemewhocancomfortablyeatoneortwomealsadaywithoutaproblemthankstonutritionalketosis,sowecangothroughperiodsoffastingquitenaturally.ButIwilltellyounowthattherewillbesocialchallengesassociatedwithfasting.Ifyourfriendsorfamilywanttogathertogetherforamealandyou’reeithernothungryorengagedinanextendedfast,thensomepeoplejustdon’tknowhowtohandleit.Youdon’twanttoberudeatthegathering,andthehostdoesn’twanttofeeltheydidsomethingwrong.Remember,theseoccasionsaren’treallyaboutthefoodasmuchastheyareaboutconnectingwithothers.Focusontheconnectionsandletthemstufftheirfacewithwhatevertheywant.Mostpeoplewillhardlynoticeyouaren’teating.Andiftheydo,it’stheirproblem,notyours.Ofcourse,thebestthingtodoistoplanyourfastaroundcelebrationsandeventswherefoodisimportant.Don’tstartaseven-dayfastthreedaysbeforeabirthdaypartyorwedding.Butforeveryday,spur-of-the-momentget-togethers,trytobehavenormallyandenjoythecompanywithoutfixatingonthefood.

ExtendedFastingTake2:AThree-WeekFastAftermysuccessformallytestingtheketogenicdietin2012and2013,

whichledtoadeeperunderstandingofnutritionalketosis,Ithoughtitwouldbeusefultotryfastingagain.Ofcourse,Ididn’tneedto“try”IF—Iwasdoingitpracticallyonadailybasisbecauseketosismadeitsoeasy—soIdecidedtorevisitlongerfastingtoseeifIcouldgobeyondaweek.ImetDr.JasonFunginSeptember2015,andafterlearningabouttheworkhewasdoingwithoverathousandpatients,usingvariousfastingprotocolstoimprovetheirhealth,Iwasintriguedbytheideaoffastingformorethanoneweek.CouldImakeitfortwenty-onedaysinarowthistimearound?

InSeptember2015,Isetoutonatwenty-one-dayfastwithonlywater,kombucha,andbonebrothwithseasalt,togethertotalingwellunder200caloriesdaily.Whiletechnicallythiswasnotapurefast,sincetherewassomeminimalcaloricintake,Dr.FungadvisedmethatIwouldgetmostofthebenefitsofawater-onlyfastwiththisprotocol.IshareddailyupdatesduringthefastonmyPeriscopechannel.Predictably,myweightcamedownveryquickly,asdidmybloodsugarlevels—theywentintothe70sandevenupper60swithnosignsofhypoglycemia.Icheckedmybloodketonesaswell,andwhiletheystartedatverylowlevels,theycatapultedtowellabove2.5millimolarbyday4ofthefast.Ifelteuphoricandsurprisinglyenergetic—unliketheprevioustimeIdidalongerfast!

didalongerfast!MyfirstdayoffastingwasextremelyeasybecauseIwasalreadyusedto

fastingfortwenty-fourhourswithmyketogenicdiet.Day2wasthemostdifficultforme—thedesiretoeatwasmuchmoreintensethanIhadexpected.ButthensomethingincrediblehappenedonceIgotpastthesecondday:fastingbecamesurprisinglysimple!Itwasalmosttooeasytojustnoteat.Thenotionthatifyoudon’teat,you’llexperienceanincreasingfeelingofhungerthelongeritlasts,issimplynottrue.Infact,Idaresaythatafterfastingforafewdays,youwillactuallyfeelmorenormalthanperhapsyoueverhavebefore.Andwhenyoudon’tthinksomuchaboutwhatyou’lleat,whenyou’lleat,whereyou’lleat,andalltheothersocialcustomssurroundingfood,itfreesyouuptodootherthings.You’llrealizetheurgeanddesiretoeatismorementalthanphysical.

Sohowdidmytwenty-one-dayfastingattemptgo?Imadeitatotalofseventeenandahalfdays,onlytobesabotagedbysomethingthatIreallydidn’texpect:stressfromtraveling.MywifeandIwentonvacationwithfriendsinMyrtleBeach,SouthCarolina,beginningonday15oftheexperiment,andbytheeveningofday17,mystomachwasgrowlingforforty-fiveminutesstraight!Becauseitwasclosetobedtime,Idecidedtowaituntilthenextmorningtoseeifthehungerwoulddissipate.Itdidnot,andsoIbrokethefastjustafewdaysshortofmyoriginalgoal.ButIlistenedtomybody,andthatisalwaysveryimportantwhenyouarefasting.

It’snotabigdealtoendthefastwhenitbecomesobviousthetimetostopfastinghascome.I’dfastedfornearlythreetimeslongerthanIeverhadinmylife,soIwasprettystoked.ButthefactthatIhadtostopshowedmejusthowprofoundlyimpactfulstresscanbe,andnowI’vestartedtakingactivemeasurestoreducestressinmylife—meditation,lesstimeonline,yogaclasses,andregularmassagesallhelp.BecauseIhavesevereinsulinresistanceduetoyearsofpoornutrition,Ithinkstressprobablyimpactsmemorethanmost.IfIcanfigureoutthispieceofthehealthpuzzle,thenmaybeabookcalledStressClaritycouldbeinmyfuture.Staytuned!

ROBBWOLFFASTINGALL-STARSFastingisastress.Whetheritisahormetic(beneficial)stressorpotentiallyadetrimentalstressislargelydeterminedbywhatotherlifestressorsareatplay.

Predictably,Ilostweightonthisfast:nineteenpounds.Whilethatwasn’titsprimarypurpose,itwasanicelittlesideeffect.MostfascinatingtomewasthefactthatsixteenpoundshadstayedoffwhenIcheckedonemonthafterIendedthefast.Thatwasprettycool.AndbecauseI’msuchanerdwhenitcomestohealthmarkers,Iofcourseranaseriesofbloodtestsbeforeandaftermyseventeen-and-a-half-dayfasttoseewhatimpactthefastinghad.Someoftheseresultswerepredictable,butotherstookmetotallybysurprise.Here’swhathappenedtovariousbloodmarkerspriortoandimmediatelyaftermyfast:

PRE-FAST POST-FASTTotalcholesterol 295 195

LDL-C 216 131HDL-C 61 50

Triglycerides 90 68LDL-P 2889 1664

SmallLDL-P 1446 587Lp(a) 441 143

Fastinginsulin13.9 10.0

hsCRP1.6

.94

Mostofthosenumbersarerelatedtocardiovascularhealth,including

advancedcholesteroltests.(Youcanlearnmoreaboutcholesterolnumbersinmy2013bookCholesterolClarity.)Butletmeinterpretwhathappenedhere.Didyouseeanythingthatkindofstuckoutmorethanothers?Yep,itwasthecholesterol.Totalcholesteroldropped100pointsinlessthanthreeweeksoffasting,withouttheneedforanycholesterol-loweringmedicationslikestatindrugs.Aspatients,we’reoftentoldthatdrugsaretheonlywaytogetourcholesteroldownsowewon’thaveaheartattack,andyethereisatotallydrug-freemethodforloweringcholesterol.

MyHDL-C,knownasthe“good”cholesterol,predictablyfellfrom61to50duringthefast.OneofthebasicmaterialsneededforHDLcholesterolisfat,

especiallysaturatedfat.Sowhenyoudon’tconsumeanyfoodatall,youcanexpectyourHDLtodrop.ButmostofthereductioninthetotalcholesterolnumberwasintheLDL-C,whichdippedfrom216to131,butthisdoesn’ttelltheentirestoryabouttheimprovementstomyhearthealth.FastingdidsomethingI’veneverseenanypharmaceuticaldrugdobefore.

TheadvancedlipidpanelknownasanNMRlipoprofiletestshowstheactualnumberofLDLparticlesandthesizeofthoseparticles.WhenIbeganmyfast,thetotalLDLparticles(LDL-P)was2889andthesmallLDL-P(thetrulybadLDL)was1446.Afterthefast,thesenumbersdroppedto1664and587,respectively,representingasignificantimprovement.ButperhapsthemoststunningresultofallofthesetestswastheLp(a)(Lipoproteina),ariskfactorinthedevelopmentofcardiovasculardisease.MyinitialLp(a)of441wasextremelyhigh(alwayshasbeen),anditplummetedto143.That’sapowerfulindicationofthetherapeuticeffectsoffasting.

ThefinaltwobloodtestswereforfastinginsulinandhsCRP(high-sensitivityC-reactiveprotein),akeyinflammationmarker.Thegoodnewsisthatthesenumbersweren’tbadbeforeIstartedandonlygotbetterafterthefast.Therewasanearlyfour-pointdropinthefastinginsulin,andmyhsCRPfellalmostinhalf.

Allinall,thenumbersshowedthatmythree-weekfastwasagreatsuccess.ButIwasn’tfinishedyet.

ExtendedFastingTakes3,4,and5:AnotherWeek,FastingCycles,andaMonthWithoutFood

Inmid-October2015,IdidanotherfastforoneweektoseeifIwouldseesimilarchangesinmykeymarkers.Interestinglymybloodsugarfellonceagainintothe70sand80s,andIlost13.4pounds.However,thatweightdidn’tstayoffthistimearound.PerhapsIamoneofthosepeoplewhoneedlongerfaststoseetheresultsstick.

MynextfastingexperimenttookplaceinDecember2015,whenItriedcyclingthefastingwithsomenonfastingdaystoseehowthatwouldworkforme.Ifastedforsixdays,thenateonday7,fastedanotherfivedays,thenateonday13,thenfastedanotherfourdays,andendedthefast.Itwasfunchangingthingsupabit,butIdidn’tseethesameresultsdoingthisasIdidwiththenearlythree-weekconsecutivefast.MybloodsugarandbloodketonelevelsneverfelltothelevelsI’dcometoexpectfromanextendedfast.Thatsaid,Ilost18.2poundsandhadkeptofffivepoundsofitwhenIcheckedamonthlater.But

Ihadonemoreideaforafastthatwouldbemymostcontroversialoneofall.InJanuary2016,Ihadtheideatofastfortheentiremonth.Yep,youheard

meright.Iwantedtofastforthirty-onedaysinarow.Itwasdaunting,butI’dbeenencouragedbytheresultsofmytwopreviousextendedfasts,soIdecidedtogiveitago.Thistimearound,Ithoughtitwouldbefuntohaveadual-energyX-rayabsorptiometryscan—betterknownasaDXAscan—runtoseewhathappenedtomybodyfatandmusclemassduringthisfast.SeveralofmyfollowersonsocialmediawereconcernedthatIwaslosingmassiveamountsofmuscleonthesefastingexperiments.SoIwasscannedbeforeandaftertheJanuary2016fast.Moreonthoseresultsinamoment.

Iwasgoingalongswimminglyonthisfast,seeingfabulousimprovementsinmybloodsugar,whichplummeteddownintothe70sand60sagain,andbloodketones,whichwerewellover2.5millimolaragain,andIwasfeelingfantastic.Infact,onday11Idecidedtotestmybloodsugarandbloodketoneseveryhouronthehourtoseewhatwasgoingon.Theresultsareinthetableonhere.

Thosearesomeprettyspectacularnumbers,andIwasfeelingincrediblethroughouttheday,despitehavingnoteatenforelevendaysinarowatthatpoint.

Onday13,IneededtopausethefastandeatbecauseweweredrivingtoVirginiatobewithmywife’sfamily.Onceagain,thestressbugbitmehard,andittookatollonmyabilitytofast.ThankfullyIgotrightbackonitaftertakingonedayoffandwasdoingwelluntilthreedayslater,whenweneededtodrivehome.Onceagain,thestresscausedmetopausethefastforasecondtime.Duringtravel,hunger,weakness,andageneralfeelingofblahjusthitmelikeatonofbricks,andIknownottoignorethatfeeling.SoIagainateonday16andbeganthefastagainthenextday.Ifastedforsixmoredaysafterthat,pausedonelasttimeonday22,andthenmadeitthefinalninedaysofthemonth.Allinall,Ifastedtwenty-eightofthethirty-onedaysinJanuary2016.

AlthoughmybloodsugarandbloodketonelevelswereupanddownbecauseIhadtopausethefastoccasionally,Istilllost22.4poundsandkeptofffourteenofitinthemonththatfollowed.

AndwhataboutthoseDXAscanresults?Nowthiswasfascinating.The

scanshowedIlosttenpoundsofbodyfatandanothertenpoundsofwhatitidentifiedas“leantissue,”generallyinterpretedasmuscle.Allofthissupposed“muscleloss”happenedinthetrunkarea;Iactuallygainedmuscleinmyarmsandlegs.WhenIdiscussedthisresultwithDr.Fung,henotedthattheDXAscancanmistakefatlossinorgantissuesformuscleloss.Inotherwords,mostlikelyIlostnotmusclebutratherfataroundmyinternalorgans—averygoodthing!

SoIreturnedtomylow-carb,ketogenicwayofeatingforacoupleofweeksandhadtheDXAscanrunagain.WhathappenedtothatleantissueitshowedIlostduringmyfast?Everysinglepoundofthatso-calledmusclelosswascompletelygoneandIwasbacktothelevelIwasatpriortothefast.Itjustgoestoshowyouthatthesemeasurementsaremerelytoolsandshouldneverleadtofalseassumptions.Thefactis,Ididn’tloseanymuscleduringmy

twenty-eightdaysoffasting,andthat’sprettyremarkable!Itgoesagainsteverythingcommonlybelievedaboutthesideeffectsoffasting.(Dr.Fungdiscussesthemyththatfastingcausesmusclelossinmoredetailonhere.)

Conclusion:AFastingFan!I’mstilltweakingmyownpersonalfastingprotocol,takingintoaccount

thatIprobablyneedlongerfaststoreceivethemostbenefitsandthat,asI’velearned,itisincrediblyimportantformetotrynottofastduringstressfultimes,evenwhenit’shappystress.Travelingmakeslonger-termfastingano-goforme(althoughIwilleasilydoanintermittentfastiftheflightisunderfourhours),andsodoanyout-of-the-ordinaryactivities,suchaswritingbooksorattendingconferences.ThisisagreatlessonIlearnedfrommyfastingescapades.

Ifyou’renowinspiredtogivefastingatryforyourself,letmeencourageyoutojustdoit.Evenifyoubeginbysimplyskippinglunch,youcanworkyourwayuptofastingforafewdaysinarow,andthebenefitswillbetremendous.Dr.Fungwilltalkinmoredetailaboutthosebenefitsinthecomingchapters,butsufficetosay,ifyou’restrugglingwithobesityand/ortype2diabetes,fastingcanhaveanincredibleeffectonweightandbloodsugar.I’veseenitwithmyowneyes,evenwhenIwasstillskepticalaboutfasting.

Iunderstandthatitcanbearealchallengetonoteatforaperiodoftime.It’sespeciallytoughbecauseinourmodernworld,foodisinstantlyavailableoneverystreetcorner.Butwhatifyoudecidedtobuckthetrend,abstainfromeatingevenforashortperiodoftime,andseehowyoudo?Forgetaboutwhatyouthinkmighthappenandinsteadembracetheexperiencetoseewhatdoeshappen.I’mnotgoingtotellyouitwillsolveallofyourweightandhealthissues.It’scertainlynotacure-all.Butfastingcanbecomeoneofthemostpracticaltoolsthatcanempoweryoutotakebackcontrolofyourownhealth.That’sagoalweshouldallbestrivingfor!

Meetthe

FASTINGALL-STARS

ABELJAMES

AbelJamesisaNewYorkTimesbestsellingauthorandmodern-day

Renaissanceman.HestarsasacelebritycoachonABCTelevisionandhasbeenfeaturedinPeoplemagazine,WIRED,EntertainmentTonight,andNPR.Ashostofthenumberonepodcastinmorethaneightcountries,Fat-BurningMan,Abelhashelpedmillionsreclaimtheirhealthandperformattheirbestwithcutting-edgescience,outdoorworkouts,andoutrageouslygoodfood.

Abelhaskeynotedforthefederalgovernment,lecturedatIvyLeagueuniversities,andadvisedFortune500companies,includingMicrosoft,Danaher,andLockheedMartin.Hewasnamedoneofthe100MostInfluentialPeopleinHealthandFitnessbyGreatistin2015and2016.

DistinguishedasaSeniorFellowwithHonorsatDartmouthCollege,Abelcreatedhisowncurriculumtospecializeinbrainscience,music,andtechnology.HelaterpublishedhisresearchinTheMusicalBrain,whichbecameanumberonebestseller.

Alsoasongwriterandmulti-instrumentalist,Abelhaswonseveralawardsinwritingandperformancearts,including“OutstandingAchievementinSongwriting.”

Songwriting.”AbelliveswithhiswifeinAustin,Texas.Heenjoysstrongcoffeeand

cheesecake,preferablytogether.

AMYBERGER

AmyBerger,MS,CNS,NTP,istheauthorofthebookTheAlzheimer’s

Antidote.Shehasamaster’sdegreeinhumannutritionandisaCertifiedNutritionSpecialistandNutritionalTherapyPractitioner.AsaUSAirForceveteran,shehasaspecialinterestintheuseoflow-carbohydrateandketogenicdietsforneurologicalhealth(includingtraumaticbraininjury),aswellasimprovingmetabolicconditionssuchastype2diabetesandobesity.

Afterspendingyearsdoingwhathealthandnutritionexpertsclaimedwere“alltherightthings”toloseweightandmaintainoptimalhealthandfailingtoexperiencetheexpectedresults,Amydiscoveredthattheconventionaladviceaboutlow-calorie,low-fatdietingandexercisedidnotleadtothepromisedoutcomes.Inpursuingtraininginnutritionandphysiology,shelearnedthatmuchofwhatwecurrentlybelieveabout“healthydiets”ismisguidedand,inmanycases,downrightincorrect.

Havinglearnedtheselessonsthehardway,Amyhasdedicatedhercareertoshowingothersthatvibranthealthdoesnotrequirestarvation,deprivation,orlivingatthegym.Menandwomencannotlivebylettucealone.Realpeopleneedrealfood!Youcanreadherblogandfindmoreofherworkat

www.tuitnutrition.com.

DR.MICHAELRUSCIO

Dr.MichaelRusciohelpspeopleidentifywhytheyaresickandhelpsthem

getwellnaturally.Heworkswithpatientsacrossthecountry,utilizinglab-basednaturalmedicinetreatmentstohelpavarietyofpatients,fromathletestothechronicallyill,overcomehealthproblemsandachieveoptimalhealthandwell-being.Visithiswebsite,DrRuscio.com,formore.

BERTHERRING

BertHerring,MD,(“Dr.Bert”)pioneereddailyintermittentfasting,first

experimentingwithithimselfin1995,thenstudyingitfurtherandsharingitwiththeworldin2005withthefirstguidetostartingandreapingthebenefitsofadailyfasting/eatingcycle,TheFast-5DietandtheFast-5Lifestyle.

Dr.Bert’sfocusisonreal-worldsolutions:thingsthatworkforrealpeoplewithreallivesandrealcommitments,likekidsandjobs.Hepaysattentiontowhatworksforpeoplewhocan’texerciseeighthoursperday,andhekeepshisskepticismhighwhenitcomestoresultsthatonlyconcernlabrats,short-durationstudiesofonlyafewweeks’duration,andstudiesinwhichpeoplearebeingobserved(because,asHeisenbergsaid,observationchangesthings).

Dr.Bertalsohaslittleinterestintemporarysolutions.Temporarysolutionsmaywork,butifyoucan’tsustainthem,theycan’tbecomepartofyourlifestyle.Hewantstoarmpeoplewiththetoolsnecessarytofightculture’sdrivestoovereatandhelpthembuildacustomized,low-hasslewayoflivingthatachievesahealthybalanceandworksforthelongterm.

Healthgoesfarbeyonddiet,soDr.Bertdoestoo.Toseemore,lookforhisTEDxtalk,“DidIEnrichToday?,”whichhasover235,000views,orvisithiswebsite,bertherring.com.

MEGANRAMOS

MeganRamosworkedwithDr.Fungforoversixteenyearsasamedical

researcherpriortocofoundingtheIntensiveDietaryManagementProgram.Havinghelpedhundredsofpatientsincorporatefastingintotheirlives,thereislikelynobodyelseintheworldwithherclinicalexpertise.

THOMASN.SEYFRIED

ThomasN.SeyfriedisaprofessorofbiologyatBostonCollegeand

receivedhisPhDingeneticsandbiochemistryfromtheUniversityofIllinois,

receivedhisPhDingeneticsandbiochemistryfromtheUniversityofIllinois,Urbana,in1976.HedidhisundergraduateworkattheUniversityofNewEngland,whereherecentlyreceivedthedistinguishedAlumniAchievementAward.Healsoholdsamaster’sdegreeingeneticsfromIllinoisStateUniversity.HewasapostdoctoralfellowintheneurologyattheYaleUniversitySchoolofMedicineandthenservedonthefacultyasanassistantprofessorinneurology.ThomasSeyfriedservedwithdistinctionintheUSArmy’sFirstCavalryDivisionduringtheVietnamWarandreceivednumerousmedalsandcommendations.

OtherawardsandhonorshavecomefromsuchdiverseorganizationsastheAmericanOilChemistsSociety,theNationalInstitutesofHealth,theAmericanSocietyforNeurochemistry,andtheKetogenicDietSpecialInterestGroupoftheAmericanEpilepsySociety.Dr.SeyfriedpreviouslyservedaschairoftheScientificAdvisoryCommitteefortheNationalTay-SachsandAlliedDiseasesAssociationandpresentlyservesonseveraleditorialboards,includingthoseforNutrition&Metabolism,NeurochemicalResearch,JournalofLipidResearch,andASNNeuro,whereheisasenioreditor.Dr.Seyfriedhasover170peer-reviewedpublicationsandistheauthorofCancerasaMetabolicDisease:OntheOrigin,Management,andPreventionofCancer.Hisfulllistofpeer-reviewedpublicationscanbefoundonPubMed(http://www.ncbi.nlm.nih.gov/pubmed).

MARKSISSON

MarkSissonistheauthorofthebestsellingbookThePrimalBlueprint,as

wellasThePrimalBlueprintCookbookandthetop-ratedhealthandfitnessblogMarksDailyApple.com.HeisalsothefounderofPrimalKitchen,acompanydevotedtodesigning,manufacturing,anddistributinghealthy,great-tastingfoodproductsmadewithcleanproteins,healthyfats,andnosugars.

ROBBWOLF

RobbWolf,aformerresearchbiochemist,istheNewYorkTimes

bestsellingauthorofThePaleoSolution:TheOriginalHumanDiet.AstudentofProfessorLorenCordain,authorofThePaleoDiet,Robbhastransformedthelivesofhundredsofthousandsofpeoplearoundtheworldviahistop-rankediTunespodcast,book,andseminars.

RobbhasbeenarevieweditorfortheJournalofNutritionandMetabolism,iscofounderofthenutritionandathletictrainingjournalThePerformanceMenu,isco-ownerofNorCalStrength&Conditioning,oneoftheMen’sHealthtop30gymsinAmerica,andisaconsultantfortheNavalSpecialWarfareResiliencyprogram.Heservesontheboardofdirectors/advisorsfor:SpecialtyHealthInc.,PaleoFX,andPaleoMagazine.

RobbisaformerCaliforniaStatePowerliftingChampion(565lb.squat,345lb.bench,565lb.deadlift)anda6–0amateurkickboxer.HecoachesathletesatthehighestlevelsofcompetitionandconsultswithOlympiansand

athletesatthehighestlevelsofcompetitionandconsultswithOlympiansandworldchampionsinMMA,motocross,rowing,andtriathlon.Robbhasprovidedseminarsinnutritionandstrengthandconditioningtoanumberofentities,includingNASA,NavalSpecialWarfare,theCanadianLightInfantry,andtheUnitedStatesMarineCorps.

RobblivesinReno,Nevada,withhiswife,Nicki,anddaughtersZoeandSagan.

FEARS

—forgetthem

ADVANTAGES

—somany

SCHEDULE

—wheneveryouneedit

THERAPEUTIC

—forsomanyhealthconcerns,likeobesity,diabetes,cancer,andAlzheimer’s

Chapter1

WHATISFASTING?

Mentioningfastingasatreatmentforobesityandtype2diabetesalways

getsthesameeye-rollingresponse.Starvation?That’stheanswer?You’regoingtostarvepeople?No.Thatisnotitatall.I’mnotgoingtostarvepeople;I’maskingthemtofast.

Fastingiscompletelydifferentfromstarvationinonecrucialway:control.Starvationistheinvoluntaryabstentionfromeating.Itisneitherdeliberatenorcontrolled.Starvingpeoplehavenoideawhenandwheretheirnextmealwillcomefrom.Thishappensintimesofwarandfamine,whenfoodisscarce.Fasting,ontheotherhand,isthevoluntaryabstentionfromeatingforspiritual,health,orotherreasons.Foodisreadilyavailable,butyouchoosenottoeatit.Nomatterwhatyourreasonforabstaining,thefactthatfastingisvoluntaryisacriticaldistinction.

Starvingandfastingshouldneverbeconfusedwitheachother,andthetermsshouldneverbeusedinterchangeably.Fastingandstarvingliveonoppositesidesoftheworld.Itisthedifferencebetweenrecreationalrunningandrunningbecausealionischasingyou.Starvationisforceduponyoubyoutsideforces.Fasting,ontheotherhand,maybedoneforanyperiodoftime,fromafewhourstomonthsonend.Youmaybeginafastatanytimeofyourchoosing,andyoumayendafastatwill,too.Youcanstartorstopafastforanyreason,orfornoreasonatall.

Fastinghasnostandardduration—sinceitismerelytheabsenceofeating,anytimethatyouarenoteating,youaretechnicallyfasting.Forexample,youmayfastbetweendinnerandbreakfastthenextday,aperiodoftwelvehoursorso.Inthatsense,fastingshouldbeconsideredapartofeverydaylife.Considerthetermbreakfast.Thewordreferstothemealthat“breaksyourfast”—whichisdonedaily.Theworditselfimplicitlyacknowledgesthatfasting,farfrombeingsomesortofcruelandunusualpunishment,isperformeddaily,evenifonlyforashortduration.Itisnotsomethingstrangebutapartofeverydaylife.

I’vesometimescalledfastingthe“ancientsecret”ofweightloss.Why?Itiscertainlyanancienttechnique,datingthousandsofyears,aswe’lldiscussinChapter2.Fastingisasoldashumankind,farolderthananyotherdietarytechnique.Buthowisfastinga“secret”?

Althoughfastinghasbeenpracticedformillennia,ithasbeenlargelyforgottenasadietarytherapy.Therearevirtuallynobooksaboutit.Therearefewwebsitesdedicatedtofasting.Thereisalmostnomentionofitin

fewwebsitesdedicatedtofasting.Thereisalmostnomentionofitinnewspapersormagazines.Evenitsverymentiondrawsstaresofincredulity.Itisasecrethidinginplainsight.Howdidthishappen?

Throughthepowerofadvertising,bigfoodcompanieshaveslowlychangedhowwethinkoffasting.Insteadofbeingapurifying,healthfultradition,it’snowseenassomethingtobefearedandavoidedatallcosts.Fastingwasextremelybadforbusiness,afterall—sellingfoodisdifficultifpeoplewon’teat.Slowlybutinevitably,fastinghasbecomeforbidden.Nutritionalauthoritiesnowallegethatevenskippingonesinglemealwillhavedirehealthconsequences.

Youmustalwayseatbreakfast.

Youmustsnackconstantly,alldaylong.

Youshouldeatabedtimesnack.

Youmustnever,evermissameal.

Thesemessagesareeverywhere—ontelevision,inthenewspaper,inbooks.Hearingthemoverandoveragaincreatestheillusionthattheyareabsolutelytrueandscientificallyprovenbeyondadoubt.Thetruthisexactlytheopposite.Thereisnocorrelationwhatsoeverbetweenconstanteatingandgoodhealth.

Sometimesauthoritieswilltrytoconvinceyouthatyoucan’tfastbecauseyou’llbeconsumedbyhunger.It’stoodifficult.Itissimplyimpossible.Here,thetruthisalsotheexactopposite.

FASTINGALL-STARSMARKSISSONIhadcertainlyreadatonontheantiagingbenefitsoffasting,butIwashesitanttotryitformyself,fearingImightlosepreciousmusclemass.Then,onalongoverseasflight,withnofoodavailableandnothavingeatensincethepreviousnight,Iwasforcedintoa36-hourfast.Ifoundmyselfcompletedenergeticandclear-headed.Basedonthatexperience,IstartedexperimentingwithhowlongIcouldgowithouteating(actually,withoutfeelinglikeIhadtoeat).Ifounditcouldbequitelongperiodsoftime.IalsonoticedthatIdidn’tlosemassorstrength,whichwaskeyforme.

Canyoufast?Yes—it’sbeendonebyliterallymillionsofpeoplearound

Canyoufast?Yes—it’sbeendonebyliterallymillionsofpeoplearoundtheworld,forthousandsofyears.

Isitunhealthy?No.Infact,ithasenormoushealthbenefits.Willyouloseweight?Ifyoudon’teatanythingforaday,doyouthinkyou

willloseweight?Ofcourse.Fastingiseffective,simple,flexible,practical,andvirtuallyguaranteedto

work.Askachildhowtoloseweight,andshewillprobablysaytoskipafewmeals.Sowhat’stheproblem?Nobodymakesmoneywhenyoufast.NotBigFood.NotBigPharma.Nobodywantstoyoutofindouttheancientsecretofweightloss.

TheDisappearanceofDailyFastingInthe1970s,atypicalAmericanatethreemealsaday—breakfast,lunch,

anddinner,withnosnacks.DatacompiledfromtheNationalHealthandNutritionExaminationSurvey(NHANES)showedanaverageofthreeeatingopportunitiesperday.Igrewupinthe1970sandrememberitwell.Whatwouldhappenifwetriedtogetanafter-schoolsnack?Usuallytherewouldbeaslaponthehandandanadmonitionthat“you’llruinyourdinner.”

Atypicaldaymightincludebreakfastat8:00a.m.,lunchatnoon,anddinnerat6:00p.m.Thatmeansthatwewouldbeeatingfortenhoursoftheday,whichisnicelybalancedbyfourteenhoursoffasting.Andguesswhat?Obesityandtype2diabeteswerenotnearlytheproblemstheyaretoday.

Figure1.1.Theaveragenumberofmealsandsnacksconsumedbyadultsincreasedfrom3perdayin1977–78toalmost6perdayin2003–06.

Source:PopkinandDuffey,“DoesHungerandSatietyDriveEatingAnymore?”

Fast-forwardtotoday.Insteadoftryingtostopsnacking,weactivelyencourageitinbothadultsandchildren.Someevenfeelthatsnackingmorewillhelploseweight,asridiculousasthatsounds.Considermyson’stypicalschedule.Heeatsbreakfastthemomenthewakesup.There’samid-morningsnackatschool,thenlunch,thenanafter-schoolsnack,dinner,andthenanothersnackbetweenhalvesofhissoccergame,andthenmaybeabedtimesnack.He’seatingsixorseventimesaday!Thisisbynomeansatypical.TheNHANESdatashowsthattheaverageAmericaneatsfiveorsixtimesperday.

Ithinkthehardestthingaboutfastingisdecidingtodoit.GettingitinmyheadthatIcanbeginandmakeitthroughisverytough,butonceIstart,thatblockdissolvesanditbecomeseasier.

—ScottJ.,Minneapolis,MN

Soinsteadofhavingbalancedperiodsoffeedingandfasting,wearenoweatingperhapssixteentoeighteenhoursofthedayandonlyfastingforsixtoeighthours.Isitanywonderthatobesityhasbecomeanepidemic?

Toexaminethereasonsthatfastingismorebeneficialthanmostpeoplethink,let’sstartbylookingatwhatactuallygoesoninthebodywhenweeatandwhenwefast.

WhatHappensWhenWeEat?Whenweeat,weingestmorefoodenergythanwecanimmediatelyuse.

Someofthisenergyneedstobestoredawayforlater.Thekeyhormoneinvolvedinboththestorageanduseoffoodenergyisinsulin,whichrisesduringmeals.Bothcarbohydratesandproteinstimulateinsulin.Fattriggersafarsmallerinsulineffect,butit’srarelyeatenalone.

Insulinhastwomajorfunctions.First,itallowsthebodytoimmediatelystartusingfoodenergy.Carbohydratesareabsorbedandrapidlyturnedintoglucose,raisingbloodsugarlevels.Insulinallowsglucosetoenterdirectlyintomostcellsofthebody,whichuseitforenergy.Proteinsarebrokendownintoaminoacidsandabsorbed,andexcessaminoacidsmayalsobeturnedintoglucose.Proteindoesnotraisebloodglucose,butitcanraiseinsulinlevels.Theeffectisvariable,anditsurprisesmanypeopletolearnthatsomeproteinscanstimulateinsulinasmuchassomecarbohydrate-containingfoods.Fatsaredirectlyabsorbedasfatandhaveminimaleffectoninsulin.

Second,insulinhelpsstoretheexcessenergy.Therearetwowaystostoretheenergy.Glucosemoleculescanbelinkedintolongchainscalledglycogenandthenstoredintheliver.Thereis,however,alimittotheamountofglycogenthatcanbestoredaway.Oncethislimitisreached,thebodystartstoturnglucoseintofat.Thisprocessiscalleddenovolipogenesis(literally,“makingfatfromnew”).

Thisnewlycreatedfatcanbestoredintheliverorinfatdepositsinthebody.Whileturningglucoseintofatisamorecomplicatedprocessthanstoringitasglycogen,thereisnolimittotheamountoffatthatcanbecreated.

WhatHappensWhenWeFast?Theprocessofusingandstoringfoodenergythatoccurswhenweeatgoes

inreversewhenwefast.Insulinlevelsdrop,signalingthebodytostartburning

inreversewhenwefast.Insulinlevelsdrop,signalingthebodytostartburningstoredenergy.Glycogen(theglucosethat’sstoredintheliver)isthemosteasilyaccessibleenergysource,andtheliverstoresenoughtoprovideenergyfortwenty-fourhoursorso.Afterthat,thebodystartstobreakdownstoredbodyfatforenergy.

Soyousee,thebodyreallyonlyexistsintwostates—thefed(high-insulin)stateandthefasted(low-insulin)state.Eitherwearestoringfoodenergyorweareburningfoodenergy.Ifeatingandfastingarebalanced,thenthereisnonetweightgain.

If,however,wespendthemajorityofthedaystoringfoodenergy(becausewe’reinthefedstate),thenovertime,wewillgainweight.Whatisneededthenistorestorebalancebyincreasingtheamountoftimeweburnfoodenergy(bygoingintothefastedstate).

Thetransitionfromthefedstatetothefastedstateoccursinseveralstages,asclassicallydescribedbyGeorgeCahill,oneoftheleadingexpertsinfastingphysiology:

1.Feeding:Bloodsugarlevelsriseasweabsorbtheincomingfood,andinsulinlevelsriseinresponsetomoveglucoseintocells,whichuseitforenergy.Excessglucoseisstoredasglycogenintheliverorconvertedtofat.

2.Thepostabsorptivephase(sixtotwenty-fourhoursafterbeginningfasting):Atthispoint,bloodsugarandinsulinlevelsbegintofall.Tosupplyenergy,theliverstartstobreakdownglycogen,releasingglucose.Glycogenstoreslastforapproximatelytwenty-fourtothirty-sixhours.

3.Gluconeogenesis(twenty-fourhourstotwodaysafterbeginningfasting):Atthispoint,glycogenstoreshaverunout.Thelivermanufacturesnewglucosefromaminoacidsinaprocesscalledgluconeogenesis(literally,“makingnewglucose”).Innondiabeticpersons,glucoselevelsfallbutstaywithinthenormalrange.

4.Ketosis(twotothreedaysafterbeginningfasting):Lowinsulinlevelsstimulatelipolysis,thebreakdownoffatforenergy.Triglycerides,theformoffatusedforstorage,arebrokenintotheglycerolbackboneandthreefattyacidchains.Theglycerolisusedforgluconeogenesis,sotheaminoacidsformerlyusedcanbereservedforproteinsynthesis.Thefattyacidsareuseddirectlyforenergybymosttissuesofthebody,thoughnotthebrain.Thebodyusesfattyacidstoproduceketonebodies,whicharecapableofcrossingtheblood-brainbarrierandareusedbythebrainforenergy.Afterfourdaysoffasting,approximately75percentoftheenergyusedbythebrainisprovidedbyketones.Thetwomajortypesofketonesproducedarebeta-hydroxybutyrateandacetoacetate,whichcanincreaseoverseventyfoldduringfasting.

5.Theproteinconservationphase(fivedaysafterbeginningfasting):Highlevelsofgrowthhormonemaintainmusclemassandleantissues.Theenergyforbasicmetabolismisalmostentirelysuppliedbyfattyacidsandketones.Bloodglucoseismaintainedbygluconeogenesisusingglycerol.Increasednorepinephrine(adrenaline)levelspreventanydecreaseinmetabolicrate.Thereisanormalamountofproteinturnover,butitisnotbeingusedforenergy.

Inessence,whatwearedescribinghereistheprocessofswitchingfromburningglucosetoburningfat.Fatissimplythebody’sstoredfoodenergy.In

timesoflowfoodavailability,storedfoodisnaturallyreleasedtofillthevoid.Thebodydoesnot“burnmuscle”inanefforttofeeditselfuntilallthefatstoresareusedup.(MoreonthismythinChapter3.)

Onecriticalpointtounderscoreisthatthesemechanismsareentirelynaturalandentirelynormal.Periodsoflowfoodavailabilityhavealwaysbeenanaturalpartofhumanhistory,andourbodyevolvedmechanismstoadapttothisfactofPaleolithiclife.Otherwise,wewouldnothavesurvivedasaspecies.Therearenoadversehealthconsequencestoactivatingtheseprotocols,exceptinthecaseofmalnourishment(youshouldnotfastifyou’remalnourished,ofcourse,andextremefastingcancausemalnourishment,too).Thebodyisnot“shuttingdown”;it’smerelychangingfuelsources,fromfoodtoourownfat.Itdoesthiswiththehelpofseveralhormonaladaptationstofasting.

Figure1.2.Thefivestagesofmetabolism.Duringfasting,bloodglucoselevelsaremaintainedbybreakingdownstoredglycogenandproducingnewglucosethroughgluconeogenesis.

Source:Cahill,“FuelMetabolisminStarvation.”

InsulinGoesDownAdecreasedinsulinlevelisoneofthemostconsistenthormonaleffectsof

fasting.Allfoodsraiseinsulintosomedegree.Refinedcarbohydratestendtoraiseinsulinthemostandfattyfoodstheleast,butinsulinstillgoesupinbothcases.Therefore,themosteffectivemethodofreducinginsulinistoavoidallfoodsaltogether.

Duringtheinitialstagesoffasting,insulinandbloodglucoselevelsfallbutremaininthenormalrange,maintainedbythebreakdownofglycogenaswellasgluconeogenesis.Afterglycogenisusedup,thebodybeginstoswitchovertoburningfatforenergy.Longer-durationfastsreduceinsulinmoredramatically.

Regularlyloweringinsulinlevelsleadstoimprovedinsulinsensitivity—yourbodybecomesmoreresponsivetoinsulin.Theoppositeofinsulin

yourbodybecomesmoreresponsivetoinsulin.Theoppositeofinsulinsensitivity,highinsulinresistance,istherootproblemintype2diabetesandhasalsobeenlinkedtoanumberofdiseases,including:

HeartdiseaseStrokeAlzheimer’sdiseaseType2diabetesHighcholesterolHighbloodpressureAbdominalobesityNonalcoholicsteatohepatitis(fattyliverdisease)PolycysticovarysyndromeGoutAtherosclerosisGastroesophagealrefluxdiseaseObstructivesleepapneaCancer

Figure1.3.Extendedfastingover4daysleadstodecreasedinsulinandbloodsugarlevels.

Source:Zauneretal.,“RestingEnergyExpenditureinShort-TermStarvationIsIncreasedasaResultofanIncreaseinSerumNorepinephrine.”

Loweringinsulinalsoridsthebodyofexcesssaltandwaterbecauseinsuliniswellknowntocausesaltandwaterretentioninthekidneys.Thisiswhylow-carbohydratedietsoftencausediuresis,thelossofexcesswater—infact,muchoftheinitialweightlostonalow-carbdietiswater.Thisdiuresisisbeneficialinreducingbloatingandhelpingyoufeellighter.Somemayalsonotealowerbloodpressure.

ElectrolytesRemainStableElectrolytesarecertainmineralsintheblood.Theyincludesodium,

chloride,potassium,calcium,magnesium,andphosphorus.Thebodykeepsthesebloodlevelsunderverytightcontrolinordertomaintainhealth.Prolongedstudiesoffastinghavefoundnoevidenceofelectrolyteimbalances—thebodyhasmechanismsinplacetokeepelectrolytesstableduringfasting.

Sodiumandchloride:Thesemineralsarefoundprimarilyinsalt.Dailysaltrequirementsarequitelow,andmostofusexceedthisbymanyordersofmagnitude.Duringshort-termfasts,saltdepletionisnotaconcern.Duringprolongedfasting(morethanoneweek),thekidneysareabletoreabsorbandretainmostofthesaltneededbythebody.However,rarely,somesaltsupplementationmayberequired.

Potassium,calcium,magnesium,andphosphorus:Potassiumlevelsmaydecreaseslightlyduringfasting,butthey’llremaininthenormalrange.Magnesium,calcium,andphosphoruslevelsarealsostableduringfasting.Thebonescarrylargestoresoftheseminerals—99percentofwhat’sinthehumanbody.Normallysomemineralsarelostinthestoolandurine,butduringfasting,thatlossisminimized.However,inchildrenandpregnantandbreastfeedingwomenthereisanongoingdemandfortheseminerals,sofastingisnotadvisable.

Othervitaminsandminerals:Thedailyuseofageneralmultivitaminsupplementwillprovidetherecommendeddailyamountofmicronutrients.Atherapeuticfastof382dayswasmaintainedwithonlyamultivitaminwithnoharmfuleffectsonhealth.Infact,thismanfeltterrificduringthisentireperiod.

Inastudyofsupervisedfastswithonlywaterandvitaminslastingupto117days,researchersconfirmedthattherewerenochangesinserumelectrolytes,lipids,proteins,oraminoacids.Moreover,theyfoundthathungerwasvirtually

lipids,proteins,oraminoacids.Moreover,theyfoundthathungerwasvirtuallyabsentduringtheseprolongedfasts.

AdrenalineIncreasesandMetabolismSpeedsUpMostpeopleexpectthataperiodoffastingwillleavethemfeelingtiredand

drainedofenergy.However,thevastmajorityofpeopleexperiencetheexactopposite:theyfeelenergizedandrevitalizedduringfasting.

Partlythisisbecausethebodyisstillbeingfueled—it’sjustgettingenergyfromburningfatratherthanburningfood.Butit’salsobecauseadrenalineisusedtoreleasestoredglycogenandtofacilitatefat-burning,evenifbloodsugarishigh.Theincreasedadrenalinelevelsinvigorateusandstimulatethemetabolism.Infact,studiesshowthatafterafour-dayfast,restingenergyexpenditureincreasedby12percent.Ratherthanslowingthemetabolism,fastingrevsitup.

Figure1.4.Electrolytesremainstableduringextendedfasting.

Source:DatafromStewartandFleming,“FeaturesofaSuccessfulTherapeuticFastof382Days’Duration.”

GrowthHormoneGoesUpHumangrowthhormone(HGH)ismadebythepituitarygland.Asthe

nameimplies,itplaysahugeroleinthenormaldevelopmentofchildrenandadolescents.Levelspeakduringpubertyandgraduallydecreasewithage.Excessivelylowgrowthhormonelevelsinadultsleadstomorebodyfat,lessmusclemass,anddecreasedbonedensity(osteopenia).

Growthhormone,alongwithcortisolandadrenaline,isacounterregulatoryhormone.Thesehormonessignalthebodytoincreasetheavailabilityofglucose—counteringtheeffectofinsulinandproducinghigherbloodsugarlevels.Levelsofcounterregulatoryhormonespeakjustbeforewaking,atapproximately4:00a.m.orso,increasingbloodsugarlevels,whichfallduringthenight.Theincreasepreparesthebodyfortheupcomingdaybymakingmoreglucose

availableforenergy.Growthhormonealsoincreasestheavailabilityoffatsforfuelbyraising

levelsofkeyenzymes,suchaslipoproteinlipaseandhepaticlipase.Sinceburningfatreducestheneedforglucose,thishelpsmaintainstablebloodsugar.

Manyoftheeffectsofagingmayresultfromlowgrowthhormonelevels.Replacinggrowthhormoneinolderpeoplewithlowlevelshassignificantantiagingbenefits.Arandomizedcontrolledstudyfoundthatinmen,sixmonthsofgrowthhormonereplacementincreasedleanmass(boneandmuscle)byanastounding3.7kilograms(8.2pounds),evenasfatmassdecreasedby2.4kilograms(5.3pounds).Similarresultswerefoundinwomen.

However,exogenousgrowthhormone—thatis,growthhormonethatisn’tmadebyyourownbody—carriestheriskofunwantedsideeffects.Bloodsugarlevelscanincreasetopre-diabeticlevels.Bloodpressurealsogoesup,andthereisatheoreticalincreasedriskofincreasedprostatecancerandheartproblems.Forthesereasons,injectionsofartificialgrowthhormoneareusedrarely.Butwhatifwecouldboostgrowthhormonenaturally?

Mealsveryeffectivelysuppressthesecretionofgrowthhormone,soifwe’reeatingthreemealsperday,wegeteffectivelynogrowthhormoneduringtheday.Worse,overeatingsuppressesgrowthhormonelevelsbyasmuchas80percent.

Themostpotentnaturalstimulustogrowthhormonesecretionisfasting.Inonestudy,overafive-dayfastingperiod,growthhormonesecretionmorethandoubled.Duringfasting,inadditiontotheusualearly-morningspikeofgrowthhormone(pulsatile),thereisalsoregularsecretionthroughouttheday(non-pulsatile).Bothpulsatileandnon-pulsatilereleaseofgrowthhormoneisincreasedduringfasting.Interestingly,verylow-caloriedietsarenotabletoprovokethesamegrowthhormoneresponse.

Astudyofareligiousforty-dayfastfoundthatbaselinegrowthhormonelevelsincreasedfrom0.73ng/mLtopeakat9.86ng/mL.Thatisa1250percentincreaseingrowthhormone,alldonewithoutdrugs.Anda1992studyshowedafivefoldincreaseingrowthhormoneinresponsetoatwo-dayfast.

Figure1.5.Fastingsignificantlyincreasesgrowthhormone.

Source:Cahill,“FuelMetabolisminStarvation.”

BENEFITSFORATHLETESAllthesehormonalchangesmaybeparticularlybeneficialforathletes.First,theirnetphysiologicaleffectistomaintainleanmass(muscleandbone)overthefastingperiod,whichhasenormousimplicationsforathletes.Second,whilestudiesarefew,thehighergrowthhormonelevelmayimproverecoverytimefromhardworkouts.Theincreasedadrenalinealsoallowsamoreintenseworkout.Athletescantrainharderandrecoverfaster.Manyeliteathletesarebecomingmoreinterestedintheadvantagesof“traininginthefastedstate.”

Itisnotbyaccidentthatmanyoftheearlyproponentsoftraininginthefastedstatearebodybuilders.Thisisasportthatdemands,inparticular,high-intensitytrainingandextremelylowbodyfat.BradPilon,authorofEat,Stop,Eat,andMartinBerkhan,whopopularizedtheLeanGainsmethodoffasting,arebothbodybuilders.

TheImportanceofHealthyEatingOfcourse,fastingisn’tacure-all—healthyeatingstillmatters.Modernmedicine’sgreatestchallengesaremetabolicdiseases:obesity,type

2diabetes,highbloodpressure,highbloodcholesterol,andfattyliver,collectivelyknownasmetabolicsyndrome.Thepresenceofanyofthesediseasestremendouslyincreasestheriskofheartdisease,stroke,cancer,andprematuredeath.AndtherootsofmetabolicsyndromelieintheWesterndiet,

withitsabundanceofsugar,highfructosecornsyrup,artificialflavors,artificialsweeteners,andoverdependenceonrefinedgrains.

Societiesthathavekepttheirtraditionalpatternsofeatingarenotafflictedwiththesemetabolicdisorders.Thisbookfocusesononeparticularfacetoftraditionaleatingpatternsthatisvirtuallyforgottenintoday’ssociety:intermittentfasting.However,thisisonlypartofthesolution.Foroptimalhealth,itisnotenoughtosimplyaddfastingtoyourlife.Youmustalsofocusonhealthyeatingpatterns.

What“healthyeating”doesn’tmeanThereisatendencytodefineahealthyeatingpatternassimplysome

combinationofmacronutrients.Thereareonlythreemacronutrients:carbohydrates,proteins,andfats.Many“healthy”dietsrecommendedbyexpertsspecifysomepercentageofthesethree—forexample,theolderDietaryGuidelinesforAmericansadvisedkeepingdietaryfattolessthan30percentoftotalcalories.Thewidespreadadoptionofnutritionandcalorielabelsonpackagedfoodhasunfortunatelycontributedtothisview.

Whilethismayappearscientific,thereisnorealbasisfortheserecommendations.Theunderlyingassumptionofmacronutrient-basedguidelinesisthatallfatsareequal,allcarbohydratesareequal,andallproteinsareequal.However,thisisclearlyfalse.Extra-virginoliveoilisnotthesameastrans-fat-ladenmargarine,eventhoughbotharepurefat.Ourbodiesrespondcompletelydifferentlytoeachone.Proteinfromwildsalmonisnotthesameashighlyrefinedgluten(whichisaproteineventhoughit’sfoundingrains).Carbohydratesfromsugararenotthesameascarbohydratesfrombroccoliorkale.Whitebreadisnotthesameaswhitebeans.Therearesimpleandeasilymeasureabledifferencesinthewayourbodiesmetabolizethesedifferentfoods.

Thesameholdstrueforcalories.Dietaryguidelinesthatspecifycalorielimitsunwittinglyassumethatallcaloriesareequal,butonehundredcaloriesofagreensaladdoesnothavethefatteningeffectasonehundredcaloriesofchocolatechipcookies.

Relyingonmacronutrient-basedguidelinesorcalorielimitsmakeseatingfarmorecomplicatedthanitshouldbe.Wedonoteataspecificpercentageoffats,protein,andcarbohydrates.Weeatfoods.Certainfoodsaremorefatteningthanothers.Therefore,thebestadvicefocusesoneatingornoteatingspecificfoods,notspecificnutrients.

Becauseconsistentlyhighinsulinlevelsaretherootcauseofallthediseasesofmetabolicsyndrome,it’sespeciallyimportantforthosewith

diseasesofmetabolicsyndrome,it’sespeciallyimportantforthosewithmetabolicsyndrometoconsiderhowfoodsstimulatethereleaseofinsulin.Fasting,ofcourse,istheultimateweaponinyourarsenalwhenitcomestoloweringinsulinlevels—sinceallfoodsstimulateinsulintosomedegree,thebestwaytolowerinsulinistoeatnothingatall.However,wecannotfastindefinitely,sotherearesomesimplerulestofollowtolowerinsulinlevels.

Eatwhole,unprocessedfoodsHumansevolvedtoeatawiderangeoffoodswithoutdetrimentalhealth

consequences.TheInuitpeoplestraditionallyatedietsextremelyhighinanimalproducts,whichmeanshighpercentagesoffatandprotein.Others,suchastheOkinawans,ateatraditionaldietbasedonrootvegetables,whichmeansit’shighincarbohydrates.Butbothpopulationstraditionallydidnotsuffermetabolicdiseases.TheseonlyappearedwiththeincreasingWesternizationoftheirdiets.

Whathumanshaven’tevolvedtoeatarehighlyprocessedfoods.Duringprocessing,thenaturalbalanceofmacronutrients,fiber,andmicronutrientsiscompletelydisrupted.Forexample,processingthewheatberrytoremoveallthefatandproteinmeansthattheresult,whiteflour,isalmostpurecarbohydrates.Wheatberriesarenatural;whiteflourisnot.Itisalsogroundtoanextremelyfineconsistencythatgreatlyspeedstheabsorptionofcarbohydratesintothebloodstream.Mostotherprocessedgrainssufferthesameproblems.Ourbodyhasevolvedtohandlenaturalfoods,andwhenwefeeditunnaturalones,theresultisillness.

ImagineabeautifulredFerrarisportscarsittinginthedriveway.Thenimaginethatwe“process”itbyremovingthedoorsandwheelsandaddingbicycletiresandrustybluedoorsfromatruck.Isitthesamecar?Notatall.

Thereisnothinginherentlyunhealthyaboutcarbohydrate-containingfoods.Theproblemariseswhenwestartchangingthesefoodsfromtheirnaturalstateandthenconsumingtheminlargeamounts.Thesamealsoappliestoprocessedfats.Processingtransformsrelativelyinnocuousvegetableoilsintofatsthatcontaintransfats,toxinswhosedangershavenowbeenwellrecognized.

Foodsshouldberecognizableintheirnaturalstateassomethingthatwasaliveorhascomeoutoftheground.BoxesofCheeriosdonotgrowintheground.Ifitcomesprepackagedinabagorabox,itshouldbeavoided.Ifithasanutritionlabel,itshouldbeavoided.Realfoods,whetherbroccoliorbeef,havenolabels.

Thetruesecrettohealthyeatingisthis:Justeatrealfood.

ReducesugarsandrefinedgrainsAvoidingallprocessedfoodsispreferablebutnotalways100percent

possible,formanyreasons.Itisthereforeimportanttorecognizewhichfoodsarethebiggestoffenders,sothatwemayavoidthem.

Foreveryone,butespeciallyforthosewithmetabolicsyndrome,it’smostimportanttoavoidsugarsandrefinedgrains,suchasflourandcornproducts.Thesearemorefatteningthanotherfoods,evenwhentheycontainthesamenumberofcalories,whichiswhylow-carbohydratedietsareeffectiveforweightloss.

EatmorenaturalfatsFormanydecades,dietaryfatwasconsideredpublicenemynumberone.

(We’lltalkmoreaboutthemisconceptionsbehindlow-fatdietsforweightlossinChapter5andforhearthealthinChapter8.)Gradually,healthauthoritieshavecometorecognizethatithasbeenunfairlytargeted.Infact,althoughthetermhealthyfatswasonceconsideredanoxymoron,they’renowjustawell-acceptedfactoflife.Foodshighinmonounsaturatedfats,suchasoliveoil,nuts,andavocados,whichwerepreviouslyshunned,arenowconsidered“superfoods”becausetheyaresohealthy.Consumingfattyfish,suchaswildsalmon,hasbeenproventoreducetheriskofheartdisease.Andmoreandmoreevidenceisshowingthatnaturallyoccurringsaturatedfats,suchasthosefoundinmeatanddairy,arealsonotharmfultoourhealth.

