Fasting Series - DR Fung (Part 10-26) KHedit

2nd Document of the Fasting Series by Dr.
Fung
for Parts 1 to 9 see “Fasting Series Dr Fung (Part 1-9)” or go to Fasting part 1
Women and Fasting (Part 10)

Not surprisingly, the use of fasting for weight loss has a long history, since it’s, kind of, like,
obvious. I mean, everybody understands that if you do not eat, you are highly likely to lose weight.
Duh. Which makes it even more surprising how much people fear missing even a single meal, let
alone fast for a prolonged period of time. They think that fasting (not eating) will make you fat.
That’s kind of like saying that splashing water on your head will dry your hair. That’s modern
dietetics for you. Kind of a Bizarro world.
There are also still many doctors who argue that eating sugar is not bad for type 2 diabetics. Kind of
makes you wonder how they got into medical school at all. Since it is quite obvious that missing
meals leads to weight gain, the old bogeyman, ‘starvation mode’ is often invoked to instill fear.
Tales of people ‘ruining’ their metabolism abound. Food companies, of course have eagerly
‘educated’ medical professionals about the dangers of missing meals and the safety of eating sugar.
Nobody makes money when you skip meals.
Fasting appeared in modern medical literature over a century ago. Interestingly, they describe
‘professional fasters‘ who would fast for specific periods of time for exhibition. One professional
faster went for 30 days and drank a quantity of his own urine. Talk about being starved for
entertainment. Kind of like watching paint dry. This was depicted in Franz Kafka’s short story “A
Hunger Artist”. Fasting for entertainment was popular from 1883-1924. My guess is that it really is
not that entertaining.
Fasting Series Part 10-26 page 1 of 65

In the early 1900s, Drs. Folin and Denis described fasting as ‘a safe, harmless and effective method
for reducing weight of those suffering from obesity’. Great. That’s exactly what we need.
Something safe, harmless, and effective. The fact that fasting has been performed (mostly for
religious purposes) for several thousand years only reinforces the long history of safety. It’s hard to
argue that fasting is dangerous if people have been doing it for the last 5000 years across all
cultures. You may as well argue that using soap is dangerous. Yet, myths about the dangers of
fasting are everywhere.
By the early 1950’s, Dr. W. Bloom reignited interest in fasting as a therapeutic measure mostly
using shorter fasting periods. However, many longer periods were also described in the literature.
Dr. Gilliland reviewed fasting in the revival of the 1950’s and1960’s and reported his experience
with 46 patients “whose reducing regime started with a standard absolute fast for 14 days”. Whoa. I
love that. When I tell people to fast for more than 24 hours their eyes just about bug out of their
head. The people Dr. Gilliland worked with had a ‘standard’ fast that lasted for 2 weeks! And that
was just the beginning!
Of these, there were 14 males and 32 females. This is
important, because I constantly get questions about
whether fasting works for females. This is primarily, I
think due to a post on women and fasting found online that’s
been viewed close to 100,000 times. What she wrote in
2012 is this – “Intermittent fasting and women: Should
women fast? The few studies that exist point towards NO.”
I claim, that nothing could