EatlessartificialfatsButnotallfatsaresoinnocent.Partiallyhydrogenatedvegetableoils—

foundinfoodssuchasshortening,deep-friedfoods,margarine,andbakedgoodssuchascakesandcookies—containtransfats,whichourbodiesdonothandlewell.TransfatsraiseLDL(“bad”)cholesterolandlowerHDL(“good”)cholesterol,increasingtheriskofheartdiseaseandstroke.

Highlyprocessedvegetableoils,suchascorn,sunflower,andcanolaoils,wereonceconsidered“hearthealthy.”It’seasytomistakecornoil,forinstance,foranaturalfat.Butactually,cornisnotnaturallyoily.Tofillthebottleofcornoilyoucanbuysocheaplyinthesupermarketrequiresprocessingliterallytonsofcorn.Andasitturnsout,recentdatasuggeststhattheseoilsareveryhighininflammatoryomega-6fats.Whilesomeomega-6fatsarenecessary,wearelikelyeatingtentotwentytimesmorethanwedidinthepast,andwhenourconsumptionofomega-6fatsisoutofbalancewithourconsumptionofomega-3

fats(foundinfattycold-waterfish,nuts,andseeds),theresultissystemicinflammation,whichisafactorinheartdisease,type2diabetes,inflammatoryboweldisease,andotherchronicillnesses.

Eatingmorehealthyfatsandavoidingartificialfats,suchaspartiallyhydrogenatedoilsandhighlyprocessedvegetableoils,iskeyforgoodhealth.

Thebasicsofgoodnutritioncanbesummarizedinthesesimplerules.Eatwhole,unprocessedfoods.Avoidsugar.Avoidrefinedgrains.Eatadiethighinnaturalfats.Balancefeedingwithfasting.

!

DifferentKindsofFastingTherearemanydifferentwaystofast,andthereisnoone“correct”wayto

doit.Anabsolutefastwithholdsbothfoodandliquid.Thismaybedoneforreligiouspurposes,suchasduringtheholymonthofRamadanintheMuslimtradition.Duringthattime,nofoodordrinkisconsumedduringtheperiodbetweensunriseandsunset.

Medically,thiscombinesthefoodrestrictionoffastingwithdehydrationduetotherestrictionoffluids.Thismakesanabsolutefastmuchmorephysicallydifficultandlimitsthedurationtofairlyshortperiods.Absolutefastsarenotgenerallyrecommendedforhealthpurposes.Theaccompanyingdehydrationconfersnoadditionalhealthbenefitsthatcompensatefortheincreaseindifficulty.Theriskofmedicalcomplicationsisalsomuchhigherwithabsolutefasts.

Wewillcovermanydifferentfastingscheduleslaterinthebook.Intermittentfastingcanbesuccessfullyimplementedwitheithershortfasts(lessthantwenty-fourhours)orlongerfasts(morethantwenty-fourhours).Extendedfasting(morethanthreedays)canalsobesafelyusedforweightlossandotherhealthbenefits.

We’llexplainindetailthe“bestpractices”forfastinginChapter10,butingeneral,weencourageconsumingplentyofnoncaloricliquids(water,tea,coffee)andhomemadebonebroth,whichisfullofnutrients.

OverallEffectsofFastingWhataboutpotentialsideeffectsoffasting?Increasedglucose?Nope.

Increasedbloodpressure?Nope.Higherriskofcancer?Nope.Actually,fastinghastheoppositeeffects—lowerglucose,lowerbloodpressure,andlowerriskofcancer.Plus,wereapallthebenefitsoftheincreasedgrowthhormone.

Fastingdoesnotmakeyoutired.Fastingdoesnotburnmuscle.Thereisnostarvationmodefromfastingwhereyoushrivelupintothefetalpositiononyourcouch.

Rather,fastinghasthepotentialtounleashtheantiagingpropertiesofgrowthhormonewithoutanyoftheproblemsoftakingartificialgrowthhormone.Infuturechapters,we’lllookindepthathowfastinghelpswithweightloss(Chapter5)andtype2diabetes(Chapter6),boostsbrainpowerandslowsaging(Chapter7),andimproveshearthealth(Chapter8).Allofthesebenefitsareachievedwithoutdrugs,supplements,oranycosts.

References

A.S.Cornford,A.L.Barkan,andJ.F.Horowitz,“RapidSuppressionofGrowthHormoneConcentrationbyOvereating:PotentialMediationbyHyperinsulinemia,”JournalofClinicalEndocrinologyandMetabolism96,no.3(2011):824–30.

BarryM.PopkinandKiyahJ.Duffey,“DoesHungerandSatietyDriveEatingAnymore?:IncreasingEatingOccasionsandDecreasingTimeBetweenEatingOccasionsintheUnitedStates,”AmericanJournalofClinicalNutrition91,no.5(2010):1342–7.

ChristianZauner,BrunoSchneeweiss,AlexanderKranz,ChristianMadl,KlausRatheiser,LudwigKramer,ErichRoth,BarbaraSchneider,andKurtLenz,“RestingEnergyExpenditureinShort-TermStarvationIsIncreasedasaResultofanIncreaseinSerumNorepinephrine,”AmericanJournalofClinicalNutrition71,no.6(2000):1511–5.

DanielRudman,AxelG.Feller,HoskoteS.Nagraj,GregoryA.Gergans,PardeeY.Lalitha,AllenF.Goldberg,RobertA.Schlenker,LesterCohn,IngeW.Rudman,andDaleE.Mattson,“EffectsofHumanGrowthHormoneinMenover60YearsOld,”NewEnglandJournalofMedicine323(1990):1–6.

ErnstJ.Drenick,MarionE.Swendseid,WilliamH.Blahd,andStewartG.Tuttle,“ProlongedStarvationasTreatmentforSevereObesity,”JAMA187,no.2(1964):100–05.

GeorgeF.CahillJr.,“FuelMetabolisminStarvation,”AnnualReviewofNutrition26(2006):1–22.

HeleneNørrelund,AnneLeneRiis,andNielsMøller,“EffectsofGHonProteinMetabolismDuringDietaryRestrictioninMan,”GrowthHormone&IGFResearch12,no.4(2002):198–207.

HeleneNørrelund,K.SreekumaranNair,JensOttoLundeJørgensen,JensSandahlChristiansen,andNielsMøller,“TheProtein-RetainingEffectsofGrowthHormoneDuringFastingInvolveInhibitionofMuscle-ProteinBreakdown,”Diabetes50,no.1(2001):96–104.

J.Oscarsson,M.Ottosson,andS.Eden,“EffectsofGrowthHormoneonLipoproteinLipaseandHepaticLipase,”JournalofEndocrinologicalInvestigation22(1999):2–9.

K.Y.Ho,J.D.Veldhuis,M.L.Johnson,R.Furlanetto,W.S.Evans,K.G.Alberti,andM.O.Thorner,“FastingEnhancesGrowthHormoneSecretionandAmplifiestheComplexRhythmsofGrowthHormoneSecretioninMan,”JournalofClinicalInvestigation81,no.4(1988):968–75.

MaryLeeVance,“CanGrowthHormonePreventAging?,”NewEnglandJournalofMedicine348(2003):779–80.

M.L.Hartman,J.D.Veldhuis,M.L.Johnson,M.M.Lee,K.G.Alberti,E.Samojlik,andM.O.Thorner,“AugmentedGrowthHormone(GH)SecretoryBurstFrequencyandAmplitudeMediateEnhancedGHSecretionDuringaTwo-DayFastinNormalMen,”JournalofClinicalEndocrinologyandMetabolism74,no.4(1992):757–65.

M.R.Blackman,J.D.Sorkin,T.Münzer,M.F.Bellantoni,J.Busby-Whitehead,T.E.Stevens,J.Jayme,etal.,“GrowthHormoneandSexSteroidAdministrationinHealthyAgedWomenandMen:ARandomizedControlledTrial,”JAMA288,no.18(2002):2282–92

PeterR.Kerndt,JamesL.Naughton,CharlesE.Driscoll,andDavidA.Loxtercamp,“Fasting:TheHistory,PathophysiologyandComplications,”WesternJournalofMedicine137(1982):379–99.

S.Klein,O.B.Holland,andR.R.Wolfe,“ImportanceofBloodGlucoseConcentrationinRegulatingLipolysisDuringFastinginHumans,”AmericanJournalofPhysiology—EndocrinologyandMetabolism258,no.1(1990):E32–E39.

W.K.StewartandLauraW.Fleming,“FeaturesofaSuccessfulTherapeuticFastof382Days’Duration,”PostgraduateMedicalJournal49(1973):203–9.

SAMANTHA

FASTINGSUCCESSSTORY

In1999,Iwasdiagnosedwithpolycysticovarysyndrome(PCOS),aconditionassociatedwithinsulinresistancethatalsoincludesotherhorriblesymptomssuchasweightgain,hirsutism,askinconditioncalledacanthosisnigricans,andearlydevelopmentofdiabetes.ItriedlotsofthingstofixmyPCOS—naturalherbs,progesteronetherapy,andsoon.Nothingworked.

InMay2015,whenIwasthirty-seven,Iwasalsodiagnosedwithtype2diabetes.Ihadbeentryingtopreventthis,andhereitwasanyway.Mygrandmotherhadsufferedwithitforyearsandexperiencedmassivebloodclotsandlossoftheuseofherhandsandeyes,andsheeventuallydiedfromitscomplications.Mymother-in-lawdiedfromadiabetes-relatedheartattackatagesixty-two.Twoelderlyneighborshadlosttheirlegstoit.Ialreadyknewdiabetesisevilandunmerciful.Itstealsfromyoueveryday,makesyourlifemiserable,andthenkillsyou.IfiguredI’dbedeadbysixty,maybeseventyifIwaslucky.

Mydoctordidn’tgivemeanyhope,either.Shesaid,“Diabetesisaprogressivedisease.ThemedicationI’mgoingtoprescribeyouwillhelpdelaytheconsequencesofhavingdiabetesforabouttenyears,butafterthat,youwilldevelopsomeorallofthesesymptoms:lossofyoureyesight,lossoftheuseofyourlegsand/orfeet,orpossiblylossofthoselimbsentirely,lossofsensationinyourhands,highbloodpressure,whichcouldresultinstrokeorheartattack,painindifferentareasofyourbody...”IaskedherifIcouldresolvethiswithdietandexercise.Inresponse,shejustrepeated,“Diabetesisaprogressivedisease.”

Iwasjustlookingforanyhope,evenaslimchancethatIcouldbeatthis.Instead,shegavemefourprescriptionstotreatmydiabetes,highbloodpressure,andhighcholesterol.ButIhadnointentionoftakinganymedication.Iknewonethingforsure:everyoneIknewwho’dgotondiabetesmedicationhadlivedmiserablyandeventuallydiedfromthedisease.

IspentseveralhoursthatnightresearchingontheInternet,andIdiscoveredDr.JasonFung.Hewastheonlyperson,letalonedoctor,thatIfoundwhonotonly

JasonFung.Hewastheonlyperson,letalonedoctor,thatIfoundwhonotonlyadvocatedadietchangebutpinpointedfastingasthekey.

Istartedimmediatelyonawater-onlyfastingregimen.Iusedmostlythree-tofive-dayfastsbecauseIwantedquickresultsthatIcouldn’tundobyeatingsomethingwrong.Iwasn’tfocusedonweightlossbutonbeatingdiabetes—still,Ilosttwelvepoundsthefirstmonthandthensixpoundsamonththereafter,forthirtypoundsinfourmonths—Iwentfrom256poundsto226.Althoughalternate-dayfastingdoesn’tslowyourmetabolism,multiple-dayfastsdoseemtoslowitalittle.Buttheimprovementininsulinsensitivityiswellworthalongfastoverashortone.

Inadditiontofastingregularly,Ichangedmydiet.Dr.Fungsupportsanywhole-foodapproachthatlimitsprocessedfoodsinadditiontofasting,withoutdictatingwhichdietisbest.Ichosetodolow-carb.Previously,everythingIatewasunderpinnedwithriceorpasta.NowIlearnedthatmeatandvegetablesalonearefine.Iunderpinmyfoodswithbulgurwheat,finelychoppedandsautéedcauliflower,spaghettisquash,orjustwell-butteredandseasonedvegetables.Itrytomixcheeseandnutsintoeverymealbecausetheyfillmeup.Ievenlearnedhowtomakesweetandspicyhotwingsusinghotsauce,balsamicvinegar,xylitol,andoilfromtherenderingsfrombakingthewings.

Forthefirstmonthonmyfastingregimen,Itookamultivitamin,magnesium,B-complexvitamin,andvitaminDeveryday.Forthesecondmonth,Iusedonlymagnesium,aB-complexvitamin,potassium,andHimalayanpinksalt.Ithelpedreducethecoldnessinmyfeetandhandsforsomereason.Istartedsupplementingwith500to1000mcgofchromiumperdaystartinginmonth3.Itreallyhelpedmetogetmybloodsugarstofalltopreprandiallevelswithintwohoursofeatingamealinsteadoffourhours.InSeptember2015,fourmonthsafterIwasdiagnosedwithtype2diabetesandbeganmyfastingregimen,Igotabloodsugarreadinginthe70sforthefirsttimeever.ThisreadingwassounusualformethatIhadtogobackandlookupwhatwasnormal!

Iwasn’texpectingit,butfastingalsoalsoresolvedthePCOS.Thefactis,Ihavenotbeenthishealthy—ever!EvenwhenIwastwentyyearsoldinthemilitaryandhad21percentbodyfat,runningthreetofivemilesperday,fivedaysperweek,Iwasnotthishealthy.

Here’swhathappenedsymptombysymptom:

ImmediatelyafterIstartedfasting,thetingling,numbness,swelling,andburninginmyleftfootwentaway.Aburninginmyleftupperthighnearmyhiptooklongertogoaway,butafterfourmonthsIhadcompleterelief.Myfingersusedtogotosleep,andnowthathappensrarelyandislimitedtoonlymyleftpinkyfinger.

Isufferedfromchronicyeastandbacterialinfections,whicharenowgonecompletely.ThehaironmyfacefromthePCOS-relatedhirsutismisdisappearing,andwhat’sleftisfinerandsofter.Thehaironmyheadissofterandnaturallyoiledinsteadofdryandflaking.Ihaveasmallerwaistlineandanicerbutt—sosaysmyhusband!Myperiodhasreturnedontimeeachmonth,startingatthebeginningofJuly,justtwomonthsafterIbeganthefastingregimen.

Mybloodpressuredroppedfrom142/92to128/83inonemonth.BySeptember,itwas101/75—withoutanymedication.Theprescriptionsthedoctorsentmearestillintheenvelopes.

Chapter2

ABRIEFHISTORYOFFASTING

Thereisnothingnew,exceptwhathasbeenforgotten.

—MarieAntoinette

Fromanevolutionarystandpoint,eatingthreemealsadayandsnackingthroughoutthedayisnotarequirementforsurvivalorgoodhealth.Beforethemodernera,foodavailabilitywasunpredictableandhighlyirregular.Drought,war,insectinfestations,anddiseaseallplayedapartinrestrictingfood,sometimestothepointofstarvation.Sodidtheseasons:duringthesummerandfall,fruitsandvegetableswereplentiful,butduringthewinterandspring,theywerescarce.Periodswithoutfoodcouldlastweeksorevenmonths.There’sareasonthatoneoftheFourHorsemenoftheApocalypseisFamine.

Ashumansocietiesdevelopedagriculture,theseperiodsoffamineweregraduallyreducedandeventuallyeliminated.However,ancientcivilizations,liketheGreeks,recognizedtherewassomethingdeeply,intrinsicallybeneficialtoperiodicfasting.Asperiodsofinvoluntarystarvationfaded,ancientculturesreplacedthemwithperiodsofvoluntaryfasting.Thesewereoftencalledtimesof“cleansing,”“detoxification,”or“purification.”TheearliestrecordedhistoriesofancientGreeceshowanunyieldingbeliefintheirpower.Indeed,fastingisthemosttime-honoredandwidespreadhealingtraditionintheworld.Ithasbeenpracticedbyvirtuallyeverycultureandeveryreligiononearth.Fastingisanancient,time-testedtradition.

SpiritualFastingFastingiswidelypracticedforspiritualpurposesandremainspartof

virtuallyeverymajorreligionintheworld.Threeofthemostinfluentialmeninthehistoryoftheworld,JesusChrist,Buddha,andtheProphetMuhammadallsharedacommonbeliefinthehealingpoweroffasting.Inspiritualterms,itisoftencalledcleansingorpurification,butpractically,itamountstothesamething.

Thepracticeoffastingdevelopedindependentlyamongdifferentreligions

andcultures,notassomethingthatwasharmfulbutassomethingthatwasdeeply,intrinsicallybeneficialtothehumanbodyandspirit.Fastingisnotsomuchatreatmentforillnessbutatreatmentforwellness.Theregularapplicationoffastinghelpsprotectpeoplefromillnessandkeepsthemfeelingwell.

InthestoryofAdamandEve,theonlyactthatisprohibitedintheGardenofEdenistoeatthefruitofonetree,andEveistemptedbytheserpenttobetraythistrust.FastingisthusanactofturningawayfromtemptationandbacktowardGod.

IntheBible,Matthew4:2states,“ThenJesuswasledbytheSpiritintothewildernesstobetemptedbythedevil.Afterfastingfortydaysandfortynights,hewashungry.”(I’llmentionheretheinterestingpointthathungeroftendisappearsduringextendedfasts,whichhasbeennotedthroughouthistory.)IntheChristiantradition,fastingandprayerareoftenmethodsofcleansingandrenewingthesoul.Symbolically,believersemptytheirsoulssothattheymaybereadytoreceiveGod.Fastingisnotsomuchaboutself-denialbutaboutareachingforspiritualityandbeingabletocommunewithGodandhearhisvoice.Byfasting,youputyourbodyundersubmissiontotheHolySpirit,humbleyoursoulbeforethepresenceofGod,andprepareyourselftohearthevoiceofGod.

One unexpected consequence of fasting is the feeling of a strongconnectionwithmyancientancestorsandinparticularmycavewomanancestor forwhom fastingwasan everyday,normal reality.She, andallthesubsequentancientancestors,notonlysurvivedbutwerelikelytohavebeenextremelyhealthyandstrong.Ithinkofthemwithgreatfondness andaffection.Goingwithout food for long stretches iswhatweevolvedtodo.

—StellaB.,Leeds,UK

FASTINGALL-STARSABELJAMESFormillionsofpeopleacrosstheworld,regularfastingiscommonplaceandhasbeenpartofspiritualpracticeforthousandsofyears.Butbeforethat,fastingwassimplyawayoflife.Withnostorablegrains,andfewotherfoodsthatstayedfreshforverylong,mostofourancestorsexperiencedbothfeastandfamineona

freshforverylong,mostofourancestorsexperiencedbothfeastandfamineonaregularbasis.Whengamewasscarce,seasonschanged,orthepickingswereslim,hunter-gatherersdidwithout.Eatingallthetimeisnotnormal.

GreekOrthodoxChristiansmayfollowvariousfastson180to200daysoftheyear.FamousnutritionresearcherAncelKeysoftenconsideredCretetheposterchildforthehealthyMediterraneandiet.However,therewasacriticallyimportantfactoroftheirdietthathecompletelydismissed:mostofthepopulationofCretefollowedtheGreekOrthodoxtraditionoffasting.Thismayhavecontributedtothehealthylongevityofthispopulation.

Buddhistmonksareknowntoabstainfromeatingafternoon,fastinguntilthenextmorning.Inaddition,theremaybewater-onlyfastsfordaysorweeksonend.Theyfasttoquenchtheirhumandesires,whichhelpsthemriseabovealldesiresinordertoachievenirvanaandendallsuffering.Thisfitswiththeircorebeliefsinmoderationandausterity.

Hinduismembracesfastinginthebeliefthatoursinslessenasthebodysuffers.Itisalsoseenasamethodofcultivatingcontroloverdesiresandguidingthemindtowardpeace:thephysicalneedsofthebodyaredeniedforspiritualgains.CertaindaysoftheweekaredesignatedforfastinginHinduism,asarecertaindaysofthemonth.Fastingisalsocommonatfestivals.TraditionalAyurvedicmedicinealsoascribesthecauseofmanyillnessestotheaccumulationoftoxinsinthebodyandprescribesfastingtocleansethesetoxins.

MuslimsfastfromsunrisetosunsetduringtheholymonthofRamadan.AccordingtotheQur’an,theProphetMuhammadsaid,“ThemonthofRamadanisablessedmonth,amonthinwhichAllahhasmadefastingobligatory.”TheProphetMuhammadalsoencouragedfastingonMondaysandThursdays.Ramadanisthebeststudiedofthefastingperiods,butitdiffersfrommanyfastingprotocolsinthatfluidsareforbidden,whichresultsinaperiodofmilddehydration.

TheEarlyAdoptersOneearlyfastingadvocatewasHippocratesofCos(c.460–c.370BC),

widelyconsideredthefatherofmodernmedicine.Inhislifetime,peoplecametotherealizationthatobesitywasanevolvingandseriousdisease.Hippocrateswrote,“Suddendeathismorecommoninthosewhoarenaturallyfatthaninthelean.”Headvisedthattreatmentforobesityshouldincludeexertionaftermealsandeatingahigh-fatdiet,andherecommendedthat“theyshould,moreover,eatonlyonceaday.”Inotherwords,incorporatingadailytwenty-four-hourfast

onlyonceaday.”Inotherwords,incorporatingadailytwenty-four-hourfastwaseventhenrecognizedashighlybeneficialinthetreatmentofobesity.ProvingonceagainthatHippocratesisworthyofourreverence,healsorecognizedthebenefitsofphysicalexerciseandeatingplentyofhealthyfatsinahealthylifestyle.

TheancientGreekwriterandhistorianPlutarch(c.46–c.120)echoedthesesentiments.Hewrote,“Insteadofusingmedicine,betterfasttoday.”RenownedancientGreekthinkersPlatoandhisstudentAristotlewerealsostaunchsupportersoffasting.

TheancientGreeksbelievedthatmedicaltreatmentscouldbeobservedfromnature,andsincehumans,likemostanimals,naturallyavoideatingwhentheybecomesick,theybelievedfastingtobeanaturalremedyforillness.Infact,fastingcanbeconsideredaninstinct,sinceallanimals—dogs,cats,cattle,sheep,andalsohumans—avoidfoodwhensick.Thinkaboutthelasttimeyouhadtheflu,orevenacold.Thelastthingyouprobablywantedtodowaseat.Sofastingcanbeconsideredauniversalhumaninstinctforhandlingmultiplekindsofillnesses.It’strulyingrainedinhumanheritage,andit’sasoldasmankinditself.

TheancientGreeksalsobelievedthatfastingimprovedmentalandcognitiveabilities,andtheyrecognizedthattheycouldsolveproblemsandpuzzlesbetterduringfasting.Thisiseasytounderstand.ThinkaboutthelasttimeyouateahugeThanksgivingmeal.Didyoufeelmoreenergeticandmentallyalertafterwards?Ordidyoufeelsleepyandalittledopey?Mostofusfeelsleepy.Afteralargemeal,bloodisshuntedtoyourdigestivesystemtocopewiththehugeinfluxoffood,leavinglessbloodtogotothebrain.Theresult?Afoodcoma.Maybealittlenap.Nowthinkaboutatimewhenyouhadnoteatenformanyhours.Doyourememberbeinglethargicandmentallysluggish?Notlikely.Itismorelikelyyoufeltmentallysharpandcompletelyattunedtoyourenvironment.Thisisnotbyaccident.InPaleolithictimes,weneededallourmentalfacultiesandkeensensestofindfood.Whenfoodwasscarce,ouralertnessandmentalfocusnaturallyincreased.

Otherintellectualgiantsthroughouthistorywerealsogreatproponentsoffasting.Paracelsus(1493–1541),aSwissGermanphysicianandthefounderoftoxicology,famouslywrote,“Thedosemakesthepoison.”Hecriticallyobservednatureandlaidthegroundworkformodernscientificmethods.Hisdiscoveriesrevolutionizedmedicine.Asamilitarysurgeon,herejectedtheoldpracticesofapplyingcowdungtowoundsandinsteadinsistedtheybekeptcleanandprotected.Healsoobjectedtothecommonmedicalpracticeof

cleanandprotected.Healsoobjectedtothecommonmedicalpracticeofbloodletting.Insteadoffollowingthesecommonpractices,hepioneeredclinicaldiagnosisandapplicationofspecifictreatments.Abrilliantandtransformativescientist,healsowrote,“Fastingisthegreatestremedy—thephysicianwithin.”

BenjaminFranklin(1706–1790),oneofAmerica’sfoundingfathers,wasworld-renownedforhisextensiveknowledgeinawiderangeofareas.Hewasaleadingscientist,inventor,diplomat,andauthor.Turninghisgeniustomedicine,heoncewrote,“Thebestofallmedicinesisrestingandfasting.”

Andfinally,MarkTwain(1835–1910),oneofAmerica’sforemostwritersandphilosophers,oncewrote,“Alittlestarvationcanreallydomorefortheaveragesickmanthancanthebestmedicinesandthebestdoctors.”

MarkTwainwasanadvocateoffastingforhealth.

ModernFastingInterestingly,inthelate1800sandearly1900s,professionalfasterswould

fastforentertainment.Onefastedforthirtydaysanddrankaquantityofhisownurine.(Talkaboutbeingstarvedforentertainment!)FranzKafkabasedhisshortstory“AHungerArtist”onthepractice.Thefadsoondiedout,nevertobereborn.Myguessisthatwatchingsomeonenoteatreallyisnotthatentertaining.

Fastingbegantoappearinthemedicalliteratureintheearly1900s.In1915,anarticleintheJournalofBiologicalChemistrydescribedfastingas“aperfectlysafe,harmless,andeffectivemethodforreducingtheweightofthosesufferingfromobesity.”However,inatimerifewithpoverty,infectiousdiseases,andwar,obesitywashardlytheproblemitistoday.SeverefoodshortageswerepresentduringthetwoworldwarsandtheinterveningGreatDepression.Treatmentsforobesitywerenotapriority.

Inthelate1950s,Dr.W.L.Bloomreignitedinterestinshort-termfastingasatherapeuticmeasure,butlongerperiodswerealsowelldescribedintheliterature.Inastudypublishedin1968,Dr.I.C.Gillilandreportedhisexperiencewithforty-sixpatients“whosereducingregimestartedwithastandardabsolutefastfor14days.”

Afterthelate1960s,interestintherapeuticfastingseemedtoagainfade,mostlybecauseobesitywasstillnotamajorpublichealthissue.Coronaryheartdiseasewasthemajorhealthconcernofthetime,andnutritionalresearchfocusedondietaryfatandcholesterol.Commercialinterestsalsobecamepervasive,andasyoumightguess,largefoodcorporationswillnotsupportanyinterventionthatthreatenstheirexistence.Sofastingasanadjuncttodietstartedtofade.Despitethefactthatfastingislow-fat,aswellaslow-everything-else,ithadalmostentirelydisappearedbythe1980s.

FASTINGALL-STARSAMYBERGERFormostofhumanhistory,largeamountsoffoodwerenotreadilyaccessibleallthroughouttheday.Intermittentfastingwaslikelyaregularpartofhumanevolution,andit’spossibleourbodies—andbrains—havecometoexpectperiodsoffoodscarcity.Becauseweareblessedwithabundantfoodallyearroundinthetwenty-firstcentury,wenowhavetomakeaspecialefforttoimposefoodscarcityuponourselvesfortherapeuticpurposes.

Despiteitslongtraditions,advantages,andeffectiveness,fastingasatherapeutictoolhasbeenextinctforthelastthirty-plusyears.Evenitsverymentiontendstobringridicule.But,intruth,theideaisverystraightforward.Ifmetabolicdiseasessuchastype2diabetesarecausedbyeatingtoomuch,thenlogically,thesolutionistoeatlittletobalanceitout.Whatcouldbesimpler?

References

ChristosS.Mantzoros,ed.,ObesityandDiabetes(Totowa,NJ:HumanaPress,2006).

Hippocrates,HippocraticWritings,ed.G.E.R.Lloyd(NewYork:PenguinClassics,1983).

I.C.Gilliland,“TotalFastingintheTreatmentofObesity,”PostgraduateMedicalJournal44,no.507(1968):58–61.

OttoFolinandW.Denis,“OnStarvationandObesity,withSpecialReferencetoAcidosis,”JournalofBiologicalChemistry21(1915):183–192.

Chapter3

BUSTINGTHEMYTHSOFFASTING

Althoughfastingwaswidelypracticedhistorically,mostofustodaygrew

upbelievingsomefundamentalmythsaboutthedangersoffasting.Theyarerepeatedsooftenthattheyareoftenperceivedasinfallibletruths.Someofthemorecommonmythsinclude:

Fastingputsyouin“starvationmode”FastingmakesyouburnmuscleFastingcauseslowbloodsugarFastingresultsinovereatingFastingdeprivesthebodyofnutrients“It’sjustcrazy”

Althoughtheywerelongagodisproven,thesemythsstillpersist.Mostpeoplemistakenlybelievefastingisdetrimentaltohealth.Thetruthisquitetheopposite—thereareasignificantnumberofhealthbenefits,aswe’llexploreinlaterchapters.Butfirst,let’sexaminethesemyths.

Myth#1:FastingPutsYouin“StarvationMode”“Starvationmode”isthemysteriousbogeymanalwaysraisedtoscareus

awayfrommissingevenasinglemeal.Whyisitsobadtoskipameal?Let’sgetsomeperspectivehere.Assumingweeatthreemealsperday,overoneyear,that’salittleoverathousandmeals.Tothinkthatfastingforoneday,skippingthreemealsoftheonethousand,willsomehowcauseirreparableharmissimplyabsurd.

Theideaof“starvationmode”referstothenotionthatourmetabolismdecreasesseverelyandourbodies“shutdown”inresponsetofasting.Wecantestthisnotionbylookingatthebasalmetabolicrate(BMR),whichmeasurestheamountofenergythatourbodyburnsinordertofunctionnormally—tokeepthelungsbreathing,brainfunctioning,heartpumping,kidneys,liver,anddigestivesystemallworking,andsoon.Mostofthecalorieswespendeachdayarenotusedforexercisebutforthesebasicfunctions.

TheBMRisnotfixednumberbutactuallyincreasesordecreasesupto40percentinresponsetomanyvariables.Forexample,Ineverseemedtogetcoldasateenager.Evenskiingin-22°Fweather,Istayedwarm.MyBMRwashigh—Iwasburningalotofcaloriestokeepmybodytemperatureup.AsI’vegottenolder,I’venoticedthatInolongerendurethecoldsowell.IalsoeatfarlessthanIdidasateenager.MyBMRhasgottenlower,soInolongerburnasmany

Ididasateenager.MyBMRhasgottenlower,soInolongerburnasmanycaloriesonbasicbodyfunctions.Thisiswhatmostpeoplemeanwhentheysaythatmetabolismslowsdownwithage,anditcontributestothewell-knowntendencyofolder“snowbirds”fromtheNortheastandCanadatoretireinwarmplaceslikeFloridaandArizona.

DailycaloricreductionhasbeenwelldocumentedtocauseadramaticreductioninBMR.Instudieswithabaselinedailycalorieconsumptionofapproximately2500caloriesperday,reducingcaloriesconsumedtoapproximately1500caloriesadayforalongstretchoftimewillresultina25to30percentreductioninBMR.Ontheotherhand,overfeedingstudies,wheresubjectsareaskedtodeliberatelyeatmorethantheynormallydo,causesanincreaseinBMR.

Reducedmetabolismmakesusgenerallycold,tired,hungry,andlessenergetic—ourbodiesareessentiallyconservingenergybynotburningcaloriestokeepuswarmandmoving.Fromaweightstandpoint,reducedmetabolismisadoublecurse.First,wefeellousywhiledieting.Evenworse,becausewe’reburningfewercaloriesperday,it’sbothhardertoloseweightandmucheasiertogainweightbackafterwe’velostit.Thisisthemainproblemwithmostcaloric-reductiondiets.

Supposeyounormallyeat2000caloriesadayandcutbacktoonly1500.Yourbodycannotrunadeficitindefinitely—itwilleventuallyrunoutoffattoburn—soitplansaheadanddecreasesyourenergyexpenditure.TheendresultisadecreasedBMR.Thishasbeenprovenrepeatedlybyexperimentsoverthelastcentury,andwe’lltalkaboutitinmoredetailinChapter5.Becauseofthiswell-known“starvationmode”effectofdailycaloricrestriction,manypeopleassumethatfastingwillresultinasimilarbutmoreseveredecreaseinBMR.

Luckily,thisdoesnothappen.Ifshort-termfastingdroppedourmetabolism,humansasaspecieswouldnotlikelyhavesurvived.Considerthesituationofrepeatedfeast/faminecycles.DuringlongwintersbackinthePaleolithicera,thereweremanydayswherenofoodwasavailable.Afterthefirstepisode,youwouldbeseverelyweakenedasyourmetabolismfalls.Afterseveralrepeatedepisodes,youwouldbesoweakthatyouwouldbeunabletogethuntorgatherfood,makingyouevenweaker.Thisisaviciouscyclethatthehumanspecieswouldnothavesurvived.Ourbodiesdonotshutdowninresponsetoshort-termfasting.

Infact,metabolismrevsup,notdown,duringfasting.Thismakessensefromasurvivalstandpoint.Ifwedonoteat,ourbodiesuseourstoredenergyas

fuelsothatwecanfindmorefood.Humanshavenotevolvedtorequirethreemealsaday,everyday.

Whenfoodintakegoestozero(fasting),ourbodyobviouslycannottakeBMRdowntozero—wehavetoburnsomecaloriesjusttostayalive.Instead,hormonesallowthebodytoswitchenergysourcesfromfoodtobodyfat.Afterall,thatispreciselywhywecarrybodyfat—tobeusedforfoodwhennofoodisavailable.It’snotthereforlooks.By“feeding”onourownfat,wesignificantlyincreasetheavailabilityof“food,”andthisismatchedbyanincreaseinenergyexpenditure.

Studiesdemonstratethisphenomenonclearly.Inone,fastingeveryotherdayfortwenty-twodaysresultedinnomeasurabledecreaseinBMR.Therewasnostarvationmode.Fatoxidation—fatburning—increased58percent,from64g/dayto101g/day.Carbohydrateoxidationdecreased53percent,from175g/dayto81g/day.Thismeansthatthebodyhasstartedtoswitchoverfromburningsugartoburningfat,withnooveralldropinenergy.

Inanotherstudy,fourdaysofcontinuousfastingincreasedBMRby12percent.Levelsoftheneurotransmitternorepinephrine(alsoknownasnoradrenaline),whichpreparesthebodyforaction,increasedby117percent,keepingenergylevelshigh.Fattyacidsinthebloodstreamincreasedover370percentasthebodyswitchedoverfromburningfoodtoburningstoredfats.

Figure3.1.Duringfasting,basalmetabolismandexercisecapacityaremaintained.

Source:Zauneretal.,“RestingEnergyExpenditureinShort-TermStarvationIsIncreasedasaResultofan

IncreaseinSerumNorepinephrine.”

FASTINGALL-STARSDR.BERTHERRINGThe“fastingisunhealthy”reflexislargelyanoutcomeofthemarketingpushtoencourageconsumerstobuyfood.Anenormousamountofadvertisingmoneyisspenteveryyearinanefforttoconvinceconsumersthatatanymomentthattheyarenotconsumingfood,theyareatriskforunderperforming.TheSnickerscampaignlaunchedin2015offersaperfectexample:candybarslabeledwithwords—”sleepy,”“grouchy,”“impatient,”etc.—hintedthattheseundesirableconditionswerebestovercomebyconsumingfood,essentiallyclaimingpsychoactiveeffectsforthecandybar.

We’llexplorehowthebodystoresenergyandaccessesitinmoredetailinChapter5,butfornow,justknowthatwe’redesignedtofunctionwellduringperiodsoffasting—ourbodiesdon’tstarttoshutdownorgointo“starvationmode.”

Myth#2:FastingMakesYouBurnMuscleOnepersistentmythoffastingisthatitburnsmuscle,thatourbody,if

we’renoteating,willimmediatelystartusingourmusclesasanenergysource.Thisdoesnotactuallyhappen.

Thehumanbodyevolvedtosurviveperiodsoffasting.Westorefoodenergyasbodyfatandusethisasfuelwhenfoodisnotavailable.Muscle,ontheotherhand,ispreserveduntilbodyfatbecomessolowthatthebodyhasnochoicebuttoturntomuscle.Thiswillonlyhappenwhenbodyfatisatlessthan4percent.(Forcomparison,elitemalemarathonrunnerscarryapproximately8percentbodyfatandfemalemarathonersslightlymore.)Ifwedidnotpreservemuscleandburnfatinsteadwhennofoodisavailable,wewouldnothavesurvivedverylongasaspecies.Almostallmammalshavethissameability.

Real-worldstudiesoffastingshowthattheconcernovermusclelossislargelymisplaced.Alternate-dayfastingoverseventydaysdecreasedbodyweightby6percent,butfatmassdecreasedby11.4percentandleanmass(muscleandbone)didnotchangeatall.

Figure3.2.Duringfasting,thebodyswitchesfromburningsugar(carbohydrates)tofatforenergy.Proteinisspared.

Source:McCue,ed.,ComparativePhysiologyofFasting,Starvation,andFoodLimitation.

Atbaseline,eatingnormally,energycomesfromamixofcarbohydrates,fat,andprotein.Asyoustartfasting,thebodyincreasescarbohydrateoxidation.Thisisjustafancywayofsayingthatitisburningsugar,intheformofglycogen,forthefirsttwenty-fourtoforty-eighthoursafteryoustopeating,untilitrunsoutofglycogen.Withnomoresugartoburn,thebodyswitchestoburningfat.Fatoxidationincreasesascarbohydrateoxidationdecreasestowardzero.(SeeFigure3.2.)

Atthesametime,proteinoxidation—thatis,burningprotein,suchasmuscle,forfuel—actuallydecreases.Thenormalproteinbreakdownofaroundseventy-fivegramsperdayfallstofifteentotwentygramsperdayduringfasting.Ratherthanburningmuscleduringfasting,westartconservingmuscle.Muchoftheaminoacidsthatarebrokendownduringregularturnoverofcellsarereabsorbedintonewproteins.

FASTINGALL-STARSABELJAMESRunningjustonthefatstoredintheirbodies,mostAmericanscouldwalkfromNewYorktoFloridawithouttechnicallyneedingabitetoeat.

Afterall,whywouldyourbodystoreexcessenergyasfatifitmeantto

Afterall,whywouldyourbodystoreexcessenergyasfatifitmeanttoburnproteinassoonasthechipsweredown?Musclesandotherproteinsarefunctionaltissuesandhavemanypurposes.Theyarenotdesignedtostoreenergy.Glycogenandfatare.Toburnmuscleforenergywouldbelikestoringfirewoodandthen,assoonascoldweatherhits,choppingupyoursofaandthrowingitintothefire.

Infact,fastingisoneofthemostpotentstimuliforgrowthhormonesecretion,andincreasedgrowthhormonehelpsmaintainleanbodymass.Instudiesthatuseddrugstosuppressgrowthhormoneinfastedsubjects,therewasa50percentincreaseinproteinoxidation.

Musclegainorlossismostlyafunctionofexercise.Youcan’teatyourwaytomoremuscle.Supplementcompanies,ofcourse,trytoconvinceyouotherwise.Takingcreatineanddrinkingwheyproteinshakesdonotbuildmuscle.That’swishfulthinking.Exerciseistheonlyreliablewaytobuildmuscle.

Ifyouareworriedaboutmuscleloss,exercisemore.It’snotrocketscience.Dietandexercisearetwoentirelyseparateissues.Don’tconfusethetwo.Don’tworryaboutwhatyourdiet(orlackofdiet—thatis,fasting)isdoingtoyourmusclemass.Exercisebuildsmuscle.Lackofexerciseleadstoatrophyofmuscles.

Ontheotherhand,ifyouareworriedaboutweightlossandtype2diabetes,thenyouneedtoworryaboutdiet,notexercise.Youcan’toutrunabaddiet.

SoletmelayitoutassimplyasIcan.Bodyfatis,atitscore,storedenergyforusto“eat”whenthereisnofood.It’snotthereforlooks,right?So,whenwefast,we“eat”ourownfat.Thisisnatural.Thisisnormal.Thisisthewayweweredesigned.Otherwise,faminecyclesinPaleolithictimeswouldhaveeventuallyleftusasaballof100percentfat!Duringfasting,hormonalchangeskickintogiveusmoreenergy(increasedadrenaline)andpreserveourleanmusclesandbones(increasedgrowthhormone).Thisisnormalandnaturalandthereisnothingheretobefeared.

Figure3.3.Therewasnolossoffat-freemassduring70daysofalternate-dayfasting.

Source:Bhutanietal.,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations.”

Myth#3:FastingCausesLowBloodSugarSometimespeopleworrythatbloodsugarwillfallverylowduringfasting

andtheywillbecomeshakyandsweaty.Luckily,thisdoesnotactuallyhappen.Bloodsugarlevelistightlymonitoredbythebody,andtherearemultiplemechanismstokeepitintheproperrange.Duringfasting,ourbodybeginsbybreakingdownglycogen(remember,that’stheglucoseinshort-termstorage)inthelivertoprovideglucose.Thishappenseverynightasyousleeptokeepbloodsugarsnormalasyoufastovernight.

FASTINGALL-STARSAMYBERGERPeoplewhoengageinfastingforreligiousorspiritualpurposesoftenreportfeelingsofextremeclear-headednessandphysicalandemotionalwell-being.Someevenfeelasenseofeuphoria.Theyusuallyattributethistoachievingsomekindofspiritualenlightenment,butthetruthismuchmoredown-to-earthandscientificthanthat:it’stheketones!Ketonesarea“superfood”forthebrain.Whenthebodyandbrainarefueledprimarilybyfattyacidsandketones,respectively,the“brainfog,”moodswings,andemotionalinstabilitythatarecausedbywildfluctuationsinbloodsugarbecomeathingofthepastandclear

thinkingisthenewnormal.

Ifyoufastforlongerthantwenty-fourtothirty-sixhours,glycogenstoresbecomedepleted.Thelivernowcanmanufacturenewglucoseinaprocesscalledgluconeogenesis,usingtheglycerolthat’saby-productofthebreakdownoffat.Thismeansthatwedonotneedtoeatglucoseforourbloodglucoselevelstoremainnormal.

Arelatedmythisthatbraincellscanonlyuseglucoseforenergy.Thisisincorrect.Humanbrains,uniqueamongstanimals,canalsouseketonebodies—particlesthatareproducedwhenfatismetabolized—asafuelsource.Thisallowsustofunctionoptimallyevenwhenfoodisnotreadilyavailable.Ketonesprovidethemajorityoftheenergyweneed.

Considertheconsequencesifglucosewereabsolutelynecessaryforbrainfunction.Aftertwenty-fourhourswithoutfood,glucosestoredinourbodiesintheformofglycogenisdepleted.Atthatpoint,we’dbecomeblubberingidiotsasourbrainsshutdown.InthePaleolithicera,ourintellectwasouronlyadvantageagainstwildanimalswiththeirsharpclaws,sharpfangs,andbulgingmuscles.Withoutit,humanswouldhavebecomeextinct,longago.

Whenglucoseisnotavailable,thebodybeginstoburnfatandproduceketonebodies,whichareabletocrosstheblood-brainbarriertofeedthebraincells.Upto75percentofthebrain’senergyrequirementscanbemetbyketones.Ofcourse,thatmeansthatglucosestillprovides25percentofthebrain’senergyrequirements.Sodoesthismeanthatwehavetoeatforourbrainstofunction?

MARKSISSONFASTINGALL-STARSIhavealltheenergyIneedwhenIwakeupinthemorninganddon’tfeelcompelledtoeatuntilI’mhungryaroundnoonor1p.m.ImaintainmusclemassandhavediscoveredthatIfunctionoptimallyonfewercaloriesthanIthoughtnecessary.

Notreally.Betweentheglucosewehavealreadystoredawayintheformofbodyfatandwhattheliverproducesingluconeogenesis,wehaveplentyoffuelwhennofoodisavailable.Evenprolongedfastingwon’tsendbloodglucoselevelsdangerouslylow.

Myth#4:FastingResultsinOvereatingDoesfastingprovokecompensatoryovereating?Manyauthoritieswarn

againstmissingevenasinglemealbecauseitcouldmakeyouextrahungryandunabletoavoidtemptations,leadingtoovereatingandultimatelynoweightloss.

Studiesofcaloricintakedo,infact,showaslightincreaseonthefirstdayafterfasting.Onthedayafteraone-dayfast,averagecaloricintakeincreasesfrom2,436to2,914.Butifyoufactorinwhatwouldhavenormallybeenconsumedduringthattwo-dayperiod,4,872calories,thereisstillanetdeficitof1,958calories.Theincreasedcaloriesdon’tcomeclosetomakingupforthelackofcaloriesonthefastingday.

Interestingly,withrepeatedfasting,youmayseetheoppositeeffect.IntheIntensiveDietaryManagementclinic,mypersonalexperiencewithhundredsoffastingpatientsshowsthat,overtime,appetitetendstodecreaseasthefastingdurationincreases.

Myth#5:FastingDeprivestheBodyofNutrientsTherearetwomaintypesofnutrients,micronutrientsandmacronutrients.

Micronutrientsarevitaminandmineralsthatareprovidedbythedietandarerequiredforoverallhealth.Macronutrientsareproteins,fats,andcarbohydrates.

Micronutrientdeficiencyisrareinthedevelopedworld.Withshorterfastingperiods(lessthantwenty-fourhours),thereisampleopportunitybeforeandafterthefasttoeatnutrient-densefoodstomakeupformissedmeals.Forlongerfasts,itisagoodideatotakeageneralmultivitamin.Thelongestfastrecordedlasted382days,andasimplemultivitaminpreventedanyvitamindeficiencies.

Ofthethreemajormacronutrients,therearenoessentialcarbohydratesthatthebodyneedstofunction,soitisimpossibletobecomecarbohydratedeficient.However,therearecertainproteinsandfatsthatwehavetogetinourdiet.Thesearecalledtheessentialaminoacids(thebuildingblocksofproteins)andessentialfattyacids.Thesecannotbemanufacturedbythebodyandmustbeobtainedinthediet.

Thebodynormallylosesbothessentialaminoacidsandessentialfattyacidsinurineandstool.Duringfasting,itreducestheselossestohangontomuchofthenecessarynutrients.Bowelmovementsusuallydecreaseduringfasting—sincenofoodisgoingintothestomach,thereislessstoolformation—andthishelpstopreventlossofproteininthestool.Essentialnutrients,particularlynitrogen,canbelostthroughtheurine.Nitrogenintheurineisasignofproteinmetabolism,andasproteinmetabolismdecreasesduringfasting,nitrogeninthe

metabolism,andasproteinmetabolismdecreasesduringfasting,nitrogenintheurinedecreasessignificantly,toalmostnegligiblelevels.Tofurtherpreserveproteins,thebodybreaksoldproteinsdownintotheircomponentaminoacidsandrecyclestheseintonewproteins.Bykeepingessentialnutrientsinthebodyinsteadofexcretingthem,thebodyisabletorecyclemanyofthemduringfasting.

Ofcourse,nomatterhowgoodthebodyisatcompensating,fastingmeanswe’renotconsumingessentialfattyacidsandaminoacids.Beforeandafterfasting,itcanbehelpfultofollowalow-carbohydratediet,whichincreasesthepercentageoffatsandproteinsconsumed,sothebodyhasmorestoredupforarainyday.

Children,pregnantwomen,andbreastfeedingwomenhaveagreaterneedfornutrientsthanothers.Inthesesituations,recyclingoldproteinsandfatsisn’tenough—newonesareneededtogrowandbuildtissue.Forthesepeople,fastingisnotagoodoption.(SeeChapter10formoreonwhoshouldnotfast.)

Myth#6:“It’sJustCrazy”Thisalwaysseemstobethefallbackpositionofthosewhocan’tthinkof

anyotherreasonwhyfastingshouldnotbeattempted.Thescienceisclear.Obesity,atitsverycore,involvessomeformofovereating.Thisistruewhetheryoubelieveitiscausedbyconsumingtoomanycalories,carbohydrates,orfats.Fastinghelpsinallthesecases.Itseffectivenessisunquestioned.Afterall,ifyoudon’teatanythingatall,don’tyouthinkyouwouldloseweight?

Theonlytworemainingquestionsare:

•Isithealthy?Theanswertothisisyes.We’lltalkmoreaboutwhyinupcomingchapters.•Canyoudoit?Absolutely.Millionsofpeopleworldwidehavefastedforweightloss(andmanyother

reasons).Thisbookisheretohelpyougetstarted.

References

A.M.Johnstone,P.Faber,E.R.Gibney,M.Elia,G.Horgan,B.E.Golden,andR.J.Stubbs,“EffectofanAcuteFastonEnergyCompensationandFeedingBehaviourinLeanMenandWomen,”InternationalJournalofObesity26,no.12(2002):1623–8.

AncelKeys,JosefBrožek,AustinHenschel,OlafMickelsen,andHenryLongstreetTaylor,TheBiologyofHumanStarvation,2vols.(Minneapolis,MN:UniversityofMinnesotaPress,1950).

ChristianZauner,BrunoSchneeweiss,AlexanderKranz,ChristianMadl,KlausRatheiser,LudwigKramer,ErichRoth,BarbaraSchneider,andKurtLenz,“RestingEnergyExpenditureinShort-TermStarvationIsIncreasedasaResultofanIncreaseinSerumNorepinephrine,”AmericanJournalof

ClinicalNutrition71,no.6(2000):1511–5.

E.O.Diaz,A.M.Prentice,G.R.Goldberg,P.R.Murgatroyd,andW.A.Coward,“MetabolicResponsetoExperimentalOverfeedinginLeanandOverweightHealthyVolunteers,”AmericanJournalofClinicalNutrition56,no.4(1992):641–55.

HeleneNørrelund,K.SreekumaranNair,JensOttoLundeJørgensen,JensSandahlChristiansen,andNielsMøller,“TheProtein-RetainingEffectsofGrowthHormoneDuringFastingInvolveInhibitionofMuscle-ProteinBreakdown,”Diabetes50,no.1(2001):96–104.

LeonieK.Heilbronn,StevenR.Smith,CorbyK.Martin,StephenD.Anton,andEricRavussin,“Alternate-DayFastinginNonobeseSubjects:EffectsonBodyWeight,BodyComposition,andEnergyMetabolism,”AmericanJournalofClinicalNutrition81,no.1(2005):69–73.

MarshallD.McCue,ed.,ComparativePhysiologyofFasting,Starvation,andFoodLimitation(NewYork:Springer-VerlagBerlinHeidelberg,2012).

SurabhiBhutani,MonicaC.Klempel,ReedA.Berger,andKristaA.Varady,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations,”Obesity18,no.11(2010):2152–9.

Chapter4

THEADVANTAGESOFFASTING

Fasting’smostobviousbenefitisweightloss.However,thereareamyriad

ofbenefitsbeyondthis,manyofwhichwerewidelyknownbeforethemodernera.Itwasoncecommonforpeopletofastforacertainperiodoftimeforhealthbenefits.Thesefastingperiodswereoftencalled“cleanses,”“detoxifications,”or“purifications,”andpeoplebelievedthattheywouldcleartheirbodiesoftoxinsandrejuvenatethem.Theyweremorecorrectthantheyknew.Fasting:

ImprovesmentalclarityandconcentrationInducesweightandbodyfatlossLowersbloodsugarlevelsImprovesinsulinsensitivityIncreasesenergyImprovesfat-burningLowersbloodcholesterolPreventsAlzheimer’sdiseaseExtendslifeReversesagingprocessDecreasesinflammation

We’lltalkmoreaboutthesehealthbenefitsinlaterchapters.Butwhyisfastingbetterthanotherdiets?We’lllookattheadvantagestofastinginthischapter.

DietsFailOnemainproblemofthedietsthathavethehealthbenefitslistedaboveis

thattheseareoftenverydifficulttofollow,asIdiscoveredwhenworkingwithmypatientswithobesityandtype2diabetes.

Obesityandtype2diabetesarebothproblemsofexcessiveinsulin.Sincerefinedcarbohydratesareaprimecontributortohighinsulinlevels,thenaturalplacetostartwithmypatientswasalow-carbohydratediet.Protein,especiallyanimalproteins(dairyandmeat),canalsostimulateinsulinproduction,andexcessiveintakeofthesefoodscanslowdownprogress.Andprocessedfoodsalsoplayakeyroleindisease.So,thebestdietwouldemphasizewhole,unprocessedfoods.Itwouldbelowinrefinedcarbohydratesandhighinnaturalfatswithamoderateamountofprotein.

Multiplepeer-reviewedstudieshaveshownthatthatkindofdiethasexcellentresultsfortype2diabetesandisverysafe.Sothat’swhatIstartedwith

inworkingwithmypatientsattheIntensiveDietaryManagementProgram.Icounseledthemonreducingsugarsandrefinedcarbohydratesandreplacingthemwithnatural,unprocessedfoods.Igavelectures.Ifollowedup.Ibegged.Icajoled.Ireviewedpageafterpageoffooddiaries.Anditjustdidnotwork.

Thedietcouldbesuccessful,butonlyifitwasproperlyfollowed,anditwassimplytoocomplicatedformanyofmypatients.Theywouldreturnfooddiariesfilledwithnoodlesandbreadandstillclaimtheywerefollowingalow-carbohydratediet.Pitas,naan,andotherflatbreadssomehowwerenotconsidered“bread.”Theysimplydidnotunderstandwhatwasbeingaskedofthem.Thesewerenot,afterall,peopleobsessedwithnutritionwhospenteveryspareminutereadingmedicaljournals.Theyhadfull-timejobsandfamiliestotakecareof,andtryingtobreaktheirdietaryhabitsofthelastfiftyyearsprovedtobeverychallenging.Also,becausethisdietwasalmosttheoppositeofconventionaldietaryadvice,itwasoftenhardforpeopletoacceptthatitwasactuallygoodforthem.

ButIcouldn’tjustgiveup.Theirhealthand,indeed,theirverylivesdependeduponthepropertreatment.Type2diabetesisaterribledisease.Itisbyfartheleadingcauseofblindness,amputation,andkidneyfailureinNorthAmerica.Diabetesisalsoaleadingcontributortoheartattacks,stroke,andothercardiovasculardiseases.Type2diabetesisadietarydisease,anditrequiresadietarysolution.Mostimportantly,itisacurabledisease.

WhatIneededwasanewstrategy.Theoverallgoalwasnotnecessarilytoreducecarbohydrateintake.Thegoalwastoreduceinsulinlevels,andcuttingcarbohydrateswasonlyonemethodofachievingthatgoal.Yetallfoods,tovaryingdegrees,stimulatethereleaseofinsulin.Sothemostefficientmethodofloweringinsulinwouldbetoeatnothingatall.Inotherwords:tofast.

Ididn’tneedtoreinventthewheel.Peoplearealwaysdrawntothelatestandgreatestdiettrend,thenextsuperfood,likequinoa,acaiberries,orkalechips.Butwhatarethechancesthat,afterthousandsofyearsofhumanhistory,wewillfindthe“nextgreatthing”now?Thethingthatwecan’tlivewithout,despitehavinglivedwithoutitforthousandsofyears?

Fastingistheoldestdietaryinterventionintheworld.Itisprofoundlydifferentfromallotherdietarystrategies.Itisnotthelatestandgreatestbutthetriedandtrue.Itisnotsomethingtodobutsomethingtonotdo.Becauseitdiffersfromconventionaldietinginmanyimportantways,fastingcarriesmanydistinctadvantages.

Advantage#1:It’sSimpleBecausethereisnoconsensusastowhatconstitutesahealthydiet,my

patientswereoftenconfused.Shouldtheygolow-fat?Low-carb?Low-calorie?Low-sugar?Lowglycemicindex?

Fasting,bytakingacompletelydifferentapproach,ismucheasiertounderstand.Itissosimplethatitcanbeexplainedintwosentences:Eatnothing.Drinkwater,tea,coffee,orbonebroth.That’sit.

Thisworkisaderivativeof“EffectiveSimplicity”bywww.behaviorgap.com,usedunderCCBY.

DR.MICHAELRUSCIOFASTINGALL-STARSIinitiallybecomeinterestedinfastingforitsapplicationsinhealingthegut.ManyofthepatientsIworkwithhaveseverefoodsensitivitieseventhoughtheyhaveveryhealthydiets.Forthesepatientsthereisusuallysomeunderlyinginflammatoryorinfectiousissue.Fastingcanprovideinstantaneousreliefofsymptomsandaidsinsupportingrecoveryfromtheunderlyingissue.

Dietscanfailbecausetheyareineffective.Buttheyjustassurelyfailifpeoplearenotabletofollowthem.Themostobviousbenefittofastingisthatitssimplicitymakesiteffective.Whenitcomestodietaryrules,thesimpler,thebetter.

better.

Advantage#2:It’sFreeIpreferpatientstoeatorganic,localgrass-fedbeefandorganicvegetables,

andavoidwhitebreadandotherhighlyprocessedfoods.However,thetruthisthatthesekindsofhealthyfoodsareoftenveryexpensive;theycancosttentimesasmuchasprocessedfoods.

Grainsenjoysubstantialgovernmentsubsidies,makingthemfarcheaperthanotherfoods.Thismeansthatapoundoffreshcherriesmaycost$6.99,whileanentireloafofbreadwillcost$1.99.Anentireboxofpastamaycostonly$0.99onsale.Feedingafamilyonabudgetisaloteasierwhenyoubuypastaandwhitebread.

Ifadietisunaffordable,itdoesnottrulymatterifitiseffective.Thepricemakesitineffectiveforthosewhocannotaffordtofollowit.Thisshouldnotdoomthemtoalifetimeoftype2diabetesanddisability.

Fastingisfree.Infact,notonlyisitfree,itactuallysavesmoneybecauseyoudonotneedtobuyanyfoodatall!Therearenoexpensivefoods.Therearenoexpensivesupplements.Therearenomealreplacementbars,shakes,ormedications.Thepriceoffastingiszero.

Advantage#3:It’sConvenientItishealthytoalwayseatahome-cooked,prepared-from-scratchmeal.

However,manypeople,myselfincluded,simplydonothavethetimeorinclinationtocook.Betweenwork,school,family,kids,after-schoolactivities,andafter-workactivities,therejustisnotalotoftimeleftover.Cookinginvolvespreparationtime,shoppingtime,cookingtime,andcleanuptime.Everythingtakestime,andtimeseemstobeonecommoditythat’sinconstantshortage.

Thenumberofmealseatenawayfromhomehasbeensteadilyincreasingoverthepastfewdecades.Whilemanytrytosupportthe“slowfood”movement,itisclearthattheyarefightingalosingbattleagainstfastfood.

Figure4.1.Inthepast100years,thenumberofmealseatenathomehasdeclinedasthenumbereatenawayhasrisen.

Source:DerekThompson,“CheapEats:HowAmericaSpendsMoneyonFood,”TheAtlantic,March8,2013.

Soaskingpeopletodevotethemselvestohomecooking,aswell-intentionedasitmaybe,isnotgoingtobeawinningstrategy.Fasting,ontheotherhand,istheexactopposite.Thereisnotimespentbuyinggroceries,preparingingredients,cooking,andcleaningup.Itisawaytosimplifyyourlife.

Thereisnothingeasierthanfasting,becausefastinginvolvesdoingnothing.Mostdietstellyouwhattodo.Fastingtellsyounottodoanything.Itdoesn’tgeteasierthanthat.

Advantage#4:YouCanEnjoyLife’sLittlePleasuresSomedietsadvisepeopletonever,everagaineaticecreamordesserts.

Goodadviceforweightloss,obviously.ButIdon’tthinkitisactuallyverypracticaladvice.Sure,youmightbeabletoswearoffdessertsforsixmonthsorayear,butforlife?Andwouldyoureallywantto?Thinkaboutit.Imaginethejoyofsavoringthecakeandchampagneatyourbestfriend’swedding.Doweneedtodenyourselvesthatlittlebitofpleasureforever?Enjoyabirthdaysaladinsteadofbirthdaycake?Thanksgivingkalechips!All-you-can-eatBrusselssprouts!Yes,lifejustgotalittlelesssparkly.Foreverisalongtime.

Now,Iamnotsayingthatyoushouldeatdesserteverysingleday.However,fastingrestorestheabilitytooccasionallyenjoythatdessertbybalancingoutthefeast.Itis,afterall,thecycleoflife.Feastsfollowfasts.Fastsfollowfeasts.Thisishowwehavealwayslived.Birthdays,weddings,holidays,

followfeasts.Thisishowwehavealwayslived.Birthdays,weddings,holidays,andotherspecialoccasionshavealways,throughouthumanhistory,beencelebratedwithfeasts.Butthosefeastsshouldbefollowedbyfasts.

Ifyouhaveaweddingcomingup,youaremorethanentitledtolookforwardtoenjoyingyourselfandeatingdecadent,deliciousweddingcake.Andwhenyoufastregularly,youdonotneedtofeelguiltyaboutenjoyingoneoflife’slittlepleasures,becauseyoucanmakeupforit.

Themostimportantaspectoffastingisfittingitintoyourlife.Therewillbetimeswhereitisnotappropriatetofast.Whowantstoforeverbethepartypooperwhowon’teatthisandwon’tdrinkthat?Youcanindulgeyourself,aslongyoubalancethatwithsomeabstinence.Fastingisreallyaboutbalance.Itistheflipside,theB-side,ofeating.Balancethetimethatyouareeatingandthetimeyouarenoteatingtoremainhealthy.Whenthosetwofalloutofbalance,that’swhenwegetintotrouble.

Advantage#5:It’sPowerfulManytype2diabeticsaremorbidlyobeseandhighlyinsulin-resistant.

Occasionally,evenastrictketogenicdiet(onethat’sverylowincarbohydrate,moderateinprotein,andhighinfat)isnotstrongenoughtoreversetheirdisease.Thequickestandmostefficientwaytolowerinsulinandinsulinresistanceisfasting.Ithasunrivaledpowertobreakthroughweight-lossplateausandreducetheneedforinsulin.

Fromatherapeuticstandpoint,akeyadvantageoffastingisthatithasnoupperlimit—there’snomaximumamountoftimethatyoucanfast.Theworldrecordforfastingwas382days,duringwhichthepatientsufferednoilleffects.Soiffastingoccasionallyisn’tworking,allyouneedtodoisincreasethefrequencyorlengthoftimeyoufast,untilyoureachyourgoal.

Comparethistomedications.Virtuallyeverydrughasamaximumdose.Ifyoutakepenicillinforaninfection,forexample,thereisamaximumdoseabovewhichthereislittleextrabenefitandthemedicationmaybecometoxic.Atthatpoint,ifyoustillhavetheinfection,youneedtochangemedications.Thesameappliestolow-carbohydrateorlow-fatdiets.Onceyouhitzerocarbsorfat,youcangonofurtherwiththatdiet.Thereisamaximumdose.Onceyoureachthemaximum,youneedtochangedietstogainanyextraeffect.

FASTINGALL-STARSDR.BERTHERRINGThesummarybenefitsofasuccessfulfastingschedulemaintainedoveramonth

Thesummarybenefitsofasuccessfulfastingschedulemaintainedoveramonthormoreincludeappetitecorrection,lossofsurplusfat,decreasedinflammation(measuredinsymptomseverityorC-reactiveprotein,CRP),decreasedbloodsugarsindiabetics(measuredbybloodglucoseorHbA1c)anddecreasedbloodpressureinhypertensivepeople.

Fastinghasnoceiling,whichofferssignificanttherapeuticflexibility.Inotherwords,youcankeepfastinguntilthedesiredeffectsareseen.Thedosecangoupindefinitely.Askyourselfthisquestion:ifyoudon’teat,willyouloseweight?Ofcourse.Evenachildunderstandsthatyoumustloseweight.Sofasting’sefficacyisunquestioned.Itisthemostpowerfulmethodofweightlossavailable.Itisonlyaquestionofsafetyandcompliance.Formorecomplicatedorseriouscasesofobesity,wecansimplyincreasethedose.

What’smore,low-fatdiets,low-carbohydratediets,Paleodiets,andindeed

almostanydietworkforsomepeoplebutnotothers,andwhenadietdoesn’tworkforyou,thereislittleyoucandotomakeitmoreeffective.However,withfasting,allyouneedtodoisincreasetheamountoftimespentfasting.Thelongeryougo,themorelikelyyouaretoloseweight—anditwillhappeneventually.

Advantage#6:It’sFlexibleSomedietplansadvocateeatingassoonasyouwakeupandtheneverytwo

andahalfhoursduringtheday.Somepeoplehavehadgoodresultswithsuchadiet.However,findingorpackingsomethingtoeatsixorsevenoreighttimesadayisveryintrusive.Icouldnotimagineinterruptingmylifeeverytwoandahalfhourstosnack.It’stoodisruptiveonanalreadyhecticschedule.Andit’ssimplynotnecessary.

Fastingcanbedoneatanytime.Thereisnosetduration.Youmayfastforsixteenhoursorsixteendays.Youcanmixandmatchtimeperiods.Youareneverlockedintoapattern.Youmayfastforonedaythisweek,fivedaysthenext,andtwodaystheweekafter.Lifeisunpredictable.Fastingfitswhereveryouneeditto.

Fastingcanbedoneanywhere.ItdoesnotmatterifyouliveintheUnitedStates,theUnitedKingdom,ortheUnitedArabEmirates.YoumayliveinthepolardesertoftheArcticorthesandydesertofSaudiArabia.Itmattersnotatall.Onceagain,becausefastingisaboutnotdoingsomething,itsimplifiesourlife.Itaddssimplicitywhereotherdietsaddcomplexity.

Ifyoudonotfeelwellforanyreason,yousimplystopfasting.Itisentirelyreversiblewithinminutes.Ifyouwishtostopfastingforseveralweeksforpersonalormedicalreasons,thenyoumaydoso.IfyouwanttoindulgeduringtheChristmasholidaysorduringasummercruise,youcandothataswell.Simplygetbackontheprogramonceyouarefinished.

Comparethistobariatricsurgery(sometimescalled“stomachstapling”).Ithashelpedmanypeoplelosealotofweight,atleastintheshortterm.Butthissurgeryhastonsofcomplications,almostallofwhichareirreversible.Andyoucannotsimplyreversethesurgeryitself.It’spermanent.Ifyouaredoingpoorly,that’ssimplytoobad.Fasting,ontheotherhand,iscompletelywithinyourcontrol;youmayfastorstopfastinganytimeyouwish.

Fasting can be flexible. The day of a fast can bemoved around anddoesn’t have to be set in stone. If I’ve got a particularly importantmeetingonaThursday,forexample—andfeelitwouldbebesttoeatabreakfast—I can either change the hours I fast or just move it toanotherdayintheweek.

—StellaB.,Leeds,UK

Advantage#7:ItWorkswithAnyDietHereisthebiggestadvantageofall:fastingcanbeaddedtoanydiet.That

isbecausefastingisnotaboutsomethingyoudo;it’saboutsomethingyoudonotdo.Itissubtractionratherthanaddition.Thismakesfastingfundamentallydifferentfromalmosteverydietimaginable.

Youdon’teatmeat?Youcanstillfast.

Youdon’teatwheat?Youcanstillfast.

Youhaveanutallergy?Youcanstillfast.

Youdon’thavetime?Youcanstillfast.

Youdon’thavemoney?Youcanstillfast.

Youaretravelingallthetime?Youcanstillfast.

Youdon’tcook?Youcanstillfast.

Youareeightyyearsold?Youcanstillfast.

Youhaveproblemschewing?Youcanstillfast.

Whatcouldpossiblybesimpler?

ELIZABETH

FASTINGSUCCESSSTORY

IgrewupinSouthAfricaandwasoverweightmostofmylife,withperiodsofweightlossduetoyo-yodieting.In2002Iwentafat-free,high-carbohydratedietfortwoyears.Earlyin2004Iwasdiagnosedwithtype2diabetes,highcholesterol,andhighbloodpressure,andstartedonmedication.Myfatherandsiblingswerealsoonmedicationfortheseconcerns.

At105kg(231pounds),Iswitchedfrommyfat-free,high-carbohydratediettoalow-carbohydrate,severelycalorie-restricteddiet.Myweightwentdownto75kg(165pounds)overabouteighteenmonths,butthedietwassorestrictiveitwasnotsustainable.Inevitably,myweightclimbedbackup.Attheendof2010,IwashorrifiedwhenanultrasoundshowedthatIhadnonalcoholicfattyliverdisease.

InApril2011,mydoctoraddedinsulininjectionstomytype2diabetesmedications.HesaidIhadtoincreasetheinsulindoseuntilmybloodglucoselevelwasdown,withnootherexplanation—soIdidjustthat!Latein2011Iwasinjecting120unitsoflong-actinginsulineverynightand80unitsofrapid-actinginsulinwitheachmeal.Iwasalsostilltakingmyotherdiabetesmedicationmorningandnight.

AfterIstartedtakinginsulin,nomatterwhatIdidorhowhardIexercised,Icouldnotloseweight—evenwhenIquitcarbohydrates.Iknewithadsomethingtodowiththeinsulin.Fast-forwardtoJanuary2015:Ihadhadenough.Ibegancuttingcarbohydratesagainandstartedathirty-minutehigh-intensityintervaltrainingclass.Myglucoselevelsweredroppingtoabout2.3mmol/L.ThenIcameacrossanarticlebyDr.Fung,whohadjustpresentedattheLowCarbHighFatConventioninCapeTown,sayingtype2diabetescouldbereversed.IwatchedhisYouTubepresentations,andforthefirsttime,Ifoundsomethingthatmadesense.Iimmediatelydecidedthatquittinginsulinwasmyfirstpriority,butIcouldnotfindasingledietitianordoctorinSouthAfricawhowouldhelpme.

JANUARY2015

Weight 96kg(212pounds)

Fastingglucose 9.5mmol/LHbA1c 7.6%

Insulindosage 360units/day

SoIreadmoreonDr.Fung’sIntensiveDietaryManagementblog,andtowardtheendofFebruaryIstartedafastingregimenalongwithlow-carbohydratemeals.Icutallmyinsulindosesinhalf.Ibeganwiththreedaysoffastingaweek.Onfastingdays,Idrankcoffeewithcreaminthemorningandwaterwithasliceoflemoninittheremainderoftheday.Later,Ilearnedthatyoudon’treallyneedbreakfast,soIstartedeatingjustonemealinthelateafternoononnonfastingdays.

Myglucoselevelscontinuedtodrop,soIquitallinjectedinsulinandcontinuedtoeatalow-carb,Paleo-stylediet(inotherwords,realfood).Myweightwasslowlycomingdownandtheneedleonthescalewas87.8kg(194pounds).Ihadlostatotalof6.2kg(14pounds)ofbodyfat(2.9%ofmytotal),andmywaistlinedropped35cm(14inches).

JUNE2015

Weight 79.7kg(176pounds)

Fastingglucose 7.6mmol/LHbA1c 6.2%

Insulindosage

none

BythebeginningofJune,myweightwas79.7kg(176pounds)andIhadlostatotalof13.03kg(29pounds)ofbodyfat(7.3%)andatotalof46.5cm(18inches)frommywaist.Icontinuedmyfastingregimen,andinAugustIfinallyfoundaphysiciantohelpmethelastbitoftheway.Myresultshaveastoundedvariouspeopleinvariousways,includingsomefriendsinthemedicalprofessionwhoweretoopolitetotellmethattheythoughtIwasnuts!

NOVEMBER2015

Weight 68kg(150pounds)

Fastingglucose 5.9mmol/LHbA1c 5.3%

Insulindosage

none

It’stheendofNovember2015,andInowweigh68kg(150pounds)andhavelostatotalof20.64kg(46pounds)ofbodyfat(12.4%)andatotalof77.5cm(31inches)frommywaist.

IrealizethatIamalwaysgoingtostrugglewithmyloveofcarbohydrates,especiallybreadandfruit,butIknowthatmywayofeating—realfoodscombinedwithafastingregimen—issustainable.AsDr.Fungputit,therearetimesoffeast,butitiseasyenoughtobalancethesewithtimesoffamine(fasting).Ifeelsomuchbetterhavinglostsomuchweight,andIhavelotsofenergywhenfasting.

Chapter5

FASTINGFORWEIGHTLOSS

Long-termdietingisanexerciseinfutility.Alldiets—whetherthe

Mediterraneandiet,theAtkinsdiet,oreventheold-fashionedlow-fat,low-caloriediet—seemtoproduceweightlossintheshortterm.Butaftersomeinitialsuccess,weightlossplateaus,andthedreadedweightregainfollows.Evenlow-carbohydratediets,whichareproventoresultinmoreweightlossthanotherdietsintheshortterm,showthesameinexorableplateauandweightregain.Thisrelentlessregainoccursdespitecontinueddietarycomplianceandregardlessofdietarystrategy.

Inotherwords,eventually,alldietsfail.Thequestionis,why?

“EatLess,MoveMore”Doesn’tWorkHaveyoueverheardthephrase“Theproofisinthepudding”?Theoriginal

versionwasactually“Theproofofthepuddingisintheeating.”Itmeansthattoreallyjudgewhethersomethingissuccessfulornot,youmustlookattheendresults.Justbecauseyouthinksomethingwillworkdoesnotnecessarilymeanitwill.

Solet’sapplythistoobesity.Thedominantnutritionalparadigmofthelasthalfcenturyhasbeen“caloriesin,caloriesout.”Theideaisthatconsumingfewercaloriesthanareusedwillultimatelyleadtolastingweightloss.Dietaryfat,beingcaloricallydense(thereareninecaloriesineverygramoffat,comparedtofourineverygramofcarbohydrateorprotein),wasbelievedtobeespeciallyfattening.

Thecommonlyrecommendedweight-lossapproachofalow-fat,low-caloriedietcombinedwithincreasedexercise—allaimedatincreasingthenumberofcaloriesburnedwhilereducingthenumberofcaloriesconsumed—canbeneatlysummarizedas“eatless,movemore.”Thereiscertainlyalogicatworkhere,andwecanimagineallkindsofreasonswhyitshouldwork,butdoesit?Whataretheresultsofthisapproach?

AsyouandIbothknow,thisdietaryapproachhasbeenwidelyadvocatedoverthepastfewdecadesandhascreatedahuge,rampantglobalobesityepidemic.TheCentersforDiseaseControlandPreventioninAtlantacloselytracksobesitytrendsintheUnitedStates,andaccordingtoitsdata,in2015,nostatehadanobesityratebelow20percent.Onlytwentyyearsearlier,in1995,nostatehadanobesityrateabove20percent.

Sowehavetwoincontrovertiblefacts:

Sowehavetwoincontrovertiblefacts:

Fact#1—Overthepasttwentyyears,conventionalweight-lossadvicehascalledforeatinglessandmovingmore.

Fact#2—Overthepasttwentyyears,obesityrateshaveexploded.

Consideringthesefactstogether,thereareonlytwopossibleconclusions.Thefirstisthatourstandarddietaryadviceisgood,butpeoplearesimplynotfollowingit.Thiswouldbearealstretchoftheimagination.Whenitcomestohealth,peoplereallydolistentotheirdoctors,aswecanseewhenwelookatotherlifestylechangesdoctorsbegantorecommend.Whendoctorsadvisedpeopletostopsmoking,theystoppedsmoking.Inthemid-1960s,asthedatalinkinglungcancerandsmokingbecameclear,theSurgeonGeneraloftheUnitedStatesfirstissuedapublichealthwarning.Cigaretteconsumptionshortlythereafterbeganitsrelentlessdownwardtrend,whichwasacceleratedbytheSurgeonGeneral’sreportonsecondhandsmoke.

Whendoctorsadvisedpeopletowatchtheirbloodpressureandcholesterol,theywatchedtheirbloodpressureandcholesterol.Yetsomehow,whendoctorsadvisedpeopletoeatlessandmovemore,theydidn’t?Doubtful.

Figure5.1.Adultpercapitacigaretteconsumption,1900–2012.Whendoctorsstartedtellingpeoplethatsmokingwasbadfortheirhealth,peoplelistenedandsmokingratesdeclined.

Source:SurgeonGeneral.gov

Thiswayofthinkingisalsoknownas“blamingthevictim.”Weassumetheadviceisgoodandtherefore,ifitfails,itmustbebecausethepersondidn’treallyfollowtheadvice.Thisshiftstheblamefromtheadvice-givertotheadvice-taker.

Americanshave,infact,followedthegovernment’snutritionalguidelines.TheUSDA’sfirstDietaryGuidelinesforAmericanswasreleasedin1977.ItrecommendedthatAmericansadjusttheirdietstomeettwospecificgoals:increaseconsumptionofcarbohydratesandreduceintakeoftotalfat.Althoughcaloricreductionwasnotaspecifiedgoal,thereductionindietaryfatwas

expectedtoreducecalories,sincefatiscaloricallydensecomparedtocarbohydrates

Since1970,consumptionofvegetables,fruits,andgrainshasincreased,andconsumptionofredmeat,eggs,andanimalfatshasdeclined,justastheUSDA’sdietaryguidelinesrecommended.Butthepromisedbenefitsnevermaterialized.

Thesecondpossibleconclusion—theonlyonethatremains—isthattheadvicetoeatlessandmovemoreissimplywrong.Andscientificstudiesbackthisup.

We’veknownabouttheabysmalsuccessrateofthecaloric-reductionapproach—theonethat’sbasedonsimplyreducingcaloriesconsumedandincreasingcaloriesburned—fordecades.A1959studyestimateditsfailurerateatasky-high98percent.Only2percentofdietersusingacaloric-reductionstrategywereabletomaintainatwenty-poundweightlossfortwoyears.

Figure5.2.Since1970,Americanshavelargelyfollowedthegovernment’sdietaryrecommendations.Atthesametime,theobesityepidemichasexploded.

Source:WellsandBuzby,“DietaryAssessmentofMajorTrendsinU.S.FoodConsumption,1970–2005.”

Morerecently,in2015,researchersintheUnitedKingdomreviewedtheweight-lossratesofmorethan175,000obesemenandwomenoverthepreviousnineyears.Theprobabilityofachievinganormalweightbycaloricreductionalonewas0.8percentinwomenand0.47percentinmen.Sothebest-casescenariousingconventionalcalorie-countingmethodsisa99.2percentfailurerate.

Eventheverybeststudyeverdoneoncaloricreductionasapathtolastingweightlossshowedthatitfailed.TheWomen’sHealthInitiative,agiganticrandomizedcontrolledtrial,followedalmostfiftythousandwomenoversevenandahalfyears.Onegroupofthewomenfollowedalow-fat,low-caloriediethighingrains,fruits,andvegetablesandreducedtheirtotaldailycaloriesby361calories;theirpercentageofcaloriesfromfatwasreducedfrom38.8percentto29.8percent.Theyalsoincreasedtheiramountofexerciseby14percent.Theothergroupfollowedtheirusualdiet.Theexpectedweightlossforthelow-calorie,increased-exercisegroupwasthirty-sixpoundsperyear,or252poundsoversevenyears.Theothergroupwasnotexpectedtoseeanyweightloss.

oversevenyears.Theothergroupwasnotexpectedtoseeanyweightloss.Thefinalresultswereacompleteshocktoeverybodyinvolved.Theactual

differenceinweightlossbetweenthetwogroupswasnoteventwopounds!Worsestill,theaveragewaistsizeinthelow-calorie,increased-exercisegroupgrewfrom35to35.4inches.Thesewomenwhosocarefullyfollowedthe“eatless,movemore”strategyforsolongactuallyendedupfatterthanever.

There’sabetter-knownexampletobefoundinTheBiggestLoser,along-runningrealityTVshowthatpitsobesecontestantsagainstoneanotherinabidtolosethemostweight.Whileshort-termresultsareoftenstunning,contestantsnearlyalwaysregainweightafterfilmingends.KaiHibbard,thewinnerofseasonthree,saidofparticipatingontheshow,“Itwasthebiggestmistakeofmylife.”Seasontwo’sSuzanneMendoncasaysthatthereisneverareunionshowbecause“we’reallfatagain.”

Figure5.3.ParticipantsintheWomen’sHealthInitiativestudyreducedtheiroverallcaloriesandfatconsumptionwhileincreasingtheirexerciseandcarbohydrateconsumptionoversevenyears.

Source:DatafromHowardetal.,“Low-FatDietaryPatternandWeightChangeover7Years:TheWomen’sHealthInitiativeDietaryModificationTrial.”

Figure5.4.Despitealow-fat,low-caloriediet(seeFigure5.3),participantsintheWomen’sHealthInitiativesawlittlechangeintheirBMIorwaist-to-hip

ratio,andtheirwaistcircumferenceactuallyincreasedslightly.

Source:DatafromHowardetal.,“Low-FatDietaryPatternandWeightChangeover7Years:TheWomen’sHealthInitiativeDietaryModificationTrial.”

Figure5.5.Overnineyears,womenadheringtoacalorie-restricteddietshowednoweight-lossbenefitsoverthoseeatinganormaldiet.

Source:Howardetal.,“Low-FatDietaryPatternandWeightChangeover7Years:TheWomen’sHealth

InitiativeDietaryModificationTrial.”

Butwhyshouldthishappen?TheBiggestLoserdietrestrictscaloriesto70percentofbaselineenergyrequirements,whichusuallymeans1200to1500caloriesperday.Thisiscombinedwithvigorousphysicalexertionforseveralhoursperday,sixdaysaweek.Thisistheclassic“eatless,movemore”advicegivenbydietitiansandhealth-careprofessionalseverywhere.NowondertheBiggestLoserdietrankednumberthreeinweight-lossdietsaccordingtoUSNews&WorldReportin2015.

AstudyofBiggestLosercontestantsshowedthatinthirtyweeksoffilming,averageweightdroppedfrom329poundsto202pounds.That’sanaveragedecreaseof127pounds!Bodyfatdropped,onaverage,from49percentto28percent.Almostalloftheweightlostwasfatmass,asopposedtoleantissue,or“fat-freemass”.(Thereisinevitablysomeleantissuelostalongwithfat,butthisisgenerallyskinandconnectivetissue,notnecessarilymuscle.)Wow!Amazing!

Unfortunately,thoseresultssimplydidn’tlast.Sixyearsaftertheiralmostmiraculousweightloss,thirteenofthefourteen

contestantsstudiedhadregainedtheweightthey’dlost.Thisisafailurerateof93percent.Themainreasonfortheweightregainisthatthecontestants’metabolismshadslowedsignificantly(we’llexplainwhylaterinthischapter).DannyCahill,thewinnerofSeason8,lost239poundsduringthecompetition.However,hisbodywasnowburning800calorieslessperdaythanithadpreviously.Thisprovedtobeaninsurmountableobstacletolastingweightloss,andsureenough,he,alongwithalmostalltheothercontestants,endedupregainingalltheirhard-lostweight.

ButIprobablydidn’treallyneedtoconvinceyouthat“eatless,movemore”doesn’twork.Youalreadyknewthat.Forthevastmajorityofpeople,personalexperienceconfirmsthisepicfail.Yes,studiesprovethatitdoesnotwork,butjustassignificantly,sodothebitterexperiencesofthemillionsofpeoplewhohavetriedit.Ninety-ninepercentfailurerate?Soundsaboutrighttome.

Thisisthecruelhoaxofthe“eatless,movemore”strategy.Itiscruelbecauseallofourtrustedhealthsourcestellusitshouldwork,andwhenitfails,weblameourselves.

Here’sthething,though.Let’ssay,forthesakeofargument,thatwhenfollowedtotheletter,“eatless,movemore”doeswork.Intheend,itactuallydoesn’tmatter.Whetherit’sgoodadvicethatpeopledon’tfolloworbadadvice

thatpeopledofollow,theresultisthesame:itdoesn’tproduceweightloss.Andiftheendresultsarebad—andtheyare!—thentheadviceisbad.Theproofisinthepudding.

Figure5.6.Duringthirtyweeksoffilming,BiggestLosercontestantsshowedamazingweight-lossresults.

Source:Johannsenetal.,“MetabolicSlowingwithMassiveWeightLossDespitePreservationofFat-FreeMass.”

Whatistobedone?Theonlylogicalconclusionistochangethatadvice.Weneedanewstrategy—fasting.

Figure5.7.Aftersixyears,nearlyalltheBiggestLosercontestantshadregainedtheweighttheylost.

Source:Kolata,“After‘TheBiggestLoser,’TheirBodiesFoughttoRegainWeight.”

Figure5.8.SlowingmetabolismsmadeitimpossibleformostBiggestLosercontestantstomaintaintheirweightloss.

Source:Kolata,“After‘TheBiggestLoser,’TheirBodiesFoughttoRegainWeight.”

Why“EatLess,MoveMore”Fails:HowOurBodiesReallyUseCalories

Thereason“eatless,movemore”doesn’tworkforweightlossisthatit’sbasedonafalseideaabouthowourbodiesusecalories:thesingle-compartmentmodel.Accordingtothismodel,thebodyreducesallfoodstosimplecaloriesandstoresthosecaloriesforuseinwhatwecanthinkofasasinglecompartment;then,thebodyaccessesthatcompartmenttousethecaloriesforexerciseandbasalmetabolism(remember,thatreferstothebody’sbasicfunctions,suchasbreathing,removingtoxinsfromthebloodstream,digestingfoods,andsoon—alltheserequireenergyfromcalories).

Thismodelislikeabathroomsink.Calories,likewater,canflowintooroutofthissink.Excesscaloriesareheldinthissinkandcanbeeasilyaccessedifourbodiesrequiremorecalories—forexample,exercisewoulddraincaloriesout

ourbodiesrequiremorecalories—forexample,exercisewoulddraincaloriesoutofthissink.Thereisnodistinctionmadebetweenanyofthestorageformsofcalories.Whethercaloriesarestoredasglucose,whichisusedforimmediateenergy;glycogen,whichisusedintheintermediatetimeframe;orfat,whichislong-termenergystorage,allcaloriesaretreatedequally.

However,thismodelisknowntobeacompletefabrication.Itdoesnotexistexceptinourimaginations.

Thesingle-compartmentmodelofcaloriestorageanduse.

Itismoreaccuratetouseatwo-compartmentmodel,becausetherearetwodistinctwaysenergyisstoredinthebody:asglycogenintheliverandasbodyfat.

Whenweeat,ourbodyderivesenergyfromthreemainsources:glucose(carbohydrates),fat,andprotein.Onlytwoofthesearestoredforlateruse,glucoseandfat—thebodycan’tstoreprotein,soexcessproteinthatcan’tbeusedrightawayisconvertedtoglucose.Glucoseisstoredintheliverasglycogen,buttheliver’scapacityforstoringglycogenislimited.Onceglycogen

glycogen,buttheliver’scapacityforstoringglycogenislimited.Onceglycogenstoresarefull,excesscaloriesmustbestoredasbodyfat.Dietaryfatisabsorbeddirectlyintothebloodstreamwithoutpassingthroughtheliver,andwhat’snotusedisstoredasbodyfat.Thiswasoneofthereasonswhylow-fatdietswereinitiallyrecommended,buttheimmediatedestinationofingestedcaloriesisnotthemaindeterminantofweightgain.

Thinkofglycogenasarefrigerator.It’sdesignedforshort-termstorageoffood;it’sveryeasytomovefoodinandout,butthestoragespaceislimited.Bodyfat,ontheotherhand,ismorelikeabasementfreezer.It’sdesignedforlong-termstorageandismoredifficulttoaccess,butithasmuchgreatercapacity.Plus,youcanalwaysaddmorefreezerstothebasementifyouneedthem.Whenwebuygroceries,westorefoodintherefrigeratorfirst,andthenwhenthefridgeisfull,westoretheexcessfoodinthefreezer—thatis,westorefoodenergyfirstasglycogenandthen,whenthespaceforglycogenisfull,asbodyfat.

Bothbodyfatandglycogenareusedforenergyintheabsenceoffood,buttheyaren’tusedequallyoratthesametime.

Thebodypreferstouseglycogenforenergyratherthanbodyfat.Thisislogicalbecauseitiseasiertoburnglycogen—intermsofouranalogy,it’smucheasiertogetfoodfromtherefrigeratorinthekitchenthantotrekallthewaydowntothefreezerinthebasement.Andaslongasthereisfoodinthefridge,wewon’tretrieveanyfromthefreezer.Inotherwords,ifyouneed200caloriesofenergytogoforawalk,thebodywillgetthatenergyfromglycogenaslongasit’savailable—itwon’tgotothetroubleofaccessingbodyfat.

Thetwo-compartmentmodelofcaloriestorageanduse.

Thetwocompartments,thefridgeandthefreezer,arenotused

simultaneouslybutsequentially.Youneedto(mostly)emptyoutthefridgebeforeyoucanusewhat’sinthefreezer—youneedtoburnmostoftheglycogenbeforeyoucanburnfat.Inessence,thebodycanburneithersugarorfat,butnotboth.

Insulin’sCrucialRoleinWeightLossandRegainHoweasyitistogettothefatfreezerdependsuponthehormoneinsulin.Is

thefreezerlockedawayinthebasementbehindsteelgates,orisitlocatedrightbesidetherefrigerator?Insulinlevelsaretheprimedeterminant.

Whenwearenoteating,insulinlevelsarelow,allowingfullaccesstothefatfreezer—thebodyisabletoeasilygetatthestoredfat.Withlowinsulinlevels,youdon’tevenhavetocompletelyemptytheglycogenrefrigeratorbeforeopeningthefatfreezer,sinceit’ssoeasilyaccessible.Thinkaboutyourfridgeathome.Doesithavetobecompletelyemptyofeverything,includingthathalf-emptybottleofketchupandtubofyogurt,beforeyouopenthatpackofburgersfromthefreezer?Ofcoursenot!Similarly,withlowinsulinlevels,thebodycanburnfatevenifthereisstillsomeglucosearound.Thatmeansthatifyou’recuttingcaloriesandhavelowinsulinlevels,it’seasyforyourbodytocompensateforthereducedfoodenergybygettingsomefatoutofthefreezerevenifyourglycogenfridgeisn’tcompletelyempty.Buttheemptieryourglycogenfridge,themorelikelyyouwillbetousewhat’sinthefatfreezer,andtheeasieritistogettothefreezer,themorelikelyitisthatyouwilluseit.

FASTINGALL-STARSDR.BERTHERRINGAfteraweekortwooffastingfor19hoursadayandeatingonlywithina5-hourwindow,Iwassurprisedtoseethatmyexcessweighthadclearlystartedtomeltaway.Ihadonly20extrapoundsatthattime,buttheweightbotheredmebecausemyeffortstoeatlessandexercisemorehadfailedtoeliminateit.Intheyearsthatfollowed,IkeptturningtothiseatingscheduletoloseweightthatinevitablyaccumulatedwheneverIwoulddriftbacktoeating3mealsaday.Ifoundthatthewide-intervaleatingscheduleworkedeverytime.

I have done dinner-to-dinner intermittent fasting for amonth and ahalf.Ihaveexperiencedmoreenergy,andIhavebeenabletoincreasethe amount of weight I’m lifting during my workouts. I averagebetween2and4poundsperweekinweightloss,andI’vehadaDXAscanthatshowstheweightI’mlosingisfat,notmuscle.Ontopoftheweightlossitself,Ihavelostnoticeableinchesinmyabdominalarea.Iamalso a type2diabetic, and intermittent fastinghas allowedme tokeepmybloodsugarlevelsinanormalrange.

—EricR.,Ogden,UT

Notonlydolowinsulinlevelsallowaccesstothefatfreezer,theyactuallytriggerfat-burningforenergy.Ifinsulinlevelsareabnormallylow,thenfatiscontinuallyburned.Weseethissituationintype1diabetes,whentheinsulin-producingcellsinthepancreasaredestroyed.Asinsulinfallstoundetectablelevels,patients,oftenchildren,burnthroughalltheirfatstoresandareunabletogainweightnomatterhowmanycaloriestheyconsume.Untreated,thisisafataldisease.Treatmentwithinsulininjectionsallowsthemtostorefatnormallyonceagain.

Ontheotherhand,highinsulinlevelspreventthebodyfromaccessingthefatinthefreezer.Itislockedawaybehindsteelbars.Insulininhibitslipolysis—itstopsthebodyfromburningfat.Highinsulinlevels,whicharenormalaftermeals,signalourbodytostoresomeoftheincomingenergy.Logically,therefore,wealsostopburningstoredfat(whybotherwhenthere’senergyfromfood?).

food?).Thisdoesn’tjusthappenaftermeals,however—wealsoseethisindiseases

oftoomuchinsulin.Forexample,insulininjections,oftenusedinthetreatmentofdiabetes,commonlyleadtoincreasedfataccumulationbecausethebodyisunabletoburnfat.(That’sgreatfortype1diabetics,whohavetoolittlefattobeginwith,butnotsogreatfortype2diabetics,whousuallyhavetoomuch.)Insulinresistance,sometimescalledprediabetesormetabolicsyndrome,isthemostcommonsituationwhereinsulinlevelsarepersistentlykeptabnormallyhigh.

Figure5.9.From1922,agirlwithtype1diabetesbeforeandaftertreatmentwithinsulin.

“Casesbeforeandafterinsulintreatment”byWellcomeImagesislicensedunderCCBY

InsulinResistanceOneofinsulin’smainjobsistomoveglucosefromthebloodstreamintothe

cellssothatitcanbeusedforenergy.Ifyouhaveinsulinresistance,yourcellsarenolongersensitivetoinsulin.Normalamountsofinsulinarenotabletomoveglucoseintocells,leadingtoabuildupofglucoseintheblood.Tocompensate,thebodymustproduceextrainsulintoforcetheglucosein.Thisleadstoconstanthighinsulinlevels,whichblocksfat-burning.(We’llcoverthisinmoredetailinthenextchapter,ontype2diabetesandfasting.)

Butwhatcausesinsulinresistanceinthefirstplace?Theclueliesinitsveryname.Insulinresistancedevelopsbecausecells

needtoresisttheeffectsoftoomuchinsulin.Therootcauseoftheproblemisconsistentlyhighlevelsofinsulin,whichcreatesaviciouscycle:toomuchinsulincreatesresistance,insulinresistancetriggershigherlevelsofinsulin,andthatinturnonlyservestostimulatemoreresistance.Thecyclereinforcesitselfeachtimeitgoesaround.Thewaytosuccessfullybreaktheinsulinresistancecycleisnottocontinuallyincreaseinsulinlevelsbuttodrasticallydecreaseinsulinlevels.

Thissoundsalmostcounterintuitive,butconsidertheanalogousproblemofantibioticresistance.Whenanantibioticisfirstused,itkillsoffmostbacteria,butafewbacteriaarenaturallyresistant,andthesesurvive—andwiththerestofthebacteriagone,they’reabletoflourishwithoutanycompetitionforresources.Theseresistantbacteriareproduceandspread,renderingtheantibioticlesseffectiveingeneral—therearefewerbacteriathatitwillworkagainst.Inthiscase,antibioticscreatesantibioticresistance.

Howdoyoustopantibioticresistance?Theknee-jerkreactionistouseevenhigherdosesofantibioticstokilltheresistantbacteria.Andthiswillworkforatime,buteventually,thehigherdoseofantibioticsonlycreatesmoreresistance.Thiscreatesaviciouscycleofantibioticusageanddevelopmentofresistance.Theansweristheexactopposite:wemustseverelycurtailtheuseofantibiotics,soresistantbacteriadon’tflourish.

Thesamelogicappliestoinsulinresistance.Whenourcellsbecomelesssensitivetoinsulin,thebody’sknee-jerkreactionistoincreaseinsulinproduction.Ithelpsforawhile,butovertime,thisonlycreatesmoreinsulinresistanceandtriggerstheviciouscycleofincreasinginsulinandincreasingresistance.Theanswerisreallytheexactopposite:sinceinsulinresistancedevelopsinresponsetopersistentlyhighinsulinlevels,wemustcreaterecurrentperiodsofverylowinsulinlevels.

Ifweareunabletobreakthecycleofinsulinresistance,theninsulinlevelsremainhigh.Thisblocksourabilitytoburnthebodyfatwehavesocarefullystoredaway.Ourbodyisconstantlyreceivingthesignaltostoreenergyasfatandisnevertoldtoburnfat.Insulinplaysacrucialroleinthedecisionofwhichfueltoburn.

HighInsulin+ReducedCalories=SlowingMetabolismTofindoutwhatallthishastodowithlosingweight,let’sreturntothe

single-compartmentandtwo-compartmentmodels.Rememberthatthe

single-compartmentandtwo-compartmentmodels.Rememberthatthetraditionaladviceto“eatless,movemore”forweightlossisbasedonthesingle-compartmentmodel,the(incorrect!)ideathatallcaloriesareequalandstoredinonesinglecompartment,soifyou’reusingmorecaloriesthanyou’reconsuming,youmustbeburningbodyfat.Inreality,thebodystoresenergyasbothglycogenandbodyfat—that’sthetwo-compartmentmodel.Toburnfat,twothingsmusthappen:youmustburnthroughmostofyourstoredglycogen,andinsulinlevelsmustdroplowenoughtoreleasethefatstores.

Andneithertaskiseasy.Whenstoredglycogengetslow,yourbodysensesitandstartstogetantsy.Ittriggershungersignals,soyouwanttoeatmore.Ifyoudon’teatenoughtofilluptheglycogenstoresbutyourinsulinremainshigh,bodyfatcan’tbereleased.Thebody’sonlyremainingoptionistodecreaseyourmetabolismsothatyou’reburninglessenergy.

Wheneitherfoodorglycogenisavailable,wedonotuseourless-accessiblefatstores.Thisensuresthatbodyfatisonlyusedintimesofneed.Butoverdecadesofabundantglucose,fatstoresproliferatebecauseweneverallowourfridgetoempty.Inotherwords,thefoodgoesintothefreezer,butitnevergetsachancetocomebackout.Andasinsulinresistanceprogresses,theresultinghighinsulinlevelsmakeitharderandhardertoaccessthefatstores.

Thebodyalwayswantstostayatacertainweight,andanydeviationaboveorbelowthatweighttriggersadaptivemechanismstogetustoreturntothatweight.That’swhy,afterweightloss,webecomehungrierandourmetabolismrelentlesslyslows,sothatwehavetoeatevenlessjusttomaintainourlowerweight.That’sthebodytryingtogetustogainweighttogetusbacktooursetweight.

Thereasonthebodyhastoresorttodecreasingmetabolismandincreasinghungerisbecauseinsulinremainshigh,soitdoesn’thaveaccesstotheenergystoredasfat.Yourbodyhasnootheroptionbuttoslowmetabolism—it’stryingtoconserveenergybecauseitcan’tgetatthefatfreezer.Thisiswhyinsulinresistanceplayssuchacrucialroleinobesity:thehighinsulinlevelstellyourbodytohangontobodyfatandsimultaneouslytriggerthebodytoloweryourmetabolism.Thisinexorablyerodesweight-lossefforts.Bodyweightplateausandthenruthlesslyclimbsbackup,evenastheproperdietismaintained.Forsomeofus,changingwhatweeatisclearlynotenough.

Let’stakeanexample.Supposeyoueat2,000caloriesperday.Yourweightisstable,soyouareburning2,000caloriesperday.Thereare3,500caloriesinapoundoffat,soifyoucarry100poundsoffat,thereare350,000caloriesinfatstores.

Now,let’ssayyouwanttoloseweight,soyoureduceyourdailycaloriesto

Now,let’ssayyouwanttoloseweight,soyoureduceyourdailycaloriesto1,200.Initially,fatwillbelosttomakeupforthereducedcalories.However,ifyouhaveinsulinresistance,thenpersistentlyhighinsulinlevelswillmakeitdifficulttoaccessfatstores.Thehighinsulinisinstructingthebodytostoreenergy,notburnit.Thebodyisusedtoburning2,000calories,butnow,only1,200areavailable,soitisforcedtoreduceitsenergyexpendituretomatch.Basalmetabolicratedecreasesto1,200calories.

Themajorproblem,asyoucansee,isnotthattherearen’tenoughcaloriesavailable.Thereare350,000caloriesstoredawayinthefatfreezer.Theproblemisthatthesecaloriesarenotavailableforthebodytouse.Themainissueishowtogetaccesstotheenergylockedawayinthefat.Insulinisthecrucialfactortoconsiderhere,notthenumberofcaloriesyoueat.

ThisexplainswhytheBiggestLosercontestants,justlikealldietersusingthe“eatless,movemore”approach,gainedtheirweightback:theirmetabolismsloweddowninresponsetocaloricreduction.Theheavyexercisescheduledemandedbytheshowisalsonotsustainableforlong.Betweentheslowedmetabolismandthereductioninexercise,weseetheveryfamiliarweightplateau.Oncecalorieexpendituredropsbelowintake,weseetheevenmorefamiliarweightregain.Bam!Goodbyereunionshow.

Imaginehowthiswouldfeel.Reducingyourcaloricintakeby800caloriesperday,asthecontestantsdid,meansthatyoufeelcold,lethargic,andtiredasyourbodystartstoslowdowntoconserveenergy.Afterawhile,youcan’ttakeitanymore.Asyouincreaseyourcaloriesslightly,youarestilleatinglessthanyouusedto,butbecauseoftheslowedmetabolism,nowyouaregainingweight.Youreturntoyouroriginalweightasyourfriendsandfamilysilentlyaccuseyouofcheatingonyourdiet.

Allofthisiscompletelypredictable.Sincethecaloric-reductionstrategyhasaknown99percentfailurerate,it’snosurprisethattheBiggestLoserstrategyhasasimilarlydismaloutlook.

Myinsulinresistancemademeimpervioustolastingweightloss.Atage61, I don’t think I had ever gone one day in my life without eatinganything,so itwasreallyscaryformeto fast.Myfirst fastwas for6days (about a month ago). I came to realize that hunger pangs areshort-livedandpassquickly,makingitverydoable.Ilost8poundsthatweekandhavebeenfastingfor24–36hoursa fewtimesaweeksince

then.Ihave lostanother4pounds inafewshortweeks.MyA1Chascomedownfrom5.7to5.2andmyfastingbloodsugarfrom97to75onaverage. YAY!!! Thank you, thank you, thank you, Jimmy and DrFung!!!

—RobinG.,Freeland,MD

TheSolution:FastingWhenweeat,insulinrisesandblocksfat-burning,andthebodyinstead

burnsglucose,whichisnowfreelyavailablefromtheingestedfood.Butofthethreemacronutrients—carbohydrates,fat,andprotein—carbohydratesstimulatetheproductionofinsulinthemost.Refinedcarbsandsugarinparticularhavethegreatesteffectoninsulin,soadietlowintheseismostcertainlyagreatstartforbreakingtheinsulinresistancecycleandlosingweight.Yetforsomepeople,thisisnotenough.Sinceallfoodsraiseinsulinlevels,thebestansweristocompletelyabstainfromfood.Theanswerwearelookingforis,inaword,fasting.

FastingVersusLow-CarbDietsBothlow-carbdietsandfastingareabletoreduceinsulin.Sowhycan’ta

successfulweight-lossstrategybesimplyeliminatingallcarbohydratesinsteadoffasting?It’ssimplyaquestionofpower.Reducingrefinedcarbohydratesreducesinsulin.However,protein,especiallyfromanimalsources,alsoraisesinsulin.Fasting,byrestrictingeverything,keepsinsulinlower.Fastingissimplymorepowerful.

Verylowcarbohydratediets(inwhichcarbscomposelessthan3percentoftotalcalories)areveryeffectiveatreducingbloodsugarinthosewithtype2diabetescomparedtoastandarddiet(inwhichcarbscompose55percentoftotalcalories).Thisholdstrueevenwhenthenumberofcaloriesconsumedareidentical.Inotherwords,theglucose-loweringbenefitsofcarbrestrictionarenotsimplyduetocalorierestriction.Thisisusefulknowledge,especiallyconsideringhowmanyhealthprofessionalsinsist,“It’sallaboutthecalories.”

Theverylowcarbdietdoesremarkablywell,providingyou71percentofthebenefitsoffasting,withoutactualfasting.Butsometimeslow-carbjustisn’tenough.I’vehadmanypatientswholimitedtheircarbohydratesbutstillhadelevatedbloodsugars.Howdoyougetmorepower?Fasting.

Insulinisthemaindriverofobesityanddiabetes.Averylowcarbdietcan

Insulinisthemaindriverofobesityanddiabetes.Averylowcarbdietcanreduceinsulinbymorethan50percent,butyoucangoanother50percentbyfasting.That’spower.

Figure5.10.WeightchangeovertimeintheDiabetesPreventionProgram,whichexperimentedwithpreventingdiabetesthroughdietandexerciseormedication.Lifestylechangesresultinweightlossatfirst,buteventuallytheweightreturns.

Source:DiabetesPreventionProgramResearchGroup,“ReductionintheIncidenceofType2DiabeteswithLifestyleInterventionorMetformin.”

Fastingissimplythemostefficientandeffectivewaytolowerinsulinlevels.Notice,however,Ididnotsayitwastheeasiest.Butdoyouwantamethodthatiseasy,oramethodthatworks?

Ihavebeenonalow-carb/high-fatdietsince2011andinitiallylost60pounds.IwasdisappointedwhenIstartedtogainbacktheweighteventhough I was faithful! I started incorporating alternate-day 24-hourfasting,andnowmyweightiscomingoffagain,23poundsinlessthan3months!I feel likeIhavefoundthemissingpiece inmyweight-losspuzzleandI’mincontrolofmyhealthagain.

—JennyH.,FortWorth,TX

FastingStopsInsulinResistanceWhenCaloricReductionDoesn’tTherearethosethatarguethatfastingisbeneficialonlytotheextentthatit

reducescalories.Butifthat’sthecase,whyistheresuchastrikingdifferencebetweencaloricreductionandfasting?Caloric-reductionstrategieslike“eatless,movemore”failvirtuallyeverysingletime,yetfastingisofteneffectivewhensimplecaloricreductionisnot.Why?

Theshortansweristhatwhenyou’reeatingregularly,evenifyou’reeatingfewercalories,you’renotgettingthebeneficialhormonalchangesoffasting.Duringfasting,unlikeduringcaloricreduction,metabolismstabilizesorevengoesuptomaintainnormalenergylevels.Adrenalineandgrowthhormoneincreasetomaintainenergyandmusclemass.Bloodsugarandinsulinlevelsgodownasthebodychangesfromburningsugartoburningfat.Allthisbeginstoaddressthelong-termproblemofinsulinresistance.

Arecentrandomizedtrialillustratedthedifferencebetweenthetwostrategiesverywell.Thestudycomparedtheeffectivenessofdailycaloricreductionandintermittentfastingamong107women.Onegroupreducedtheirdailycaloricintakefrom2,000caloriesto1,500calories.Theothergroupwasallowednormalcaloricintake(2,000calories)fivedaysaweekbutonly25percentofthat(500calories)ontheremainingtwodays—thisisreferredtoasa5:2fast.Thismeansthatoverthecourseofaweek,averagecaloricintakeforthetwogroupswasverysimilar:10,500caloriesperweekforthereduced-caloriegroupand11,000caloriesperweekforthefastinggroup.BothgroupsconsumedsimilarMediterranean-styledietswith30percentfat.

Aftersixmonths,bothgroupshadsimilarlevelsofweightlossandfatloss.Butthe5:2fastinggroupshowedaclear,substantialimprovementininsulinlevelsandinsulinresistance,whereasthecaloric-reductiongroupdidnot.

Figure5.11.Astudyoftype2diabeticsshowedthataverylowcarbdietdoesreduceinsulincomparedtoastandarddiet,butfastingreducesitevenmore.

Source:DatafromNuttalletal.,“ComparisonofaCarbohydrate-FreeDietVs.FastingonPlasmaGlucose,InsulinandGlucagoninType2Diabetes.”

Figure5.12.Overtime,fastingreducesinsulinlevelsmoreeffectivelythancalorierestriction.

Source:Harvieetal.,“TheEffectsofIntermittentorContinuousEnergyRestrictiononWeightLossandMetabolicDiseaseRiskMarkers:ARandomizedTrialinYoungOverweightWomen.”

Inthelongterm,thisisacrucialproblemwithcaloricreduction.Higher

insulinresistanceeventuallyleadstohigherinsulinlevels,whichinturncontributetohigherinsulinresistanceinaviciouscycle.Thesehigherinsulinlevelsinexorablyleadtoobesity.

Theinabilityofmostdietstoreduceinsulinresistanceisexactlywhytheyeventuallyresultinweightregain.Fasting,ontheotherhand,introducesprolongedperiodsoflowinsulinlevels,whichbreaksthecycleofhighinsulinandinsulinresistance.

Anotherwaytolookatthisisthatmostdietsignorethebiologicalprincipleofhomeostasis.Thebodyadaptstochangingenvironments.Forexample,ifyouareinadarkroomandsuddenlygointothebrightsunlight,youwillmomentarilybeblinded,butwithinmomentsyoureyeswilladapt.Thesameappliestoweightloss.Ifyoumaintainaconstantreduced-caloriediet,thebodywillquicklyadapttoit.Energyexpenditure(metabolism)declinestomatchthereducedintake.Weightplateaus,thenisregained.Thisisnotbecauseyouhavestoppedyourdietbutbecauseyourbodyhasnowadaptedtoit.

Topreventthebodyfromadaptingtothenewweight-lossstrategyandmaintainweightlossrequiresanintermittentstrategy,notaconstantone.Thisisacrucialdistinction.Restrictingsomefoodsallthetimediffersfromrestrictingallfoodssomeofthetime.Thisisthedifferencebetweenfailureandsuccess.

ABELJAMESFASTINGALL-STARSAsacelebritycoachonABC’sMyDietIsBetterThanYours,IworkedwithcontestantKurtMorgan,whobeganthecompetitionat352poundsand52%bodyfat.Afterjust14weeksfollowingtheWildDietwithintermittentfasting,Kurtlostanastounding87pounds.Moreimportantly,Kurtdroppedfrom52%bodyfattolessthan30%bodyfat—nearlydoublingthefatlossresultsofcompetingdietaryapproaches.Inmyexperience,combiningahigh-fat,low-carbnutritionplanwithintermittentfastingandstrategicstrengthtrainingcanresultinrapidanddramaticfatloss.

BariatricSurgery:AnArgumentforFastingOneintensiveweight-lossstrategyhasprovedfarmoresuccessfulthan“eat

less,movemore”:bariatricsurgery,commonlycalled“stomachstapling.”AstudydirectlycomparingBiggestLosercontestants—who,you’llrecall,usedthe

“eatless,movemore”strategybutultimatelyregainedtheweighttheylost—tobariatricpatientswithsimilarweightlossfoundthatwhilethecontestantsexperiencedmetabolicslowdown,thebariatricsurgerygroupdidnot.

Bariatricsurgeryisalsospectacularlysuccessfulforthereversaloftype2diabetes.Inonestudy,astunning95percentofadolescentpatientswithtype2diabeteswhounderwentbariatricsurgerysawtheirdiseasereversed.Inthesamestudy,afterthreeyears,74percentsawtheirhighbloodpressureresolvedand66percentsawtheirabnormallipidsresolved.

Whydoesbariatricsurgeryworksowellwhenotherdietsfail?Therehavebeenmanytheories.Thefirsthypothesisproposedthattheremovalofmostofthehealthystomachproducedthesebenefits.Thenormalstomachsecretesanumberofhormones,so,thetheorywent,removingthestomachmustreducesomemysteryhormone,resultinginthebenefits.

Thisisprettyfar-fetched.Newertypesofweightlosssurgeries,suchasgastricbanding,involveputtingabandaroundthestomachratherthanremovingpartofthestomach.Thiskindofsurgeryisjustassuccessfulatreversingtype2diabetesandreducinginsulinresistance.Sothebenefitcannotbeduetothereductionofsomemysteryhormonesecretedbythestomach.

Anotherthoughtwasthatlossoffatcellsexplainedthebenefits.Fatcells(adipocytes)activelysecretemanydifferenttypesofhormones,suchasleptin,aregulatorofbodyweight.Ifthefatcellsthemselvesplayaroleinsustainingobesity,thenremovaloffatcellswouldbebeneficial.However,liposuction,themechanicalremovalofsubcutaneousfat,hasnometabolicbenefit.Inonestudy,theremovalof10kg(22pounds)ofsubcutaneousfatdidnotsignificantlyimprovebloodsugars.Therewasnometabolicimprovement,onlycosmeticones.

WHATHAPPENSWHENWEBURNFAT:KETONESANDKETOACIDOSIS

Youmayhaveheardofaketogenicdiet—it’sbeenquicklygrowinginpopularityinthelastseveralyearsandisknowntobehelpfulforawiderangeofhealthproblems,includingobesity.Asithappens,aketogenicdietandfastinghaveseveralfeaturesincommon.

Aketogenicdietgetsitsnamefromketonebodies.Thesearesubstancesthe

Aketogenicdietgetsitsnamefromketonebodies.Thesearesubstancesthebodyproducesduringfat-burning;they’rewhatfuelsthebrainwhenglucoseisscarce.Aketogenicdiethelpsshiftthebodyfromburningglucosetoburningfat,whichresultsinthecreationofketones.Ofcourse,fastingcausesthebodytoburnfat,too—andthatmeansitalsoresultsinthecreationofketones.

Bodyfatiscomposedmostlyoftriglycerides,whicharemoleculesmadeofoneglycerolbackbonetowhichthreefattyacidsofvaryinglengthsareattached.

Duringfat-burning,thetriglyceridemoleculeisbrokendownintotheglycerolbackboneandthe3fattyacids.Thefattyacidsareuseddirectlybymostoftheorgansofthebody,includingtheliver,kidney,heart,andmuscles.However,certaincellsarenotabletoburnfat,includingtheinnerpartofthekidney(renalmedulla)andredbloodcells.Tosupplytheglucosethosecellsneed,theliverusestheglycerolbackbonetomanufacturenewglucosemolecules.

Moreimportantly,though,thebraincannotusefattyacids,either.Ketonebodiesproducedduringfat-burningfillthatgap,andthebrainbecomespoweredmostlyonketones,whichsupplyupto75percentofitsenergyneeds.Thisdramaticallyreducesthebrain’sneedforglucose,enablingadequateglucoseproductionfromglycerol.Inthisway,triglyceridesprovideenergyintheformoffattyacids,ketones,andglucose—enoughfortheentirebody.So,yes,thebrainstillrequiresglucosetofunctionnormallyduringfasting,butwedonotneedtoeatglucose.Wecanmanufactureenoughglucosetopowertheentirebodysimplyfrombodyfat.Thisisanormalsituation.Thisisthewayourbodyisdesignedto

work.

Ifyouhavetype1diabetes,youmayhavebeenwarnedaboutthedangersofdiabeticketoacidosis.Thisisn’tthesamethingasketosis,whichissimplythestateofproducingketonebodies.Indiabeticketoacidosis,thebodyproducesketoneseventhoughbloodsugarlevelsareveryhigh.

Inthissituation,insulinlevelsshouldbehightohandlethebloodsugar,butwiththeinsulin-producingpancreaticbetacellsdestroyed,thebodydoesn’tproduceenoughinsulin.(Thisiswhytype1diabeticsneedtotakeinsulin—theirbodiessimplydon’tmakeenough.)Duetothelackofinsulin,thebodyproduceslotsofketones.Butsincethere’splentyofglucoseinthebloodstreamandthebrainpreferstouseglucose,theketonesarenotburnedforfuel.Insteadtheypileupoutsidecells,likeunusedlogsoffirewood.Thiscreatesadangerous,evenlife-threateningsituation.

Inthenormal,non-diabeticsituation,ketonesarehighbutarecontinuouslybeingburnedbythebrainforfuel.Ifyoudon’thavetype1diabetes,don’tworry:youwon’tdevelopketoacidosis!

Butthereisnorealmagicormysteryhere.Bariatricsurgeryworksbecauseittriggersasuddenandseverecaloricreduction.Allofthebenefitsofbariatricsurgeryarealsoseenduringfasting.Simplyput,bariatricsurgeryissurgicallyenforcedfasting.

Bariatricsurgeryrequirespatientstodramaticallyreducetheirfoodintake;eatingtoomuchresultsinnauseaandvomiting.Thissudden,severecaloricreductionallowsthesamehormonaladaptationsseenduringfastingthatkeeptherestingmetabolicratesteady,soitdoesn’tdropasitdoeswhenweightislostduetomoregradual,continualcaloricreduction.Long-termstudiesfoundnodecreaseinmetabolismotherthanthatexpectedduetotheweightlossitself(carrying300poundsofweighttakesmoreenergythancarrying200pounds,soasmallslowdownisexpected—whenwerefertoslowingmetabolism,wemeantheslowdowninexcessofthat).Adrenalineandgrowthhormoneincrease,helpingtomaintainleanmusclemassandkeepmetabolismhigh.Insulinandbloodglucoselevelsfall.The“eatless,movemore”strategyfordailycaloricreductiondoesn’tprovidethesehormonalbenefits.However,fastingdoes.

Head-to-headstudiesrevealthatfastingisactuallysuperiortobariatric

surgeryinbothweightlossandreductioninbloodsugars.Bothmethodsarealsoeffectivefortype2diabetes.Sohere’sthecrucialquestion:Ifallthebenefitsofbariatricsurgerycomefromthesuddenandseverereductionincalories,whynotjustfastandskipthesurgeryentirely?Inessence,fastingisbariatricsurgerywithoutthesurgery.

Thereisapricetobepaidforanysurgery,andwithbariatricsurgery,complicationsarecommon.Withinthreeyearsofthesurgery,13percentofadolescentpatientshadproblemssevereenoughtorequiresurgery.Themostcommoncomplicationinvolvesscarringthatprogressivelynarrowstheesophagus,resultingindifficultyeating.Tofixthis,progressivelylarger-sizedtubesareshoveddownthepatient’sthroatstoopenthingsup.Thisprocedureisoftenrepeatedoverandover.

MARKSISSONFASTINGALL-STARSFastingweightlosscanoftenbefleetingbecauseafairamountofwaterislostintheearlydays(eitherthroughareductionininflammationfromremovingoffendingfoodsorfromthereleaseofglycogenanditsstoredwater).Thekeytoratchetingdowntheweightistonotovereatwhenthefastingperiodhasfinishedandtomaintainamoderateexerciseregimen.

Sowhynotjustfastinstead?Icannotthinkofanygoodreason,butthecommonperceptionisthatifI,asadoctor,recommendcuttingoutaperson’shealthystomachandrewiringtheirintestines,it’sgreatandI’mservingmypatientwell,butifIrecommendfasting,whichaccomplisheseverythingthatbariatricsurgerydoeswithoutanycomplicationsorcosts,thenI’mcrazy.It’sabizarreconclusion.Fastingismuchsaferandeasier,anditsresultsarejustasgood,ifnotbetter.

Perhapsthemostcommonreasonpeoplegivefortheirreluctancetofastisthatitistoodifficult.Yet,toooften,thisassessmentismadebeforeeventryingtofast.Peoplesaythistomeallthetime.“Ican’tfastfortwenty-fourhours.”SoIaskthem,“Howdoyouknow?Haveyoutried?”Towhichtheyanswer,“No,IjustknowthatIcan’t.”

Infact,almosteverybodycanfast.Thereareliterallymillionsofpeoplearoundtheworldwhoregularlyfastforreligiouspurposes,andbeforecertain

bloodtestsorroutineprocedureslikeacolonoscopy,itisstandardtofastforuptotwenty-fourhours.Peoplecanfastiftheysimplytry.Likeanythingelse,fastingbecomeseasierthemoreoftenyoudoit.Itdoesn’ttakeparticularskill—it’snotsomethingtodo,it’ssomethingtonotdo.Yousimplydon’teat.Itissubtraction,notaddition.Thismakesitalmosttheexactoppositeofeverypieceofadviceonhealthevergiven(takevitamins,takedrugs,havesurgery).That’sprobablywhyfastingissosuccessful.ToparaphraseSeinfeld,everybodywantsashowaboutsomething.Thisisashowaboutnothing.

Figure5.13.Bariatricsurgerypatientsdonotshowadecreaseintheirbasalmetabolicrate,unlikepeopleonsimplecaloricreduction(seeFigure5.8).

Source:Dasetal.,“Long-TermChangesinEnergyExpenditureandBodyCompositionAfterMassiveWeightLossInducedbyGastricBypassSurgery.”

Bariatricsurgerycertainlyhasmanyprovenshort-termbenefits,althoughlong-termbenefitsaremorequestionable.Butit’snotnecessary.Imaginebariatricsurgerywithoutthepostoperativecomplications.Withoutthecost.Withouttheneedforexpensivehospitalsorsurgicalequipment.Withouttheneedforspeciallytrainedsurgeons.Allthisispossiblewithwhatwemightcall“medicalbariatrics”—fasting.

FASTINGANDCORTISOL

Cortisolisahormonethat’sreleasedduringtimesofstress,whetherphysicalorpsychological.Thisactivatesthefight-or-flightresponse—it’sasurvivaladaptation.

However,cortisolisalsooneofthemajordriversofobesity.Infact,syntheticcortisol,amedicationcalledprednisone,consistentlycausesweightgain,particularlyinthetrunk.Andbecausefastingmaybeconsideredapotentialstressor,someareconcernedthatitmayraisecortisollevels.

Butstudiesofintermittentfastingshowthatcortisollevelsaregenerallyunaffected.Twoweeksofintermittentfastingcausednoincreaseincortisollevels,andevenaseventy-two-hourfastfailedtoraisecortisollevelssignificantly.Whilelevelsmayvaryamongindividuals,onthewhole,elevatedcortisollevelsarenotamajorconcernduringfasting.Inmyexperience,thevastmajorityofpeoplewhofastdonothaveanyproblemwithelevatedcortisollevels.However,thisdoesnotmeanthatnobodywilleverencounterthisproblem.Onoccasion,Ihavetreatedpatientswhofeltthatfastingnegativelyaffectedtheircortisollevels.Inthesecases,itwasnecessarytochangetheirdietarystrategy.

WhattoExpectWhenFastingforWeightLossTheamountofweightlostonafastingregimenvariestremendouslyfrom

persontoperson.Thelongerthatyouhavestruggledwithobesity,themoredifficultyou’llfindittoloseweight.Certainmedications,suchasinsulin,maymakeithardtoloseweight.Youmustsimplypersistandbepatient.

You’llprobablyeventuallyexperienceaweight-lossplateauastheweightlostduringfastingbeginstomatchtheamountregainedduringeating.(Theonlywaynottoplateauatallistocontinuallyfastforweeksormonthsatatime;otherwise,reachinganequilibriumisinevitable.)Changingeitheryourfastingregimenordiet,orboth,mayhelp.Somepatientsincreasefastingfromtwenty-four-hourperiodstothirty-six-hourperiods,ortryaforty-eight-hourfast.Sometryeatingonlyonceaday,everyday.Otherstryacontinuousfastforanentireweek.Anyofthesecanbeeffective;thekeyissimplytochangethefastingprotocol.

Fastinghasalsobeennotedtotriggeranearlyperiodofrapidweightloss,

Fastinghasalsobeennotedtotriggeranearlyperiodofrapidweightloss,oftenaveragingonetotwopoundsperdayforthefirstfewdays.Thisisn’t,unfortunately,duetolossofbodyfat.Fatlossduringfastingaveragesapproximately½poundperday.Ifyouarelosing1poundormoreaday,theexcessabove½poundiswaterweightandwillrapidlyberegaineduponeating.Thisisnotabnormalorunusual.Don’tbedisappointedwhenthewaterweightreturnsordecidethatfastingdoesn’twork.

References

AlbertStunkardandMavisMcLaren-Hume,“TheResultsofTreatmentforObesity:AReviewoftheLiteratureandReportofaSeries,”AMAArchiveofInternalMedicine103,no.1(1959):79–85.

AlisonFildes,JudithCharlton,CarolineRudisill,PeterLittlejohns,A.TobyPrevost,andMartinC.Gulliford,“ProbabilityofanObesePersonAttainingNormalBodyWeight:CohortStudyUsingElectronicHealthRecords,”AmericanJournalofPublicHealth105,no.9(2015):e54–9.doi:10.2105/AJPH.2015.302773

BarbaraV.Howard,JoAnnE.Manson,MarciaL.Stefanick,ShirleyA.Beresford,GailFrank,BobetteJones,RebeccaJ.Rodabough,etal.,“Low-FatDietaryPatternandWeightChangeover7Years:TheWomen’sHealthInitiativeDietaryModificationTrial,”JAMA295,no.1(2006):39–49.

“BestWeight-LossDiets,”USNews&WorldReport,n.d.,http://health.usnews.com/best-diet/biggest-loser-diet

CentersforDiseaseControl,ObesityPrevalenceMaps,September11,2015,http://www.cdc.gov/obesity/data/prevalence-maps.html.

ChristianZauner,BrunoSchneeweiss,AlexanderKranz,ChristianMadl,KlausRatheiser,LudwigKramer,ErichRoth,BarbaraSchneider,andKurtLenz,“RestingEnergyExpenditureinShort-TermStarvationIsIncreasedasaResultofanIncreaseinSerumNorepinephrine,”AmericanJournalofClinicalNutrition71,no.6(2000):1511–5.

DarcyL.Johannsen,NicolasD.Knuth,RobertHuizenga,JenniferC.Rood,EricRavussin,andKevinD.Hall,“MetabolicSlowingwithMassiveWeightLossDespitePreservationofFat-FreeMass,”JournalofClinicalEndocrinologyandMetabolism97,no.7(20120):2489–96.

DiabetesPreventionProgramResearchGroup,“ReductionintheIncidenceofType2DiabeteswithLifestyleInterventionorMetformin,”NewEnglandJournalofMedicine346(2002):393–403.

ErinFothergill,JuenGuo,LilianHoward,JenniferC.Kerns,NicolasD.Knuth,RobertBrychta,KongY.Chen,etal.,“PersistentMetabolicAdaptation6YearsAfter‘TheBiggestLoser’Competition,”Obesity(2016),onlineMay2,doi:10.1002/oby.21538.

FrankQ.Nuttall,RamiA.Almokayyad,andMaryC.Gannon,“ComparisonofaCarbohydrate-FreeDietVs.FastingonPlasmaGlucose,InsulinandGlucagoninType2Diabetes,”Metabolism:

ClinicalandExperimental64,vol.2(2015):253–62.

GinaKolata,“After‘TheBiggestLoser,’TheirBodiesFoughttoRegainWeight,”NewYorkTimes,May2,2016,http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html.

HodanFarahWellsandJeanC.Buzby,DietaryAssessmentofMajorTrendsinU.S.FoodConsumption,1970–2005,USDepartmentofAgriculture:EconomicResearchService,EconomicInformationBulletin,Number33,March2008.http://www.ers.usda.gov/media/210681/eib33_1_.pdf.

IldikoLingvay,EveGuth,ArsallaIslam,andEdwardLivingstone,“RapidImprovementinDiabetesAfterGastricBypassSurgery:IsIttheDietorSurgery?,”DiabetesCare36,no.9(2013):2741–7.

J.Gjedsted,L.Gormsen,M.Buhl,H.NørrelundH,O.Schmitz,S.Keiding,E.Tønnesen,etal.,“ForearmandLegAminoAcidsMetabolismintheBasalStateandDuringCombinedInsulinandAminoAcidStimulationAftera3-DayFast,”ActaPhysiologica197,no.3(2009):197–205.

JohnB.Dixon,PaulE.O’Brien,JuliePlayfair,LeonChapman,LindaM.Schachter,StewartSkinner,JosephProietto,etal.,“AdjustableGastricBandingandConventionalTherapyforType2Diabetes,”JAMA299,no.3(2008):316–23.

MaartenR.Soeters,NicoletteM.Lammers,PeterF.Dubbelhuis,MariëtteAckermans,CoraF.Jonkers-Schuitema,EricFliers,HansP.Sauerwein,etal.,“IntermittentFastingDoesNotAffectWhole-BodyGlucose,Lipid,orProteinMetabolism,”AmericanJournalofClinicalNutrition90,no.5(2009):1244–51.

MaureenCallahan,“‘We’reAllFatAgain’:More‘BiggestLoser’ContestantsRevealSecrets,”NewYorkPost,January25,2015,http://nypost.com/2015/01/25/were-all-fat-again-more-biggest-loser-contestants-reveal-secrets/.

M.N.Harvie,M.Pegington,M.P.Mattson,J.Frystyk,B.Dillon,G.Evans,J.Cuzick,etal.,“TheEffectsofIntermittentorContinuousEnergyRestrictiononWeightLossandMetabolicDiseaseRiskMarkers:ARandomizedTrialinYoungOverweightWomen,”InternationalJournalofObesity35,no.5(2011):714–22.

NicolasD.Knuth,DarcyL.Johannsen,RobynA.Tamboli,PamelaA.Marks-Shulman,RobertHuizenga,KongY.Chen,NajiN.Abumrad,etal.,“MetabolicAdaptationFollowingMassiveWeightLossIsRelatedtotheDegreeofEnergyImbalanceandChangesinCirculatingLeptin,”Obesity22,no.12(2014):2563–9.

RobertoA.Ferdman,“OneofAmerica’sHealthiestTrendsHasHadaPrettyUnexpectedSideEffect,”WashingtonPost,May24,2016,https://www.washingtonpost.com/news/wonk/wp/2016/05/24/one-of-americas-healthiest-trends-has-had-a-pretty-unexpected-side-effect/.

SaiKrupaDas,SusanB.Roberts,MeganA.McCrory,L.K.GeorgeHsu,ScottA.Shikora,JosephJ.Kehayias,GerardE.Dallal,etal.,“Long-TermChangesinEnergyExpenditureandBodyCompositionAfterMassiveWeightLossInducedbyGastricBypassSurgery,”AmericanJournalof

ClinicalNutrition78,no.1(2003):22–30.

SamuelKlein,LuigiFontana,V.LeroyYoung,AndrewR.Coggan,CharlesKilo,BruceW.Patterson,etal.,“AbsenceofanEffectofLiposuctiononInsulinActionandRiskFactorsforCoronaryHeartDisease,”NewEnglandJournalofMedicine350,no.25(2004):2549–57.doi:10.1056/NEJMoa033179

ThomasE.Inge,AnitaP.Courcoulas,ToddM.Jenkins,MarcP.Michalsky,MichaelA.Helmrath,MaryL.Brandt,CarrollM.Harmon,etal.,“WeightLossandHealthStatus3YearsAfterBariatricSurgeryinAdolescents,”NewEnglandJournalofMedicine374,no.2(2016):113–23.doi:10.1056/NEJMoa1506699

W.J.Pories,K.G.MacDonaldJr.,E.J.Morgan,M.K.Sinha,G.L.Dohm,M.S.Swanson,H.A.Barakat,etal.,“SurgicalTreatmentofObesityandItsEffectonDiabetes:10-YFollow-Up,”AmericanJournalofClinicalNutrition55,no.2(1992):582S–585S.

Chapter6

FASTINGFORTYPE2DIABETES

TheWorldHealthOrganizationreleaseditsfirstglobalreportondiabetes

in2016.It’sclearfromthereportthatdiabetesisanunrelentingdisaster.Since1980,thenumberofpeopleafflictedwithdiabeteshasquadrupled.Howdidthisancientdiseasebecomethetwenty-firstcenturyplague?

Diabetesmellitushasbeenrecognizedforthousandsofyears.TheancientEgyptianmedicaltextEbersPapyrus,writtenaround1550B.C.,wasthefirsttodescribethisconditionof“passingtoomuchurine.”Aroundthesametime,ancientHinduwritingsdiscussthediseaseofmadhumeha,looselytranslatedas“honeyurine.”Patientsweremysteriouslywastingawayandnoattempttofeedthemwassuccessful.Curiously,antswereattractedtotheirurine,whichwasinexplicablysweet.By250B.C.GreekphysicianApolloniusofMemphishadtermedtheconditiondiabetes,whichbyitselfconnotesexcessiveurination.Howisitpossiblethatthisdiseaseofantiquitycoulddominateourcurrenthealth-caresystemdespitealltheadvancesinmedicine,technology,andnutritionofthepastfewthousandyears?

Therearetwomaintypesofdiabetes,type1andtype2.Inmanywaysthesetwoareoppositesofoneanother.Type1diabetesisanautoimmunedisease.Forunknownreasons,thebody’sownimmunesystemattacksanddestroystheinsulin-producingcellsinthepancreas,leadingtoasevereinsulindeficiency.

Type2diabetes,ontheotherhand,isadietaryandlifestyledisease.Inresponsetofrequenthighbloodsugar,thebodyproducesexcessiveinsulin,whichleadstoinsulinresistance—justaswestopbeingabletosmellaparticularodorinaroomafterawhile,thebodystopsbeingabletorespondtoinsulin’ssignalsafterprolongedexposuretoexcessinsulin.Thereisaclearassociationbetweentype2diabetesandobesity,andweightlossoftenreversesthistypeofdiabetes.

Becausetype1diabeticslackinsulin,forthem,insulininjectionsarealife-savingtreatment.However,inthecaseoftype2diabetes,givinginsulintopatientsnotparticularlysuccessful—afterall,theirbodiesarealreadymakingplentyofinsulin(toomuch,infact).Forthem,dietarytherapiesholdthemostpromiseofsuccess.Thehistoryofdietarytherapiesfortype2diabetesgoesbackseveralcenturies,butunfortunately,thelessonsofthepasthavelargelybeenforgotten.

EarlyTreatmentsforDiabetesUpuntilthemid-nineteenthcentury,nospecifictreatmentswereavailable

foreithertypeofdiabetes.Type1diabeteswasuniformlyfataluntilthediscoveryofinsulinin1921.Type2diabeteswasquiteuncommonuntilthetwentiethcentury,fortworeasons:first,itistypicallydiagnosedafteragefifty(infact,itusedtobecalledadult-onsetdiabetes)andaveragelifeexpectancywaslowerthanitistoday,andsecond,foodwasnotnearlyasavailableandplentiful.Thecombinationofrelativefoodscarcityandlowaveragelifeexpectancymeantthattype2diabeteswasrare,andlittleeffortwasexpendedtosearchforeffectivetreatments.Itwasgenerallyacceptedthatdiabeteswasauniformlyfataldiseasewithoutanyspecificoreffectivetreatment.

LCHFgotmehalfway,fastinggotmetherestoftheway!I’vefixedtheinsulin resistance that I’ve had for 20 years, and I’m now down 30pounds.I’maUSsize4at40yearsold.Amazing!

—Claire,Adelaide,Australia

ThischangedwhenApollinaireBouchardat(1806–1886),sometimescalledthefounderofmoderndiabetology,establishedatherapeuticdietfordiabetesbaseduponhisobservationthatduringtheFranco-PrussianWar,periodicstarvationresultedinlessurinaryglucoseexcretion.HisbookDelaGlycosurieouDiabèteSucré(GlycosuriaorDiabetesMellitus)laysouthiscomprehensivedietarystrategy,whichforbadefoodssuchassugarsandstarches.Thisiseerilysimilartothelow-carbohydratedietsthathaverecentlybeenrecognized,onceagain,tobeeffectiveinthetreatmentoftype2diabetes.

Attheturnofthetwentiethcentury,prominentAmericanphysiciansFrederickMadisonAllen(1879–1964)andElliottJoslin(1869–1962)becametheleadingproponentsofintensivedietarytherapyfordiabetes.Allenenvisioneddiabetesasadiseasewherethe“overstrained”pancreascouldnolongerkeepupwiththedemandsofanexcessivediet.Thisideadoesnotstrayfarfromourcurrentunderstandingofthe“burned-out”pancreasintype2diabetes.Allen’shypothesiswasthataseverelyreduceddietwouldreducetheworkloadforthedysfunctionalpancreasenoughthatitcouldcope.Patientscouldthussurviveuntilthepancreascompletelyfailed.

Allen’s“starvationtreatment”waswidelyconsideredthebesttherapy(dietaryorotherwise)untilthediscoveryofinsulinin1921.Thisdietwasvery

(dietaryorotherwise)untilthediscoveryofinsulinin1921.Thisdietwasverylowincalories(800perday)andveryrestrictedincarbohydrates(lessthan10gramsperday).Patientswereadmittedtohospitalandtreatedwithwhiskeyandblackcoffeeeverytwohoursfrom7a.m.to7p.m.;theyabstainedfromallotherfoods.(It’sunclearwhyDr.Allenthoughtwhiskeywasnecessary.)Thiscontinueduntilsugardisappearedfromtheurine.Afterthisinductionphase,low-carbohydratefoodsweregraduallyreintroducedintothediet,alongwithprotein,aslongastheglucoseintheurineremainedlow.Thisdraconianrestrictiononfoodsresultedinmanyreportsofadultsweighingonly65pounds.Nevertheless,theresponseofsomediabeticswasstunning,unlikeanythingseenpreviously.Thesymptomsofexcessiveurinationandthirst,causedbytheglucoseintheurine,oftenimprovedsignificantly.

Allenpublishedhisfirstcaseseriesofforty-fourpatientsin1915intheAmericanJournaloftheMedicalSciences.Between1914and1917,hetreatedafurtherninety-sixpatientswithanaverageadmissionofsixty-ninedays,thelongestbeing304days.Therewasnoshortageofphysiciansreadytorefertheir“hopeless”diabeticstoAllen.However,itisunclearwhetherpatientscontinuedtofollowsuchaSpartandietaryregimenoncedischargedfromhospital.Allenpublisheddetailedclinicalresultsofseventy-sixpatientsinhis1919bookTotalDietaryRegulationintheTreatmentofDiabetes.

ItishighlylikelythatthepatientswhorespondedsowelltoAllen’streatmentwere,infact,sufferingfromtype2diabetesorincompletetype1diabetes.However,theusefulnessofAllen’streatmentwasseverelyhamperedbythelackofunderstandingofthedifferencesbetweentype1andtype2diabetes.Type1diabeticpatientswereoftenseverelyunderweightchildrenwhiletype2diabeticpatientsweremostlyoverweightadults,andtheultra-low-caloriedietcouldbedeadlyfortheseverelymalnourishedtype1diabetics.Infact,manychildrenstarvedtodeathonthisdiet,whichAllenandJoslineuphemisticallycalledinanition,atermthattechnicallyreferstoexhaustionduetostarvation.Itwasatragicoutcome,butkeepinmindthatsincetype1diabeteswasalmostuniformlyfatal,AllenandJoslinweretryingalast-ditchstrategytosavetheirlives.Itwaswidelyunderstood,evenbyAllen,thathistreatmentwasonlyadesperatetrade-offbetweendeathfromdiabetesanddeathfromstarvationandmalnutrition.Nevertheless,itrepresentedthefirstviabletreatmentfordiabetesand,assuch,wasamajoradvance.TheAllendietbecamestandardtreatmentinmanyacademicmedicalcentersandiswidelyacknowledgedtohavesavedthelivesofhundredsorthousandsofpatientsbyallowingthemto

livelongenoughtoheraldthedevelopmentofinsulininjections.Joslin,thefirstAmericandoctortospecializeindiabetesandlikelythe

mostfamousdiabetologistinhistory,foundedtheworld-famousJoslinDiabetesCenterinBostonandwrotetheauthoritativetextbookTheTreatmentofDiabetesMellitus,whichisstillinpublicationtoday.HefoundthatAllen’streatmentsbroughtsignificant,almostmiraculousimprovementsinsomeofhispatientsandwrotein1916,“Thattemporaryperiodsofunder-nutritionarehelpfulinthetreatmentofdiabeteswillprobablybeacknowledgedbyallafterthesetwoyearsofexperiencewithfasting.”

In1921,FrederickBantingandJohnMacleoddiscoveredinsulinattheUniversityofToronto.Therewaswidespreadeuphoriainthebeliefthatdiabeteshadfinallybeencured,andallinterestindietarytreatmentswaseffectivelyterminated.Butunfortunately,thestoryofdiabetesdoesnotendthere.Itwasonlyafalsespring.

Whileinsulinrescuedtype1diabeticsfromthebrinkofdeath,itdidlittletoimprovetheoverallconditionoftype2diabetics.Luckily,intheearlytwentiethcentury,type2diabeteswasstillararedisease,aswasobesity.However,bythelate1970s,therateofobesityhadstarteditsrelentlessmarchupwards.Tenyearslater,type2diabetesstarteditsowninexorableincrease.

Overthepastthirtyyears,therateoftype2diabeteshasincreasedsignificantlyinbothsexes,ineveryagegroup,ineveryracialandethnicgroup,andatalleducationlevels.Itisattackingyoungerandyoungerpatients:pediatricdiabetesclinics,oncethesoledomainoftype1diabetes,arenowoverrunwithanepidemicoftype2diabetes,ofteninobeseadolescents.

Figure6.1.Asthenumberofpeoplewithobesity(definedasaBMIover30)hasincreasedsince1990,sohasthenumberofpeoplewithdiabetes.

Source:“DiabetesandObesityGrowthTrendintheU.S.,”DiabeticCare,blog,http://blog.diabeticcare.com/diabetes-obesity-growth-trend-u-s/.Datafromcdc.gov.

Figure6.2.ThepercentageofAmericanswithdiabeteshasgrownsteadilysince1980,andtherateoftheincreaserosesharplyinthelate1990s.

Source:Datafromcdc.gov.

Despitetheexplosionofmedicaladvancesandknowledgesincethe1800s,ironically,diabetesisanevenbiggerproblemtodaythanitwasthen.Inthe

ironically,diabetesisanevenbiggerproblemtodaythanitwasthen.Inthenineteenthcenturyandbefore,diabeteswasarare,thoughfrequentlyfatal,disease.Fast-forwardto2016,andtherearemoreAmericanswithprediabetesanddiabetesthanwithout:in2012,14.3percentofAmericanadultshaddiabetesand38percenthadprediabetes,foratotalof52.3percent.Diabetesisincreasingineverycorneroftheworld.Almostallthesepatientsareoverweightandwillsuffercomplicationsrelatedtotheirdiabetes.It’soneoftheworld’soldestdiseases,butwheretheincidenceofmostotherdiseaseshasimprovedovertimewithadvancingmedicalknowledge,diabetesisgettingworse,tothepointthatwenowhaveaworldwideepidemic.

Butwhy?Whyarewepowerlesstostopthespreadoftype2diabetes?

ForgottenWisdom:TheRelationshipBetweenType2DiabetesandDiet

Today,diabetesspecialistsconsidertype2diabetestobeachronicandprogressivedisease.However,bariatricsurgery,whichreducesstomachsizetoseverelyrestrictfoodintake,provesthatthisisnottrue.Type2diabetesveryoftenimproveswithinafewweeksofthissurgery,evenbeforemassiveamountsofweightarelost.

AswediscussedinChapter5,bothfastingandbariatricsurgeryresultinasudden,severerestrictionoffoods,soit’snotsurprisingthatfastinghasasimilareffect.Infact,it’sbeenknowntocuretype2diabetesforoverahundredyears.Joslinthoughtthetruthofitwassoobviousthatstudieswerenotevenneeded.Interestingly,visceralfat,fatthat’sstoredinandaroundtheorgans,likelyplaysalargeroleintype2diabetes.It’smoreharmfultohealthand,unfortunately,morecommonthansubcutaneousfat.Fastingandbariatricsurgerybothpreferentiallyreducevisceralfat.

Consider,forexample,theeffectofwartimestarvationontype2diabetes.DuringbothWorldWarIandWorldWarII,themortalityratefromtype2diabetesdroppedprecipitously.Thiswasduetowartimefoodrationing,whichresultedinasustained,severereductionofcalories.Figure6.3showstheco-occurrenceofwartimesugarrationingandadropindeathsfromdiabetes,butkeepinmindthatitwasn’tjustsugarthatwasrationed—almostallfoodswererestricted,resultinginasustained,severecaloriereductionsimilarinmagnitudetoFredrickAllen’sinfamousstarvationdiet.

Figure6.3.Diabetesmortalityimprovedduringwartimerationing.

Source:Cleave,TheSaccharineDisease.

ConsidertheseweeklyrationsforanadultintheUnitedKingdomduringWorldWarII:

Bacon 4ozSugar 8ozTea 2oz

Cheese 2ozButter 2oz

Ithinkmythirteen-year-oldsonwouldeatthroughtheseweeklyrationsina

singlemealandstillaskfordessert!Interestingly,diabeticswereforcedtosurrendertheirsugarrations

completelyandgivenbutterinstead.Intheinterwarperiod,aspeoplewentbacktotheiraccustomedeatinghabits,themortalityratewentbackup,eventhoughinsulininjectionswereintroducedasatreatmentfordiabetesintheearly1920s.

USrationbooksfromWorldWarII.

Figure6.4.Fastingresultsinbetterweightlossandbloodsugarlevelsthanbariatricsurgery.

Source:Lingvay,“RapidImprovementinDiabetesAfterGastricBypassSurgery:IsIttheDietorSurgery?.”

Astudycomparingfastingandbariatricsurgeryrevealedthatfastingisperhapsevenmorebeneficialinthetreatmentoftype2diabetes.Inahead-to-

perhapsevenmorebeneficialinthetreatmentoftype2diabetes.Inahead-to-headcomparison,fastingloweredbothbodyweightandbloodsugarbetterthanbariatricsurgery.

Theseresultsshowthat,ratherthanthechronicandprogressivediseaseit’softenseenas,type2diabetesisatreatableandreversiblecondition.Thischangeseverything.

WhyFastingWorksforType2DiabetesItiswellknownandwellacceptedthattype2diabetesisadiseaseof

insulinresistance.Oneofinsulin’smainjobsistomoveglucosefromthebloodintothetissues,whichuseitasenergy.Wheninsulinresistancedevelops,thenormallevelofinsulinisnotabletomoveglucoseintotissuecells.Why?

Letconsiderananalogy.Imaginethecelltobeasubwaytrain.Glucosemoleculesarethepassengerswaitingtogetinsidethetrain.Insulingivesthesignaltoopenthetraindoors,andthepassengers—theglucosemolecules—marchinaniceorderlymannerintotheemptysubwaytrain.Normally,itdoesn’treallyrequiremuchofapushtogetthisglucoseintothecell.

Figure6.5.Amodelofinsulinresistance:whenacellisoverfilledwithglucose,itappearsresistanttoinsulin’ssignalstoallowmoreglucosetoenter.

Butwhathappensifthetrainisnotempty?Whatifit’salreadyjam-packed

Butwhathappensifthetrainisnotempty?Whatifit’salreadyjam-packedfullofpassengers?Insulingivesthesignaltoopenthedoor,butthepassengerswaitingontheplatformcannotenter.Fromtheoutside,itappearsthatthistrain(cell)isnowresistanttoinsulin’ssignals.

So,whatcanyoudotopackmorepeopleintothetrain?Onesolutionistohiresubwaypusherstoshovepeopleintothetrains.ThiswasimplementedinNewYorkCityinthe1920s,andwhilethepracticehassincediedoutinNorthAmerica,subwaypushersstillexistinJapan,wheretheyareeuphemisticallycalled“passengerarrangementstaff.”

Insulinisthebody’ssubwaypusher,shovingglucoseintothecellnomattertheconsequences.Ifthenormalamountofinsulincan’tgettheglucosein,thenthebodycallsforreinforcements:evenmoreinsulin.Butthemaincauseoftheinsulinresistanceisthatthecellwasalreadyoverflowingwithglucose.

ByutilizingDr.Fung’sadviceonfasting,Iwasabletocomeoffinsulinandjusttakemetformin.IfindnowthatifIfastfor20to23hoursperday—basically only eat dinner—I can get by without taking mymetformin.IfindIfeelbetterifImaintainthisscheduleoffasting.

—LauraK.,Nashville,TN

Becausethecellisoverfilledwithglucose,glucosespillsoutofthecell,leadingtoincreasedbloodglucoselevels.Thisleadstothediagnosisoftype2diabetes.Ifyounowgivemoreinsulin,ordrugsthatstimulatetheproductionofinsulin,thenyes,temporarily,moreglucosecanbeshovedintothecell.However,thereisanaturallimit.Atthatpoint,evenextrainsulinwillnotbeabletomovemoreglucoseintothecell.

Thisisexactlywhathappensinthetypicaltimecourseoftype2diabetes.Atfirst,thediseasecanbetreatedwithasmalldoseofasinglemedicationthatstimulatestheproductionofinsulin.Afterafewyears,thisisnolongerenough,sothedoseisincreased.Afterafewmoreyears,asecond,thenathirdmedicationisadded,allaimedatincreasingtheproductionofinsulin.Finally,insulinitselfisprescribedinhigherandhigherdoses.Theprogressionoftreatmentsisclearlynothelpingtheunderlyingproblem:thetype2diabetesisjustgettingworse.Themedicationsonlyhelpcontrolbloodsugar;theydon’taddresswhat’scausingtype2diabetes.

Extended fasting has lowered my morning (upon awakening) bloodsugartoanall-timelowof4.7.Neverinmy15yearsasadiabetichaveIeverexperiencedthisexceptionalnumber.

—LilianaD.,Toronto,ON

Ifthecoreissueisthatglucoseisoverfillingthecells,thenthesolutionseemsratherobvious:getallthatglucoseoutofthecell!Pushingmorein,aswithinsulintreatments,willonlymakethingsworse.Sohowdoyougetridofexcessglucoseinthebody?(Remember,it’stheglucoseinthetissuecellsthat’stheunderlyingproblem—withoutthat,theglucoseinthebloodstreamisnolongeraproblem.)

Therearereallyonlytwomethodsofgettingthetoxicglucoseoverloadoutofthebody.First,youneedtostopputtingglucoseintothebody.Youcanachievethiswithverylowcarbohydratedietsorketogenicdiets.Indeed,manypeoplehavereversedtheirdiabetesbyfollowingsuchdiets.Fastingalsoeliminatescarbohydrates—andallotherfoods,forthatmatter.

Second,yourbodyneedstoburnofftheexcessglucose.Fastingisagainanobvioussolution.Yourbodyrequiresenergyjusttokeeptheallthevitalorgans,suchastheheart,lungs,liver,andkidneys,working.Yourbraininparticularrequiressubstantialenergytofunctionproperly,evenduringsleep.Duringfasting,nonewglucoseiscomingin,soyourbodyhasnochoicebuttouseupthestoredglucose.

Atitscore,type2diabetesisadiseaseofexcessiveglucose,inourbloodbutalsoinourbodies.Ifyoudon’teat,yourbloodsugarlevelwillcomedown.Onceyourbloodsugarsareconsistentlyinthenormalrange,youwillnolongerbeconsidereddiabetic.Presto!Diabetesreversed.Mischiefmanaged.

CarefulMonitoringIsEssentialIfyouareonmedicationsfortype2diabetesoranyotherconditions,thenit

isimperativethatyouspeakwithyourphysicianbeforeembarkingonthefastingjourney.Mostdiabeticmedicationsworktolowerbloodsugarbasedonyourcurrentdiet.Ifyouchangeyourdietwithoutadjustingyourmedications,thenthereisarealriskofhavinglowbloodsugar,whichisextremelydangerous.Youmayfeelshaky,sweaty,ornauseated.Inmoreseverecases,itmaycauselossofconsciousnessandevendeath.Therefore,itisessentialthatyoudiscussanyplanneddietarychangeswithyourphysiciansoheorshecanmonitoryouandadjustyourmedicationsasnecessary.

andadjustyourmedicationsasnecessary.Mostmedicationsunrelatedtobloodsugarcanbetakenduringfasting,

thoughyoushouldstilldiscussthemwithyourphysicianfirst.Ifyouarenottakinganybloodsugarmedications,thenthereisnoparticularreasontomonitoryourbloodsugarduringfasting:yourbloodsugarmaydropslightlybutwillremaininthenormalrange.

However,ifyouaretakingmedicationfordiabetes—andagain,besureyoutalktoyourphysicianbeforefasting!—thenit’sessentialtofrequentlymonitoryourbloodsugar.Youshouldcheckyourbloodsugaratleasttwiceadayandideallyuptofourtimesadayonbothfastingandnonfastingdays.Certainmedicationsaremorepronetocausinghypoglycemia(lowbloodsugar)thanothers,andyourphysicianwillbeabletoguideyou.

Ioftenadvisepatientstoreduceoravoidtheirbloodsugarmedicationsduringfastingdaysandtoonlytakethemwhenbloodsugargoestoohigh.Iftheyarealittlehigh,itisnotoftenaproblem,sinceyouarenoteatingandcanexpectittocomedownalittlewithoutintervention.However,iftheybecometoohigh,takingadoseofmedicationwillbringitbackdown.Iconsidertheoptimalbloodsugarrangewhilefastingtobe8.0to10.0mmol/L,ifyouaretakingmedication.Thisrangeishigherthanthenonfastingnorm,butthemildlyelevatedlevelsarenotharmfulintheshorttermwhileweareattemptingtoimprovethediabetes,andtheprimarygoalwhileyou’refastingandstillonbloodsugarmedicationistoavoiddangeroushypoglycemiaevents.Thelong-termgoalistosuccessfullyweanyourselfoffmedicationsandmaintainsugarsinthenormalrange.

AMYBERGERFASTINGALL-STARSOneofthebenefitsoffastingisthatithelpsverystronglyinsulin-resistant/hyperinsulinemicpeoplefinallytapintotheirstoredbodyfatforenergy—plustherearethemyriadotherbenefitsthatcomefromreducinginsulinlevels.Afterdecadesofmetabolicdysregulation,somepeoplereallyhavetopulloutallthestopstogettheirinsulinlevelsbackintoahealthyrange,andfastinghelpsmanyaccomplishthis.

Itisgenerallybettertouselessmedicationduringfasting.Ifyourbloodsugargoeshigherthanyouwish,youcanalwaystakemoremedicationtocompensate.However,ifyourbloodsugargoestoolow,youmusteatsome

compensate.However,ifyourbloodsugargoestoolow,youmusteatsomesugar.Thatwillbreakthefastandiscounterproductivetoreversingthediabetes.Again,consultwithyourdoctorbeforeyoutryfastingforyourtype2diabetes.

References

AllanMazur,“WhyWere‘StarvationDiets’PromotedforDiabetesinthePre-InsulinPeriod?,”NutritionJournal10,no.23(2011),doi:10.1186/1475-2891-10-23.

AndyMenke,SarahCasagrande,LindaGeiss,andCatherineC.Cowie,“PrevalenceofandTrendsinDiabetesAmongAdultsintheUnitedStates,1988-2012,”JAMA314,no.10(2015):1021–9,doi:10.1001/jama.2015.10029.

ElliotP.Joslin,TheTreatmentofDiabetesMellitus(Philadelphia:Lea&Febiger,1916).

ElliotP.Joslin,“TheTreatmentofDiabetesMellitus,”CanadianMedicalAssociationJournal6,no.8(1916):673–84.

FrederickAllen,“ProlongedFastinginDiabetes,”AmericanJournalofMedicalSciences150(1915):480–5.

FrederickM.Allen,EdgarStillman,andReginaldFitz,TotalDietaryRegulationintheTreatmentofDiabetes(NewYork:RockefellerInstituteforMedicalResearch,1917).

“FrederickAllen,”Diapedia:TheTextbookofDiabetes(website),August13,2014,http://dx.doi.org/10.14496/dia.1104519416.6.

IldikoLingvay,EveGuth,ArsallaIslam,andEdwardLivingstone,“RapidImprovementinDiabetesAfterGastricBypassSurgery:IsIttheDietorSurgery?,”DiabetesCare36,no.9(2013):2741–7.

T.L.Cleave,TheSaccharineDisease(Bristol,UK:JohnWright&SonsLimited,1974).

MEGAN

FASTINGSUCCESSSTORY

MynameisMegan,andIamthedirectorofDr.Fung’sIntensiveDietaryManagementPrograminToronto.Actually,I’mnotonlytheIDMProgramdirector;I’malsoapatient!Infact,Iwastheprogram’sveryfirstpatient.

Likemostofourpatients,Ihavestruggledwithmyweightandhealthovertheyears.WhenIwasyoungerIcouldeatmyweightinChickenMcNuggetseverydaywithoutgainingapound.Attwenty-three,Ionlyweighedninety-sevenpoundsandatemorethanafratboy.Ididn’thaveproblemsmaintainingmyweightorstayinghealthy,butmymotheralwayswarnedmethingswouldgodownhillatthirty-five.Asitturnedout,ithappenedevensooner.

Justaftermytwenty-sixthbirthday,Isuddenlygainedfifty-threepoundsoveraperiodoffourmonths.Thatyearwastheworstyearofmylife.IwasdrowninginpersonalturmoilandfeltlikeIwassinkinginquicksand.DuringthistimeperiodIsoughtcomfortinfood,particularlyMcNuggets—anditshowed.Astheyearprogressed,Ibecamelessdepressedaboutmypersonallifeandmoredepressedaboutmyphysicalappearance.

Ihadnoenergytodoanythingandexperiencedconstantbrainfog.Istoppedcaringaboutalmosteveryoneandeverything.Icouldn’tgetupforworkinthemorning.IshowedupplaceslookinglikeIwashomeless.

Knowingthatthingsneededtochange,Iadoptedastrictlow-fat,calorie-restricteddiet,limitingmyselfto800caloriesandlessthan15gramsoffatperday.Iatefiveorsixtimesthroughoutthedayandworkedoutforanhourfivetimesaweek.Inthefirsttwoweeks,Ilosttwelvepounds.Butoverthefollowingfourweeks,Ionlylostapoundperweek.Afterthat,theweightlossstoppedaltogether,despitemybestefforts.Infact,IstartedtogainbacksomeoftheweightIhadlost.

IcouldnotfigureoutwhyIwasn’tlosingweight.Imightnothavebeeneatingthehealthiestoffoods,butIwasn’teatingverymuch,either.CarefullytrackingmycaloricintakerevealedthatIwasonlyconsuming1461caloriesand41

mycaloricintakerevealedthatIwasonlyconsuming1461caloriesand41gramsoffateachday.HowwasIgainingweight?Iwasstumped.

IwenttoseeaveryprominentandexpensivedietitianinToronto.Afterreviewingmyfoodlist,shesaidIhadbeenmakingexcellentchoices.Herbestadvice?Ishouldexercisemore.Fivehoursofexerciseaweekwasnotenough?Iwenttothegymeverymorningandeveningforthenexttwoweeks,butmyweightdidnotbudge.ThenexttimeIwentbacktoseethedietitian,sherolledhereyesatme.IknewshethoughtIwaslying.Heradvice?Tryharder.ThatwasthelasttimeIsawher.

Iwasbeyondfrustrated.Ifeltdefeated.Eatingsixsmallmealsdaily,Ineverfeltfull.Iwasconstantlyobsessingoverfood.Notlongafter,Iwasdiagnosedwithaheartconditionandanearlystageofararecancerbelievedtoberelatedtomyaspartameaddiction.BloodworkalsorevealedthatmyHbA1c—amarkerofbloodglucose—hadclimbedupto6.2percent.Iwasnowprediabetic.

HavingworkedasamedicalresearchersinceIwaseighteenyearsold,Iwaswellawareofthedamagethattype2diabetescando.Iliterallywatcheddiabetesdestroypeople’shealtheveryday.Kidneyfailure,nervedamage,blindness,heartattacks,strokes—Ihadseenitall.Iwaspetrified.

Justatthistime,mycolleagueDr.FungwasdevelopingtheIntensiveDietaryManagementProgramtohelppeoplereversetheirdiabetesandobesity,baseduponadeeperunderstandingofthecoreproblem.

Thetruthaboutobesity,insulin,anddiabeteswasalmostthetotaloppositeofeverythingIhadlearnedinuniversityaboutnutrition.Butitmadetotalsense.Atlast,IunderstoodwhyIcouldnotloseweightandhaddevelopedprediabetes.Better,IknewexactlywhatIneededtodoaboutit.

FastingIwon’tlietoyou—Iwasscaredtotryfasting.Thefirstfastingdaywasverydifficult,andIstruggledforthefirsttwoweeks.Onmyfirstattempttodoatwenty-four-hourfast,Ionlylastedfortwenty-twohours.ButItoldmyselfthattwenty-twohourswasstillagreatsuccess.Afterall,thatwastwenty-twohourslongerthanIhadeverfastedbefore.Iwasn’tevenhungrybytheendofthetwenty-twohours.Ididn’tneedtoeat—Ijustwantedto.ThatwaswhenItrulyknewthatfastingismindovermatter.

Ireachedthetwenty-four-hourmarksuccessfullyonmysecondfastingday.Stayingbusywasthekey.IwenttothegymthateveningthinkingIwasgoingtofalloffofthespinbike.Buthey,Ifiguredtherewereenoughpeopletheretosavemeifthathappened.Incredibly,exercisewasactuallyaloteasierwhilefasting!

Eachfastingdaygoteasier.AtfirstIdidexperienceheadaches,butafewcupsofgoodhomemadebonebrothwithseasaltdidthetrick.Afteramonth,theheadacheswereathingofthepast.Myenergylevelsstartedtoincrease.Aftertwomonthsoffasting,Iwasabletoincreasethedurationofmyfasttothirty-sixhourswithoutdifficulty.Nowadays,Iwilloccasionallyaddaseven-dayfastaswell,andmylongestfastwasfourteendays.TherearedaysIactuallyfeelbetterfasting.

Ialsostruggledwiththeideaofahigh-fatdiet.Growingup,Iwastoldbaconwasreservedforpatientsinpalliativecare.Weneveratewholeeggs,justeggwhites.Avocadoswerebanned,andIdon’teverrememberseeingbutterinthehouse,onlymargarine.Ittookawhileformetoadjusttotheideaofeatingmorenaturalfats,butthemoreIate,thebettertheresults.

Reducingcarbswasnoteasy,either.Iexperiencedheadaches,nausea,andtremorsdespitenormalbloodsugarandpressurereadings.IwouldsitinmycarduringlunchbreaksbecauseIfeltlikeIwaswithdrawingfromheroinandthewallswereclosingin.Iwasscaredtogointoashoppingmallandbesurroundedbyfastfood.IfeltliketheMcDonald’sdrive-thruwastryingtopullmycarin.Iwouldavoidcertainroutesonmydailycommute.WasIgoinginsane?Ifoundthateatingmorenaturalfatshelped.Istartedtakingtablespoonsofcoconutoilandeatinghalfofanavocadoonmyeatingdays.

ResultsWithinthreemonthsofstartingmyplan,I’dlostthirty-threepoundsandreachedmytargetweight.Afewmonthslater,Ihadlostsixtypounds,andImaintainedthatweightforoverayearandahalfwithoutdifficulty.Infact,Ilostanotherfifteenpoundsofunhealthyfatwithouttrying,andputontenpoundsofleanmuscletissuebesides.

MyhemoglobinA1cinMarch2016was4.7percent,havingremainedunder5.0percentsinceFebruary2013.Ihaveneverfeltsogoodorbeeninbettershape.Previously,IhadtakenmedicationforADHDwhileattemptingcertaintasks,butnowIdon’tneedanything.Ihaveneverbeenabletofocussowellinmylife!

Istillenjoyholidaysandindulgeonspecialoccasions,butIhavelearnedhowtobalancemydiet.IfIindulgemyselfonavacation,IbalancethisbyfastingmorewhenIcomehome.IwenttoaSanFranciscoGiantsgameonSundayandhadaGhirardellisundae.ItellallofmypatientstohaveoneiftheyareeverinSanFrancisco.MyweightwasupdramaticallyonMonday,butIdidn’tpanic—Iknewthatmostofitwaswaterweight.IfastedonMonday,drinkingalotofwaterandaddingsomecoconutoilintomyteainthemorning.Ihadnoheadaches.Ididn’tfeelnauseous.Myweightwasbackdowntomypre-sundaeweightbyTuesdaymorning.Lifeisallaboutfindingabalance.Feastandfast.Ithasbeeneasyformetomaintainmyweightlossandhealthsince.

IntensiveDietaryManagementProgramMyexperienceshaveenabledmetohelpourpatientsachievetheirownhealthgoals.Ihavedonealotofself-experimentationovertheyears,andthereisnotanythingIaskofourpatientsthatIhavenottriedmyself.AndI’mconstantlylearningfromourpatientseachandeveryday.

Everyindividualhasadifferentexperiencewithfasting.Everyonehasdifferentchallenges.Weworktogetherwiththepatienttofindoutwhatworks.Somepatientsprefertofastfordaysatatimeratherthanonalternatedays.Sometimespatientshavepanicattacksthinkingaboutfastingformorethanaday.Ihelppatientsfindoutwhatworksbestfortheirlifestyle.Icoachthepatientsontheirfastingandtroubleshootanyissuesthatarise.Ihelppatientsworkuptoachievinglongerperiodsoffasting,justasIhadtodo.Weadjustthedurationandfrequencyoffastsdependingontheirgoalsandprogress.

Nutritionisanimportantaspectoftheprogram.Ourgoalistotrytolimithowmuchinsulinthebodyneedstoproduceeachday.Thisiseasyduringfastingdaysbecausethebodywillonlyproducetheamountofinsulinrequiredtofunctionnormally.However,thispresentsabitofachallengeoneatingdays.Ihelptransitionpatientstoahigh-fat,moderate-protein,andlow-carbohydratediet.MostpeoplearejustasperplexedasIwasaboutwhattheycaneatoncecarbohydratesaredrasticallyreduced.Letmereassureyou,therearemanygreatfoodsthatyoucanindulgeinthatwillleaveyoucompletelysatiated.I’velearnedtoenjoyeggsinathousanddifferentways.Ieatchickenwingsandbaconregularly.Youcaneatbaconandeggsguilt-freebecauseyouknowyouaredoingsomethingreallygoodforyourbody!Itsoundsreallyweird,Iknow.

MostofourIDMpatientshavetype2diabetesorprediabetes.Nonalcoholicfattyliverdisease,sleepapnea,andpolycysticovarysyndromearecommon.Weoffertwodifferentprogramstoourpatients:ourin-officeclinicandourlong-distanceprogram.Icoachpatientsinbothprogramsonhowtofastandwhatandwhentoeat.Ourin-officeprogramtreatspatientsfromacrossCanada.Sometimestheywilldothelong-distanceprograminbetweenofficevisits.Wewillseepatientsweekly,biweekly,ormonthlyfortheirdurationinourprogram.Ourlong-distanceprogramallowsmetoconnectwithpeopleallovertheworldandofferthemthesameadviceandpatienteducation.

Thelong-distanceprogramhashelpedfurtherdiversifymyknowledgeabout

Thelong-distanceprogramhashelpedfurtherdiversifymyknowledgeaboutfoodandnutritionamongavarietyofdifferentcultures.JustthismorningIwasabletospeaktoawomaninSwedenandamaninSingapore.WehavepatientsinFrance,NewZealand,Australia,SouthAfrica,India,China,theUnitedKingdom,andthroughoutvariouspartsofNorthAmerica.

Ithasbeensuchahonortowatchthetransformationsinmypatients.ForthefirsttimeinmycareerIgettowatchpeoplegetbetter.Almosteverytimeapatientcomestoseeus,theyarealittlebitbetterthanthetimebefore.Itisthemostincrediblefeelingtowitnessthisfirsthand.Iamsoproudandgratefultoworkwithsuchanamazinggroupofpatients,whoworksohardandaresodedicatedtoachievingahealthierlifestyle.

Chapter7

FASTINGFORAYOUNGER,SMARTERYOU

Themostobviousbenefitsoffastingarethatithelpswithweightlossand

type2diabetes,buttherearemanyotherbenefits,includingautophagy(acellularcleansingprocess),lipolysis(fat-burning),anti-agingeffects,andneurologicalbenefits.Inotherwords,fastingcanbenefityourbrainandhelpyourbodystayyounger.

BoostingBrainpowerMammalsgenerallyrespondtoseverecaloricdeprivationbyreducing

organsize,withtwoprominentexceptions:thebrainand,inmales,thetesticles.Reproductivefunctionispreservedtopropagatethespecies.Butcognitivefunctionisjustasimportantandalsohighlypreserved,attheexpenseofeveryotherorgan.

Thismakesalotofsensefromanevolutionarystandpoint.Supposefoodisscarceanddifficulttofind.Ifcognitivefunctionstartedtodecline,thementalfogwouldmakeitthatmuchhardertofindfood.Ourbrainpower,oneofthemainadvantageswehaveinthenaturalworld,wouldbesquandered.Sowhatactuallyhappensduringcaloricdeprivationisthatthebrainmaintainsorevenboostsitsabilities.Thebest-sellingnovelUnbroken,byLauraHillenbrand,describestheexperiencesofAmericanprisonersofwarinJapanduringWorldWarII.Duringtheirextremestarvation,theprisonersexperiencedsomeastonishingmentalclaritythattheythemselvesunderstoodwasduetotheeffectofstarvation.OnemanwasabletolearnNorwegianinjustunderaweek.Anotherdescribed“reading”entirebooksfrommemory.

ABELJAMESFASTINGALL-STARSOriginally,Iwasinterestedinthefastingresearchthatdemonstratedareductionininflammationandincreaseingrowthhormone.However,whenIbeganfastingthroughthemorning,Iimmediatelynoticedasignificantincreaseinmentalfocus,energy,andproductivity.Asabrainsciencegeek,I’mimpressedbythementalbenefitsoffat-adaptationandintermittentfasting.

Humans,likeallmammals,haveanincreaseinmentalactivitywhen

Humans,likeallmammals,haveanincreaseinmentalactivitywhenhungryandadecreasewhensatiated.Wehaveallexperienceda“foodcoma”—thinkabouthowyoufeelafterabigThanksgivingmeal,completewithturkeyandpumpkinpie.Areyoumentallysharpasatack?Ordullasaconcreteblock?Despitepopularbelief,it’snotthetryptophanintheturkeycausingthatpostprandialdrowsiness—infact,turkeyhasaboutthesameamountoftryptophanasotherpoultry.It’sjustthesheeramountoffood.Astheamountofbloodgoingtothedigestivesystemisincreasedtohandleallthatturkeyandpie,lessbloodisavailabletogotothebrain.Abouttheonlymentalchallengewecanhandleafterthatenormousmealissittingonthecouchwatchingfootball.

I ama 58-year-oldwoman. I intermittent fast almost daily for 16–18hours. I find that I havemore energy to get through aworkout in afastedstate.Ialsohavebettermentalclarity.

—DianeZ.,Chicago,IL

Howabouttheopposite?Thinkaboutatimethatyouwerereally,reallyhungry.Wereyoutiredandsluggish?Idoubtit.Youwereprobablyhyperalert,yoursensessharpasaneedle.Animalsthatarecognitivelysharpandphysicallyagileduringtimesoffoodscarcityhaveaclearadvantagewhenitcomestosurvival.Ifmissingasinglemealreducedourenergyandmentalacuity,wewouldhaveevenmoretroublefindingfood,makingitmorelikelythatwewouldgohungryagain,leadingtoaviciouscycleendingindeath.That’snot,ofcourse,whathappens.Ourancientancestorsgrewmorealertandactivewhenhungrysothattheycouldfindtheirnextmeal—andthesamethingstillhappenstous.

Evenourlanguagereflectstherelationshipbetweenhungerandmentalacuity.Whenwesaywearehungryforsomething—hungryforpower,hungryforattention—doesitmeanweareslothfulanddull?No,itmeansthatweareonourtoes,alertandreadyforaction.Fastingandhungerenergizeusandactivateustoadvancetowardsourgoal,despitepopularmisconceptionstothecontrary.

Inonestudyofmentalacuityandfasting,noneofthefactorsmeasured—includingsustainedattention,attentionalfocus,simplereactiontime,andimmediatememory—werefoundtobeimpaired.Anotherstudyoftwodaysofalmosttotalcaloricdeprivationfoundnodetrimentaleffectoncognitiveperformance,activity,sleep,andmood.

I’vespent6monthsdoingalternate-dayfastingaswellasperiodic1–5dayfasts.Thefirstday is thehardest,butI feelsofocusedonfastingdays,itisworthit!

—ScottJ.,Minneapolis,MN

That’swhathappenstoourbrainsduringfasting.Buttheneurologicalbenefitsoffastingaren’tlimitedtothetimeswhenwe’reactuallyforgoingfood.Animalstudiesshowthatfastinghasremarkablepromiseasatherapeutictool.Agingratsstartedonintermittentfastingregimensmarkedlyimprovedtheirmotorcoordination,cognition,learning,andmemory.Interestingly,therewasevenincreasedbrainconnectivityandnewneurongrowthfromstemcells.Aproteincalledbrain-derivedneurotrophicfactor(BDNF),whichsupportsthegrowthofneuronsandisimportantforlong-termmemory,isbelievedtoberesponsibleforsomeofthesebenefits.Inanimals,bothfastingandexercisesignificantlyincreasethebeneficialBDNFeffectsinseveralpartsofthebrain.Comparedtonormalmice,miceonanintermittentfastingregimenshowedlessage-relateddeteriorationofneuronsandfewersymptomsofAlzheimer’sdisease,Parkinson’sdisease,andHuntington’sdisease.

Humanstudiesoncaloricreductionfindsimilarneurologicbenefits—andsincefastingcertainlyrestrictscalories,thisisoneareawherefastingandcaloricreductionprovidesimilarbenefits.Witha30percentreductionincaloriesconsumed,memorysignificantlyimprovedandthesynapticandelectricalactivityinthebrainincreased.

Inaddition,insulinlevelshaveaninversecorrelationtomemory—thatis,thelowertheinsulinlevel,themorememoryimproves.Ontheflipside,ahigherbodymassindexislinkedtodeclineinmentalabilitiesanddecreasedbloodflowtothoseareasofthebraininvolvedinattention,focus,reasoning,andmorecomplex,abstractthought.Sofastingprovidesneurologicalbenefitstwoways:itdecreasesinsulinandleadstoconsistent,maintainedweightloss.

Figure7.1.Themultiplebeneficialeffectsoffastingonvariouspartsofthebody.

Source:LongoandMattson,“Fasting:MolecularMechanismsandClinicalApplications.”

SlowingAgingWhenyoubuyanewcar,everythingworksgreat.Butafterafewyears,it

startstogetalittlebeatupandneedsmoremaintenance.Youneedtoreplacethebrakepads,thenthebattery,thenmoreandmoreparts.Eventually,thecarisbreakingdownallthetimeandcostingthousandsofdollarstomaintain.Doesitmakesensetokeepitaround?Likelynot.Soyougetridofitandbuyasnazzynewcar.

FASTINGALL-STARSROBBWOLFThereappearstobesignificantresearchindicatingadramaticdropininflammation,improvementsininsulinsignaling,andaneartotal“reset”ofimmunefunctionwithfastsof3–5days.Abnormalandorpre-cancerouscells

immunefunctionwithfastsof3–5days.Abnormalandorpre-cancerouscellsappeartobepushedtowardsapoptosis,whichessentiallyselectsforhealthycelltypes.Intotalthisdescribesaprocesswhichshould(intheory)reversemanyofthesignsandsymptomsofagingwhilereducingtheprocessesthatappeartobeatplayinautoimmunityandcancer.

Inthissense,thecellsofthebodyarelikecars.Astheyage,subcellularpartsneedtoberemovedandreplaced,andeventually,acellgetstoooldtorepairandneedstobedestroyedtomakewayforahealthynewcell.

Inaprocesscalledapoptosis,alsoknownasprogrammedcelldeath,cellsthatreachacertainageareprogrammedtocommitsuicide.Whilethismaysoundkindofmacabreatfirst,theprocessconstantlyrenewscellpopulations,makingitessentialforgoodhealth.Butwhenjustsomecellularcomponentsneedtobereplaced,aprocesscalledautophagykicksin.

Thewordautophagy,coinedbyNobelPrize–winningscientistChristiandeDuve,derivesfromtheGreekauto(“self”)andphagein(“toeat”).Sothewordliterallymeans“toeatoneself.”Autophagyisaformofcellularcleansing:itisaregulated,orderlyprocessofbreakingdownandrecyclingcellularcomponentswhenthere’snolongerenoughenergytosustainthem.Onceallthediseasedorbroken-downcellularpartshavebeencleansed,thebodycanstarttheprocessofrenewal.Newtissuesandcellsarebuilttoreplacethosethatweredestroyed.Inthisway,thebodyrenewsitself.Butitonlyworksiftheoldpartsarediscardedfirst.

Ourbodiesareinaconstantstateofrenewal.Whileweoftenfocusonnewcellgrowth,wesometimesforgetthatthefirststepinrenewalisdestroyingtheold,broken-downcellularmachinery.Butapoptosisandautophagyarebothnecessarytokeepourbodiesrunningwell.Whentheseprocessesarehijacked,diseasessuchascanceroccur,andtheaccumulationofoldercellularcomponentsmayberesponsibleformanyoftheeffectsofaging.Theseunwantedcellularcomponentsbuildupovertimeifautophagocyticprocessesarenotroutinelyactivated.

Increasedlevelsofglucose,insulin,andproteinsallturnoffautophagy.Anditdoesn’ttakemuch.Evenaslittleas3gramsoftheaminoacidleucinecanstopautophagy.Here’showitworks:Themammaliantargetofrapamycin(mTOR)pathwayisanimportantsensorofnutrientavailability.Whenweeatcarbohydratesorprotein,insulinissecreted,andtheincreasedinsulinlevels,orevenjusttheaminoacidsfromthebreakdownofingestedprotein,activatethemTORpathway.Thebodysensesthatfoodisavailableanddecidesthatsince

mTORpathway.Thebodysensesthatfoodisavailableanddecidesthatsincethere’splentyofenergytogoaround,there’snoneedtoeliminatetheoldsubcellularmachinery.Theendresultisthesuppressionofautophagy.Inotherwords,theconstantintakeoffood,suchassnackingthroughouttheday,suppressesautophagy.

Conversely,whenmTORisdormant—whenit’snotbeingtriggeredbyincreasedinsulinlevelsoraminoacidsfromingestedfood—autophagyispromoted.Asthebodysensesthetemporaryabsenceofnutrients,itmustprioritizewhichcellularpartstokeep.Theoldestandmostworn-outcellularpartsgetdiscarded,andaminoacidsfromthebroken-downcellpartsaredeliveredtotheliver,whichusesthemtocreateglucoseduringgluconeogenesis.Theymayalsobeincorporatedintonewproteins.It’simportanttonotethatthedormancyofmTORisonlyrelatedtoshort-termnutrientavailabilityandnotthepresenceofstoredenergy,suchasliverglycogenorbodyfat.WhetherthebodyhasstoredenergyisirrelevantformTORandthereforeforautophagy.

AMYBERGERFASTINGALL-STARSForpeoplewithchronicinflammatoryand/orneurologicalconditions,fastingcanhelpaccelerateautophagyandthebody’sclearing-outofold,damagedtissue.Thebodyengagesin“housecleaning”allthetime,butwhenitgetsabreakfromtheconstantdigestionoflargeamountsoffood,itmaybeabletofocusmoreenergyonrepairandrestoration.

Thisiswhythestrongeststimulustoautophagycurrentlyknownisfasting,andwhyfastingalone,uniqueamongdiets,stimulatesautophagy—simplecaloricrestrictionordietingisn’tenough.Byeatingconstantly,fromthetimewewakeuptothetimewesleep,wepreventtheactivationofautophagy’scleansingpathways.Simplyput,fastingcleansesthebodyofunhealthyorunnecessarycellulardebris.Thisisthereasonlongerfastswereoftencalledcleansesordetoxifications.

Atthesametime,fastingalsostimulatesgrowthhormone,whichsignalstheproductionofsomenewsnazzycellparts,givingourbodiesacompleterenovation.Sinceittriggersboththebreakdownofoldcellularpartsandthecreationofnewones,fastingmaybeconsideredoneofthemostpotentanti-agingmethodsinexistence.

AutophagyalsoplaysanimportantroleinthepreventionofAlzheimer’s

AutophagyalsoplaysanimportantroleinthepreventionofAlzheimer’sdisease.Alzheimer’sischaracterizedbytheabnormalaccumulationofamyloidbeta(Aß)proteinsinthebrain,andit’sbelievedthattheseaccumulationseventuallydestroythesynapticconnectionsinthememoryandcognitionareas.Normally,clumpsofAßproteinareremovedbyautophagy:thebraincellactivatestheautophagosome,thecell’sinternalgarbagetruck,whichengulfstheAßproteintargetedforremovalandexcretesit,soitcanberemovedbythebloodandrecycledintootherproteinorturnedintoglucose,dependinguponthebody’sneeds.ButinAlzheimer’sdisease,autophagyisimpairedandtheAßproteinremainsinsidethebraincell,whereeventualbuildupwillresultintheclinicalsyndromesofAlzheimer’sdisease.

Cancerisyetanotherdiseasethatmaybearesultofdisorderedautophagy.We’relearningthatmTORplaysaroleincancerbiology,andmTORinhibitorshavebeenapprovedbytheFoodandDrugAdministrationforthetreatmentofvariouscancers.Fasting’sroleininhibitingmTOR,therebystimulatingautophagy,providesaninterestingopportunitytopreventcancer’sdevelopment.Indeed,someleadingscientists,suchasDr.ThomasSeyfried,aprofessorofbiologyatBostonCollege,haveproposedayearlyseven-daywater-onlyfastforthisveryreason.

FASTINGALL-STARSDR.THOMASSEYFRIEDFastingcanlimitgrowthofglucose-dependenttumors.Fastingcanalsotargetinflammationthatcontributestotheinitiationandprogressionoftumors.Weshowedthatfastingorcalorierestrictioncouldsignificantlyreducedistaltumorinvasioninourpreclinicalmodelsofbraincancer.

References

AnneM.Cataldo,CorrinneM.Peterhoff,JuanC.Troncoso,TeresaGomez-Isla,BradleyT.Hyman,andRalphA.Nixon,“EndocyticPathwayAbnormalitiesPrecedeAmyloidβDepositioninSporadicAlzheimer’sDiseaseandDownSyndrome,”AmericanJournalofPathology157,no.1(2000);277–86.

AnneM.Cataldo,DeborahJ.Hamilton,JodyL.Barnett,PeterA.Paskevich,andRalphA.Nixon,“PropertiesoftheEndosomal-LysosomalSystemintheHumanCentralNervousSystem:DisturbancesMarkMostNeuronsinPopulationsatRisktoDegenerateinAlzheimer’sDisease,”

JournalofNeuroscience16,no.1(1996):186–99.

A.V.Witte,M.Fobker,R.Gellner,S.Knecht,andA.Flöel,“CaloricRestrictionImprovesMemoryinElderlyHumans,”ProceedingsoftheNationalAcademyofSciencesoftheUnitedStatesofAmerica106,no.4(2009):1255–60.

DanielleGlick,SandraBarth,andKayF.Macleod,“Autophagy:CellularandMolecularMechanisms,”JournalofPathology221,no.1(2010):3–12.

ErinL.Glynn,ChristopherS.Fry,MicahJ.Drummond,KyleL.Timmerman,ShaheenDhanani,ElenaVolpi,andBlakeB.Rasmussen,“ExcessLeucineIntakeEnhancesMuscleAnabolicSignalingButNotNetProteinAnabolisminYoungMenandWomen,”JournalofNutrition140,no.11(2010):1970–6.

HarrisR.Lieberman,ChristinaM.Caruso,PhilipJ.Niro,GinaE.Adam,MarkD.Kellogg,BradleyC.Nindl,andF.MatthewKramer,“ADouble-Blind,Placebo-ControlledTestof2DofCalorieDeprivation:EffectsonCognition,Activity,Sleep,andInterstitialGlucoseConcentrations,”AmericanJournalofClinicalNutrition88,no.3(2008):667–76.

HelenaPópulo,JoseManuelLopes,andPaulaSoares,“ThemTORSignallingPathwayinHumanCancer,”InternationalJournalofMolecularSciences13,no.2(2012):1886–1918.

KristenC.Willeumier,DerekV.Taylor,andDanielG.Amen,“ElevatedBMIIsAssociatedwithDecreasedBloodFlowinthePrefrontalCortexUsingSPECTImaginginHealthyAdults,”Obesity19,no.5(2011):1095–7.

MarkP.Mattson,“EnergyIntakeandExerciseasDeterminantsofBrainHealthandVulnerabilitytoInjuryandDisease,”CellMetabolism16,no.6(2012):706–22.

MelanieM.Hippert,PatrickS.O’Toole,andAndrewThorburn,“AutophagyinCancer:Good,Bad,orBoth?,”CancerResearch66,no.19(2006):9349–51.

MichaelW.Green,NicolaA.Elliman,PeterJ.Rogers,“LackofEffectofShort-TermFastingonCognitiveFunction,”JournalofPsychiatricResearch29,no.3(1995):245–53.

NoboruMizushima,“Autophagy:ProcessandFunction,”Genes&Development21,no.22(2007):2861–73.

PerNilsson,KrishnapriyaLoganathan,MisakiSekiguchi,YukioMatsuba,KelvinHui,SatoshiTsubuki,MotomasaTanaka,NobuhisaIwata,TakashiSaito,andTakaomiC.Saido,“AβSecretionandPlaqueFormationDependonAutophagy,”CellReports5,no.1(2013):619–69.

ValterD.LongoandMarkP.Mattson,“Fasting:MolecularMechanismsandClinicalApplications,”CellMetabolism19,no.2(2014):181–92.

ZhinengJ.Yang,ChengE.Chee,ShengbingHuang,andFrankA.Sinicrope,“TheRoleofAutophagyinCancer:TherapeuticImplications,”MolecularCancerTherapeutics10,no.9(2011):1533–41.

Chapter8

FASTINGFORHEARTHEALTH

Alittlestarvationcanreallydomorefortheaveragesickmanthancanthebestmedicinesandthebestdoctors.

—MarkTwain

Highbloodcholesterolisclassicallyconsideredatreatableriskfactorforcardiovasculardisease,includingheartattacksandstrokes.That’sledtoapopularconceptionofcholesterolassomekindofpoison,butthisisfarfromthetruth.Cholesterolisusedtorepaircellwallsandalsotomakecertainhormones.Itissovitalforhumanhealththatvirtuallyeverycellinthebodyhastheabilitytomanufacturecholesterolifneeded.

Traditionally,bloodtestsmeasurelow-densitylipoprotein(LDL),or“bad,”cholesterol,andhigh-densitylipoprotein(HDL),or“good,”cholesterol.Cholesteroltravelsinthebloodstreambundledtogetherwithproteins,whicharethencalledlipoproteins.WhichlipoproteinsareassociatedwiththecholesterolmoleculedetermineswhetherthebundleisLDLorHDL—thecholesterolmoleculeitselfisthesame.

Whatwecall“highcholesterol”referstoLDLcholesterol,andlargeepidemiologicalstudieshaveassociatedincreasedlevelsofLDLwithincreasedriskofcardiovasculardisease.Certaindrugs,particularlystatins,cansignificantlyreducethelevelsofLDL.Butwhatcausedittogoupinthefirstplace?Thisquestionstillhasnosatisfactoryanswer.However,theinitialhypothesiswasthatitmustbeadietaryproblem.Turnsout,aswe’llexploreinamoment,that’snotthecase.

Anotherriskfactorforheartdiseaseisatypeoffatcalledtriglycerides.Whenglycogenstoresintheliverarefull,theliverstartsconvertingexcesscarbohydratesintotriglyceridesinstead.Thesetriglyceridesarethenexportedoutoftheliverasverylowdensitylipoprotein(VLDL).VLDLisusedtoformLDL.

Highlevelsoftriglyceridesinthebloodarestronglyassociatedwithcardiovasculardisease.ItisalmostaspowerfulariskfactorashighLDLcholesterol,whichiswhatdoctorsandpatientstendtobemoreconcernedabout.

cholesterol,whichiswhatdoctorsandpatientstendtobemoreconcernedabout.Higherbloodtriglyceridelevels,independentofLDL,increasetheriskofheartdiseasebyasmuchas61percent.ThisisconcerningbecausetheaveragetriglyceridelevelhasbeenrisinginexorablyintheUnitedStatessince1976,alongwithtype2diabetes,obesity,andinsulinresistance.Anestimated31percentofadultAmericansarecurrentlyestimatedtohaveelevatedtriglyceridelevels,parallelingtheriseinconsumptionofcarbohydrates.

Fortunately,hightriglyceridescanbetreatedwithalow-carbohydratediet,whichlowerstherateatwhichthelivercreatestriglycerides.Butwhiletriglyceridelevelsrespondtodiet,thesamecannotbesaidforcholesterol.

IdoIFeveryotherday,about20hours.Ihaveabsolutelynoproblemsfinishingmyworkoutsorotheractivities.Ihavefoundthebiggestthingithashelpedwithismydigestion.Iamwaymoreregularnow,andIalsocanalsogolongerbetweenmeals.InoneyearIalsoimprovedmytriglyceridesfrom135to100andraisedmyHDLacouplepointsto60.

—BrianW.,Dayton,OH

HighCholesterolIsn’taDietaryProblemIfeatingtoomuchdietarycholesterolcausedbloodcholesterollevelstogo

up,thenitwouldbereasonabletoassumethateatinglesscholesterolwouldlowerbloodcholesterollevels.Andoverthelastthreedecades,health-careprofessionalshaveexhortedpeopletoreducetheirdietarycholesterolintakebyeatingfewerhigh-cholesterolfoods,suchaseggyolksandredmeat.TheUSDA’sDietaryGuidelinesforAmericans,fromitsveryinception,statedquiteclearlythatweshould“avoidtoomuchfat,saturatedfat,andcholesterol.”

Unfortunately,thisideaisentirelywrong.Thescientificcommunityhaslongknownthateatinglesscholesteroldoesnotlowerbloodcholesterol.Ourlivergenerates80percentofthecholesterolfoundintheblood,soeatinglesscholesterolmakeslittleornodifference.Bythesametoken,eatingmorecholesteroldoesnotraisebloodcholesterolsignificantly.Ifweeatlessdietarycholesterol,ourliversimplycompensatesbycreatingmore,sotheneteffectisnegligible.Furthermore,it’snotthecholesterolparticleitselfthat’scauseforconcern—remember,that’sidenticalinbothLDLandHDL.It’sinsteadthe

lipoproteinscarriedalongwiththecholesterolparticlethatdeterminewhetherit’sgoodorbad.Reducingthecholesterolinourfoodsmakeslittleornophysiologicaldifference,afactthatwasprovenlongago.

Ourirrationalfearofdietarycholesterolbeganin1913.Atheroscleroticplaques,theblockagesinthearteriesthatcauseheartattacksandstrokes,arepredominantlycomposedofcholesterol,anditwashypothesizedthattheseplaqueswerecausedbytoomuchdietarycholesterol.Thismakesasmuchsenseassupposingthateatingbeefheartwillmakeyourownheartstronger,butthen,thiswas1913.Thatyear,RussianscientistNikolaiAnichkovdiscoveredthatfeedingcholesteroltorabbitscausedatherosclerosis.Rabbits,however,areherbivoresandaren’tmeanttoeatfoodsthatcontaincholesterol.Feedingalionhaywouldalsocausehealthproblems.Unfortunately,thisfundamentalfactwasnotappreciatedintherushtofindaculpritfortheplaques.

AncelKeysconfirmedthatdietarycholesterolwasnotaproblemasearlyasthe1950s.Oneofthepreeminentnutritionalresearchersofhisera,hefedhumansubjectsincreasingamountsofcholesteroltoseeiftherewasanyresultingincreaseinbloodcholesterollevels.Therewasnot.HisSevenCountriesStudy,oneofthelargestepidemiologicalstudiesofdietandnutritioneverdone,alsoestablishedthateatingcholesteroldoesnotraisebloodcholesterol.

Asdietarycholesterolwasacquitted,dietaryfatbecametheprimesuspect—perhaps,thethinkingwent,highdietaryintakeoffatsomehowleadstoincreasedcholesterollevels.This,too,haslongbeendisproven,primarilybytheFraminghamstudies.In1948,theresidentsofFramingham,Massachusetts,wereenrolledinalong-termstudythatfollowedallaspectsoftheirlifestyles,includingdiet,toestablishwhatfactorsareimportantinthedevelopmentofheartdisease.Itisstillrunningstrong,nowwithitsthirdgenerationofparticipants.ThousandsofmedicalpapershavebeenwrittenabouttheFraminghamHeartStudy,buthistoryhasvirtuallyforgottentheFraminghamDietStudy.

TheoriginalFraminghamstudy.

Source:Dr.MichaelEades.

Thisambitiousstudy,whichranfrom1957to1960andinvolvedoveronethousandparticipants,attemptedtofindaconnectionbetweendietaryfatandbloodcholesterol—whichresearchersalreadybelievedexisted.Aftermillionsofdollarsandyearsofpainstakingobservation,exasperatedresearchersfailedtodiscoveranydiscernablecorrelationbetweendietaryfatandbloodcholesterollevels.Whetherpeopleatealotoffatorverylittlefatmadenodifferencetocholesterol.

Thesefindingsclashedvigorouslywiththeprevailingconventionalwisdom,andresearcherswerepresentedwithachoice.Theycouldaccepttheseresultsandsearchforanutritionaltheoryclosertothetruth,ortheycouldsimplyignorethemandcontinuetobelievewhathadjustbeenprovenfalse.Unfortunately,theytookthelatterchoice.Theresultsweretabulatedandthenquietlysuppressedandneverpublishedinapeer-reviewedjournal.Dissenterstonutritionalorthodoxy,nomatterhowcorrect,werenottobetolerated.

Decadeslater,Dr.MichaelEadestrackeddownalostcopyofthisimportantstudy.ThestatisticianTaviaGordonlamented,“Unfortunately,thesedatawereneverincorporatedintoadefinitivereportbytheoriginalinvestigatorsandalargeamountofverycarefulandthoughtfulworkhaslainunusedintheFraminghamfiles.”Thestudyfoundthat“thereisaslightnegativeassociationbetweendailyintakeoftotalfat(andalsoofanimalfat)withserumcholesterollevel.”Inotherwords,themoredietaryfateaten,thelowerbloodcholesterol.

level.”Inotherwords,themoredietaryfateaten,thelowerbloodcholesterol.AndalocalnewspaperarticlefromthetownofFraminghamin1970plainlystated,“ThereisnodiscernablerelationshipbetweenreporteddietintakeandserumcholesterollevelsintheFraminghamDietStudygroup.”

Butthelow-fatreligionprevailed,andhealthyhigh-fatfoodssuchasnuts,avocados,andoliveoilwereincriminatedfordecades.Butthetruthcannotbesuppressedforever,andotherstudieswentontoconfirmthatdietaryfatdoesnotraisecholesterol.

ThelinkbetweendietaryfatandcholesterolwasalsostudiedinthecommunityofTecumseh,Michigan,in1976.Thepopulationwasdividedintothreegroupsbasedonbloodcholesterollevels—low,medium,andhigh.Thedietaryhabitsofeachgroupwerecompared,andtoresearchers’surprise,eachgroupateidenticalamountsoffat,animalfats,saturatedfats,andcholesterol.Onceagain,itwasclearthateatingfatdidnotraisebloodcholesterol.

A1970articleintheFramingham-NatickNewspointedoutthattheFraminghamDietStudyshowednorelationshipbetweendietandbloodcholesterollevels.

Source:Dr.MichaelEades.

Anotherstudyfedonegroupofvolunteersadietthatwas22percentfatandasecondgroupadietthatwas39percentfat.Baselinecholesterolforbothgroupswas173mg/dl.Afterfiftydays,thecholesterollevelsinthelow-fatgroupplummetedto...173mg/dl.Oh.High-fatdietsdon’traisecholesterolmuch,either.Afterfiftydays,cholesterollevelsinthehigh-fatgroupincreasedonlymarginally,to177mg/dl.

I’vebeenpracticingthe16:8IFprotocolandeatinga low-carb,high-fatdietbetween10a.m.and6p.m.onmostdays.AboutonceamonthIkickitintohighgearwithanextended40-hour“fatfast”consistingofsparklingwater, coffeewithbutter, cream, andMCToil, and a littlebone broth.As a result, I’ve lost about 40 pounds in 4months,withdramaticallyimprovedlipidsandglucosemarkers.

—RobertH.,WalnutCreek,CA

Evenfollowingaverystrictlow-fatdiethasnobeneficialeffectsonbloodcholesterol.Inonestudy,LDLdiddecreasemarginallyby5percent,butHDLalsodecreasedby6percent—sinceboth“bad”and“good”cholesteroldropped,theoverallriskprofilewasnotimproved.

Despitealltheevidencetothecontrary,nationaldietaryguidelinesintheUnitedStatesandUnitedKingdomwereintroducedin1977and1983recommendingadheringtoalow-fatdietinordertoreducetheriskofheartdisease.Acarefulmeta-analysisandsystematicreviewbyZoeHarcombeconfirmedthattherewasnoevidencethattheserecommendationswouldbeeffective,eitheratthetimeofpublicationortoday.

Millionsofpeoplefollowalow-fat,low-cholesteroldietbecausetheythinkthatit’sgoodfortheirheart,withoutrealizingthatthesemeasureswerelongagoprovenineffective.FrankHuandWalterWillettoftheHarvardSchoolofPublicHealthwrotein2001,“Itisnowincreasinglyrecognizedthatthelow-fatcampaignhasbeenbasedonlittlescientificevidenceandmayhavecausedunintendedhealthconsequences.”So,doesthismeanthattheonlyreliablewaytolowerbloodcholesterolistotakedrugs?Hardly.Thereisonesimple,naturalmeasurethatlowerscholesterol:fasting.

WhyFastingLowersCholesterolTheliverproducesthevastmajorityofcholesterolfoundintheblood.

Eatinglesscholesterolhasalmostnoeffectontheliver’sproduction.Infact,itmaybecounterproductive.Astheliversenseslessincomingcholesterol,itmaysimplyincreaseitsownproduction.

Sowhydoesfastingaffecttheliver’sproductionofcholesterol?Asdietarycarbohydratesdecline,theliverdecreasesitssynthesisoftriglycerides—sinceexcesscarbohydratesareconvertedtotriglycerides,theabsenceofcarbohydratesmeansfewertriglycerides.RememberthattriglyceridesarereleasedfromtheliverasVLDL,whichistheprecursorofLDL.Therefore,reducedVLDLeventuallyresultsinloweredLDL.

Figure8.1.Alternate-dayfastingreducesLDLcholesterol.

Source:Bhutanietal.,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations.”

TheonlyreliablewaytoreduceLDLlevelsistoreducetheliver’sproductionofit.Infact,studiesprovethatseventydaysofalternate-dayfastingcouldreduceLDLby25percent.Thisisfarinexcessofwhatcanbeachievedwithalmostanyotherdietandabouthalfoftheeffectachievedwithastatinmedication,oneofthemostpowerfulcholesterol-reducingmedicationsavailable.Triglyceridelevelsdropby30percent,similartowhatcanbeachievedwithaverylowcarbohydratedietormedication.Notbadforanall-

achievedwithaverylowcarbohydratedietormedication.Notbadforanall-natural,cost-freedietaryintervention.

Plus,whereasstatinscarrytheriskofdiabetesandAlzheimer’sdisease,fastingreducesbodyweight,preservesfat-freemass,anddecreaseswaistcircumference.Inaddition,fastingpreservesHDL,unlikelow-fatdiets,whichtendtodecreasebothLDLandHDL.Overall,fastingproducessignificantimprovementsinmultiplecardiacriskfactors.Forpeopleworriedaboutheartattacksandstrokes,thequestionisnot“Whyareyoufasting?”but“Whyareyounotfasting?”

Figure8.2.Alternate-dayfastingreducestriglyceridelevels.

Source:Bhutanietal.,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations.”

References

A.B.Nichols,C.Ravenscroft,D.E.Lamphiear,andL.D.OstranderJr.,“DailyNutritionalIntakeandSerumLipidLevels.TheTecumsehStudy,”AmericanJournalofClinicalNutrition29,no.12(1976):1384–92.

AncelKeys,“Atherosclerosis:AProbleminNewerPublicHealth,”JournalofMountSinaiHospitalNewYork20,no.2(1953):118–39.

F.Hu,J.Manson,andW.Willet,“TypeofDietaryFatandRiskofCoronaryHeartDisease:A

CriticalReview,”JournaloftheAmericanCollegeofNutrition20,no.1(2001):5–19

GaryJ.Nelson,PerlaC.Schmidt,andDarshanS.Kelley,“Low-FatDietsDoNotLowerPlasmaCholesterolLevelsinHealthyMenComparedtoHigh-FatDietswithSimilarFattyAcidCompositionatConstantCaloricIntake,”Lipids30,no.11(1995):969–76.

GregoryG.Schwartz,MarkusAbt,WeihangBao,DavidDeMicco,DavidKallend,MichaelMiller,HardiMundi,andAndersG.Olsson,“FastingTriglyceridesPredictRecurrentIschemicEventsinPatientswithAcuteCoronarySyndromeTreatedwithStatins,”JournaloftheAmericanCollegeofCardiology65,no.21(2015):2267–75.

IgorE.Konstantinov,NicolaiMejevoi,andNikolaiM.Anichkov,“NikolaiN.AnichkovandHisTheoryofAtherosclerosis,”TexasHeartInstituteJournal33,no.4(2006):417–23.

MichaelEades,“FraminghamFollies,”TheBlogofDr.MichaelR.Eades,M.D.,September26,2006,https://proteinpower.com/drmike/2006/09/26/framingham-follies/.

MichaelMiller,NeilJ.Stone,ChristieBallantyne,VeraBittner,MichaelH.Criqui,HenryN.Ginsberg,AnneCarolGoldberg,etal.,“TriglyceridesandCardiovascularDisease:AScientificStatementfromtheAmericanHeartAssociation,”Circulation123,no.20(2011):2292–333.

R.L.Rosenthal,“EffectivenessofAlteringSerumCholesterolLevelsWithoutDrugs,”Proceedings(BaylorUniversityMedicalCenter)13,no.4(2000):351–5.

SurabhiBhutani,MonicaC.Klempel,ReedA.Berger,andKristaA.Varady,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations,”Obesity18,no.11(2010):2152–9.

ZoëHarcombe,JulienS.Baker,StephenMarkCooper,BruceDavies,NicholasSculthorpe,JamesJ.DiNicolantonio,andFergalGrace,“EvidencefromRandomisedControlledTrialsDidNotSupporttheIntroductionofDietaryFatGuidelinesin1977and1983:ASystematicReviewandMeta-analysis,”OpenHeart2,no.1(2015):e00196,doi:10.1136/openhrt-2014-000196.

Chapter9WHATYOUNEEDTOKNOWABOUTHUNGER

Ihavediscussedthetherapeuticuseoffastingforobesityandtype2diabeteswithhundredsofpatientsovertheyears.Most,ifnotall,peopleunderstandfundamentallywhythistreatmentisundeniablyeffective:Ifyoudon’teat,youwillloseweight.Ifyoudon’teat,yourbloodsugarwilldecrease.Yet,almostuniversally,thereisstillaninitial,severeresistancetotheideaofevenattemptingtoincorporatefastingintotheirlives.Why?Onefearstandslikeacolossusaboveallothers:hunger.

Withoutadoubt,uncontrollablehungeristhemostcommonworryaboutfasting.Evensome“experts”proclaim(incorrectly!)thatthiswillleaveyoupronetosevereovereatingoncethefastisover.Theysay,“Don’tmissasinglemeal,otherwiseyouwillbesohungrythatyouwillbeforcedtostuffyourfacefullofKrispyKremedonuts.”Andmostpeopleworrythattheywillsimplybeunabletocontinuefastingbecausetheywillbeoverwhelmedwithhunger.

Somewhatsurprisingly,practicalexperiencewithhundredsofpatientsshowsthatwhilethey’reonanintermittentfastingregimen,theymostoftenseetheirhungerdiminish,notincrease.Theyoftenreportthatdespitetheirownexpectations,theyareeatinglessthanhalftheirusualamountoffoodonadailybasis,yettheyfeelcompletelyfull.Formostpeople,thisisthemostpleasantsurpriseoffasting.

Westarttofeelhungerpangsapproximatelyfourhoursafterourlastmeal.Soweimaginethatfastingforafulltwenty-fourhourscreateshungersensationssixtimesstronger—andthatwouldbeintolerable.Butthisisdoesnothappen.Overcominghungeroftenseemsadauntingtask,butthatstemsfromafundamentalmisunderstandingaboutthenatureofhunger.

The first threedays, Iwas clamoring for something to chewandwasconsumingmanycupsofbonebrothtomakethefeelinggoaway.Onthefourthday,itdid—allwaswell.Ihaveusedfastingtolosethelast10poundsthatwastoostubborntoleaveme,andnowIdoamonthlyfastforweightmaintenanceandinsulincontrol.

—GloriaM.,Washington,DC

HungerStartsintheMindWeoftenbelievethathungerissimplyanaturalphysiologicalreactionto

noteating,asinevitableasarainstorm.Wehaveamentalimagethatasourstomachfillsupwithfood,itsignalsourbrainthatwearefull.Weimaginethatasourstomachemptiesanddropsbelowacriticalthreshold,ourbrainsignalsustoeat.Thatisnottheentiretruth.Considerhowhungryyoufeelfirstthinginthemorning.Studiesofcircadianrhythmconfirmthatformostpeople,hungerisverylowfirstthinginthemorning,eventhoughithasbeentwelvetofourteenhourssincethelastmeal.Conversely,hungeratdinnertimeisoftenveryhigh,eventhoughwehaveofteneatenlunchjustameresixhoursago.

Hunger,obviously,isnotsimplyareflectionoftheamountoffoodfillingourstomach.Instead,hungerispartlyalearnedphenomenon.Evenwhenwedon’tthinkwe’rehungry,smellingasteakandhearingitsizzlemaymakeusquiteravenous.Thesekindsoffood-relatedstimulidonotneedtobelearned;they’reinnateinalmosteveryone.Butwecanalsolearntobecomehungryduringconditionsthatareintrinsicallyunrelatedwithfood.Forexample,thesoundofadinnerbellcancreatehungerwhereithadnotpreviouslyexisted.ThepowerofthesestimuliwasdemonstratedbytheclassicexperimentsofPavlov’sdogs.

Inthe1890s,theRussianscientistIvanPavlovwasstudyingsalivationindogs.Dogssalivatewhentheyseefoodandexpecttoeat.Thisreactionoccursnaturallyandwithouttraining.Inhisexperiments,labassistantsfedthedogs,andthedogssoonbegantoassociatelabcoatswitheating.Thereisnothingintrinsicallyappetizingaboutamaninalabcoat,butbecausethedogsconsistentlywerefedbyalab-coat-wearingman,thelabcoatandfoodbecamepairedinthedogs’minds.

Soonthedogsbegantosalivateatthesightofthelabcoatsalone,eveniffoodwasnotpresent.IvanPavlov,geniusthathewas,noticedthisassociation,andbeforeyouknowit,hewaspackinghisbagstoStockholmtoreceivehisNobelPrize.

TheapplicabilityofthisPsychology101lessontohungerisobvious.Wecanbecomehungryformanyreasons.Somestimulinaturallymakeushungry,suchasthesmellandsizzleofsteak.Otherstimulineedtobeconsistentlyassociatedwithfoodinordertoprovokehungerontheirown.

Theseconditionedresponsescanbeverypowerful.Infact,therearemeasurablephysicalreactionstothemeresuggestionoffood.Salivation,

pancreaticfluidsecretion,andinsulinproductionincreaseimmediatelyupontheexpectation,nottheactualdelivery,offood.Thishelpssynchronizethegutresponseandtheincomingfood,andisknownasthecephalicphaseresponse.

Thereasongreatrestaurantsspendsomuchtimeandenergyonplatingfoodisbecausetheyunderstandthatourenjoymentdoesnotbeginwiththefirstbite—itbeginswhenweseethefood.Anattractivelyplatedmealmakesushungrierthanthesamefoodsloppedhaphazardlyintoadogdish.Hunger,inthiscase,startswiththeeyes.Butthereareinfiniteotherpossibleassociationswithfoodsthatmakeushungry.

Ifweconsistentlyeateverymorningat7:00a.m.,thenwedevelopaconditionedresponsetothattimeandbecomehungryat7:00a.m.,evenifweateahugemealatdinnerthenightbefore.Thesameappliestolunchanddinnertime.Webecomehungrymerelybecauseofthetime,notanytrueintrinsichunger.Thisislearnedonlythroughdecadesofassociation.Children,ontheotherhand,oftenrefusefoodearlyinthemorningbecausetheyaresimplynothungry.

Similarly,byconsistentlypairingmovieswithdeliciouspopcornandsugarydrinks,themerethoughtofamoviemaymakeushungry.Foodcompanies,ofcourse,spendbillionsofdollarstryingtoconditionustomaketheseassociations.Foodattheballgame!Foodatthemovies!FoodwhilewatchingTV!Foodinbetweenhalvesatourkids’soccergames!Foodwhilelisteningtoalecture!Foodataconcert!Conditionedresponses,everyone.Thepossibilitiesareendless.

Hungerstartsinthemind.

Thereisacoffeeshoporfastfoodrestaurantoneverycorner.TherearevendingmachinesineverynookandcrannyofeverybuildinginNorthAmerica.AndifwestartsalivatinglikePavlov’sdogeveryfourhourssimplybecausetheclocksaysit’stimetoeat,andwe’reconditionedtoassociatethesightofthegoldenarcheswitheating,itislittlewonderwefinditincreasinglydifficulttoresistMcDonald’s.Wearebombardeddailywithimagesofandreferencestofood.ThecombinationoftheirconvenienceandouringrainedPavlovianresponseisdeadlyandfattening.Howcanwefightthis?

DefeatingHungerConditioningIntermittentfastingoffersauniquesolution.Byrandomlyskippingmeals

andvaryingtheintervalsatwhichweeat,wecanbreakourhabitofeatingthreetimesaday,comehellorhighwater.Wenolongerhaveaconditionedresponseofhungereverythreetofivehours.Wenolongerbecomehungrysimplybecauseit’snoonorwe’reatthemovies.That’snottosaywedon’tgethungryatall—wedo,butnotsimplybecausewehaveaconditionedresponsetoacertaintimeoroccasion.Instead,wegethungrybecausewearehungry.Weallowourbodytotelluswhenitneedsnourishmentratherthaneatingbytheclock.

Haveyoueverbeensobusyatworkorschoolthatyousimplyforgottoeatbreakfastandlunch?Youweresimplytoofocusedonthetaskathandtoheedanyofthenumeroushungercues.Yourbodyjustusedsomeoftheplentifulenergystoredasbodyfatasfuel.

AMYBERGERFASTINGALL-STARSFormostpeople,thebiggestobstaclestofastingarepsychological,ratherthanphysiological.Inthemodernindustrializedworld,weareaccustomedtoeating’roundtheclock.Weeatwhenwe’rehappy,sad,bored,excited,stressedout,lonely,watchingtelevision,celebrating,andjustaboutanythingandeverythingelse.Inordertofastsuccessfully,trytodivorceyourselffromthenotionthatyouare“supposedto”eatseveraltimesaday.Itisokay—beneficial,infact—tobecomereacquaintedwithfeelingsofhunger.Infact,it’sactuallykindofnicetogetreacquaintedwiththesignalsourbodiessendus...whenwefinallyallowthemtocomethough.Wearewiredforfeastandfamine,notfeast,feast,feast.

Here’sthesimplestwaytobreakassociationsbetweenfoodandanythingelse:Eatonlyatthetable.Noeatingatyourcomputerstation.Noeatinginthecar.Noeatingonthecouch.Noeatinginbed.Noeatinginthelecturehall.Noeatingattheballgame.Trytoavoidmindlesseating—everymealshouldbeenjoyedasameal,notassomethingeatenwhilewatchingamovie.Inthisway,foodbecomesassociatedonlywiththekitchenandthetable.Thesearenotnewideas,ofcourse;itwasjustcommonsenseinyourgrandmother’sgeneration.

Butinbreakinghabits,goingcoldturkeyisnotoftensuccessful.Instead,itisbettertoreplaceonehabitwithanother,lessharmfulhabit.Thisis,ofcourse,

isbettertoreplaceonehabitwithanother,lessharmfulhabit.Thisis,ofcourse,thereasonthatpeoplewhoaretryingtoquitsmokingoftenchewgum.Ifyourhabitistoeatmunchieswhilewatchingtelevision,simplystoppingwillmakeyoufeellikesomethingismissing.Instead,replacethatsnackinghabitwithahabitofdrinkingacupofherbalorgreentea.Yes,thismayseemweirdatfirst,butyouwillfeelalotlesslikesomethingismissing.Ultimately,swappingonehabitforanotherisafarmoresuccessfulstrategy.

It’salsohelpfultoavoidartificialsweeteners.Eventhoughtheycontainnocalories,theymaystillkickoffthecephalicphaseresponse,stimulatinghungeraswellasinsulinproduction.Idon’trecommendartificialsweetenersduringfastingforthisveryreason.Recentstudiesconfirmthatdietsodasaregenerallynothelpfulforweightloss,probablybecausetheytriggerhungerbutdon’tsatisfyit.

FASTINGALL-STARSABELJAMESFastingcanbeapowerfultooltorecalibrateyourrelationshipwitheatinghabitsandperceivedhunger.Truehungerisgenerallyexperiencedinthebodyandbrain,notinthestomach.Itmaytakesomepractice,butonceyoureconnectwiththefeelingoftruehunger,youcanfollowyourbody’sleadandeatwheneverthefeelingstrikes.

HandlingHungerConditioningDuringFastingOurconditionedresponsetofeelhungeratcertainstimuliandthecephalic

phaseresponsemeanthattherearecertainthingswecandotomakefastingeasier.Ofcourse,therearemanynaturalstimulitohungerthatcannotentirelybeabolished.However,followingsomesimpleruleswillmakehungermucheasiertohandle.

First,asmentionedabove,artificialsweetenerscankickoffthecephalicphaseresponse,triggeringhungerandinsulinproduction,soIrecommendavoidingthemduringafast.Therearecertainlypeoplewhofeelthataddingsweetenerstotheircoffeehelpsthemloseweightbyincreasingcompliancewiththeirfast,andifitworksforyou,great.Butmybestadviceistotrytofastwithouttheuseofsweeteners.Ifyoucannotdothat,thentryaddingasmallamount.However,ifitmakesfastingharderorpreventsyoufromseeingresults,thenstop.

thenstop.Second,trytophysicallyremoveyourselffromallfoodstimuliduringa

fast.Cookingamealorevenjustseeingandsmellingfoodwhilefastingisalmostunbearablydifficult.Thisisnotsimplyamatterofweakwillpower.Ourcephalicphaseresponsesarefullyactivated,andtofeelthoseresponseswithoutactuallyeatingisliketryingtostopapiranhafeedingfrenzy.This,ofcourse,isthesamereasonyoushouldnotshopforfoodwhenhungry,orkeepsnacksinthepantry.

Simplybreakingthehabitofeatingatcertaintimescanbedifficult.Onethingyoucantryistomakeahabitofdrinkingalargecupofcoffeeorteaalongwithbreakfastonnonfastingdays.Onfastingdays,youwillstillmissthefood,buthavingyourdailycupofjoewillmakeiteasiertonoteat—youwon’tbeavoidingthehabitofconsumingsomethinginthemorning.Youcanalsohaveabowlofhomemadebonebrothatdinnertimeonfastingdays.Itmakesfastingeasierinthelongrun.

Oneofourmostimportanttipsforfastingistostaybusy.WorkingthroughlunchandstayingbusymeansIoftendon’tevenremembertobehungry.Mycephalicphaseresponsehasnotbeenactivated.Ifsomebodyweretoputfoodinfrontofme,Iwouldfindithardtoresist,butifthereisonlyapileofpaperwork,Ijustplowrightthroughandforgettobehungry.

TheRealityofHunger:RidingOuttheWaveThere’snodenyingthatyou’llexperiencehungerduringfasting.Butit’s

importanttorememberthathungerisnotasterribleanexperienceasweexpectittobe.WeoftenimaginethathungerwillbuildandbuilduntilitisunbearableandweneedtostuffourselveswithKrispyKremedonuts.However,thisisnotthecaseatall.Thesecretistounderstandthathungercomesinwaves.Youjustneedtorideoutthewaves.

Thinkbacktoatimewhenyouskippedlunch.Perhapsyouwerecaughtupinameetingandcouldn’tgetaway.Atfirst,yougothungry.Thehungerbuiltandbuilt,buttherewasnothingtobedone.Butwhathappenedafteranhourorso?Thehungerentirelydissipated.Thewavehadpassed.

What’sthebestwaytoendurethewaveofhungerduringfasting?Drinkinggreenteaorcoffeeisoftenenough.Bythetimeyou’refinished,thehungerhaspassedandyou’vegoneontothenextthingtodothatday.Hungerisnotacontinuouslygrowingphenomenon.Itwillbuildup,peak,andthendissipate,andallyouhavetodoisignoreit.Itwillcertainlyreturn,butknowingthatitwillpassonceagaingivesyouthepowerandconfidencetohandleit.

OneofthemostimportantthingsIlearnedduringextendedfastingistobepreparedforhungerthefirstfewdaysbyhavingalistofthingstodoasadistraction.Ikeptthelistonmyrefrigerator,andwheneverIfoundmyself opening the refrigerator door to look for something toeat, I would stop and choose something off the list to do instead.Distractions included walking, cleaning out a drawer or a cabinet,drinkingaglassofwater, andanything else I could comeupwith. Itworks,andthehungerwouldbeforgottenbythetimeIwasdone!

—KimberlyH.,Sacramento,CA

Thisevenappliestoextendedfastingperiods.Hungercomesquitestronglyduringthefirstoneortwodaysoffasting,generallypeakingondaytwo.Afterthat,thehungerjustsubsidesandthengoesaway.Somepeoplespeculatethattheketonesgeneratedduringfat-burningareactivelysuppressingappetite.Dr.IanGilliland,anexpertinendocrinology,wroteabouthisexperienceswithfastingpatientsthat“afeelingofwell-beingiscertainlyengendered...andmayamounttoeuphoria.Wedidnotencountercomplaintsofhungerafterthefirstday.”Peopleweren’thungryandactuallyfelt“euphoric”duringfourteendaysoffasting.Somepeoplefeltsogoodduringfastingthattheywantedtocontinuepastthefourteendays.Infact,theabsenceofhungerduringextendedfastingisaconsistentfindingthroughoutthescientificliteratureonfasting,aswellasinourownIDMProgram.

Whenpeoplefeeltheycannotgobeyondtwenty-fourhoursoffasting,wesometimesadvisethemtotrythreetosevenfulldaysoffasting.Thissoundscompletelycounterintuitive.Ifyoucan’tgooneday,howcanyougosevendays?This“hack”worksbecausetheextendedfastinggivespeoplethechancetoexperiencehowhungercandisappearwithouteatingasthebodylearnshowtometabolizeitsownfat.Thelongfastrapidlyacclimatestheirbodiestofasting.Oncetheygetoverthefirstoneortwodays,hungerstartstodisappearandtheybecomereassuredthattheyarenotoverwhelmedbyhunger.Itisapartoffasting,butnotaninsurmountableone.

Ihavereversedmyinsulinresistancewithafastingprotocolof18-hourfastsfor5daysfollowedby2dayswater-onlyfasting.Ialsowater-onlyfast for 10–18 consecutive days every other month. After day 3, all

hunger diminishes, ketones soar, and that’s when I feel invincible! Ifeelbetterat51thanIeverfeltat21!

—DebbieF.,Knoxville,IA

Howcanpeoplefastfordayswithoutbeinghungry?Itcomesdowntothefactthathungerisnotdeterminedbynoteatingforacertainperiodoftime.Rather,itisahormonalsignal.Itdoesnotcomeaboutsimplybecausethestomachisempty.Whenyouavoidnaturalstimulitohunger,suchasthesightandsmelloffood,aswellastheconditionedstimulitohunger—specificmealtimes,movies,ballgames,anyeventwhereyounormallyeatandhavelearnedtoexpectfood—youhelpavoidthathormonalsignal.

Fastinghelpstobreakalltheconditionedstimuliandthushelpstoreduce,notenhance,hunger.

Hungerisastateofmind,notastateofstomach.

References

A.M.Johnstone,P.Faber,E.R.Gibney,M.Elia,G.Horgan,B.E.Golden,andR.J.Stubbs,“EffectofanAcuteFastonEnergyCompensationandFeedingBehaviourinLeanMenandWomen,”InternationalJournalofObesity26,no.12(2002):1623–28.

AmenehMadjd,MoiraA.Taylor,AlirezaDelavari,RezaMalekzadeh,IanA.Macdonald,andHamidR.Farshchi,“EffectsonWeightLossinAdultsofReplacingDietBeverageswithWaterDuringaHypoenergeticDiet:ARandomized,24-wkClinicalTrial,”AmericanJournalofClinicalNutrition102,no.6:1305–12.doi:10.3945/ajcn.115.109397.

I.C.Gilliland,“TotalFastingintheTreatmentofObesity,”PostgraduateMedicalJournal44,no.507(1968):58–61.

DARRYL

FASTINGSUCCESSSTORY

Darryl,asixty-six-year-oldman,wasreferredtomeinNovember2015fortreatmentofhistype2diabetes,whichhe’dhadforelevenyears.Healsosufferedfromhighcholesterolandhighbloodpressure,andhehadonlyonekidney.Hehadbeenexperiencingsignificantlowbackpain,causedinpartbyhisabdominalobesity.Carryingaroundallthatextraweightaroundhisbellythrewoffhisbalanceandputsignificantstrainonhislowerback.Eventuallythiscausedarthritisinhisspineandcripplinglowbackpain.

Hewasreferredtoapainspecialist,whoimmediatelyrecognizedtheclassicfeaturesofthemetabolicsyndromeandknewthatweightlosswouldhelpsignificantlywithhispain.

Darryl’sdiabetesstorywastypical.Hehadstartedwithasmalldoseofasinglemedication,butovertheyears,thishadrelentlesslyincreaseduntilhewastaking70unitsofinsulindailyjusttokeephisbloodsugarundercontrol.Westartedwithalow-carbohydrate,high-fatdietandaddedsomeintermittentfasting.Hefastedfortwenty-fourhoursatatimethreedaysaweek.

Theresultswereimmediate.Hisweightandwaistsizestarteddecreasing.Withinameretwoweeks,westoppedallhisinsulinbecausehisbloodsugarswasconsistentlyinthenormalrange.Hehasremainedoffallhisdiabeticmedicationssincethen,andhismostrecentHemoglobinA1Cmeasured5.9percent,downfrom6.8percentbeforehestartedonourprogram.Inotherwords,despitestoppingallhisinsulin,hisbloodsugarlevelswerebetterthanever.Infact,hewouldnotevenbeclassifiedasadiabeticanylonger.Hisdiabeteshadcompletelyreversed.

Imaginethat.Darrylsufferedwithtype2diabetesforelevenyears,andatanytime,theproperdietcouldhaveentirelyreversedhisdiabetes.Darrylcouldhavebeeninjectinghimselfwithinsulinforthenexttwentyyearswithoutfixingtheunderlyingproblem,butinstead,justbyfollowingsomesimpledietaryrules,hecuredhistype2diabetes.

Chapter10WHOSHOULDNOTFAST?

Nowthatwe’vetalkedaboutthemanybenefitsoffasting,weneedtoaddaverybigcaveat:fastingisn’tforeveryone.Itcarriescertainrisksandnormalamountsofvitamins,minerals,andotheressentialnutrientsarenotingested.Somepeopleabsolutelyshouldnotattempttherapeuticfasting,including:

ThosewhoareseverelymalnourishedorunderweightChildrenundereighteenyearsofage

Pregnantwomen

Breastfeedingwomen

Othersshouldbecautiouswhenfastingbutdon’tnecessarilyneedtoavoidit.Inthefollowingsituations,itiswisetoseektheadviceofahealth-careprofessionalbeforeattemptingtherapeuticfasting:

Youhavegout

YouaretakingmedicationsYouhavetype1ortype2diabetes

Youhavegastroesophagealrefluxdisease

AbsolutelyDon’tFastIfYou’re:SeverelyMalnourishedorUnderweight

Whenmalnutritionisaconcern,it’sobviouslyneitherdesirablenorwisetodeliberatelyrestrictnutrientsandcalories.

Whenbodyfatfallsbelow4percent,thebodyisforcedtouseproteininordertofeeditself.(Forcomparison,averagebodyfatis25percentinmenandover35percentinwomen.Thisisonlyanaverage,andanobeseperson’sbodyfatpercentageisfarabovethat.Anelitemarathoner,despitelookingverylean,mighthaveapproximately8to10percentbodyfat.)Thestoredenergyfromfathasrunout,andthebodymustnowburnfunctionaltissuetosurvive.Thissyndromeiscalledwasting,andit’sneitherhealthynorbeneficialinanyway.

Thebodymassindex(BMI)iscalculatedbytakingyourweightinkilogramsanddividingitbyyourheightinmeterssquared:kg/m2.Onewell-accepteddefinitionofunderweightisaBMIoflessthan18.5.Foramanwhostandsfive-foot-ten,thatwouldcorrespondtoaweightof129pounds.IgenerallyadviseagainstanytypeoffastingataBMIbelow20,astheriskofcomplicationsrisesdramatically,butit’sespeciallyimportanttoavoidlongerfasts.

AMYBERGERFASTINGALL-STARSIdon’tlikeforpeopletousefastingasanexcusetoeatwhatevertheywantinmassivequantitieswhenthey’renotfasting.Itshouldalsonotbeusedasapunishmentforovereating,“cheating”or“fallingoffthewagon”oftheparticulardietprogramsomeoneisfollowing.Itcanbeusedasakindofrecalibrationorresettingifsomeonefeelsthey’llbenefitfromthat,butitshouldn’tbeusedasaquickfixtoatoneforperceiveddietarysins.

DOESFASTINGCAUSEANOREXIA?Patientssufferingfromanorexianervosashouldclearlynotbefasting,sincetheyarealreadyseverelyunderweightandmalnourished.Further,fastingmayfeed

directlyintothemanifestationsofanorexianervosa.Foodisthemedicineofchoiceforanorexia,sowithholdingitisill-advised.However,doesfastingcauseanorexia?

Thesimpleanswerisno.Anorexiaisapsychiatricdisorderofdistortedbodyimage.Patientsperceivetheirbodiesasoverweighteventhoughtheyareseverelyunderweight.Itisapsychologicaldiseaseandnotonecausedbyundereating.Thisisthesymptom,notthecause.Fastingisnotgenerallyfun,andthereislittledangerofgettinghookedonit.Itiscertainlynotaddictiveinthewaythatcocaineisaddictive.

Arguingthatfastingcausesanorexiaislikearguingthatwashingyourhandswillleadtoobsessive-compulsivedisorder.Excessivehand-washingisasymptomofthedisease,notitscause.

Furthermore,fastinghasbeenpracticedsafelyforthousandsofyearsbymillionsofpeopleworldwide,butanorexianervosaisonlyaveryrecentphenomenon.Iffastingcausedanorexia,itwouldhavebeendescribedthousandsofyearsagoandaffectedmenaswellaswomen.Thisarguesstronglyagainstfastingasasignificantcause.Bottomline?Fastingdoesnotcauseanorexia—butitshouldnotbeattemptedbyanorexics.

UnderEighteenYearsOldInchildren,propergrowthoutweighsallotherhealthconcerns,and

adequatenutritionisanabsoluteprerequisitefornormalgrowth.Restrictingcaloriesalsorestrictstheessentialnutrientsnecessaryforpropergrowthandthedevelopmentofvitalorgans,especiallythebrain.Thenormalgrowthspurtinpuberty,inparticular,requirestremendousamountsofnutrients.Underfeedingduringthisperiodmayresultinstuntedgrowth,whichmaybeirreversible.Inallchildrenundereighteen,theriskofmalnutritionduringfastingisunacceptablyhigh.

That’snottosaythatmissingamealhereandthereisharmfultochildren’shealth,butprolongedfastinglongerthantwenty-fourhoursisnotadvisable.Thisfacthaslongbeenrecognizedbyvirtuallyallculturesintheworld.Childrenhavealwaysbeenexcludedfromculturalorreligiousfastingtopreventtheunintentionaldevelopmentofmalnutritionatacriticaltimeofdevelopment.

Itismoreimportanttoteachchildrenaboutmakingproperfoodchoices.

Itismoreimportanttoteachchildrenaboutmakingproperfoodchoices.Choosingtoeatwhole,unprocessed,naturalfoodsisagoodstart.Avoidinghighlyprocessedgrainsandespeciallyreducingaddedsugarsalsogoesalongwaytowardpreventingobesityandpromotinggoodhealth.

PregnantFastingduringpregnancypresentssimilarconcernsaboutproperfetal

development.Thedevelopingfetusrequiresadequatenutrientsforoptimalgrowth,andnutrientdeficiencymaycauseirreversibleharmduringthiscriticalperiod.Forthisreason,manywomentakeaspeciallyformulatedpregnancymultivitamin.Especiallyimportantisfolicacidsupplementation,asdeficiencyinfolicacidmayleadtoanincreasedriskofneuraltubedefects(forexample,thediseasespinabifida).Folicacidstoresinhumanslastonlyseveralmonths,soprolongednutrientdeficiencyputsthedevelopingfetusatenormousrisk.

Sincepregnancyislimitedtoninemonths,thereisnoreasontofastduringthistime.Itmayberesumedatasafertime,oncethepregnancy(andbreastfeeding—seebelow)isover.Onceagain,mostculturesoftheworldhavelongrecognizedtheinherentdangeroffastingduringthistimeandexemptpregnantwomenfromculturalandreligiousfasts.

BreastfeedingDevelopingbabiesreceivesalltheirnutrientsfromthemotherintheform

ofbreastmilk.IfMombecomesdeficientinvitaminsandminerals,thenthebabywillalsobedeficient.Theresultmaybeirreversiblegrowthretardation.Forthatreason,Idonotadviseanybodywhoisbreastfeedingtoundertakefasting.Missingamealhereorthereiscertainlynotharmful,butdeliberate,long-termfastingisnotadvised.

Again,sincebreastfeedingisgenerallylimitedtomonths,notyears,thereisnoreasontofast.Onceyou’vefinishedbreastfeeding,youmaysafelyfastwithoutfearofharmingyourbaby.

Fastingisanactivitythatcanbedonesafelythroughoutmostofyouradultlife,butitisfoolishtoattempttofastduringthosefewtimeswhenitpresentsadangertoyourownhealthorthehealthofyourbaby.Thereissimplynoreasontorushintoit.Thereisalwaysplentyoftimetofastlater,whenitissafetodoso.

ConsultYourDoctorIfYou:

HaveGoutGoutisaninflammatoryarthritiscausedbyexcessuricacidcrystalsinthe

joints.Highbloodlevelsofuricacidareoneofthemajorcontributingfactorstothisdisease,andmedicationstolowerthelevelofuricacidinthebloodaresometimesprescribedtoreducethechanceofrecurrence.

Uricacideliminationthroughtheurinedecreasesduringfasting,resultinginariseinuricacidlevels.Theoretically,thiscouldworsengout.Inastudyofforty-twoobesepatientswhofasted,therewasincreaseduricacidinallpatients,butnonedevelopedgout.

Mostpatientswithahistoryofgouttoleratefastingwithoutdifficulty.However,knowingthepotentialriskisimportant,andifyouhaveanydoubts,speakwithyourphysicianbeforestartingyourfastingregimen.

AreTakingMedicationsAnybodywhoistakingregularmedicationsforanyconditionmustconsult

withtheirphysicianbeforestartinganytypeofdietaryorfastingprogram.Certainmedicationsarebesttakenwithfood,whichobviouslyisnotpossibleduringfasting.Themostcommonmedicationsthatcauseproblemsduringfastingareaspirin,metformin,andironandmagnesiumsupplements.Butitisoftenpossibletoarrangethefastingscheduletoaccommodatethesemedications.

Aspiriniscommonlyusedasablood-thinnerinpeoplewithcardiovasculardisease.Onecommonsideeffectisgastritis—theirritationoftheliningofthestomach.Inseverecases,itmaycauseulcerstoforminthestomachandsmallintestine.Aspirinisoftentakenwithfoodtolessentheriskofthesecomplications.Manyaspirintabletsarenowcoatedwithaprotectivefilmtoprotecttheliningofthestomach,buttheriskofgastritisandulcersisonlyreduced,noteliminated.Takingaspirinwithoutfoodraisestheriskofstomachirritation.

Metforministhemostwidelyprescribedmedicationintheworldfortype2diabetes.Thisblood-sugar-loweringmedicationhasbeenusedsincethe1950sandisalsocommonlyprescribedforpolycysticovarysyndrome.Onemajorsideeffectisgastrointestinalupset,whichmaybecomeworseonanemptystomach.Themostcommonlyreportedsymptomsarediarrheaandnauseaorvomiting.

Ironsupplementtabletsarecommonlyprescribedforlowbloodcountsduetochronicbloodloss,alsocalledirondeficiencyanemia.Forexample,manywomenhaveheavymonthlyperiodsthatleadtolowironlevels.Amongthemostcommonsideeffectsofironsupplementsarebothconstipationand

mostcommonsideeffectsofironsupplementsarebothconstipationandabdominalpain,whichmaybemadeworsebyfasting.

Magnesiumisamineralstoredlargelyinthebones.Supplementsareoftentakentotreatlegcramps,migraineheadaches,andrestlesslegsyndrome.Itisalsousedasanantacidandlaxative.Magnesiumsupplementstakenorallyareoftenpoorlyabsorbedthroughtheintestines,leadingtodiarrhea.Takingmagnesiumwithfoodoftenreducesthesesymptoms.Lowmagnesiumlevelsareparticularlycommonintype2diabetes.

Asanalternative,magnesiummaybeabsorbedthroughtheskinthroughEpsomsalts,crystalsofmagnesiumsulphate.YoucandissolveafullcupofEpsomsaltsinatubofwarmwaterandsoakforthirtyminutes.Themagnesiumwillbeabsorbedthroughtheskin.Thisisatraditionalremedyformanythings,includingmusclecramps,constipation,andskinproblems.Alternatively,therearepreparationsofmagnesiumoilormagnesiumgelthatmaybeappliedtotheskin.

HaveDiabetesIfyouhavetype1ortype2diabetes,it’sessentialtobeparticularlycareful

whilefastingorevenjustchangingdietarypatterns.Thisisespeciallytrueifyouaretakingmedications.Ifyoucontinuethesamedoseofmedicationbutreducefoodintake,thereisariskofyourbloodsugargoingextremelylow—asituationcalledhypoglycemia.

Symptomsofhypoglycemiaincludeshaking,sweating,irritabilityornervousness,feelingfaint,hunger,andnausea.Moreseveresymptomsincludeconfusion,delirium,andseizures.Untreated,hypoglycemiamayevenleadtodeath.Symptomsmayappearveryrapidly,andiftheydo,youmustquicklyingestsomesugarybeverageorfoodtoreversethislife-threateningsituation.

Youmustconsultwithaphysiciantoadjustthedosesofdiabeticmedicationsorinsulinbeforestartinganydietaryprogram.Carefulmonitoringofbloodsugarsiscruciallyimportant.Ifyoucannotdothis,thenyoushouldnotattemptfasting.(Seehereformoreonfastingwithdiabetes.)

HaveGastroesophagealRefluxDiseaseIngastroesophagealrefluxdisease(GERD),commonlyknownas

heartburn,stomachacidbacksupintotheesophagus,causingdamagetothesensitivetissuesoftheesophagus.Thisisfeelslikeadullpaininthelowerchestorupperabdomenandoftenbecomesworsewhenlyingdown.Peopleoftendescribefeelingtheirstomachcontents“comingbackup.”

Excessiveabdominalfatplacesincreasedpressureonthestomachandforcesfoodandstomachacidbackupintotheesophagus.Thiscanoccasionallybemadeworseduringfastingbecausethereisnothinginthestomachtoabsorbthestomachacid.(Thisismildly,andsadly,ironic,sincefastingisoftenundertakenforthepurposeoflosingweight,whichshouldultimatelymaketheheartburnbetter.)Afterweightlossisachieved,heartburnoftenresolves.Sometimesfastingimprovessymptomsofheartburnbecausefoodcanstimulatetheproductionofstomachacid,sofastingreducesit.

HerearesomesimpletechniquestohelpreducesymptomsofGERD:

•Avoidfoodsthataggravatereflux—includingchocolate,caffeine,alcohol,friedfoods,andcitrus.Caffeinerelaxestheloweresophagealsphincter,whichmayworsenreflux.

•Finisheatingatleastthreehoursbeforebed.•Goforawalkafterdinner.•Elevatetheheadofthebedwithblocks.•Tryalkalinewaterorwaterwithlemon.•Takeover-the-countermedicationssuchasantacids,bismuthsolutions,orranitidine(Zantac).•Askyourphysicianaboutstrongerprescriptionmedications,suchasprotonpumpinhibitors.

Ifthesestrategiesdonotwork,itisoftenpossibletomodifythefastingregimentoavoidheartburn.Forexample,ratherthandoingatruefast,tryeatingahandfulofsaladgreensatregularintervals.Thispreservesmostofthebenefitsofthefastwhilealleviatingthesymptomsofheartburn.A“fatfast,”inwhichonlyfatiseatenduringthefastingperiod,mayalsobeeffective—seehere.

ShouldWomenFast?I’moftenaskedwhetherwomenshouldfast.Iamnotsurewheretherumor

thatwomenshouldn’tfaststarted,butIhavehearditoftenenoughtoaddressthisquestionspecifically.

Thereissomepersistentconcernthatwomenmaynotexperiencethesamebenefitsoffastingasmen.Nothingcouldbefurtherfromthetruth.Virtuallyallstudiesonfastingconfirmthatbothmenandwomenbenefitfromfasting.Further,thereisnoparticulardifferenceinefficacybetweenthetwosexes.

Myownclinicalexperienceconfirmsthis.Havinghelpedhundredsofmenandwomenfastoverthelastfiveyears,I’veseennodifferencebetweenthesexes.Ifanything,womentendtodobetter.Manyofourgreatestsuccessstoriesarewomen.Megan,programdirector,improvedherhealthsomuchwithfastingprotocolsthatshelefthercareerinmedicalresearchtohelpotherssucceedwithfasting.Whilewomencan,ofcourse,haveproblemsduringfasting,menoften

havethesametroubles,too.Interestingly,I’veseenthehighestsuccessrateswithhusbandsandwiveswhotryfastingtogether:themutualsupportisabighelpandmakesfastingfareasier.

Figure10.1.Menandwomenhavesimilarratesofweightlossduringfasting.

Source:Drenick,Hunt,andSwendseid,“InfluenceofFastingandRefeedingonBodyComposition.”

Fastinghasbeenpartofhumancultureforatleasttwothousandyears.AreMuslimwomenexemptfromfasting?AreBuddhistwomenexemptfromfasting?AreCatholicwomenexemptfromfasting?Nope!Withthousandsofyearsofpracticalfastingexperience,noneofthesereligionsmakeadistinctionbetweenadultmenandwomen,exceptwhenwomenarepregnantorbreastfeeding.

Oneareaofspecificconcernwithwomenisthatfastingcouldaffectreproductivehormones.Certainly,malnourishedwomenshouldnotfast,sinceexcessivelylowbodyfatcanleadtoamenorrhea(lossofmenstrualcycles)anddifficultyconceiving.Butnormal-weightwomendonotseeasignificantdifferenceintheirsexhormoneprofileduringfasting.Onestudyexaminedtheeffectofathree-dayfastonthereproductivehormonesduringdifferentpartsof

themenstrualcycle.Glucoseandinsulinlevelsstayedlow,showingcompliancewiththefast,butallreproductivehormonesremainedwithinnormallimits.Ultrasoundalsodemonstratednormalgrowthofthedominantfollicle(egg),andmenstrualcyclesremainedunchanged.Theproblemsofamenorrheaandanovulatorycycles(menstrualcycleswherenoeggisproduced)arisewhenbodyfatpercentagefallstoolow.However,womenwithexcessivelylowbodyfatshouldnotbefastinginthefirstplace(neithershouldmen,forthatmatter).Ifamenorrheaoranyothermenstrualproblemsappearduringfasting,stopimmediately.

DR.MICHAELRUSCIOFASTINGALL-STARSIt’simportanttotrackwhateveryourkeysymptomsare.It’salsoimportanttoassessifgloballyyouappeartobegettingorbetterorworseasthedaysgoon.Ifyouaregenerallygettingbetter,thenstickwithit.Ifyoufeelyouaregenerallygettingworse,thenyourcurrentapproachmaynotbesuitedforyouandyoumightwanttotryadifferentfastingapproach.

Pregnantandbreastfeedingwomen,aspreviouslynoted,shouldnotfast.Thesearesituationsthatabsolutelyrequireadequatenutrientsforgrowth.

Let’sbeclear.Therearecertainlypotentialproblemswomenmayfaceduringfasting.Butalltheseproblemscomeupwithmen,too.Sometimeswomendon’tloseweightthewaytheywant—andsometimesneitherdomen.Sometimeswomenfindthatfastingisdifficult—asdomen.Thestudiesonfasting,manygoingbackoverahundredyears,allshowthatit’ssafeforbothsexes.

Themostimportantthingtoalwaysrememberisthatifyouarefeelingpoorlyinanyway,whetheryouareamanorawoman,youmuststopfastingimmediatelyandcontactyourhealth-careprovider.

References

D.A.JohnstonandK.G.Wormsley,“TheEffectsofFastingon24-hGastricSecretionofPatientswithDuodenalUlcersResistanttoRanitidine,”AlimentaryPharmacologyandTherapeutics3,no.5(1989):471–9,doi:10.1111/j.1365-2036.1989.tb00238.x.

E.J.Drenick,I.F.Hunt,andM.E.Swendseid,“InfluenceofFastingandRefeedingonBody

Composition,”AmericanJournalofPublicHealth58,no.3(1968):477–84.

I.C.Gilliland,“TotalFastingintheTreatmentofObesity,”PostgraduateMedicalJournal44,no.507(1968):58–61.

J.RuncieandT.J.Thomson,“TotalFasting,HyperuricaemiaandGout,”PostgraduateMedicalJournal45,no.522(1969):251–3.

KristinK.Hoddy,CynthiaM.Kroeger,JohnF.Trepanowski,AdrienneR.Barnosky,SurabhiBhutani,andKristaK.Varady,“SafetyofAlternateDayFastingandEffectonDisorderedEatingBehaviors,”NutritionJournal14,no.44(2015),doi:10.1186/s12937-015-0029-9.

M.R.Soules,M.C.Merriggiola,R.A.Steiner,D.K.Clifton,B.Toivola,andW.J.Bremner,“Short-TermFastinginNormalWomen:AbsenceofEffectsonGonadotrophinSecretionandtheMenstrualCycle,”ClinicalEndocrinology40,no.6(1994):725–31.

Chapter11KINDSOFFASTSANDBESTPRACTICES

It’susefultocategorizefastsbytwofeatures:whatisallowedonthefastandhowlongorfrequentthefastis.We’lltakeupthequestionsoflengthandfrequencyinChapters12,13,and14,butfirst,let’slookatthedifferentkindsoffastsintermsofwhatmaybeconsumed.

Mostdefinitionsoffastingallownoncaloricdrinksonly.Thismeansthatwater,tea,andblackcoffeeareallallowedduringfasting,butsugar,honey,fructose,agavenectar,andothersugarsareprohibited.Thereissomedisagreementaboutartificialsweetenerslikestevia,aspartame,andsucralose.Sincetherearenocaloriesinthese,technically,theycouldbeallowed.However,theuseofchemicalsintheseartificialsweetenersdefeatsthespiritoffasting,whichistocleanseorpurifythebody,notonlyfromunwantedsugarsandfatsbutalsofromchemicalsandotherartificialagents.Thesameargumentappliestoartificialflavors,suchasthoseinCrystalLightorKool-Aid,andtobouilloncubes.

Thewater-onlyfastisatraditionalandclassicvariant—allotherbeveragesandadditivesarenotpermittedduringthefastingperiod.It’simportanttonotethatthisfastgenerallyincludeszerosalt.Withoutsalt,thebodycannotholdontowater,andthereforethereissomeriskofdehydration.Somevariantsofthewater-onlyfastallowyoutodrinksaltwater,althoughitcanbedifficulttogetdown.However,thebodyhasaremarkableabilitytoretainsaltwhenitisnotreadilyavailableinthediet.Thismeansthataslongasthewater-onlyfastislimitedinduration,yoursaltrequirementswillbefairlylow,andsaltdeficiencyshouldn’tbeaproblem.

Juicefastingpermitstheconsumptionofjuiceaswellaswater.Sincejuicesnaturallycontainsugarsandcalories,thisisnottechnicallyatruefast,butthewordisoftenusedinthiscontext.Resultsofthisfastwillvarydependinguponthetypeandamountofjuiceconsumed.Fruitjuicestendtobeveryhighinsugarandthereforewilloftennotproduceasgoodaresultasother,stricterfasts.“Green”juicefastinghasrecentlysurgedinpopularity.Asyoumightguessfromthename,thisinvolvesjuicinggreenleafyvegetables,likespinachandkale.Theresultingjuicecontainsfarlesssugarthanthejuiceofsweetfruitslikeorangesandapples.Inaddition,leafyvegetablescontainlittleactualjuice,sotheleavesareoftengroundupandblendedwiththejuice,whichprovidesfiberand

nutrients.Celeryisoftenjuicedinthismixture,too.The“fatfast”isanewervariationoffasting.Relativelypurefats,suchas

coconutoil,cream,andbutter,areallowedduringthisfast,soit,too,isnotatruefast.Fatisnormallynoteateninisolation—werarelydrinkacupofoliveoiloreatapatofbutterbyitself—butsomepeoplefeelthateatingfatthiswayhelpsreducehungerandmakesfastingmucheasier.

Thepopularityof“bulletproofcoffee”hashelpedthistrend.Tomakecoffee“bulletproof,”youaddfatintheformofcoconutoil,medium-chaintriglycerides(MCToil),orbutterfromgrass-fedcows.Thehighfatcontentofthecoffeegivesthisdrinkasubstantialnumberofcalories(400to500percup,dependingupontherecipe),sothiswouldbemoreaccuratelytermedamealreplacement.However,virtuallyallofthecaloriesarederivedfromfat.(SeehereforarecipeforBulletproofCoffee.)

Thereareanumberofpurportedbenefitstothefatfast.Someclaimthatithelpsweightlossaspartofaketogenicorverylowcarbohydratediet,inwhichthebodyburnsfatforenergy.Othersfeelthatthefathelpswithmentalclarityorthatithelpskillcravings.Whilescientificproofoftheeffectivenessofthefatfastiscurrentlyscarce,anecdotesofsuccessabound.

AMYBERGERFASTINGALL-STARSDuringafast,smallamountsofpurefatoralmostpurefat(aspoonfulofoliveorcoconutoil,apatofbutter),andforsome,evenaverysmallamountofsolidfood,suchasmacadamianutsorwalnuts—somethingthatisprimarilyfatwithanegligibleamountofcarbohydrateandlittletonoprotein—canbeconsumedwithoutinterferingwiththephysiologicalbenefitsofthefast.Sometimesjusthavingasmallbiteofsomethinglikethiscanhelpapersonsticktoafastwhentheymightotherwisebestruggling,andthesefoodsareunlikelytobeobstaclestogettingthedesiredresults.

Ina“dryfast,”nofluidsofanykindareallowed.MuslimspracticethistypeoffastingduringthedaylighthoursoftheholymonthofRamadan.Thiscombinesfastingwithmilddehydration.Inmyopinion,thismakesfastingmuchmoredifficultthanothertypesoffast,andIdonotrecommendthisformedicalreasons.Theriskofcomplicationsisalsomuchhigherduetotheaccompanying

dehydration.The“fasting-mimickingdiet”isadietcreatedbyresearcherstore-create

thebenefitsoffastingwithoutactualfasting.Itisacomplicatedregimenofreducedcaloricintakeoverfivedayseverymonth.Thefirstdayallows1,090calories,composedof10percentprotein,56percentfat,and34percentcarbohydrate.That’sfollowedbyfourdaysof725calories,withthesamenutritionalbreakdown.Thereissparsedatatosupporttheclaimthatthisdietprovidesallthebenefitsoffasting,andIdon’trecommenditbecauseofitsunnecessarycomplexity.Tome,itisfarsimplertofollowfivedaysofregularfastingpermonth.

FASTINGALL-STARSDR.THOMASSEYFRIEDAlltypesoffastscanhavetherapeuticbenefit.Thekeytotherapyisprolongedtherapeuticketosis(bloodketonesintherangeof3–6mM),togetherwithreducedbloodglucoselevels(3–4mM).PatientswillneedtousethePrecisionXtrameterfromMedisensetodeterminewhentheycanenterthetherapeuticzone.GKIratiosof1.0ofbelowwouldbestrepresentthetherapeuticrange.

IntensiveDietaryManagementFasting:BestPracticesWeusefastingextensivelyintheIntensiveDietaryManagement(IDM)

Programforweightlossandothermetabolicdisorders,suchastype2diabetesandfattyliverdisease.Regardlessofthedurationofyourfast,thegeneralguidelinesoutlinedherewillhelpyoufastinahealthyway.Certainaspectsmayworkforyou;othersmaynot.Youarealwaysfreetoexperimentandadjust,astherearenohardandfastrules.

TheIDMfastpermitswater,tea,andcoffee.Sugar,honey,agavenectar,andothersweetenersarenotpermitted.Artificialsweetenersorflavorsarenotallowed,butnaturalflavorssuchaslemonjuice,mint,cinnamon,orotherspicesare.

TheIDMfastalsoallowshomemadebonebroth,whichbothmakesfastingeasierandmayhelppreventsaltdeficiencyduringlongerfasts.

I’velostover50pounds(wentfrom215to165)andmaintainedit.Asa

matterofroutine,IeatLCHFandintermittentfastforaminimumof18hours,andIdoawater-onlyfastfor2to3daysaweek.Ican’tsayIenjoythewater-only fasts,but there’snodenyingthat they’vehelpedmebreakthroughweight-lossplateaus.Ifindkeepingbusyisthebestwaytogetthroughawater-onlyfast.

—PhilipM.,Bellaire,TX

WaterBesuretostaywellhydratedthroughoutyourfast.Water,bothstilland

sparkling,isalwaysagoodchoice.Aimtodrinktwolitersofwaterandotherfluidsdaily.Asagoodpractice,starteverydaywitheightouncesofcoolwatertoensureadequatehydration.Addasqueezeoflemonorlimetoflavorthewater,ifyouwish.Alternatively,youcanaddorangeslices,berries,orcucumberslicestoapitcherofwaterforaninfusionofflavor.Dilutedapple-cidervinegarinwatermayhelploweryourbloodsugar.However,artificialflavorsandsweetenersareprohibited.Kool-Aid,CrystalLight,orTangshouldnotbeaddedtoyourwater.

TeaAlltypesofteaareexcellentchoices,includinggreen,black,oolong,and

herbal.Greenteaisanespeciallygoodchoiceduringafast:thecatechinsingreenteaarebelievedtohelpsuppressappetite.Teascanbeblendedtogetherforvarietyandcanbeenjoyedhotorcold.Spicessuchascinnamonornutmegaddflavor.

Herbalteasarenottrueteasbecausetheydonotcontaintealeaves.However,theyalsoaregreatforfasting.Cinnamonteaandgingerteahavebothbeenusedfortheirreputedappetite-suppressingpower.Mintteaandchamomileteaareoftenusedfortheirsoothingproperties.Becauseherbalteascontainnocaffeine,theycanbeenjoyedanytimeduringthedayornight.Allteas,includingherbalteas,canbeenjoyedeitherhotorcold.

Addingasmallamountofcreamofmilktoyourteaisacceptable(seebelow),butsugarandartificialsweetenersandflavorsarenotallowed.However,ifyouarefindingprogressslow,youmaywanttoeliminateallcaloriescompletelyduringfasting.Weoftenadvisepatientstogobacktoaclassicwater-onlyfastiftheyhitastubbornweightplateau.

CoffeeCoffee,bothcaffeinatedanddecaffeinated,ispermittedduringafast.We

alsopermitasmallamountofcreamorcoconutoiltobeaddedtocoffeeortea.Whilethisdoestechnicallymeanit’snotatruefast,theeffectissmallenoughthatitseemstomakenodifferencetotheoveralloutcomeofthefast.Furthermore,thisflexibilitymayimproveyourabilitytosticktotheprogram.By“smallamount,”wemean1to2teaspoonsofcreamorcoconutoil—nowherenearthecopiousamountsoffatusedinbulletproofcoffee.

Spicessuchascinnamonornutmegmayalsobeadded,butnotsweeteners,sugar,orartificialflavors.Onhotdays,icedcoffeeisagreatalternative.Simplybrewapotasyounormallywouldandletitcoolintherefrigerator.Coffeehasmanyhealthbenefitsthatarejustbeingrecognized—forinstance,itmayreducetheriskoftype2diabetesandisagreatsourceofantioxidants.

BoneBrothHomemadebonebroth,madefrombeef,pork,chicken,orfishbones,isa

goodchoiceforfastingdays.Animalbonesaresimmeredwithothervegetablesandseasoningsforlongperiodsoftime,anywherefromeighttothirty-sixhours—seehereforarecipe.Vegetablebrothisasuitablealternative,althoughbonebrothcontainsmorenutrients.Allvegetables,herbs,andspicesaregreatadditionstobonebroth,butdonotaddbouilloncubes,whicharefullofartificialflavorsandmonosodiumglutamate.Bewareofcannedbroths:theyarepoorimitationsofthehomemadekind.

Weoftenadvisepeopletoaddagoodpinchofseasalttotheirhomemadebonebroth.Duringlongerfasts,itispossibletobecomedeficientinsaltsinceitisnottakenwithwater,tea,orcoffee,andsaltdeficiencycanleadtodehydration.Seasaltalsocontainsothertraceminerals,suchaspotassiumandmagnesium,whichmaybeparticularlybeneficialduringfasting.(Forshorterfasts,suchasthetwenty-four-andthirty-six-hourvariety,itprobablymakeslittledifference.)

Thereisalsoasmallamountofproteinandsomeminerals(calciumandmagnesium)inbonebroth,sotechnically,anyfastthatallowsbrothisnotatruefast.Butmanypeoplehavefoundthatthebrothmakesalonger-durationfastmuchmorebearable.Thegelatinandproteincontainedinthebrothhelpdiminishhungerpangs,andtherearenumerousotherhealthbenefitsascribedtobonebroth,includinganti-inflammatoryeffectsandbenefitsforboneandjointhealth.

Chapter12INTERMITTENTFASTING

InPartI,I’vearguedthatfastingisn’tbadforyou—infact,itwasaregularpartofhumansocietyforthousandsofyears,andtherearebenefitstoitforthosewhoaredealingwithcertainhealthissues—inparticular,obesityandtype2diabetes—intoday’sworldofconstantfoodabundance.

Traditionalhunter-gatherersocietiesvirtuallyneverdevelopobesityordiabetes,evenduringtimesofplentifulfood.Inthepre-agriculturalera,itisestimatedthatanimalfoodsprovidedabouttwo-thirdsofthecaloriesinthehumandiet.So,despiteallthemodernteethgnashingaboutredmeatandsaturatedfats,itseemsthatourancestorshadlittleproblemseatingthem.

Abouttenthousandyearsago,withtheagriculturalrevolutionanditsgreaterreliabilityoffood,wedevelopedthehabitofeatingtwoorthreetimesperday.Butmanyearlyagriculturalsocietiesatecarbohydrate-baseddietswithoutproblemswithobesity.Itseemstobeamodernproblem.

Fromthesehistoricalexamples,wecanseethatitiscertainlypossibletoeatmeatandcarbohydrateswithouttheproblemofdiabesityinasociety.Whatmattersmostisourinsulinresponsetofood,sinceobesityislargelyaproblemofexcessiveinsulin.Andwhenitcomestoinsulin,aswe’vediscussedinChapters5and6,thetimingandfrequencyofmealsisasimportantasthecompositionofthemeal.Thatis,thequestionofwhentoeatisasimportantaswhattoeat.Itispreciselyherethatintermittentfastingmayhelpusthemost.

WhatIsIntermittentFasting?Thetermintermittentfastingsimplymeansthatperiodsoffastingoccur

regularlybetweenperiodsofnormaleating.Howlongeachperiodoffastinglasts,andhowlongtheperiodofnormaleatinglasts,canvarywidely.Therearemanydifferentfastingregimens,andthere’sno“best”one.Theyallworktodifferentdegreesfordifferentpeople.Oneregimenmayworkforonepersonbutbeutterlyineffectiveforthenext.Onepersonmayprefershorterfastswhileanotherpreferslongerones.Neitheriscorrectorincorrect.Itisallpersonalpreference.

Fastscanrangefromtwelvehourstothreemonthsormore.Youcanfastonceaweekoronceamonthoronceayear.Shorterfastsaregenerallydonemorefrequently,evendaily,whilelongerfasts—twenty-fourtothirty-sixhoursisthemostcommonduration—areusuallydonetwotothreetimesperweek.

Prolongedfastingmayrangefromoneweektoonemonth.Icategorizefastingperiodsasshort(lessthantwenty-fourhours)orlong

(morethantwenty-fourhours),butthisissomewhatarbitrary.IntheIDMProgram,shorterregimensaregenerallyusedbythosemostlyinterestedinweightlossratherthanintreatingtype2diabetes,fattyliverdisease,orothermetabolicdiseases.However,shorter,morefrequentfastsstilloftenworkwellfortheseconditions.

Duringshort-durationfasts,youarestilleatingdaily,whichminimizestheriskofmalnutrition.Shorterfastsalsofitintoworkandfamily-lifescheduleseasily.

AMYBERGERFASTINGALL-STARSIthinkintermittentfastingisgreat.Doneonaregularbasis,thebodygetsaccustomedtoitandyoudon’tthinktwiceaboutit.Yourhungersignalswillbecomemoreregular—thatis,they’lladjusttothefastingandyou’llstarttobecomehungrywhenyourbodyisreadytoeat,ratherthanfrom“false”signalsbeingdrivenbywildfluctuationsininsulin,bloodglucose,andstresshormones.

Longer-durationfastsgivequickerresultsbutareusuallydonelessfrequently.Fastingformorethantwenty-fourhoursmaysounddifficult,butI’vefoundthatasurprisingnumberofpatientsprefertofastlongerandlessfrequently.We’lllookatlongerfastsinChapters13and14.

Remember,youcanalwaysswitchfromonefastingregimentotheother.Youareneverlockedin.Butkeepinmindthatthefirstseveralfastingperiodsarealwaysdifficult,andunfortunatelythereisnotmuchyoucandoaboutthat.Likeeverythingelseinlife,fastingbecomeseasierthemoreyoudoit.

ShortDailyFastingRegimens

12-HourFasts

Inyearspast,adailytwelve-hourfastingperiodwasconsideredanormaleatingpattern.Youwouldeatthreemealsadayfrom,say,7a.m.to7p.m.,andthenfastfrom7p.m.to7a.m.Atthatpoint,youwould“breakyourfast”withasmallbreakfast.Thiswasprettystandarduntilthe1970s,andperhapsnot

smallbreakfast.Thiswasprettystandarduntilthe1970s,andperhapsnotcoincidentally,therealsowasmuchlessobesitybackthen.

Twomajordietarychangeshappenedstartingin1977.WiththepublicationoftheUSDA’sDietaryGuidelinesforAmericansthatyear,wechangedtoahigher-carbohydrate,lower-fatdiet.Dietshighinrefinedcarbohydratesstimulateconstant,highlevelsofinsulin,whichmakespeoplegainweightand,eventually,becomeobese.

FASTINGALL-STARSDR.BERTHERRINGAfastingschedulecannotcorrectappetitepermanently;thecorrectioniseffectiveonlywhenthefastingscheduleismaintained,thoughadayortwooffscheduledoesnotimmediatelyerasetheappetitecorrectioneffect.

Figure12.1.Insulinlevelsduringatraditional12-hourfastingschedulewiththreemealsaday.

Figure12.2.Insulinlevelsduringa16-hourfastingschedulewithan8-houreatingwindow.Youcouldeasilyeatthreetimeswithinthatwindowratherthantwice,asthegraphshows.

Figure12.3.Insulinlevelsduringa20-hourfastingschedule,withallmealseatenwithinafour-hourwindowintheevening.

Theothercritical,thoughrarelyrecognized,dietarychangewasthegradual

increaseinmealfrequency.In1977,eatingopportunities(bothmealsandsnacks)averagedthreeperday—breakfast,lunch,anddinner.By2003,thatfigurewasclosertosixperday.Peoplewereeatingthreemealsandthreesnacksdaily,andinsulinlevelswerebeginkeptperpetuallyhigh.Overtime,the

constantstimulationofinsulinleadstothedevelopmentofinsulinresistance,whichleadsbacktohighinsulinlevels,which,inturn,leadstoobesity.(SeeChapters5and6formoreoninsulinandinsulinresistance.)

Dailytwelve-hourfastingintroducesaperiodofverylowinsulinlevelsduringtheday.Thispreventsthedevelopmentofinsulinresistance,makingthetwelve-hourfastapowerfulpreventativeweaponagainstobesity.Infact,thecombinationofwholefoods,lower-carbohydratediets,lessaddedsugars,andadailytwelve-hourfastwasenoughtopreventmostAmericansinthe1950sand1960sfromdevelopingobesity—eventhoughtheystillateplentyofwhitebreadandjam,andwhole-wheatbreadwasrareandwhole-wheatpastaunheard-of.

Butwhileadailytwelve-hourfastmaybegreatpreventativestrategy,itmaynotbepowerfulenoughtoreverseweightgain.Slightlylongerfastingperiodsareoftenrequiredforthat.

16-HourFasts

Thisregimenincorporatesasixteen-hourperiodoffastingintoyourdailymealschedule.Forexample,youmightfastfrom7p.m.to11a.m.daily.Youcouldalsosaythatyouhaveaneight-houreatingwindoweveryday.Forthatreason,itissometimescalledtime-restrictedeating.Onthisschedule,mostpeopleskipthemorningmealeveryday.Buthowmanymealsyoueatwithinthateight-hourwindowisyourchoice.Somepeoplechoosetoeattwomealsduringthatwindowandotherseatthree.

FASTINGALL-STARSABELJAMESFormostpeople,Irecommend16:8intermittentfasting(acompressedeatingwindow)overlonger-termfasting.Thefactthatyousleepthroughthemajorityofyourfastmakesitrelativelypainless.

ASwedishbodybuildernamedMartinBerkhanpopularizedthisregimen,whichissometimescalledtheLeanGainsmethod.Severalyearsafterwards,abookcalledThe8-HourDietespousedthesameeight-houreatingwindow.

Amajoradvantageofthesixteen-hourfastisthatitisfairlysimpletoincorporateintoeverydaylife.Formostpeople,itonlymeansskippingbreakfastandeatinglunchanddinnerwithineighthoursofeachother.Manypeopledo

andeatinglunchanddinnerwithineighthoursofeachother.Manypeopledonotfeelhungryinthemorningdespiteskippingbreakfastandfindthismethodextremelyeasytoimplement.

Thedailysixteen-hourfastcertainlyhasmorepowerthanthedailytwelve-hourfast,butitshouldbecombinedwithalow-carbohydratedietforthebesteffect.Weightlossonthisregimentendstobeslowandsteady.

20-HourFasts:“TheWarriorDiet”Inhis2002bookTheWarriorDiet,OriHofmeklerstressesthatthetiming

ofmealsmattersalmostasmuchastheircomposition—asIdiscussedearlier,boththe“whentoeat”and“whattoeat”questionsareimportant,but“when”isseriouslyunderappreciated.

Hofmekler,drawinguponinspirationfromancientwarriortribessuchastheSpartansandRomans,deviseda“warriordiet”inwhichallmealsareeatenintheeveningduringafour-hourwindow.Thisresultsinatwenty-hourfastingperiodeachday.Hofmekler’sdietalsoemphasizesnatural,unprocessedfoodsandhigh-intensityintervaltraining,bothofwhichIbelievetobehealthypractices.

CircadianRhythmsCircadianrhythmsarerepetitive,predictable,cyclicalchangesinbehaviors

andhormonesovertwenty-fourhours.Thesepatternsareseeninmostanimals.Almostallourhormones,includinggrowthhormone,cortisol,andparathyroidhormone,aresecretedinacircadianrhythm.Circadianrhythmsalsohelpgoverninsulin,whichaffectsweightgain,andghrelin,whichcontrolshunger—leadingtopracticalimplicationsforeatingpatternsandweightloss.

InsulinandNighttimeEatingCircadianrhythmshaveevolvedtorespondtodifferencespredominantlyin

ambientlight,asdeterminedbytheseasonandtimeofday.ItisbelievedthatfoodwasrelativelyscarceinPaleolithictimesandwaspredominantlyavailableduringdaylighthours.Humanshuntedandatebyday,andoncethesunwentdown,well,youjustcouldn’tseethefoodinfrontofyourface.Nocturnalanimalsmayverywellhavecircadianrhythmsmoresuitedtoeatingatnight,butnothumans.

Giventhat,isthereadifferencebetweeneatingduringthedayandeatingatnight?Well,thestudiesarefew,butperhapsrevealing.Ina2013study,twogroupsofoverweightwomenwererandomlyassignedtoeatalargebreakfastoralargedinner.Bothate1400caloriesperday;onlythetimingofthelargestmeal

alargedinner.Bothate1400caloriesperday;onlythetimingofthelargestmealwaschanged.

Thebreakfastgrouplostfarmoreweightthanthedinnergroup.Why?Despitefollowingsimilardietsandeatingaboutthesameamount,thedinnergrouphadamuchlargeroverallriseininsulin.Anearlier1992studyshowedsimilarresults.Inresponsetothesamemealgiveneitherearlyorlateintheday,theinsulinresponsewas25to50percentgreaterintheevening.

FASTINGALL-STARSROBBWOLFIfyou’reinahigh-stressenvironment,IFmaybeabittoomuchtodealwith.Hard-trainingathletesneedtobecarefulinhowtheyrolloutanIFprotocol.ThereissomeindicationIFcanenhancefatadaptation(particularlywheninconcertwithanutritionalketosisprotocol),butIhavealsoseenfolksgetinto“deepwater”bychronicallyundereating.Fastingisapowerfultool,butlikealltools,youreallyneedtoconsiderwhyyouareusingitandwhatthespecificcontextis.

Weightgainisdrivenbyinsulin,andthehigherinsulinresponseintheeveningwastranslatingintomoreweightgainforthedinnergroup.Thisillustratestheveryimportantpointthatobesityisahormonal,notacaloric,imbalance,anditmayhelpexplainthewell-knownassociationofnightshiftworkandobesity.(However,thatcouldalsohavetodowiththeincreasedcortisolresponseduetodisturbedsleep.)

Eatingthelargestmealintheeveningseemstocauseamuchlargerriseininsulinthaneatingearlier.Folkwisdom,ofcourse,alsoadvisestoavoideatinglargemealsintheevening.Thereasonofferedusuallyissomethingalongthelinesof,“Ifyoueatjustbeforebed,youdon’tgetachancetoburnitoffanditwillturntofat.”Maybethat’snottechnicallytrue,butperhapsthereissomethinghere.Eatinglateatnightseemstobeespeciallyproblematicforweightgain.Thisresponsemayhaveevolvedtohelpusgainfat,whichmayhavehadasurvivaladvantageintimespast.

GhrelinandHungerPatternsHunger,too,hasanaturalcircadianrhythm.Ifhungerweresimplydueto

lackoffood,wewouldconsistentlybehungryinthemorningafterthelong

overnightfast.Butpersonalexperienceandstudiesshowthathungerislowestinthemorning,andbreakfastistypicallythesmallest,notthelargest,mealoftheday.Hungerfollowsanatural,circadianrhythmthatisindependentoftheeat/fastcycle.

Ghrelin,thehungerhormone,risesandfallsinanaturalcircadianrhythm,withalowat8:00a.m.andahighat8:00p.m.Correspondingly,hungertypicallyfallstoitslowestlevelat7:50a.m.andpeaksat7:50p.m.Thesearenaturalrhythmsinherentinourgeneticmakeup.Hungerisnotsosimpleas“thelongeryoudon’teat,thehungrieryou’llbe.”Hormonalregulationofhungerplaysakeyrole.

Interestingly,duringextendedfasting,ghrelinpeaksduringthefirsttwodaysandthensteadilyfalls.Thisalignsperfectlywithwhatweseeclinically:hungeristheworstproblemonthefirsttwodays,butmanypeopleonlongerfastsreportthathungertypicallydisappearsafterday2.

Figure12.4.Duetocircadianrhythms,hungerisnaturallylowestat8:00a.m.andhighestat8:00p.m.

Source:Scheer,Morris,andShea,“TheInternalCircadianClockIncreasesHungerandAppetiteintheEveningIndependentofFoodIntakeandOtherBehaviors.”

Figure12.5.Ghrelin,thehormonethatregulateshunger,peaksonday2duringaprolongedfast.

Source:Espelundetal.,“FastingUnmasksaStrongInverseAssociationBetweenGhrelinandCortisolinSerum:StudiesinObeseandNormal-WeightSubjects.”

TimingtheLargestMealoftheDaySo,what’sthepracticalimplicationofthesehormonalrhythmsfordaily

eating?At8a.m.,ourhungerisactivelysuppressed.Itiscounterproductiveto

force-feedourselvesthen.What’sthepoint?Eatingdoesnotproduceweightloss.Forcingourselvestoeatatatimewhenwearenothungryisnotawinningstrategy.

Eatinglateatnightisalsoapoorstrategy.Hungerismaximallystimulatedatapproximately7:50p.m.Atthistime,insulinismaximallystimulatedbyfood,whichmeansthatthesameamountoffoodresultsinhigherinsulinlevels.Thishigherinsulinlevelwillnaturallydriveweightgain.

Unfortunately,thattimingcoincideswiththelargestmealofthedayinNorthAmerica.Makingdinnerthebiggestmealofthedayismostlydrivennotbyhealthconcernsbutbythehoursoftheworkdayandschool.Shiftworkersareataparticulardisadvantage.Theytendtoeatlargermealsevenlaterintheevening,leadingtohigherinsulin.

Sotheoptimalstrategyseemstobeeatingthelargestmealinthemidday,sometimebetweennoonand3:00p.m.,andonlyasmallamountintheeveninghours.Interestingly,thisisthetraditionalMediterraneaneatingpattern.Theyeatalargelunch,followedbyasiestaintheafternoon,andthenhaveasmall,

alargelunch,followedbyasiestaintheafternoon,andthenhaveasmall,almostsnack-sizeddinner.WhileweoftenthinkoftheMediterraneandietashealthyduetothetypeoffoodsinit,thetimingofmealsintheMediterraneanmayalsoplayarole.

References

DanielaJakubowicz,MaayanBarnea,JulioWainstein,andOrenFroy,“HighCaloricIntakeatBreakfastvs.DinnerDifferentiallyInfluencesWeightLossofOverweightandObeseWomen,”Obesity21(2013):2504–21.

E.VanCauter,E.T.Shapiro,H.Tillil,andK.S.Polonsky,“CircadianModulationofGlucoseandInsulinResponsestoMeals:RelationshiptoCortisolRhythm,”AmericanJournalofPhysiology:EndocrinologyandMetabolism262,no.4(1992):E467–E475.

F.A.Scheer,C.J.Morris,andS.A.Shea,“TheInternalCircadianClockIncreasesHungerandAppetiteintheEveningIndependentofFoodIntakeandOtherBehaviors,”Obesity21,no.3(2013):421–3.

L.Cordain,S.B.Eaton,J.BrandMiller,N.Mann,andK.Hill,“TheParadoxicalNatureofHunter-GathererDiets:Meat-Based,yetNon-Atherogenic,”EuropeanJournalofClinicalNutrition56,suppl.1(2002):S42–S52.

SatchidanandaPanda,JohnB.Hogenesch,andSteveA.Kay,“CircadianRhythmsfromFliestoHuman,”Nature417,no.6886(2002):329–35,doi:10.1038/417329a.

U.Espelund,T.K.Hansen,K.Hollund,H.Beck-Nielsen,J.T.Clausen,B.S.Hansen,H.Orskoy,J.O.Jorgensen,andJ.Frystyk,“FastingUnmasksaStrongInverseAssociationBetweenGhrelinandCortisolinSerum:StudiesinObeseandNormal-WeightSubjects,”JournalofClinicalEndocrinologyandMetabolism90,no.2(2005):741–6.

Chapter13LONGERPERIODSOFFASTING

InPartI,wetalkedabouthowinsulinandinsulinresistanceareattheheartofbothobesityandtype2diabetes.Sinceallfoodsincreaseinsulintosomedegree,themostefficientmethodofloweringinsulinistoeatingnothingatall.Evenshorterfastsoflessthantwenty-fourhourscanpreventthedevelopmentofinsulinresistanceandreverserelativelyminorlevelsofresistance,andtheycertainlyhelpwithweightloss.

Butbecausebreakinginsulinresistancerequiresnotjustlowinsulinlevelsbutpersistentlylowlevels,weneedlongerfastingperiods.

TheRisksandBenefitsofLongerFastsDuringlonger-durationfasts,healthbenefits—includingweightlossand

reducedinsulinlevels—accruequickly,butthereisalsoahigherriskofcomplicationsfordiabeticsandthosewhoaretakingmedications.I’vefoundlongerfaststobeparticularlyhelpfulintreatingtype2diabeticsandrecalcitrantobesitycasesbecausetheyaremorepowerfulthanshorterfasts.However,Ialwaysmonitorpatients’bloodpressure,vitalsigns,andbloodworkmonitoredveryclosely.Icannotstressenoughthatifyoudonotfeelwellatanypoint,youmuststopfasting.Youcanbehungry,butyoushouldnotfeelsick.

Ifyouareonmedication,youmustbecarefullymonitoredbyaphysicianduringfasting—andofcourse,makesuretotalktoyourdoctorbeforebeginningafastingregimenormakingchangestoyourdiet.Thisisparticularlyimportantifyou’reondiabetesmedications.Duringlongerfasts,thereducedintakeoffoodoftenlowersbloodglucose.Ifyoutakethesamedoseofmedicationasyouwouldonanormaleatingday,thereisahighriskofbecominghypoglycemic,whichisverydangerous.

Symptomsofhypoglycemiaincludeconfusion,sweating,andtremors.Youmayalsoexperienceafeelingofhunger,shakiness,orweakness.Leftuntreated,itmayadvancetolossofconsciousness,seizures,and,inextremecases,death.

Lowerbloodsugarisnotacomplicationperse,becauseit’sexpectedduringfasting.Wewanttolowerbloodsugar.Butitdoesmeanthatifyou’retakingmedicationtoloweryourbloodsugar,youareovermedicatedwhenyou’refasting.Bloodsugarandmedicationsmustbecarefullymatchedinordertoavoidbothlowandhighbloodsugar.Youmustworkverycarefullywitha

physiciantoadjustmedicationsandmonitorbloodsugaronafastingregimen.Ingeneral,diabeticmedicationsandinsulinmustbereducedonthefasting

daytoavoidhypoglycemia.Exactlyhowmuchtoreduceitshouldbeoverseenbyyourphysician.

Makesurethatifyou’retakingmedication,youtalktoyourphysicianbeforetryingalongerfast! !

24-HourFastsAtwenty-four-hourfastinvolvesfastingfromdinnertodinner,orbreakfast

tobreakfast,whateveryouprefer.Forexample,ifyoufinishdinnerat7p.m.onday1,youwouldthenfastuntilhavingdinnerat7p.m.onday2.Despitethename,youdonotactuallygoafulldaywithouteating,sinceyouarestilltakingonemealonthefastingday.Inessence,youareeatingasinglemealforthatday.

Thisfastingregimenhasseveralimportantadvantagescomparedtootherlongerfasts.Becauseyoustilleatamealonthefastingday,youcantakeanymedicationsthatmustbetakenwithfood,suchasmetformin,ironsupplements,oraspirin.

Thisfastingregimenisalsothemosteasilyincorporatedintoeverydaylife.Youcanfastwithoutdisruptingfamilydinners—itreallyonlyinvolvesskippingbreakfastandlunch.It’sparticularlyeasyduringabusydayatwork.Youstartthemorningwithalargecupofcoffee,skippingbreakfast,thenworkrightthroughlunchandgethomeintimefordinner.Thissavesbothtimeandmoney.Thereisnocleanuporcookingforbreakfast.You’llbehomefordinnerwithoutanybodyevenrealizingyouwerefasting.

Nutrientdeficiencyisnotamajorconcernwithatwenty-four-hourfast.Sinceyouarestilleatingdaily,youjustneedtomakesurethatduringthatmealyouconsumeadequateproteins,vitamins,andmineralsbyeatingnutrient-dense,natural,unprocessedfoods.Youcouldfollowthisregimendaily,althoughmostwillgetgoodresultsdoingatwenty-four-hourfasttwotothreetimesperweek.BradPilon,theauthorofEat,Stop,Eat,recommendsusingatwenty-four-hourfasttwiceaweek.

EATINGAROUNDALONGERFASTWhenyou’refollowingaregularfastingregimenthatinvolveslongerfasts,it’sbestnottodeliberatelyrestrictcaloriesafteryourfast.Youshouldstillremainonalow-carbohydrate,high-fat,unprocessed-fooddiet,butyoushouldeatuntilfull.Thefastingperiodensuresthatyouburnthroughquiteabitofyourstoredenergy,anddeliberatelytryingtocutcaloriesfurtherisoftendifficultinthelongterm.

Three 24-hour fasts spread throughout the week works for me. It’sactuallynotabigdealmerelymissingamealortwo.AndIknowthatmost of the fast happens when I am sleeping. I eat my meal in theevening on the fast day and it’s interesting to note that I enjoy it somuchmorebecauseIamproperlyhungry—justasnatureintended.

—StellaB.,Leeds,UK

The5:2DietArelatedapproachisthe5:2dietchampionedbyDr.MichaelMosley,a

TVproducerandphysicianbasedintheUK,wherehisbookTheFastDietwasabest-seller.Ratherthancompletelyabstainingfromfoodforaperiodoftime,thisdietcallsforaperiodoflowcaloricintake.However,thecaloriesarekeptlowenoughtotriggermanyofthesamebeneficialhormonaladaptationsasfasting.Therearemanyanecdotesofsuccesswiththismethod.

The5:2dietconsistsoffivenormaleatingdays.Ontheothertwo“fast”days,womenmayeatupto500caloriesperdayandmenupto600calories.Thesetwofastdayscanbedoneonconsecutivedaysorspacedapart,dependinguponyourpreference.The500to600caloriescanbeconsumedinasinglemealorspreadoutintomultiplemealsoverthecourseofaday(thoughofcoursetheywouldbeverysmallmeals).

Thereasonalimitednumberofcaloriesareallowedonfastdaysistoincreasecompliance.Dr.Mosleyfeltthattakingnocaloriesatallduringadaywasexcessivelydifficult,tothepointthatmanypeoplesimplycouldn’tdoit.WhileI’vefoundthatpeoplearemorecapableoffastingthantheymaythink,

WhileI’vefoundthatpeoplearemorecapableoffastingthantheymaythink,the5:2dietcanbeagoodwaytoeaseintofasting.The5:2dietisgenerallyfollowedindefinitely,evenaftertargetweightisreached,inordertomaintainweightloss.

MARKSISSONFASTINGALL-STARSIfsomeonehadaseriousamountofweighttoloseandhadspenttherequisitetimeteachingtheirbodytoburnfat,Iwouldhavethemtry24-,36-,and48-hourfasts.Probablynotmuchlongerthanthat,butprobablywithsomefrequency(2dayseveryweekorevery2weeks,for6weeks,andthenrest).Aslongastheywereexercisingandperformingsubstantialmovementthroughouttheday,theywouldbeburningfat,utilizingketones,andpossiblyevenbuildingmuscle.

Alternate-DayFastingAsthenamesuggests,inalternate-dayfasting,youfasteveryotherday.As

onthe5:2diet,500to600caloriesarepermittedoneachfastingday,butbecausefastingisdoneeveryotherdayratherthantwiceperweek,it’saslightlymoreintenseregimenthanthe5:2diet.Thisregimenshouldbefolloweduntilyoureachtargetweight.Afterthat,thenumberoffastingdayscanbereducedaslongasyou’remaintainingtheidealweight.

LeonieHeilbronn,insearchingforanalternativetodailycaloricrestriction,testedthefeasibilityofusingalternate-dayfastingforweightloss.Testingthisregimenonmenandwomenvolunteersprovedthatweightlosscouldbesustained.

KristaVarady,anassistantprofessorofnutritionattheUniversityofChicago,confirmedtheefficacyandvalidityofthisfastingscheduleinastudysheperformedin2010.Sheguidedmenandwomenthroughanalternate-dayfastingprotocolforonemonth.Afterthat,theycontinuedwiththeprotocolontheirownforthenextthirtydays.Attheendofthosethirtydays(twomonthstotalontheprotocol),weightlossaveraged12.6pounds.Importantly,leanmass(muscle,protein,andbone)remainedunchanged—thatweightlosswaspurelyduetolossoffat.

Justdowhatyoucandependingonyourmindsetand stress levels atthe time, and never be disappointed if you “snap.” Think of it asturningoffthe“foodswitch”inyourmindforaslongasyoucan.

—DianneD.,Norfolk,UK

FASTINGALL-STARSROBBWOLFLongerfastingseemsbestapproachedwhenyouhavesomedowntimeandcancontrolyouractivity,workdemands,etc.Fromtheancestralperspectivefastingisalmostcertainlyakeypieceofourgeneticheritage.Thatsaid,wetendtohavemorechronicstressanddemandsthanwhatwouldtypifytheancestralenvironment...soIthinkit’simportanttokeepaneyeonallostaticloadwhenconsideringwhatdurationoffastonemighttackle.

36-HourFastsInathirty-six-hourfast,youdonoteatforoneentireday.Forexample,if

youfinishdinnerat7p.m.onday1,yourfastwouldbeginimmediatelyafter—youskipallmealsonday2andnoteatagainuntilbreakfastat7a.m.onday3.Thattotalsthirty-sixhoursoffasting.

InourIDMProgram,weusethirty-six-hourfasts,onathree-times-a-weekschedule,withpatientswhohavetype2diabetes.Wecontinuethisscheduleuntilthedesiredresultsareachieved:thepatientisabletogooffofalldiabetesmedicationandhasreachedthedesiredweight.Afterthat,wereducethefrequencyoffastingtoalevelthatletsthepatientmaintainthehard-wongainsbutiseasieronthepatient.Howlongthethree-times-a-weekscheduleismaintainedvaries,butingeneral,thelongerthepatienthashaddiabetes,thelongerthedurationoffastingrequired.Wecannotreversetwentyyearsofdiabetesinafewweeks.Butthelonger-durationfastingperiodgivesustheneededpowertogetgoodresultsinareasonabletime.

By following Dr. Fung’s 36-hour fasting protocol, my blood glucose

wentfrom112to88in6months.

—SandyR.,Sacramento,CA

DR.MICHAELRUSCIOFASTINGALL-STARSMostofmypatientsfeelbestwhentheystartwithalongerfastof2–4daystogettheirgastrointestinalsymptomsundercontrol.Thentheycanperiodicallyfastforahalfdayorfulldayasneededformaintenance,maybeonceaweekorafewtimesaweek.Themoreseveresomeone’ssymptomsare,themorelikelyIamtorecommendalongerfast,butthelongerfastscontainsometypeofliquidnutrition,suchasbrothorsemi-elementalnutrition.Themainconcernsarefatigue,weightloss,andnutrientdepletion,butthesecanbesafeguardedagainstbyusingagoodliquidformulalikeasemi-elementaldiet.

Figure13.1.Alternate-dayfastingresultsinsteadyweightloss.Thepeaksrepresentfeddays,whenweightgoesbackupslightly.

Source:Heilbronnetal.,“Alternate-DayFastinginNonobeseSubjects:EffectsonBodyWeight,BodyComposition,andEnergyMetabolism.”

Figure13.2.Overtwomonthsofalternate-dayfasting,bodyweight,BMI,bodyfat,andwaistcircumferencealldeclined,buttherewasnolossoffat-freemass(muscleandbone).

Source:Bhutanietal.,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations.”

Werecommendthatbloodsugarbecheckedregularlybetweentwoandfourtimesperday,asthereisthepotentialforlowbloodsugaraswellashighbloodsugar.Medicationsaregenerallyreducedonthefastingdaytopreventhypoglycemia—again,talktoyourdoctorifyou’reonmedicationbeforetryingafastingregimen.However,sincechangesinmedicationaffecteveryoneslightlydifferently,thereisthepossibilityofreducingmedicationstoomuch,resultinginhighbloodsugar.Testingregularlyallowsyoutofine-tunethemedicationsoyou’regettingjustasmuchasyouneed,nomore,noless.

42-HourFasts

ManyclientsintheIDMProgramroutinelyskipthemorningmealandhavetheirfirstmealofthedayaroundnoon.Thismakesiteasytofollowasixteen-hourfastingregimen(seehere)onregulardays.Thereisnothingmagicalabouteatingassoonasyougetup.Startingthedaywithjustalargecupofcoffeeisquiteacceptable.

Combiningthisdailyroutinewithanoccasional(twotothreetimesperweek)thirty-six-hourfastresultsinaforty-two-hourfastingperiod.Forexample,youwouldeatdinnerat6p.m.onday1.Youskipallmealsonday2andeatyourregular“breakfast”mealatnoononday3.Thisgivesyouatotalfastofforty-twohours.

References

AlisonFildes,JudithCharlton,CarolineRudisill,PeterLittlejohns,A.TobyPrevost,andMartinC.Gulliford,“ProbabilityofanObesePersonAttainingNormalBodyWeight:CohortStudyUsingElectronicHealthRecords,”AmericanJournalofPublicHealth105,no.9(2015):e54–e59.

LeonieK.Heilbronn,StevenR.Smith,CorbyK.Martin,StephenD.Anton,andEricRavussin,“Alternate-DayFastinginNonobeseSubjects:EffectsonBodyWeight,BodyComposition,andEnergyMetabolism,”AmericanJournalofClinicalNutrition81,no.1(2005):69–73.

SurabhiBhutani,MonicaC.Klempel,ReedA.Berger,andKristaA.Varady,“ImprovementsinCoronaryHeartDiseaseRiskIndicatorsbyAlternate-DayFastingInvolveAdiposeTissueModulations,”Obesity18,no.11(2010):2152–9.

SUNNY&CHERRIE

FASTINGSUCCESSSTORY

IfirstmetSunnyinSeptember2015intheIntensiveDietaryManagementProgram.Sunny,agefifty-one,hadbeendiagnosedwithtype2diabetesinthemid-1990s,whenhewasonlyinhisthirties,andhadbeenstartedonthemedicationmetformin.Overtheyears,he’drequiredmoreandmoremedicationstocontrolhisbloodsugarlevels.In2011hewasprescribedinsulin.BythetimeIsawhim,hewastakingmaximaldosesofmetformininadditiontoinjecting70unitsofinsulineveryday.

Despitethislargedoseofmedication,hisbloodsugarwasstillsuboptimallycontrolled;hisHbA1C,whichreflectsthethree-monthaveragebloodsugarlevel,was7.2percent.Optimalbloodsugarcontrolisdefinedaslessthan7.0percent,althoughmanyphysiciansrecommendgettingittolessthan6.5percent.

SunnystartedparticipatinginourIDMProgramonOctober2,2015.Hechangedtoadietlowinrefinedcarbohydratesandhighinnaturalfats.Inaddition,weaskedhimtofastforthirty-sixtoforty-twohoursthreetimesaweek.Ifhefinisheddinneronday1,hewouldnoteatagainuntillunchonday3.

Hisbloodsugarimprovedimmediately.Injusttwoweeks,wewereabletodiscontinueallofhisinsulin.Onemonthafterthat,westoppedallhisdiabeticmedicationsentirely.Hehassincemaintainednormalbloodsugarwithoutanymedications,managedentirelybydietarymeasures.

OvertheChristmasholidayperiod,he,likemanypatientsinourprogram,didgainweightandhisbloodsugardidincreaseslightly.However,withtheresumptionofhisdietandintermittentfasting,hisweightandbloodsugarfellbackdown,andhedidnotrequiremedications.

Sunnyfeltremarkablywellthroughouthisentirejourney.Hehadnodifficultymaintaininghislow-carbohydratedietortheintermittentfastingprotocols.ByMarch2016,hisweighthadstabilizedandhisbodymassindexwasonly19.Moreimportantly,hiswaistsizehadcomedowndramatically.Waistsizeisagoodreflectionofhowmuchvisceralfataroundtheorgansoftheabdomenand

goodreflectionofhowmuchvisceralfataroundtheorgansoftheabdomenandthereforemoreaccuratelyreflectsthebody’smetabolicstate.Thewaist/hipratioandwaist/heightratioareconsideredbetterpredictorsofhealththansimplebodyweight.

Evenmoreremarkably,Sunny’skidneyfunctionimprovedrightawayontheprogram.Whenhestartedthefastingregimen,hewasspillingproteininhisurine,wellabovethenormallimit.Thisproteinintheurineisthefirstsignofdiabeticdamagetothekidneyandisoftenconsideredirreversible,justastype2diabetesitselfisconsideredirreversible.ButbyNovember,justamonthafterhestartedfasting,hisproteinexcretionhadfallentowellwithinthenormalrange,whereithasremainedeversince.

InMarch2016,Sunnydidnotneedtoloseanymoreweight,sohisfastingregimenwasreducedtotwenty-fourhoursoffastingthreetimesaweekformaintenance.Ofcourse,ifhehaddietaryindiscretionsorifhisbloodsugarorweightstartedtorise,hecouldeasilyincreasehisfastingdaysasneeded.

Afterinjectinghimselfwithinsulintwicedailyforfiveyearsandtakingdiabeticmedicationsforovertwentyyears,Sunnywasfreeoftype2diabetes,withjustafewshortmonthsofproperdietandintermittentfasting.Hisbloodsugarlevelsnowclassifyhimasprediabetic,notafull-fledgeddiabetic.Hisdiseasehadreversed.

Butthatisnottheendofthestory.

CherrieInJanuary2016,Sunny’soldersisterCherriewasastonishedathowwellheryoungerbrotherwasdoing.Hisweightwasdown.Hiswaistsizewasdown.Hehadstoppedallhisdiabeticmedications.Hedidn’tevenfindthelifestylechangeverydifficult.Histwentyyearsofdiabeteshadbeenreversedalmostovernight.Cherriewantedin.

Cherriewasfifty-fiveyearsoldandhadbeendiagnosedwithtype2diabetesnineyearsearlieratageforty-six.Herstorywassimilartoherbrother’s:shehadstartedoffwithasmalldoseofasinglemedicationfordiabetes,butovertheyears,hermedicationpilehadslowlygrown.Shewasnowtakingthreemedicationsfordiabetes,alongwithmedicationforcholesterol,bloodpressure,andheartburn.

Wediscussedhersituationandtogetherdecideduponadietaryplanforher.Shewouldchangetoadietlowinrefinedcarbohydratesandhighinnaturalfats.Shewasalittlelesssureofhowshewouldfeelduringfasting,sowedecideduponatwenty-four-hourfastingperiodthreetimesperweek.Herdiabeteswasnotassevereasherbrother’s,andshecouldalwaysincreaseherfastingifnecessary.

ShestartedourprograminFebruary2016.Herbloodsugarlevelsrespondedimmediately.Withintwoweeks,shehadstoppedallthreeofherdiabeticmedications,astheywerenolongernecessary.Herbloodsugarwasnowconsistentlyinthenormalrange.Herweightbeganasteadydecline,asdidherwaistsize.

Herheartburndisappeared,soshestoppedherheartburnmedication.Herbloodpressurenormalized,soshestoppedherbloodpressuremedication.Hercholesterolnumberswereimproved,soshestoppedhercholesterolmedications.Withinasinglemonth,shestoppedallsixofhermedications,yetherbloodworkwasbetterthanever.HerHbA1cof6.2percentwasbetterthanwhenshewastakingallthreediabetesmedications.Shewasnolongerconsidereddiabetic,onlyprediabetic.Thismeantthatherdiseasewasreversing.

Furthermore,shefeltextremelywellduringthisentireprocess.Shedidnothaveanytroublewiththefastingprotocol.WhileherfastingperiodwasshorterthanSunny’s,shewasstillgettingexcellentresults,sotherewasnoneedtochangeit.Shehadbeentakingsixmedicationsatthebeginning.Nowshewasonnone,andshefeltahundredtimesbetter.

Thisillustratesanimportantpoint.Type2diabetesisadietarydisease.Assuch,theonlylogicaltreatmentistochangedietandlifestyle.Iftheproblemstemsfromanexcessiveintakeofcarbohydrates,thenreducingcarbohydratesistheanswer.Iftheproblemstemsfromexcessiveweight,thensuccessfulweightlosswithfastingistheanswer.Oncewefixtheunderlyingissue,thediseasereverses.

However,wehavebeenbrainwashedtobelievethattype2diabetesandallitscomplicationsareinevitable.Wehavebeendeceivedintobelievingthatwecansuccessfullytreatadietarydiseasewithincreasingdosesofdrugs.Whenthedrugsfailtohaltthediabetes,wearetoldthatthediseaseischronicandprogressive.

Sunnyhadtype2diabetesforovertwentyyears,yethemanagedtosuccessfullyreversehisdiseasewithinamatteronmonths.Cherriehadbeenondiabetesmedicationforsevenyearsandalsosuccessfullyreversedherdiseaseinafewmonths.Buttheyarenotanomalies.Almosteverysingleday,Imeetpeopleofallageswhohavereversedorarereversingtheirtype2diabeteswithafastingregimen.

Chapter14

EXTENDEDFASTING

Extendedfasts—thoselastinglongerthanforty-twohours—havebeen

followedforcenturiesinculturesallovertheworld.Theyhavealsobeenextensivelystudiedinthemedicalliteratureasfarbackas1915,whendoctorsOttoFolinandW.Denisdescribedfastingasa“safeandeffectivemethodforreducingtheweightofthosesufferingfromobesity”;theywereechoedbyFrancisGanoBenedictinthesameyearinhisbookonprolongedfasting.Butthereafter,interestinextendedfastingasatherapeutictoolseemedtofadeaway.

Interestrevivedinthelate1950sand1960sasmoreandmorephysiciansreportedtheirexperienceswithfasting.Earlystudiesfocusedmostlyonshorterfastingperiods,butoncetheybecamemorefamiliarwithfasting,manyphysiciansextendedthefasts.

In1968,endocrinologistIanGillilandstudiedtheeffectsofextendedfastingonforty-sixpatients.Afteradmittingthemtothehospitalforobservationtomakesuretheywerecompliantwiththefast,heinitiatedafourteen-dayfastduringwhichtheywereallowedonlywater,tea,andcoffee.Afterthat,theyweredischargedandaskedtofollowa600-to1000-caloriedietathome.Interestingly,twopatientsaskedtobereadmittedforasecondfourteen-dayperiodoffasting.Havinggottengoodresultsalreadywithrelativeease,theywantedevenbetterresultsbyincreasingthedurationofthefast.

Figure14.1.Oneindividual’sexperienceofweightlossona14-dayfastduringGilliland’s1968study.

Source:Gilliland,“TotalFastingintheTreatmentofObesity.”

Afterfourteendaysoffasting,theaverageweightlosswas17.2pounds.Bloodsugarlevelsfellduringfasting,asexpected,tolevelsthatsignificantlybenefitedtheparticipantswithdiabetes—allthreediabeticpatientswerecompletelyoffinsulinbytheendofthetwoweeks.

Insulinencouragesthekidneystoretainsaltandwater,sobyloweringinsulinlevels,fastinghelpsthebodyexcreteexcesssaltandwater.Duringthefirstseveraldaysoffasting,there’sacorrespondingincreaseinurineflow.TheeliminationofexcesswaterandsalthelpedonepatientinGilliland’sstudywhohadseverecongestiveheartfailure:bytheendofthetwoweeks,hewasabletowalkwithoutbreathlessness.

Wasfastingfortwoweekshard?Quitetheopposite,infact.Gillilanddescribestheparticipantshavinga“feelingofwellbeing”and“euphoria.”Weretheyhungry?Perhapssurprisingly,notreally:“Wedidnotencountercomplaintsofhungerafterthefirstday.”Theseexperienceswereconfirmedbyotherresearchersofthetime.

However,thestudyparticipantsdidn’tdosowellfollowingthe600-to1000-caloriedietGillilandprescribedoncetheyweresenthome.Inthetwo-yearfollow-upperiod,50percentofparticipantsdidnotadheretothisdiet.Given

whatwenowknowaboutreduced-caloriediets(seeChapter5),that’snotsurprising.

Fastinghasnoupperlimit.Inthe1970s,atwenty-seven-year-oldScottishmanstartedfastingataweightof456pounds.Overthenext382days,hesubsistedononlynoncaloricfluids,adailymultivitamin,andvarioussupplements,settingtheworldrecordforthelongestfast.Aphysicianmonitoredhimduringthefastingperiodanddeterminedthattherewerenosignificantdeleterioushealtheffects.

Hisbodyweightdecreasedfrom456poundsto180pounds.Evenfiveyearsafterhisfast,heremainedat196pounds.Hisbloodsugarleveldecreasedbutremainedwellwithinthenormalrange,andhehadnoepisodesofhypoglycemia.

Ifast3.5consecutivedaysaweekandeatLCHFtheother3.5days.Ithas been working very well! It is my version of an alternate-daypattern but in blocks instead. I love that Dr. Fung encouragesexperimentation to find a pattern that works for each uniqueindividual.

—EvelynC.,Regina,SK

WhattoExpectDuringanExtendedFastInGilliland’sstudy,forty-fourofforty-sixpatientscompletedthetwo-week

fastingperiod.Onedevelopednauseaandonesimplydecidedagainstitanddroppedout.That’sa96percentcompletionrate!Evenatwo-weekfastisnotasdifficultasmanythink.Ourclinicalexperienceconfirmsthis:peopleoftenbelievetheycannotfast,butonceweexplaintheprocess,givehelpfultipsforsuccess,andprovidepropersupport,patientsintheIDMProgramquicklyrealizethatfastingisactuallyquiteeasy.

That’snottosaythatthere’snotanadjustmentperiod.Infact,thefirstseveraldaysoffastingareoftenquitedifficult.Day2seemstobethehardestintermsofhunger.However,onceyoupushthroughthatsecondday,thingsgetprogressivelyeasier.Hungerslowlydisappearsandasenseofwell-beingoftendevelops.It’sjustlikeexercising.Whenyoufirststarttoliftweights,forexample,yourmusclesareverysoreafterward.Thisisexpectedandshouldnotdissuadeyoufromcontinuingtoworkout—andovertime,asyougrowstronger,

dissuadeyoufromcontinuingtoworkout—andovertime,asyougrowstronger,youcanliftthesameweightwithoutdifficultyorsoreness.Similarly,withfasting,theinitialperiodmayalsobedifficult,butthingsgeteasierwithpractice.

Weightlossaveraged0.76poundsperdayinDr.Gilliland’sstudy,adjustingfortheexpectedwater-weightregainoncethefastwascompleted.Otherstudiesoffastingforovertwohundreddaysshowsimilarratesofweightloss,rangingfrom0.41to0.67poundsperday.IntheIDMProgram,wetellpatientstoexpectanaveragefatlossofhalfapoundperdayoffasting.Ifyoulosemoreweightthanthat,it’slikelywaterweightthatyou’resheddingduetothereductionininsulin.

Ifweassumethat2,000caloriesareburnedduringanormalday,andweknowthatonepoundoffatcontainsapproximately3,500calories,thenduringanabsolutefast—whennocaloriesatallarebeingconsumed—wewouldexpect0.57poundstobelosteachday(2,000caloriesexpended/3,500caloriesperpound=0.57poundslost).That’sfairlyclosetowhatstudieshaveshown.Thismeansthatmetabolismstaysrelativelystablethroughoutthefastingperiod—there’snometabolicslowdown,sothose2,000caloriesthatareburnedonanormaldayarealsoburnedduringfasting.So,forapatientwith100poundsoffat,youcanexpectthatitwouldtakeroughly200fulldaysoffastingtoloseitall.

Duringextendedfasting,thebrainreducesitsrelianceonglucoseasanenergysource.Instead,themajorityofthebrain’sfuelissuppliedbyketonebodies,whicharecreatedbyburningfat.Itisbelievedthatthebrainisabletomoreefficientlyusetheseketones,possiblyleadingtoimprovedmentalabilities.Ketoneshavesometimesbeenreferredtoasa“superfuel”forthebrain.Ketonesgenerallyrequirethirty-sixtoforty-eighthoursoffastingtorampup.Priortothis,mostofthebody’senergyrequirementsaremetbythebreakdownofglycogen.(Seehereformoredetails.)

Incorporating intermittent fasting (16:8 and 20:4) and heavy lifting /interval training (to preserve muscle mass and drain those glucosestores) helpedme get into ketosis faster and lose fatmore efficientlythan using a well-formulated ketogenic diet alone. Diet alone takesabout3+weekstogetpasthunger,but fastingandexercisewithketocutstimeinhalf.

—LeslieE.,Venice,FL

Extendedfastingrarelycauseselectrolyteabnormalities.Calcium,phosphorus,sodium,potassium,chlorideurea,creatinine,andbicarbonatelevelsinthebloodremainwithinthenormallimitsandarevirtuallyunchangedbytheendofthefast.Bloodmagnesiumlevelsoccasionallygolow.Thisseemstobeespeciallyprevalentindiabetics.Mostofthebody’smagnesiumisintracellularandnotmeasuredbybloodlevels.Whilemonitoringtheworld-record-breaking382-dayfast,researchersmeasuredthemagnesiumcontentwithinthecells,whichremainedfirmlyinthenormalrange.Nevertheless,weoftensupplementpatientswithmagnesiumtobeonthesafeside.

Figure14.2.Afterafastofseveralweeks,thebrainisfueledprimarilybyketones.

Source:Cahill,“FuelMetabolisminStarvation.”

It’snormalforbowelmovementstoslowdownduringprolongedfasting—nothinggoesintothedigestivesystem,soitmakessensethatlittlecomesout.Duringtheworld-recordfast,bowelmovementsoccurredeverythirty-seventoforty-eightdays.It’simportanttonoteisthatthisisanentirelynormalphenomenon.Youdonotneedtohaveadailybowelmovementtofeelwell.Discomfortfromconstipationoccurswhenyourintestinesarefullofstool,butduringanextendedfast,thereislittleinsidethecolonandthereforelittlediscomfort.Thisalsoreflectsthefactthatthebodyisrecyclingalltheessential

fatsandaminoacidsfromthebreakdownofoldordysfunctionalcells.Finally,onemorecautionarynoteforthosewhohavediabetesand/orare

takingmedications:youmusttalktoyourphysicianbeforestartinganyprolongedfasting.Also,ifyoufeelunwellatanypointduringthefasting,youmuststop.Youmayfeelhungry,butyoushouldnotfeelfaint,unwell,ornauseated.Thisisnotnormal,andyoushouldnotattempttopushthrough.

Two-toThree-DayFastsWhendealingwithstubbornweightplateausorpersistentlyhighblood

sugar,oneoptionistosimplyextendthefastingperiodforlongerthanforty-twohours.Howlongtocontinuethefastisamatterofpersonalpreference.However,therearesomegeneralguidelineswecanoffer.

IntheIDMProgram,werarelyadvisepatientstousefastingdurationsoftwotothreedays.Themajorityofpeoplefindday2ofanextendedfasttobethemostdifficultintermsofhunger.Afterday2,manypeopledescribeagraduallesseningandthenatotaleliminationofhunger.(Somehavehypothesizedthatthiseffectisduetothehighnumberofketonebodiesthatbegincirculatingafteracoupleofdays.)Fromapracticalstandpoint,itseemsratherharshtoendafastassoonasyouhavepasseditsmostdifficultday.Instead,weencouragepatientstocontinuetheirfastforseventofourteendays.Afourteen-dayfastdeliversseventimesthebenefitofatwo-dayfastbutisonlymarginallymoredifficult.

Seven-toFourteen-DayFastsWeoftenstartpatientswithseveretype2diabetesonaseven-tofourteen-

dayfast.Thereareseveralreasonsforthis.First,itallowsthebodytoquicklyadjusttofastingconditions,whichmanypeoplefindeasierthanamoregradualtransition.Itisreallythedifferencebetweendoingacannonballjumpintothedeependofthepoolandgraduallywadingin,oneinchatatime.Forsome,thecannonballistheeasierchoice.

Second,thelongerfastingperiodallowsformorerapidimprovementsinbloodglucoseandtype2diabetes.Inpatientsonhighdosesofmedicationorwhoaresufferingthecomplicationsoforgandamage,thereisamoreurgentneedtoreversethediabetesandloseweight—muchoftheorgandamagecausedbydiabetesisirreversibleonceitoccurs.It’softennotuntilday5or6thatweseesignificantimprovementinbloodsugarandareabletoreducethediabetesmedication.Thisresultwouldtakemuchlongerusingashorterfastingduration.

Wegenerallycapthedurationofafastatfourteendaysinordertominimizetheriskofrefeedingsyndrome(seebelow).However,manypeople

minimizetheriskofrefeedingsyndrome(seebelow).However,manypeoplehaveextendedtheirfastswellpastfourteendayswithoutincident.Ingeneral,though,weadvisepatientstoswitchtoanalternate-dayfastingregimenfortwoweeksbeforerepeatinganextendedfast.

RefeedingSyndromeRefeedingreferstotheonetotwodaysimmediatelyafteranextendedfast.

MedicalcomplicationsduringrefeedingwerefirstdescribedinseverelymalnourishedAmericansinJapaneseprisonerofwarcampsafterWorldWarII.Sincethen,refeedingsyndromehasalsobeendescribedupontreatmentoflongstandinganorexianervosaandofalcoholicpatients.Itisparticularlypronetooccurinthesegroupsofpatientsbecausetheyareoftenmalnourishedanddonothavesignificantbodyfatstorestobeginwith.Duringtheensuinglongperiodswithoutfood,theirbodiesmaybreakdownfunctionalproteinstosupplymuch-neededenergy.Thissyndromeisextremelyuncommoninpatientswithadequatebodyfatstoreswhoarewell-nourished.Buteventhen,itmayoccurrarelyifyouareattemptinganextendedfast—typicallygreaterthanfivedaysatatime.

Refeedingsyndromeoccurswhenelectrolytes,particularlyphosphorus,aredepletedduetomalnourishment.Adultsstore500to800gramsofphosphorusinthebody.Approximately80percentofthatisheldwithintheskeleton,therestinsofttissues.Mostphosphorusiskeptinsidethetissuecellsratherthanintheblood,andthebloodlevelofphosphorusisverytightlycontrolled.Duringprolongedmalnutrition,bloodlevelsofphosphorusremainnormalasbonestoresareusedup.

Oncerefeedingbegins,thefoodraisesinsulinlevels,whichstimulatesthesynthesisofglycogen,fat,andprotein.Allofthatrequiresmineralslikephosphorusandmagnesium.Thisputsanenormousdemandonalready-depletedphosphorusstores.Toolittlephosphorusisleftintheblood,andthatcausesthebodyto“powerdown.”Muscleweaknessandoutrightmusclebreakdownhavebeendescribed.Itmayevenaffecttheheartmuscleandthediaphragm,themuscleresponsibleforbreathing.

Magnesiumcanalsobecomedepleted,resultingincramps,confusion,tremor,and,occasionally,seizures.Lowpotassiumandmagnesiumcanalsocauseheartrhythmdisturbancesorevenoutrightcardiacarrest.Inaddition,higherinsulinlevelsduringrefeedingmayoccasionallycausethekidneystoretainsaltandwater.Thismayshowupasswellingofthefeetandanklesandhasbeentermedrefeedingedema.

Chronicallymalnourishedand/orseverelyunderweightpeopleareatthehighestriskofrefeedingsyndrome.Thisincludesthosewithanorexia,chronicalcoholism,cancer,uncontrolleddiabetes,orboweldisease—ifanyoftheseapplytoyou,fastingmaynotbeforyou;discussyouroptionswithyourdoctor.Andmoregenerally,peoplewithabodymassindexlessthan18.5,unintentionalweightlossofmorethan10percentoftheirbodyweightinthepastsixmonths,orahistoryofalcoholismormisuseofdrugsshouldbeespeciallycarefulaboutextendedfasting.Thesegroupsofpatientsaregenerallymalnourishedandunderweightratherthanoverweight,sothere’snoreasontotryfastingasatherapeutictool.However,ifabsolutelynecessary(forexample,religiousorspiritualpurposes),theymayconsidershorter-termfastslastinglessthantwenty-fourhours.

Fortunately,refeedingsyndromeisveryrare.Evenamongverysickhospitalizedpatients,studiesfounditoccurredinonly0.43percent.Themainriskfactorforrefeedingsyndromeisprolongedmalnutrition.WhenweusefastingasatherapeutictoolinourIDMclinic,mostpeoplehavenevermissedasinglemealinovertwenty-fiveyears!Malnutritionisdefinitelynotaconcern.

Refeedingsyndromeoccursmostlywhenpeoplehavebeenstarved—thatis,they’veundergoneanuncontrolled,involuntaryrestrictionoffood—andparticularlywhenthey’vebegunwasting(experiencingseveremalnutritionduetostarvation).Refeedingsyndromeduetofasting—thatis,thecontrolled,voluntaryrestrictionoffood—isveryuncommon.

Tohelppreventproblemsinthepost-fastrefeedingperiod,therearetwostepswerecommend:

1.Donotmakeanextendedfastawater-onlyfast.Drinkinghomemadebonebrothprovidesphosphorusandotherproteinsandelectrolytes,whichreducesthechancesofdevelopingrefeedingsyndrome.Andtopreventvitamindeficiency,takeadailymultivitamin.

2.Doallyourusualactivities,especiallyyourexerciseprogram,duringyourfast.Thishelpstomaintainyourmusclesandbones.

In2003,theperformanceartistDavidBlaineunderwentaforty-four-daywater-onlyfast.Helost54pounds(24.5kg),amassive25percentofhisbodyweight.Hisbodymassindexdroppedfrom29to21.6.Whilehisbloodsugarandcholesterollevelsremainednormal,hedevelopedrefeedingsyndromeandedema.

DavidBlainewassuspendedinaPlexiglasboxforthedurationofhisfast.Hecouldnotdoanyofhisusualactivities,orevenstandup,forforty-fourdays.Thisisfarmorethanafast.Hismusclesandbonesactuallydevelopedsignificantatrophyduringthatperiod.Hewaslosingfarmorethanfat:helost

significantatrophyduringthatperiod.Hewaslosingfarmorethanfat:helostsignificantleanweight,muscleandbone.Thiswasnotduetofastingbutinsteadtobeingcoopedupinaboxforforty-fourdays.

In2003,DavidBlaineunderwenta44-daywater-onlyfastsuspendedinaPlexiglasboxaboveLondon.

References

ErnstJ.Drenick,MarionE.Swendseid,WilliamH.Blahd,andStewartG.Tuttle,“ProlongedStarvationasTreatmentforSevereObesity,”JAMA187,no.2(1964):100–5.

FrancisGanoBenedict,AStudyofProlongedFasting(Washington,DC:CarnegieInstituteofWashington,1915):27,42,182.

GeorgeF.CahillJr.,“FuelMetabolisminStarvation,”AnnualReviewofNutrition26(2006):1–22.

I.C.Gilliland,“TotalFastingintheTreatmentofObesity,”PostgraduateMedicalJournal44,no.507(1968):58–61.

M.A.CampandM.Allon,“SevereHypophosphatemiainHospitalizedPatients,”MineralandElectrolyteMetabolism16,no.6(1990):365-8.

M.A.Crook,V.Hally,andJ.V.Panteli,“TheImportanceoftheRefeedingSyndrome,”Nutrition

17,nos.7–8(2001):632–7.

OttoFolinandW.Denis,“OnStarvationandObesity,withSpecialReferencetoAcidosis,”JournalofBiologicalChemistry21(1915):183–92.

W.K.StewardandLauraW.Fleming,“FeaturesofaSuccessfulTherapeuticFastof382Days’Duration,”PostgraduateMedicalJournal49,no.569(1973):203–9.

Chapter15FASTINGTIPSANDFAQS

Fastingusedtobeanintegralpartofnormallife.Infact,itstillisinmanyreligions—forexample,theGreekOrthodoxandMuslimreligions.Inthesecontexts,it’sacommunalpractice.You’renotfastingalonebutwithallofyourfamilyandfriends.Peersupportiswidelyavailable,andpracticaltipsarepassedonfromgenerationtogeneration.However,withthedeclineinthepracticeoffasting,goodadviceisoftendifficulttofind.

Inthischapter,we’llpresentpracticaltipsandanswercommonquestionsbasedonourexperienceswithhundredsoffastingpatients.

Butfirst,twogeneralsuggestionsforfastingsuccess:One,alwayskeepyourgoalsinmind.Forexample,ifyouaretryingtoloseseveralpoundsforanupcomingclassreunion,yourfastingstrategywillbedifferentthanifyouare400poundsandseverelydiabetic.

Two,readjustyourstrategybasedonyourresults.Ifyoufollowaregimenofalternate-dayfastingandgetgoodresults,great!Butifyourprogressstalls,thenitmaybeagoodideatochangepaths.Ifyoufindlongerfastsmucheasierthanshorterones,thenadjustyourregimentoaddlongerfastsintoyourfastingschedule.Oryoumayfindshorter,more-frequentfastsbetterinthesummerandlonger,less-frequentfastsbetterinthewinter.Adjustandadapt.Nothingiswritteninstone.

Top9FastingTips

1.Drinkwater:Starteachmorningwithafulleight-ounceglassofwater.Itwillhelpyoustartyourdayhydratedandsetthetonefordrinkingplentyoffluidsthroughouttheday.

2.Staybusy:It’llkeepyourmindofffood.Tryfastingonabusyworkday.Youmaybetoobusytoremembertobehungry.

3.Drinkcoffee:Coffeeisamildappetitesuppressant.There’salsosomeevidencethatgreenteamaysuppressappetite.Blackteaandhomemadebonebrothmayalsohelpcontrolappetite.

4.Ridethewaves:Hungercomesinwaves;itisnotconstant.Whenithits,slowlydrinkaglassofwaterorahotcupofcoffee.Oftenbythetimeyou’vefinished,yourhungerwillhavepassed.

5.Don’ttellpeopleyouarefasting:Mostpeoplewilltrytodiscourageyousimplybecausetheydon’tunderstandthebenefitsoffasting.Aclose-knitsupportgroupofpeoplewhoarealsofastingisoftenbeneficial,buttellingeverybodyyouknowisnotagoodidea.

6.Giveyourselfonemonth:Ittakestimeforyourbodytogetusedtofasting.Thefirstfewtimesyoufastwillbedifficult,sobeprepared.Don’tbediscouraged.Itgetseasier.

7.Followanutritiousdietonnonfastingdays:Intermittentfastingisnotanexcusetoeatwhateveryoulike.Duringnonfastingdays,sticktoanutritiousdietlowinsugarandrefinedcarbohydrates.Followingalow-carbohydratedietthat’shighinhealthyfatscanalsohelpyourbodystayinfat-burningmodeand

makefastingeasier.8.Don’tbinge:Afteryourfast,pretenditneverhappened.Eatnormally(andnutritiously—see#7),asif

youhadneverfasted.9.Fitfastingintoyourownlife:ThisisthemostimportanttipIcanoffer,andithasthegreatestimpacton

whetheryousticktoyourfastingregimen.Donotchangeyourlifetofityourfastingschedule—changeyourfastingscheduletofityourlife.Don’tlimityourselfsociallybecauseyou’refasting.Therewillbetimesduringwhichit’simpossibletofast,suchasvacations,holidays,andweddings.Donottrytoforcefastingintothesecelebrations.Theseoccasionsaretimestorelaxandenjoy.Afterwards,youcansimplyincreaseyourfastingtocompensate.Orjustresumeyourregularfastingschedule.Adjustyourfastingscheduletowhatmakessenseforyourlifestyle.We’lltalkmoreaboutthisonhere.

Fastingisnodifferentthananyotherskillinlife:practiceandsupportareessentialtoperformingitwell.

BreakingYourFastBreakyourfastgently.Thelongerthefastingperiod,thegentleryoumust

be.Thereisanaturaltendencytoovereatassoonasthefastisover—though,interestingly,mostpeoplesaythatthisisn’tbecauseofoverwhelminghungerbutmoreofapsychologicalneedtoeat.Overeatingrightafterfastingoftenleadstostomachdiscomfort.Whilenotserious,itcanbequiteuncomfortable.Thisproblemtendstobeself-correcting.

Trybreakingyourfastwithasnackorsmalldishtostart,thenwaitforthirtytosixtyminutesbeforeeatingyourmainmeal.Thiswillusuallygivetimeforanywavesofhungertopassandallowyoutograduallyadjusttoeatingagain.Short-durationfasts(twenty-fourhoursorless)generallyrequirenospecialprecautions,butforlongerfasts,itisagoodideatoplanahead.Prepareasmalldishandleaveitintherefrigeratorsothatwhenitcomestimetobreakthefast,youarereadyandlesslikelytobetemptedbythemyriadofotherconveniencefoodsavailable.Herearesomesuggestionsforthatfirstsnack:

1/4to1/3cupmacadamianuts,almonds,walnuts,orpinenuts

1tablespoonpeanutbutteroralmondbutterAsmallsalad(insteadofsaladdressing,trycottagecheeseorcrèmefraîche)AsmallbowlofrawvegetableswithsomeoliveoilandvinegardrizzledonthemAbowlofvegetablesoupAsmallamountofmeat(forinstance,threeslicesofprosciuttoorasliceortwoofporkbelly)

Forthosewhoexperiencegastrointestinaldistresswhenbreakingafast,eggsseemtobethebiggestculprit.Ifyouhaveasensitivestomachorareconcernedaboutbreakingyourfast,youmaywanttoavoideggsatyourfirst

concernedaboutbreakingyourfast,youmaywanttoavoideggsatyourfirstmeal.

TipsforBreakingYourFastwithaSnack•Makesureyourportionsizesaresmall.Youwillbeeatingafullmealshortly,sothereisnoneedtogorge.•Takethetimetochewthoroughly.Thiswillgreatlyhelpyourdigestivesystem,whichhasbeenrestingfor

awhile.Youareslowlybringingyoursystembackonline.•Takeyourtimeingeneral.Yourfastisover.Ifyouarefeelinganxioustoeatagain,takecomfortknowing

youwillbehavingawholemealwithinthehour.•Don’tforgettodrinkwater!Drinkatallglassofwaterbeforeyoubreakyourfastandafteryourfirstmeal.

Peopleoftenforgettoconsumefluidoncetheystopfasting,butweoftenmistakethirstforhunger.Makesureyouarestayinghydratedsoyoudon’tovereat.

CommonConcernsHunger

Thisisprobablythenumber-oneconcernpeoplehaveaboutfasting.Theyassumethey’llbeoverwhelmedwithhungerandunabletocontrolthemselvesduringthefast.We’vedevotedChapter9tohunger,debunkingmythsandexplaininghowitreallyworks,buthere,weofferaquickoverviewofwhatyoucanexpectintermsofhungerandwhatcanhelpminimizeit.

Thetruthisthathungerdoesnotpersistbutinsteadcomesinwaves.Ifyou’reexperiencinghunger,itwillpass.Stayingbusyduringafastdayisoftenhelpful.

Asthebodybecomesaccustomedtofasting,itstartstoburnitsstoresoffat,whichhelpssuppresshunger.Manypeoplenotethatoverseveralweeks,astheycontinueafastingregimen,appetitenotonlydoesn’tincrease,itactuallystartstodecrease.Duringlongerfasts,manypeoplenoticethattheirhungercompletelydisappearsbythesecondorthirdday.

Therearesomedrinksorspicesallowedonfaststhatcanhelpsuppresshunger.Herearemytopfivenaturalappetitesuppressants:

Water:Startyourdaywithafullglassofcoldwater.Stayinghydratedhelpspreventhunger.(Drinkingaglassofwaterpriortoamealmayalsoreducehungerandhelppreventovereating.)Sparklingmineralwatermayhelpfornoisystomachsandcramping.

Greentea:Fullofantioxidantsandpolyphenols,greenteaisagreataidfordieters.Thepowerfulantioxidantsmayhelpstimulatemetabolismandweightloss.

Cinnamon:Cinnamonhasbeenshowntoslowgastricemptyingandmayhelpsuppresshunger.Itmayalsohelplowerbloodsugarandthereforeisuseful

inweightloss.Cinnamonmaybeaddedtoallteasandcoffeesforadeliciouschangeofpace.

Coffee:Whilemanyassumethatitisthecaffeineincoffeesuppresseshunger,studiesshowthatthiseffectismorelikelyrelatedtoantioxidants—althoughcaffeinemayraiseyourmetabolism,furtherboostingfat-burning.Butastudyshowsthatbothdecaffeinatedandregularcoffeesuppresshungerbetterthancaffeineinwater.Givenitshealthbenefits,thereisnoreasontolimitcoffeeintake.

Chiaseeds:Chiaseedsarehighinsolublefiberandomega-3fattyacids.Theseseedsabsorbwaterandformagelwhensoakedinliquidforthirtyminutes,whichmayaidinappetitesuppression.Theycanbeeatendryormadeintoagelorpudding.Thesemaybetakenduringafasttohelpsuppresshunger.Onceagain,whiletechnicallybreakingthefast,theeffectissoslightthatitdoesnotsignificantlydetractfromthebenefitsofthefast.Theincreasedcompliancemorethancompensates.

Formoreonhunger,seeChapter9.

I was unable to water fast in the past due to severe nausea andweakness.NowI’vesuccessfullycompleteda7-daywater-onlyfastfor7 days by adding 1 teaspoon of salt to a glass of water daily. I feltwonderful,withnonauseaorweakness!

—CindaH.,Colorado

DizzinessIfyouexperiencedizzinessduringyourfast,mostlikely,you’rebecoming

dehydrated.Preventingthisrequiresbothsaltandwater.Besuretodrinkplentyoffluids,andincaseyou’relowonsalt,addextraseasalttohomemadebonebrothormineralwater.

Anotherpossibilityisthatyourbloodpressureistoolow—particularlyifyou’retakingmedicationsforhypertension.Speaktoyourphysicianaboutadjustingyourmedication.

HeadachesHeadachesarecommonthefirstfewtimesyoufast.Itisbelievedthat

they’recausedbythetransitionfromarelativelyhigh-saltdiettoverylowsalt

they’recausedbythetransitionfromarelativelyhigh-saltdiettoverylowsaltintakeonfastingdays.Headachesareusuallytemporary,andasyoubecomeaccustomedtofasting,thisproblemoftenresolvesitself.Inthemeantime,takesomeextrasaltintheformofbrothormineralwater.

ConstipationThisiscommonandtobeexpected.Bowelmovementswilltypically

decreaseduringafastsimplybecausethereislessfoodintake.Ifyouarenotexperiencingactualdiscomfort,thenthere’snoneedtoworryaboutdecreasedbowelmovements.

However,increasingyourintakeoffiber,fruits,andvegetablesduringthenonfastingperiodmayhelpwithconstipation.Metamucilcanalsobetakenduringorafterfastingtoincreasefiberandstoolbulk.Iftheproblemcontinues,askyourdoctortoconsiderprescribingalaxative.

HeartburnTopreventheartburnafterafast,avoidtakinglargemeals—trytojusteat

normally.Avoidinglyingdownimmediatelyafteramealcanalsohelp;trytostayinanuprightpositionforatleasthalfhouraftermeals.Similarly,placingwoodenblocksundertheheadofyourbedtoraiseitmayhelpwithnighttimesymptoms.Inaddition,drinkingsparklingwaterwithlemonoftenhelps.Ifnoneoftheseoptionsworkforyou,consultyourphysician.

MuscleCrampsLowmagnesium,whichisparticularlycommonindiabetics,maycause

musclecramps.Youmaytakeanover-the-countermagnesiumsupplement.YoumayalsosoakinEpsomsalts,whicharemagnesiumsalts.Addacuptoawarmbathandsoakinitforhalfanhour—themagnesiumwillbeabsorbedthroughyourskin.Alternatively,youmaylookformagnesiumoil,whichalsoallowsmagnesiumtobeabsorbedthroughtheskin.

FAQsWillfastingmakemecranky?

Interestingly,thishasnotbeenaprobleminourIntensiveDietaryManagementProgram,despiteyearsofexperienceandhundredsofpatients.Similarly,membersofreligionsthatembraceroutinefastingarenotknowntobe

cranky.Forexample,nobodywouldstereotypeaBuddhistmonk,whoengagesinfastingalmostdaily,asacrankyguy.Ithinkthatwhenpeoplebecomeirritablewhentheydon’teat,it’sbecausetheyexpecttobecranky,sotheyactouttheirroleinaself-fulfillingprophecy.Whenwenormalizetheideaoffastingintheirminds,theyforgettobecomecranky.

Willfastingmakemetired?No.InourexperienceattheIntensiveDietaryManagementProgram,the

oppositeistrue.Manypeoplefindthattheyhavemoreenergyduringafast—probablyduetoincreasedadrenaline.You’llfindthatyouhaveplentyofenergyforallthenormalactivitiesofdailyliving.Persistentfatigueisnotanormalpartoffasting.Ifyouexperienceexcessivefatigue,youshouldstopfastingimmediatelyandseeyourdoctor.

Willfastingmakemeconfusedorforgetful?No.Youshouldnotexperienceanydecreaseinmemoryorconcentration

duringyourfast.Onthecontrary,fastingimprovesmentalclarityandacuity.Overthelongterm,fastingmayactuallyhelpimprovememory.Onetheoryisthatfastingactivatesaformofcellularcleansingcalledautophagythatmayhelppreventage-associatedmemoryloss—seehereformore.

Doesfastingleadtoovereating?Thesimpleanswerisyes,youwilleatmorethanusualimmediatelyafter

fasting.However,theamountoffoodeatenabovethebaselineonnonfastingdaysisnotenoughtooffsettheprecedingfast.Astudyofthirty-six-hourfastsshowsthatthemealtakenafterthefastisalmost20percentlargerthanusual,butovertheentiretwo-dayperiod,therewasstillanetdeficitof1,958calories.Theamount“overeaten”didnotnearlycompensateforthefast.Thestudyconcludes,“A36-hourfast...didnotinduceapowerful,unconditionedstimulustocompensateonthesubsequentday.”

Mystomachisalwaysgrowling.WhatcanIdo?Trydrinkingsomemineralwater.Themechanismisunclear,butitis

believedthatsomeofthemineralshelpsettlethestomach.

Itakemedicationswithfood.WhatcanIdoduringfasting?Certainmedicationsmaycausesideeffectsonanemptystomach:Aspirin

cancausestomachupsetorevenulcers.Ironsupplementsmaycausenauseaandvomiting.Metformin,oftenprescribedfordiabetes,maycausenauseaor

vomiting.Metformin,oftenprescribedfordiabetes,maycausenauseaordiarrhea.Talktoyourphysicianaboutwhetherornotthesemedicationsneedtobecontinuedduringyourfast.Also,youcantrytakingyourmedicationswithasmallservingofleafygreens,whichislowincaloriesandmaynotdisruptyourfast.

Bloodpressurecansometimesdropduringfasting.Ifyoutakeblood-pressure-loweringmedications,youmayfindyourbloodpressurebecomestoolow,causinglight-headedness.Consultwithyourphysicianaboutadjustingyourmedications.

Ifyoutakediabetesmedication,it’sparticularlyimportanttotalktoyourdoctorbeforebeginningafastingregimen—seethenextquestion.

WhatifIhavediabetes?Specialcaremustbetakenifyouhavetype1ortype2diabetesorare

takingdiabeticmedications.(Certaindiabetesmedications,suchasmetformin,areusedforotherconditions,suchaspolycysticovarysyndrome.)Monitoryourbloodsugarcloselyandadjustyourmedicationsaccordingly.Closemonitoringbyyourphysicianismandatory.Ifyoucannotbefollowedclosely,donotfast.

Fastingreducesbloodsugar.Ifyoucontinuetakingthesamedoseofdiabetesmedications,especiallyinsulin,duringyourfast,yourbloodsugarmaybecomeextremelylow,resultinginhypoglycemia.Thiscanbealife-threateningsituation.Youmusttakesomesugarorjuicetoraiseyourbloodsugarbacktonormal,evenifitmeansyoumuststopyourfastforthatday.Youmustcloselymonitoryourbloodsugarduringyourfast.Ifyourepeatedlyhavelowbloodsugar,itmeansthatyouareovermedicated,notthatthefastingprocessisnotworking.IntheIntensiveDietaryManagementProgram,wereducemedicationsbeforestartingafastinanticipationoflowerbloodsugar.Butbecausethebloodsugarresponsetoafastisunpredictable,closemonitoringbyaphysicianisessential.

CanIexercisewhilefasting?Manypeopleassumeitwillbedifficulttoexercisewhilefasting,and

sometimesthosewithphysicallydemandingjobsworryaboutfastingwhileworking.

Yes,exercisedemandsextraenergyfromthebody.However,theprocessofusingstoredfoodenergyduringafastremainsthesame.Thebodystartsbyburningglycogen,thesugarstoredintheliver.Sincethereisextrademandforenergyduringexercise,glycogenrunsoutsoonerthanotherwise.Butyourbodygenerallycarriesenoughglycogenfortwenty-fourhours,soitcansustainafair

generallycarriesenoughglycogenfortwenty-fourhours,soitcansustainafairamountofexercisebeforerunningout.

However,enduranceathletes,suchasIronmantriathletes,marathoners,andultra-marathoners,dooccasionally“hitthewall.”Glycogenstoresrunout,leavingtheirmusclesessentiallyrunningonempty.Perhapsthereisnomoreindelibleimageofhittingthewallthanthe1982IronmanTriathlon,whenAmericancompetitorJulieMosscrawledtothefinishline,unabletoevenstand.

Butevenwhenourglycogenrunsout,we’restillcarryingvastamountsofenergyintheformoffat,andduringfasting,ourbodyswitchesfromburningsugartoburningfat.Followingaverylowcarbohydratediet,orketogenicdiet,trainsyourbodytissuestoburnfat.

Similarly,exercisinginthefastedstatetrainsyourmusclestoburnfat.Insteadofrelyingonlimitedglycogenstores,youcanusealmostunlimitedenergyfromyourfatstores.Musclesadapttousewhateverenergysourceisavailable.(Thisistheproblemencounteredbyenduranceathleteswhohitthewall:theyhaven’tadaptedtousingfatratherthanglycogenforenergy.)Whenwedepleteourglycogenthroughfasting,ourmuscleslearntobecomemuchmoreefficientatburningfat.Thenumberofspecializedfat-burningproteinsisincreased,andthebreakdownoffatforenergyisenhanced.Aftertraininginthefastedstate,musclefibersshowincreasedavailablefat.Allthesearesignsthatthemusclesaretrainingtoburnfat,notsugar.

Doesperformancesuffer?Notreally.Inonestudy,athree-and-a-half-dayfastdidnotaffectanymeasurementsofathleticperformance,includingstrength,anaerobiccapacity,andaerobicendurance.

However,duringtheperiodwhenyouareadjustingtothechangefromburningsugartoburningfat,youmaynoticeadecreaseinyourathleticperformance.Thislastsapproximatelytwoweeks.Asyoudepletethebodyofsugar,yourmusclesneedtimetoadapttousingfat.Yourenergy,musclestrength,andoverallexercisecapacitywillgodown,buttheywillrecover.Thisprocessissometimescalledketo-adaptation.Verylowcarbdiets,ketogenicdiets,andtraininginthefastedstatemayallhavebenefitsintrainingyourmusclestoburnfat,butyourmusclesdoneedtimetoadapt.

Youcanstorefarmoreenergyintheformoffatthaninglycogen,andforenduranceathletes,theincreaseinavailableenergywhentheystartburningfatisasignificantadvantage.Ifyouarerunningultramarathons,beingabletoutilizeyouralmostunlimitedfatstoresinsteadofhighlylimitedglycogenstoresmeansthatyouwon’t“hitthewall,”givingyouachancetowinthatrace.

Iusuallygo3–5dayswithwater,coffee(Iuseheavycream),andbonebrothwithseasalt.MybodyhastotallychangedsinceIstartedfasting.Irunamarathoneveryyear,andthisyearwasjustamazing!Icouldkeepmyenergyuptheentireraceandimprovedmytimemorethan30minutesfromlastyear.Itwasalsomyfastesttime,eventhoughIam8years older than when I ran my first marathon! Fasting definitelymakesmehealthierandmuchstronger!

—KaoriO.,Houston,TX

Sinceyourbodyisrelyingonyourfatstores,there’snoshortageofenergyduringfasting,andyoucanandshoulddoallyourusualactivities.Thereisnoreasonwhyexerciseshouldstopduringfasting.Infact,manyeliteathletesandenduranceathletestraininthefastedstate.Thecombinationoflowinsulinandhighadrenalinelevelscreatedbyfastingstimulatesthebreakdownoffatandburningoffatforenergy.

Thesix-foot-two-inchAcademyAward–nominatedactorHughJackmanroutinelyneedstogainandloseweightfordifferentfilmroles.WhenheneededtolosetwentypoundsforthefilmLesMiserables,hefollowedalow-carbohydratediet.WhenheneededtopackonmuscleforhisroleasWolverinein2013,heusedintermittentfasting.

Canyouexercisewhilefasting?Absolutely.Thebenefitsinclude:

1.Youcantrainharderduetoincreasedadrenaline.2.You’llrecoverfromaworkoutandbuildmusclefasterduetoincreasedgrowthhormone.3.You’llburnmorefatduetoincreasedfattyacidoxidation.

Trainharder,buildmuscle,burnfat.Perfect!

ProblemstoWatchForClosemonitoringduringfastingisessentialforanyonewithahealth

condition,butespeciallyfordiabetics.Bloodsugarshouldbemonitoredatleastfourtimesdailyifyouaretakinginsulin.Ifyouarefeelinganysymptomsofhypoglycemia,suchasshakingorsweating,youshouldimmediatelycheckyourbloodsugar.

Bloodpressureshouldbemonitoredregularly.Thiscanbedoneathomewithanyofthewidelyavailabledevices.Besuretodiscussroutinebloodwork,includingelectrolytemeasurement,withyourphysician.Inadditiontotheusualelectrolytes,weoftenmonitorcalcium,phosphorus,andmagnesiumlevels.

electrolytes,weoftenmonitorcalcium,phosphorus,andmagnesiumlevels.Shouldyoufeelunwellforanyreason,stopyourfastimmediatelyandsee

yourdoctor.Inparticular,persistentnausea,vomiting,dizziness,fatigue,highorlowbloodsugar,andlethargyarenotnormalwithintermittentorcontinuousfastingandshouldraisearedflag.

Hungerandconstipation,however,arenormalsymptomsandcanbemanaged.

FeastsandFasts:UnderstandingtheRhythmsofLifeCelebrationswithfamilyandfriendsareintegraltoalifewelllived.Every

onceinawhile,weneedtoremindourselvesthatlifeissweetandweareluckytobealive.Andthroughouthumanhistory,we’vedonethatthroughfeasting.Theveryactofeatingisacelebrationoflife,andwhenwecelebrateimportantevents,wedosowithafeast.Anydietthatdoesnotacknowledgethisfactisdoomedtofailure.Weeatcakeonourbirthday.WehavefeastsonholidayslikeThanksgivingandChristmas.Weprepareweddingbanquets.Wegotoanicerestaurantonouranniversary.

Wedon’tcelebratewithbirthdaysalad.Wedon’teatweddingmealreplacementbars.Wedon’tgorgeongreenshakesonThanksgiving.

Likeeverythinginlife,weightgainisnotconstant;it’sintermittent.Certainperiodsoflifeareassociatedwithincreasedweightgain.Thisincludesadolescence,whenweightgainispartofnormaldevelopment,andpregnancy,whenweightgainisnormalandnecessary.

Figure15.1.Themajorityoftheyear’sweightgainhappensduringtheend-of-yearholidayperiod—ashumansalwayshave,wecelebrateholidayswithfeasts.

Source:Yanovskietal.,“AProspectiveStudyofHolidayWeightGain.”

Everyyear,themajorityoftheyear’sweightgainhappensinashortperiodoftimearoundtheholidays.TheperiodfromThanksgivingtoNewYear’scoversonlysixweeks,butitaccountsforroughlytwo-thirdsoftheyear’s1.4-pound(onaverage)weightgain.

Ifweightgainisnotuniformthroughouttheyear,thenweightlosseffortsmustalsovary.Youneedastrategythatincreasesweightlossatcertaintimesandmaintainsweightatothertimes.Aconstantcalorie-reduceddietdoesnotmatchthecycleoffeastandfastandisthusdoomedtofailure.

Therearetimesthatyoushouldeatalot.Thereareothertimesthatyoushouldbeeatingalmostnothing.Thatisthenaturalcycleoflife.Mostmajorreligionsacknowledgethisbyprescribingfeastingatcertaintimes—Christmas,forinstance—andfastingatothers—suchasLent.Theancientcivilizationsalsoknewthissimplerhythmoflife.Whentheharvestcamein,theyfeasted.Buttheyoftenfastedinthewinter.

In Louisiana, food is a big part of our social fabric and heritage.Implementing fasting in my daily routine made me realize theimportanceofthe“feast”fromatotallydifferentperspective.Withoutfasting, you simply don’t truly understand the purpose of the

celebration.Fastinghasgivenmeadeeperunderstandingofthefeastsand celebrationswe so enjoy here in our regional culture.And ifwefeastedwithperiodsof fasting, likeourCajunancestors, therewouldbealotlessobesityinourregion.

—JamesB.,Shreveport,LA

THEDAWNPHENOMENONTheoccurrenceofhighbloodsugarafteraperiodoffastingisoftenpuzzlingtothosenotfamiliarwiththeDawnPhenomenon.Whyarebloodsugarselevatedifyouhaven’teatenforawhile?Thiseffectisevenseenwithprolongedfasting.

TheDawnPhenomenon,sometimescalledtheDawnEffect,wasfirstdescribedapproximatelythirtyyearsago.Itisestimatedtooccurinupto75percentoftype2diabetics,althoughseverityvarieswidely,andit’scausedbycircadianrhythms.

Justbeforeawakening(around4:00a.m.),thebodysecreteshigherlevelsofgrowthhormone,cortisol,glucagon,andadrenaline.Together,thesearecalledthecounterregulatoryhormones—theycountertheblood-sugar-loweringeffectsofinsulin,meaningthattheyraisebloodsugar.

Thesenormalcircadianhormonalsurgesprepareourbodiesforthedayahead.Afterall,weareneverquitesorelaxedaswhenwe’reinadeepsleep.Sothesehormonesgentlygetusreadytowakeup.Glucagontellsthelivertostartpushingoutsomeglucose.Adrenalinegivesourbodiessomeenergy.Growthhormoneisinvolvedincellrepairandthesynthesisofnewprotein.Cortisol,thestresshormone,increasesasageneralactivator.Allthesehormonespeakintheearlymorninghoursandthenfalltolowlevelsduringtheday.

Sincethesehormonesalltendtoraisebloodsugaraspartofpreparingfortheupcomingday,wemightexpectthatourbloodsugarwouldgothroughtheroofintheearlymorning.Thisdoesnotnormallyhappen.Why?Insulinalsoincreasesintheearlymorningtomakesurethatbloodsugardoesnotgotoo

high.

Soeveninnondiabetics,bloodsugarisnotstablethroughoutthetwenty-four-hourcircadiancycle.It’sjustthattheearly-morningriseinbloodsugarisverysmallinnondiabetics,soit’seasilymissed.

Butinpeoplewithinsulinresistance,insulinhastroubleputtingthebrakeson—thebodyisn’tlisteningtoitssignals.Sincethecounterregulatoryhormonesarestillworking,bloodsugarrisesunopposed,resultinginhigher-than-normalbloodsugarearlyinthemorning.

Thesamephenomenonisseenduringfastingatanytimeofday.Thehormonalchangesduringfastingincludeincreasesingrowthhormone,adrenaline,glucagon,andcortisol—thesamehormonalcocktailthat’sreleasedbeforewaking.Asyoufast,yourinsulindrops,butthesehormonesarestillcausingstoredsugartobereleasedintothebloodstream,raisingbloodsugarlevels.

Insulinmovesthesugarfromtheblood,whereitcanbeseen,intothetissues(liver)whereitcannotbeseen.Itislikemovingthegarbagefromyourkitchentobeneathyourbed.Itsmellsthesame,butyoucan’tseeit.Wheninsulinlevelsdrop,thatgarbagestartstomovebacktothekitchen,andweseehigherbloodsugar.

Isthisriseinglucoseinthemorningorduringextendedfastingsomethingworrisome?No,notreally.Thinkofitthisway:ifyouhavefastedfortwodaysandnoticehighbloodsugar,wheredidthatsugarcomefrom?Itcouldonlyhavecomefromyourownbody,specificallytheliver.Thatglucosemoleculewasalwaysinyourbody,butyouworryaboutitnowbecauseyoucanseeit.

TheDawnPhenomenon,inwhichyouseehigherbloodsugarduringfasting,doesnotmeanyouaredoinganythingwrong.It’sanormaloccurrence.Itjustmeansthatyouhavemoreworktodotoclearoutthestoredsugar.Andovertime,fastingwilldothat.

Whathashappenedinthepastfiftyyearsorsoisthatwehavekeptallthefeastingbuteliminatedallthefasting.Thenormalbalancehasbeenperturbed,andobesityisthepredictableoutcome.Ifyoufeast,youmustfast.That’sreally

allthereistoit.Butifobesityistheresultoflosingthefasting,whathappenswhenyou

loseallthefeasting?Well,lifebecomesalittlelessspecial.Ifyouarethepersonattheweddingwhowon’tdrink,won’teatthecake,won’teatthefullmeal,won’teattheappetizers—there’sanameforthat:thepartypooper.Andnobodywantstobethepartypooper.

With4kidsunder10,dinneratmyhouseisalwayschaotic.BythetimeI’ve helped everyone with what they need (serving, cutting, morewater,adroppedfork,etc.),Ifindmyselfeatingasquicklyaspossibletofinishbythetimetheyarealldone.WhenI’mfasting,Iactuallylookforward to dinner.We have conversations about the day, things arerelaxed,andI’mdonewhentheyare!

—AmberlyC.,Anderson,SC

Maybeyoucankeepitupforsixmonths,oreventwelvemonths.Butforever?That’sprettyhardtodo.Lifeisfullofupsanddowns,andweneedtocelebratetheupsbecausethedownsarerightaroundthecorner.Butwemustbalancetheperiodsofeatingalotwithperiodsofeatingverylittle.It’sallamatterofbalance.

EatingOutSocializingoverfoodplaysalargeroleinourlives.Weoftengettogether

withfriendsforamealorcoffee.Thisisnormal,natural,andpartofhumancultureworldwide.Tryingtofightitisclearlynotawinningstrategy.Avoidingallsocialsituationsduringfastingisnothealthyandwilllikelyleadtolong-termnoncompliance.

Fitfastingintoyourschedule,nottheotherwayaround.Ifyouknowyouaregoingtoeatalargedinner,thenskipbreakfastandlunch.Oneoftheeasiestwaystofitfastingintoyourlifeistoskipbreakfast,sincethat’snotamealwesocializeoverasmuchaslunchordinner.Duringworkdays,skippingbreakfastiseasytodowithoutanybodynoticing.Thiswillquiteeasilyallowyoutofastforsixteenhours.

Missinglunchonworkdaysisalsorelativelyeasy:simplyworkthroughlunch.Thisallowsyoutoslipinatwenty-four-hourfastwithoutanyspecialeffort.Therearealsootheraddedbenefits.Youareabletogetmoreworkdone,

effort.Therearealsootheraddedbenefits.Youareabletogetmoreworkdone,soyoumightbeabletoleaveearlier.Becauseyouarestayingbusy,youmayforgettobehungry.Youalsosavesomemoney.Andunlessyougoouttoluncheverydaywiththesamecrowd,nobodymayevennotice.Savemoneyandtimewhilegettingthinner?Notabaddeal.

References

A.M.Johnstone,P.Faber,E.R.Gibney,M.Elia,G.Horgan,B.E.Golden,andR.J.Stubbs,“EffectofanAcuteFastonEnergyCompensationandFeedingBehaviourinLeanMenandWomen,”InternationalJournalofObesity26,no.12(2002):1623–8.

ChristianZauner,BrunoSchneeweiss,AlexanderKranz,ChristianMadl,KlausRatheiser,LudwigKramer,ErichRoth,BarbaraSchneider,andKurtLenz,“RestingEnergyExpenditureinShort-TermtarvationIsIncreasedasaResultofanIncreaseinSerumNorepinephrine,”AmericanJournalofClinicalNutrition71,no.6(2000):1511–15.

DeliaE.Smith,CoraE.Lewis,JenniferL.Caveny,LauraL.Perkins,GregoryL.Burke,andDianeE.Bild,“LongitudinalChangesinAdiposityAssociatedwithPregnancy:TheCARDIAStudy,”JAMA271,no.22(1994):1747-51.

D.F.Williamson,J.Madans,E.Pamuk,K.M.Flegal,J.S.Kendrick,andM.K.Serdula,“AProspectiveStudyofChildbearingand10-YearWeightGaininUSWhiteWomen25to45YearsofAge,”InternationalJournalofObesityandRelatedMetabolicDisorders18,no.8(1994):561–9.

GeremiaB.Bolli,PierpaoloDeFeo,SalvatoreDeCosmo,GabrielePerriello,MariarosaM.Ventura,FilippoCalcinaro,ClaudioLolli,etal.,“DemonstrationofaDawnPhenomenoninNormalHumanVolunteers,”Diabetes33,no.12(1984):1150–3.

JackA.Yanovski,SusanZ.Yanovski,KaraN.Sovik,TucT.Nguyen,PatrickM.O’Neil,andNancyG.Sebring,“AProspectiveStudyofHolidayWeightGain,”NewEnglandJournalofMedicine342(2000):861–7.

JosephJ.Knapik,BruceH.Jones,CarolMeredith,andWilliamJ.Evans,“Influenceofa3.5DayFastonPhysicalPerformance,”EuropeanJournalofAppliedPhysiologyandOccupationalPhysiology56,no.4(1987):428–32.

KarenVanProeyen,KarolinaSzlufcik,HenriNielens,MoniqueRamaekers,andPeterJ.Hespel,“BeneficialMetabolicAdaptationsDuetoEnduranceExerciseTrainingintheFastedState,”JournalofAppliedPhysiology110,no.1(2011):236–45.

K.DeBock,E.A.Richter,A.P.Russell,B.O.Eijnde,W.Derave,M.Ramaekers,E.Koninckx,etal.,“ExerciseintheFastedStateFacilitatesFibreType-SpecificIntramyocellularLipidBreakdownandStimulatesGlycogenResynthesisinHumans,”JournalofPhysiology564(Pt.2)(2005):649–60.

K.DeBock,W.Derave,B.O.Eijnde,M.K.Hesselink,E.Koninckx,A.J.Rose,P.Schrauwen,etal.,“EffectofTrainingintheFastedStateonMetabolicResponsesDuringExercisewith

CarbohydrateIntake,”JournalofAppliedPhysiology104,no.4(2008):1045–55,doi:10.1152/japplphysiol.01195.2007.PeterJ.Campbell,GeremiaB.Bolli,PhilipE.Cryer,andJohnE.Gerich,“PathogenesisoftheDawnPhenomenoninPatientswithInsulin-DependentDiabetesMellitus—AcceleratedGlucoseProductionandImpairedGlucoseUtilizationDuetoNocturnalSurgesinGrowthHormoneSecretion,”NewEnglandJournalofMedicine312,no.23(1985):1473–9.

R.R.Wing,K.A.Matthews,L.H.Kuller,E.N.Meilahn,andP.L.Plantinga,“WeightGainattheTimeofMenopause,”ArchivesofInternalMedicine151,no.1(1991)97–102.

FASTING-FLUIDSOnlycertainfluidscanbeconsumedduringfastingperiods:water,teaandcoffee(hotoriced),andhomemadebroth.

WATERItisimportanttodrinkwaterfrequentlythroughoutthedaywhenyoufast.Youcanenjoyflat,mineral,orcarbonatedwater.Whatyoucanaddtoyourwater Whatyou

can’taddtoyourwater

•Limes•Lemons•Slicesofotherfruits(donoteatthefruititselforconsumefruitjuice)•Vinegars(especiallyraw,unfilteredapplecidervinegar)•Himalayansalt•Chiaandgroundflaxseed(1tablespoonin1cupofwater)

•Sweetenedpowdersordrops(evenifthey’resugar-free)

COFFEEYoucanconsumeuptosixcupsofcoffeeonafastingday.Thecoffeemaybecaffeinatedordecaffeinated.Blackcoffeeispreferable,butyoucanaddupto1tablespoonofcertainfatstoeachcupofcoffeeifyouwish(seethelistofpermittedfatsbelow).Also,youcanhaveunsweetenedicedcoffee:simplybrewyourcoffeeasusualandthenrefrigerateitorpouritoveracupofice.ForBulletproofCoffee,seetherecipeonhere.

Whatyoucanaddtoyourcoffee Whatyoucan’taddtoyourcoffee

•Coconutoil•Medium-chaintriglycerideoil(MCToil)•Butter•Ghee•Heavywhippingcream(35%fat)•Halfandhalf•Wholemilk•Groundcinnamon,forflavor

•Trytoavoidlow-fatandskimmilks;wholemilkisbetter•Powdereddairyproducts•Naturalorartificialsweetenersofanykind

HERBALTEAYoumayconsumeunlimitedherbalteaduringyourfastingperiod.Thereareavarietyofteasthatcanhelpsuppressyourappetite,loweryourbloodsugarlevels,orareotherwisebeneficial.

GreenTea •Goodappetitesuppressant

CinnamonChaiTea

•Canhelplowerbloodsugarlevels•Greatforsuppressingcravingsforsweetfoods

PeppermintTea

•Goodappetitesuppressant•GoodforalleviatingGIdiscomfort,suchasgasandbloating

BitterMelonTea •Canhelplowerbloodsugarlevels

BlackTea •Canhelplowerbloodsugarlevels

OolongTea •CanhelplowerbloodsugarlevelsIt’sbesttoconsumeyourteablackduringyourfastingperiods,butyoumayaddupto1tablespoonofcertainfatstoeachcupofteaifyoulike(seethelistofpermittedfatsbelow).Youcanalsobrewanyherbalteaandrefrigerateitorpouritovericetomakeunsweetenedicedtea.YoucanalsomakeBulletproofTeabysubstitutingteaforcoffeeintherecipeonhere.

Whatyoucanaddtoyourtea Whatyoucan’taddtoyourtea

•Coconutoil•Medium-chaintriglycerideoil(MCToil)•Butter•Ghee•Heavywhippingcream(35%fat)•Halfandhalf•Wholemilk•Groundcinnamon,forflavor•Lemon

•Trytoavoidlow-fatandskimmilks;wholemilkisbetter•Powdereddairyproducts•Naturalorartificialsweetenersofanykind

HOMEMADEBROTH

It’snotuncommontoexperiencesomelightheadednessduringyourfirstfewfastingperiods.Thisisoftencausedbydehydrationanddecreasedlevelsofelectrolytesandcanbeeasilyremediedbyconsumingagoodhomemadebroth.Bothvegetablebrothandbrothmadewiththemeatorbonesfromanyanimalorfishwillwork,butbonebrothhasoneadvantage:unlikevegetablebroth,itcontainsgelatin,whichisverybeneficialforthosewhohavearthritisorotherjointproblems.Youmayconsumeasmuchbrothasyouneedtohelpyougetthroughyourfastingday.Astimegoeson,youwillfindthatyouneedlessandlessbrothduringyourfastingperiods.Seehereforarecipeforhomemadebonebroth.Whatyoucanaddtoyourbroth Whatyoucan’tadd

toyourbroth•Anyvegetablethatgrowsabovetheground•Leafygreens•Carrots•Onionsorshallots•Bittermelon•Animalmeat•Animalbones•Fishmeat•Fishbones•Himalayansalt•Anyherbs(dryorfresh)andspices•Groundflaxseed(1tablespoonpercupofbroth)

•Vegetablepureeofanykind•Potatoes,yams,beets,orturnips•Avoidstore-boughtbroths,

ofbroth) boughtbroths,evenorganic

24-HourFastingProtocol

Inthistwenty-four-hourfastingprotocol,you’llfastfromlunchonedaytolunchthenext,orfromdinneronedaytodinnerthenext,threetimesaweek.Italsoincludesadailysixteen-hourfast(whichreallyjustmeansskippingbreakfastandeatingonlywithinaneight-hourwindowonnonfastingdays;seehereformore).IntheIntensiveDietaryManagementProgram,we’vefoundthatthisprotocolworkswellforweightlosswithouturgency.However,ifyoupreferaless-intensiveregimen,youcouldhavejusttwotwenty-four-hourfastsperweek.

Oneatingdays,werecommendyoufollowadietthatislowinrefinedcarbohydratesandhighinnaturalfats.Strivetoeatonlywhole,unprocessedfoodsandavoidprocessedorpreparedfoodsasmuchaspossible.

Inthisprotocol,youeatamealeveryday,soit’sidealifyouaretakingmedicationsthatneedtobetakenwithfood.Also,itmaybeeasiertofitintoyourschedule.Forexample,manypeoplefindthatdinnerisimportantnotjustasatimetoeatbutasatimetoreconnectwithspousesandchildren—onthisschedule,you’llstillhavethatfamilytime.Thissortoffastingschedulealsofitseasilyintoatypicalworkschedule.

Intheexamplebelow,you’dfastfromdinneronSundaynightuntildinneronMondaynight.IfyoufinishdinneronSundayat7:30p.m.,thenyouwouldnothavedinneronMondayuntil7:30p.m.Themealslistedaresuggestionsforfollowingalow-carbdietthat’shighinhealthyfats.

Sampleofathree-times-per-week24-hourfastingregimen.Thisshowsfastingfromdinnertodinner,butyoucouldalsofastfromlunchtolunch.

36-HourFastingProtocol

Inthisthirty-six-hourfastingregimen,you’llfastfortheentiredayatleastthreedaysoftheweek.Unlikethetwenty-four-hourfastingprotocol,nomealsaretakenonfastingdays,onlyfastingfluids(seehere).Overall,thisprotocolismoreeffectiveforweightlossthanthetwenty-four-hourfastingprotocol(here),andthelongerfastingperiodisalsobetterforreducingbloodsugarandthereforemaybebetterforthosewithprediabetes.Also,somepeoplepreferthesimplicityoffastingfortheentireday,ratherthaneatingonemealonfastingdays,asonthetwenty-four-hourprotocol.

Oneatingdays,werecommendyoufollowadietthatislowinrefinedcarbohydratesandhighinnaturalfats.Strivetoeatonlywhole,unprocessedfoodsandavoidprocessedorpreparedfoodsasmuchaspossible.

Intheexamplebelow,you’dfastfromdinneronSundaynightuntilbreakfastonTuesdaymorning.IfyoufinishdinneronSundayat7:30p.m.,thenyouwouldnoteatagainuntilbreakfastonTuesdaymorningat7:30a.m.Youmayconsumebreakfast,lunch,anddinneronnonfastingdays.

Sampleofathree-times-per-week36-hourfastingregimen.Nomealsorsnacksofanykindareconsumedonthefastingdays,butyoumayconsumeanyfastingfluid(seehere).

42-HourFastingProtocol

Inthisforty-two-hourfastingregimen,you’llfastfortheentiredayatleastthreedaysoftheweekandskipbreakfasteveryday,regardlessofwhetherornotyouarefasting.Onfastingdays,youareonlyallowedfastingfluids(here).

IntheIntensiveDietaryManagementProgram,wetypicallyusethisforty-two-hourfastingprotocolfortype2diabetes.Theextendedfastingperiodallowsbloodglucoseandinsulinmoretimetodrop.However,ifyouaretakingmedications,youwillneedtoconsultyourphysicianbeforefastingonthisprotocol,inordertoavoidlowbloodsugar.Whilewewantandexpectbloodsugarstodrop,ifyou’reovermedicated,theymaydroptoolow,atwhichpointyoumayhavenochoiceexcepttoeatsomesugartoraiseit—whichdefeatsthepointoffasting.

Oneatingdays,werecommendyoufollowadietthatislowinrefinedcarbohydratesandhighinnaturalfats.Strivetoeatonlywhole,unprocessedfoodsandavoidprocessedorpreparedfoodsasmuchaspossible.

Intheexamplebelow,you’dfastfromdinneronSundaynightuntillunchonTuesday.IfyoufinishdinneronSundayat7:30p.m.,thenyouwouldnotresumeeatinguntillunchonTuesdayafternoonat1:30p.m.Onnonfastingdays,youwouldconsumelunchanddinneronly,notbreakfast.

Sampleofathree-times-per-weekforty-two-hourfastingregimen.Nomealsorsnacksofanykindareconsumedonthefastingdays,butyoumayconsumeanyfastingfluid(seehere).Breakfastisnotconsumedonnonfastingorfastingdays.

7-to14-DayFastingProtocol

Thisfastingprotocolcallsforfastingforseventofourteendaysconsecutively.Thismeansseventofourteendaysinarowwithoutanymealsorsnacks.Youareonlyallowedfastingfluids(here)duringthefastingperiod.

IntheIntensiveDietaryManagementProgram,wetypicallyusethisprotocolforseverediabetesormorbidobesity.Incaseswherecontrolofdiabetesand/orobesityismoreurgent,weoftensuggeststartingtherapywiththisprotocol,thentransitioningtoaforty-two-hourfastingprotocol(here).Thisprotocolisalsousefulwhenhittingplateausinweightlossandafterperiodsofweightregain,suchastheholidaysandvacations(suchasacruise)—andknowingthatyou’llfollowthisprotocolafteraperiodofcelebrationcanletyouenjoyitwithoutguilt.

Thisisaveryintensiveregimenandshouldonlybeattemptedwiththesupervisionofyourphysician.Ifyouaretakingmedications,someofthemwillneedtobeadjustedpriortobeginningthefast.(Seehereformoreinformation.)Inthisprotocol,wealsorecommendthedailyuseofageneralmultivitamininordertopreventmicronutrientdeficiency.Yourphysicianmayalsowanttomonitoryourbloodworkthroughoutthefast.

Remember,hungerdoesnotprogress.Day2istypicallythehardestdayonthisregimen:studiesofthehungerhormoneghrelinshowthatitpeaksonday2ofextendedfastingandthereafterdeclines.Typically,eachdaygetseasier.Mostpeopleremarkaftersevendaysthattheyfeeltheycouldhavekeptupthefastingforever!

Becauseoftheriskofrefeedingsyndrome(seehere),wedonotoftenextendthefastingperiodpastfourteendays.Instead,werecommendthatyouuseanalternate-dayfastingschedulesuchasthethirty-six-hourprotocol(here)orforty-two-hourprotocol(here)beforerepeatingtheseven-tofourteen-dayfast.Werecommendthatyouundertakeseven-dayfastsnomorethanonceamonthandfourteen-dayfastsnomorethaneverysixweeks.

Rememberthatifatanypointduringthefastyoudonotfeelwell,foranyreason,youshouldstop.

Onthisprotocol,nomealsorsnacksaretakenforatleastsevenfulldays—forexample,startingonSundaymorningandcontinuingthroughSaturdaynight.

What?

RECIPESINABOOKONFASTING?YES.Intermittentandextendedfastingonlyformpartofahealthyeatingpattern.Therearetwopartstohealthyeating:thepartwhereyoueat(feeding)andthepartwhereyoudon’t(fasting).We’vecoveredfastingextensively,butacomprehensiveplanrequiresbothparts.Obviously,youcannotfastindefinitely,soeatingahealthydietiscrucial.(Seehereformoreonahealthydiet.)

MeganRamosistheprogramdirectoroftheIntensiveDietaryManagementPrograminToronto.Shecounselshundredsofpatientsinbothdietsandfastingtoachieveoptimalhealth.Underherexpertguidance,patientshavereversedtheirobesity,type2diabetes,andmetabolicsyndrome.Inmanycases,patientshavereducedoreveneliminatedtheirneedformedicationsandlearnedhowtomaintainahealthyeatingpatternfortherestoftheirlives.

Inthissection,Megansharessomeofherfavoriterecipes,whichcanbeincorporatedintoafastingprotocollikethoseon(Seeheretohere).

BERRYPARFAIT

PREPTIME:15minutes,plus30minutestochill(optional)

COOKTIME:—

YIELD:2servings

INGREDIENTS

½cupheavywhippingcream(atleast35%fat)

1tablespoon100%purecocoapowder(optional)

1teaspoonpurevanillaextract(optional)

6almonds,crushed

6walnuts,crushed

3strawberries,diced

⅓cupraspberries

⅓cupblackberries

10blueberries

½tablespoongroundflaxseed(optional)

½tablespoonchiaseeds(optional)

1teaspooncinnamon,forserving(optional)

DIRECTIONS

1.Placetheheavywhippingcreaminabowlandstirinthecocoapowderandvanillaextract(ifusing).

2.Usingahandmixeronmedium,whipthecreamuntilstiffpeaksform,about2to3minutes.

3.Optional:Foranicechillonahotday,placethebowlofwhippedcreaminthefreezerfor30minutes.

4.Stirthenutsandberriesintothewhippedcream.

5.Mixinthegroundflaxseedandchiaseeds(ifusing)andsprinklethecinnamonoverthetop,ifdesired.

BULLETPROOFCOFFEEBulletproofcoffeehasbecomeverytrendyinrecentyears.Thiscanbeconsumedonceadayonfastdaystohelpyoufeelsatiated.It’smosthelpfulwhenconsumedbetweenthetimeyouwakeupandyourregularlunchhour(ifyouarenoteatinglunch).

PREPTIME:2minutes

COOKTIME:—

YIELD:1cup

INGREDIENTS

1cupbrewedcoffee

1–2tablespoonscoconutoilorMCToil

1–2tablespoonsbutter

1–2tablespoonsheavywhippingcream(atleast35%fat)

DIRECTIONS

1.Addequalpartscoconutoil,butter,andcreamtothecoffee.

2.Blendwithanimmersionblenderuntilcreamy

ESSENTIALBONEBROTH

PREPTIME:10minutes

COOKTIME:4to48hours,dependingonthekindofbones

YIELD:6quarts

INGREDIENTS

6quartswater

2tablespoonsraw,unfilteredapplecidervinegar

2poundsanimalbones(chicken,turkey,beef,pork,fish,orother)

1mediumonion,coarselychopped

3largecarrots,coarselychopped

10stalkscelery,coarselychopped

1redbellpepper,coarselychopped

1greenbellpepper,coarselychopped

1tablespoonHimalayansalt

1tablespoonblackpeppercorns

Otherherbsorspices(optional)

DIRECTIONS

1.Fillastockpotwith6quartsofcoldwater.

2.Addthevinegartothecoldwater.

3.Placethebonesintothewater-vinegarmixtureandletsitfor30minutes.Prepyourvegetableswhilethebonesaresoaking.

4.Addtheonion,carrots,celery,bellpeppers,salt,pepper,andanyotherherbsordriedspices(ifusing).

5.Placeovermedium-highheatandheatthewateruntilitnearlyboils,thenreducetotheheattolow.Letthebrothsimmerfor4to8hoursforfishbones;18to24hoursforpoultrybones;or24to48hoursforbeeforporkbones.

6.Whenthereare30minutesremainingtocook,addanyfreshherbs(ifusing).

7.Removefromheatandletcoolfor30minutes.Thenstrainoutthevegetables,bones,andfat.

8.Storeintherefrigeratorforupto5daysorfreezeincontainers,icecubetrays,ormuffintinsandstoreinthefreezerfor3to4months.

TIP

Formoreflavor,roastthebonesonabakingsheetina300°Fovenfor30minutesbeforemakingthebroth.

GRAIN-FREEPANCAKES

PREPTIME:10minutes

COOKTIME:30minutes

YIELD:4to6pancakes(about2servings)

INGREDIENTS

2eggs

½cupheavywhippingcream(atleast35%fat),plusmorefortopping(optional)

1teaspoonvanillaextract

½tablespoonorganichoneyorerythritol

¼cupcoconutflour

½teaspoonbakingsoda

¼teaspoonHimalayansalt

1tablespoonbutterorcoconutoil,plusmorefortopping(optional)

Groundcinnamon,fortopping(optional)

DIRECTIONS

1.Preheataskilletorgriddleovermediumheat.

2.Inasmallbowl,combinetheeggs,cream,vanilla,andhoney.

3.Inaseparatemedium-sizedbowl,combinethecoconutflour,bakingsoda,andsalt.

4.Slowlystirthewetingredientsintothedryingredients.

5.Meltthebutterintheskillet.

6.Pourintwoorthreetablespoonsofbattertoformpancakesabout3inchesindiameter.Cookfor2to3minutesoneachside,untilgoldenbrown.Repeatwiththeremainingbatter.

7.Topthepancakeswithwhippedcream,butter,and/orcinnamon,ifdesired.

MINIFRITTATAS

PREPTIME:15minutes

COOKTIME:20minutes

YIELD:6frittatas(2to3servings)

INGREDIENTS

6eggs

1cupchoppedspinach

12cherrytomatoes,halved

⅓cupdicedredbellpepper

⅓cupdicedgreenbellpepper

½cupgreenonions,finelychopped

½cupgratedcheddarcheese(about2ounces),plusmorefortopping(optional)

1tablespoonHimalayansalt

1teaspoonfreshlygroundblackpepper

6slicesbacon

DIRECTIONS

1.Preheattheovento300°F.Greasea6-cupmuffintinwithbutterorcoconutoil.

2.Inamedium-sizedbowl,mixtogethertheeggs,spinach,tomatoes,bellpeppers,greenonions,cheese,salt,andpepper.

3.Wrapastripofbaconaroundtheinsideofeachmuffincup.Ifthere’sanyextra,trimitandaddittotheeggmix.

4.Filleachmuffincupaboutthree-quartersfullwiththeeggmixture.Topwithcheese(ifusing).

5.Placeintheovenandbakefor20minutes,oruntilthetopsaregolden.

6.Removefromtheovenandletcoolfor10minutesbeforeserving.

SIMPLEHOMEMADEBACON

PREPTIME:15minutes,plus5to7daystocureand12hourstochill

COOKTIME:1½to2hours

YIELD:2poundsofbacon

INGREDIENTS

2poundsporkbelly

⅔cupHimalayansalt

2tablespoonsfreshlygroundblackpepper

Anydriedherbsandspices(optional)

DIRECTIONS

1.Removetheskinfromtheporkbellywithaverysharpknife.Trytokeeptheskinintact,inonepiece,asyouremoveit.

2.Rinsetheporkbellyandpatdrywithpapertowel.

3.Inasmallbowl,mixtogetherthesalt,pepper,andanydriedherbsandspices.

Rubthemixtureonbothsidesoftheporkbelly.

4.Placetheporkbellyinsideasealedairtightcontainerandstoreintherefrigeratorfor5to7days.Theflavorbecomesstrongerthelongeryoucureit.Fliptheporkbellyovereveryday.(Makesureyouwashyourhandsthoroughlybeforetouchingtheporkbelly.)

5.After5to7days,removetheporkbellyfromtherefrigeratorandrinseoffthesalt,pepper,andanyotherherbsandspices.Patdry.

6.Preheattheovento200°F(90°C).

7.Placearoastingrackinaroastingpan.Placetheporkbellyfatsideupontherack.

8.Bakeuntilthemeatreachesaninternaltemperatureof150°F.Thisusuallytakesaboutanhourandahalftotwohours.

9.Removetheporkbellyfromtheovenandletitcoolfor30minutes.

10.Wrapthemeatinparchmentpaperandstoreintherefrigeratorovernightorfor12hours.

11.Slicethemeattothedesiredthicknesswithasharpknife.Youcannowcookyourhomemadebacon,orstoreitintherefrigeratorforupto5daysorthefreezerforupto2months.

GRAIN-FREECAULIFLOWERPIZZA

PREPTIME:10minutes

COOKTIME:30to35minutes

YIELD:18-inchpizza(about3servings)

INGREDIENTS

1½cupscauliflowerflorets(about1pound)

2largeeggs,lightlybeaten

1teaspoonHimalayansalt

1teaspoondriedoregano

1teaspoongarlicpowder

Pizzatoppingsofyourchoice

DIRECTIONS

1.Preheattheovento400°F.Lineabakingsheetwithparchmentpaper.

2.Pulsethecauliflowerfloretsinafoodprocessoruntilfinelychopped.Transfertoalargebowl.

3.Addtheeggs,salt,oregano,andgarlicpowderandmixwell.

4.Transferthecauliflowermixturetothecenterofthepreparedbakingsheetanduseyourhandstoformitintoapizzacrust.

5.Bakefor20minutes,oruntillightlygolden.

6.Addyourdesiredtoppingsandbakeforanother10to15minutes.

CHICKEN“BREADED”INPORKRINDS

PREPTIME:15minutes

COOKTIME:45minutes

YIELD:2servings

INGREDIENTS

1¼cupporkrinds

1tablespoonHimalayansalt

2teaspoonsfreshlygroundpepper

2teaspoonssmokedpaprika

4chickenthighs,skinon

2largeeggs

DIRECTIONS

1.Preheattheovento375°F.Lineabakingsheetwithaluminumfoil.

2.Placetheporkrindsinasealableplasticbagandcrushthemwithyourhandsuntiltheyresemblebreadcrumbs.Addthesalt,pepper,andsmokedpaprikatotheporkrindsandshakeuntilthespicesandporkrindsarethoroughlymixed.

3.Whisktheeggsinasmallbowl.

4.Placeoneofthechickenthighsintheeggmixtureandleaveitinfor10seconds.

5.Transfertheegg-coatedchickenthightothebagwiththecrushedporkrindsandseasonings.Shakeuntilthethighiscoated,thenremoveandplaceonthepreparedbakingsheet.

6.Repeatwiththerestofthechickenthighs.

7.Placethebakingsheetintheovenandcookfor45minutes,oruntilthechickenisgoldenbrown.

CHICKENDRUMSTICKSWRAPPEDINBACON

PREPTIME:5minutes

COOKTIME:45minutes

YIELD:2servings

INGREDIENTS

4chickendrumsticks

4slicesbacon

1½teaspoonsHimalayansalt

1teaspoonfreshlygroundblackpepper

DIRECTIONS

1.Preheattheovento400°F.Lineabakingsheetwithaluminumfoil.

2.Wraponepieceofbaconaroundeachdrumstick,workingyourwayfromthebottomofthedrumsticktothetop.Placeonthepreparedbakingsheetandseasonwiththesaltandpepper.

3.Bakefor45minutes,oruntilthebaconlooksniceandcrispy.

CHICKENSTUFFEDBELLPEPPERS

PREPTIME:10minutes

COOKTIME:1hour30minutes

YIELD:4servings

INGREDIENTS

1tablespoonbutter

1clovegarlic,minced

1smallonion,diced

1teaspoonHimalayansalt

½teaspoonfreshlygroundblackpepper

1teaspoonsmokedpaprika

1teaspoonchilipowder

1cupgrapetomatoes,halved

1poundgroundchicken

3eggs,beaten

4largebellpeppers,halved

DIRECTIONS

1.Preheattheovento350°F.Lineabakingsheetwithparchmentpaper.

2.Meltthebutterinaskilletovermediumheat.Addthegarlic,onion,salt,pepper,paprika,andchilipowder.Sautéfor5to7minutes.

3.Addthetomatoesandsautéforanother5to7minutes.

4.Addthegroundchickenandcookuntilgoldenbrown,about15minutes,stirringoccasionally.

5.Transferthecookedmeatmixturetoamedium-sizedbowlandslowlymixintheeggs.

6.Layeachbellpepperhalfcutsideuponthepreparedbakingsheet.Pourthemeatandeggmixtureintothebellpeppers.

7.Placethestuffedpeppersintheovenandbakefor60minutes,untilthepepperssoftenslightly.

GAMEDAYWINGS

PREPTIME:5minutes

COOKTIME:About20minutes

YIELD:2poundsofwings

INGREDIENTS

2poundschickenwings

1tablespoonHimalayansalt

1teaspoonfreshlygroundblackpepper

1tablespoonbakingpowder

1teaspoonsmokedpaprika

1teaspoongarlicsalt(optional)

2tablespoonscoconutoil

2tablespoonshotsauce(optional)

DIRECTIONS

1.Washthechickenwingsandpatdry.

2.Inasmallbowl,combinethesalt,pepper,bakingpowder,paprika,andgarlicsalt(ifusing).

3.Placethewingsinasealableplasticbagandaddthespicemixture.Sealandshakethebagtocoatthewings.

4.Preheataskilletovermediumheat.Meltthecoconutoilinthewarmpan.

5.Placethewingsintheskilletandcover.Cookfor10to12minutes.

6.Flipthewingsandcookforanother10to12minutes,untilgoldenbrown.

7.Removethewingsfromtheheatandletcoolfor5minutes.

8.Coatthewingswithhotsauce,ifdesired.

HOMEMADECHICKENFINGERS

PREPTIME:10minutes

COOKTIME:20to30minutes

YIELD:2servings

INGREDIENTS

1poundbonelesschickenbreasts,trimmedto1inchwideby3incheslong

2eggs

1cupcrushedporkrinds/cracklings

1tablespoonHimalayansalt

1teaspoonfreshlygroundblackpepper

1teaspoonsmokedpaprika

1teaspoongarlicsalt(optional)

2tablespoonscoconutoil

Hotsauce,forserving(optional)

DIRECTIONS

1.Preheattheovento300°F.Lineabakingsheetwithaluminumfoil.

2.Washthechickenfingersandpatdry.

3.Inasmallbowl,combinethecrushedporkrinds,salt,pepper,smokedpaprika,andgarlicsalt(ifusing).Pourthemixtureintoasealableplasticbag.

4.Inamedium-sizedbowl,beattheeggs.Dipeachchickenfingerintotheeggstocoat.

5.Addtheegg-coatedchickenfingerstothebagwiththespicemixture.Sealandshakethebagtocoatthechicken.

6.Placethechickenfingersonthepreparedbakingsheetandplaceintheoven.Bakefor10to15minutes.

7.Flipthechickenoverandcookforanother10to15minutes,untilgoldenbrown.

8.Removethechickenfromtheovenandletcoolfor5minutesbeforeserving.

9.Servewithhotsauce,ifdesired.

STEAKFAJITAS

PREPTIME:10minutes

COOKTIME:20minutes

YIELD:2to4servings

INGREDIENTS

2tablespoonsbutter,divided

1redbellpepper,thinlysliced

1greenbellpepper,thinlysliced

1yellowbellpepper,thinlysliced

½onion,chopped

1tablespoonHimalayansalt

½teaspoonfreshlygroundblackpepper

1poundskirtsteak

LargeleavesofBostonlettuce(orotherlettuce),forserving

Fortopping(optional)

Sourcream

Guacamole

Picodegallo

Limewedges

Gratedcheddarcheese

DIRECTIONS

1.Heatalargeskilletovermediumheat.Melt1tablespoonofthebutterintheskillet.

2.Addthebellpeppersandonionandseasonwithsaltandpepper.Cook,stirringoccasionally,for15to20minutes,untilthepeppersaresoft.

3.Whenthereareabout10minutesremainingforthevegetables,heatasecondlargeskilletovermediumheat.Melttheremainingtablespoonofbutterintheskillet.

4.Whenthereareabout5minutesremainingforthevegetables,seasonthesteakwithsaltandpepperandplaceitintheskilletwiththebutter.Cookfor3to5minutesperside,untilseared.

5.Removebothskilletsfromheat.

6.Letthesteakrestfor5to10minutesbeforeslicing.Cutintopiecesofdesiredthickness.

7.Dividetheslicedsteakandvegetablesinto2to4equalportionsandwrapeachportioninalargelettuceleaf.Addyourfavoritefajitatoppingsandenjoy!

ARUGULAANDPROSCIUTTOSALAD

PREPTIME:10min

COOKTIME:—

YIELD:1serving

INGREDIENTS

2–3cupsarugula,washed

6–9thinslicesofprosciutto

½cupchoppedtomato

½cupslicedolives

Forthedressing

1tablespoonextra-virginoliveoil

1teaspoonbalsamicvinegar

DIRECTIONS

1.Inamedium-sizedbowl,tosstogetherthearugula,prosciutto,tomato,andolives.

2.Tomakethedressing:Mixtogethertheoliveoilandvinegar.

3.Tossthesaladwiththedressing,orservethedressingontheside.

PEARANDARUGULASALADWITHPINENUTS

PREPTIME:10minutes

COOKTIME:—

YIELD:2servings

INGREDIENTS

4cupsarugula

1pear,thinlysliced

½cuppinenuts

½lemon

4tablespoonsextra-virginoliveoil

Himalayansaltandgroundblackpepper

DIRECTIONS

1.Inalargebowl,tosstogetherthearugula,pearslices,andpinenuts.

2.Squeezethejuicefromthelemonhalfoverthesalad.

3.Pourtheoliveoilontothesalad.

4.Seasonasdesiredwithsaltandpepper.

STRAWBERRYANDKALESALAD

PREPTIME:10minutes

COOKTIME:—

YIELD:2servings

INGREDIENTS

4cupskale

12strawberries,diced

1cupwalnuts

1tablespoonbalsamicvinegar

4tablespoonsextra-virginoliveoil

Himalayansaltandgroundblackpepper

DIRECTIONS

1.Inalargebowl,tosstogetherthekale,strawberries,andwalnuts.

2.Pourthevinegarandoliveoiloverthesalad.

3.Seasonasdesiredwithsaltandpepper.

TOMATO,CUCUMBER,ANDAVOCADOSALAD

PREPTIME:15minutes

COOKTIME:—

YIELD:2servings

INGREDIENTS

2cupsdicedcucumbers(about1mediumcucumber)

1cuphalvedcherrytomatoes

1½cupscubedavocado(about1largeavocado)

1cupgreenolives,pittedandhalved

½cupfetacheese

1tablespoonbalsamicvinegar

4tablespoonsextra-virginoliveoil

½teaspoonfreshlygroundblackpepper

1teaspoonHimalayansalt

DIRECTIONS

1.Inamedium-sizedbowl,tosstogetherthecucumbers,tomatoes,avocado,andolives.Sprinkleonthefetacheeseontop.

2.Pourthebalsamicvinegarandoliveoiloverthetopandtoss.

3.Seasonwiththesaltandpepper.

AVOCADOFRIES

PREPTIME:15minutes

COOKTIME:15minutes

YIELD:4servings

INGREDIENTS

2largeavocados,cutinto¼-inch-thickslices

Juiceof½lime

1cupporkrinds

1tablespoonHimalayansalt

Driedherbsand/orspices

1egg

2tablespoonmeltedcoconutoilorbutter

DIRECTIONS

1.Preheattheovento400°F.

2.Placetheporkrindsinasealableplasticbagandcrushwithyourhandsuntiltheyresemblebreadcrumbs.Mixinthesaltandanyotherdriedspicesorherbs.

3.Pourthelimejuiceintoasmallbowl.Inaseparatesmallbowl,whisktheegg.

4.Dipeachavocadoslicefirstinthelimejuice,thenintheegg.Letsitintheeggforabout10seconds,thenfliptocoattheothersideoftheslice.

5.Placetheegg-coatedavocadoslicesinthebagwiththecrushedporkrindsandshakeuntiltheslicesarecoveredintheporkrindmixture.

6.Pourthemeltedcoconutoilintoabakingdishandplacetheavocadoslicesinthedish.

7.Cookfor15minutes,oruntilgoldenbrown.

MUSTARDGREENBEANS

PREPTIME:10minutes

COOKTIME:10minutes

YIELD:4servings

INGREDIENTS

1poundgreenbeans,trimmed

1tablespoonextra-virginoliveoil

1tablespoonmustard(anykind)

Himalayansaltandgroundblackpepper

DIRECTIONS

1.Fillamedium-sizedsaucepanwithenoughwatertocoverthegreenbeansandbringtoaboilovermedium-highheat.Addthebeansandboiluntilcrispandtender,about3to4minutes.Alternatively,youcansteamthebeans:fillasaucepanaboutthree-quartersfullwithwaterandsetasteamerbasketontop.Bringthewatertoaboilovermedium-highheat.Addthebeanstothesteamerbasketandsteamuntilcrispandtender,about5minutes.Removefromheat.

2.Heattheoliveoilinanonstickskilletovermediumheatfor5minutes,when

addthemustard.

3.Addthecookedbeanstotheoilandmustardmixtureandcookforabout2minutes,untilwellmixedandheatedthrough.

4.Removethebeansfromtheskillet,seasonasdesiredwithsaltandpepper,andserve.

ROASTEDCAULIFLOWERRICE

PREPTIME:10minutes

COOKTIME:15minutes

YIELD:2servings

INGREDIENTS

1headcauliflower

½tablespoonHimalayansalt

DIRECTIONS

1.Preheattheovento200°F.Lineabakingsheetwithparchmentpaper.

2.Cutthecauliflowerintofloretsandremovethestems.

3.Gratethecauliflowerbyhandorpulseitinafoodprocessoruntilitlookslikerice.

4.Spreadthecauliflowerriceonthepreparedbakingsheetandsprinklewiththesalt.

5.Placethebakingsheetintheovenandbakefor12to15minutes,flippingevery5minutes.Removebeforethecauliflowerricestartstobrown.

6.Addanydesiredherbsorspices.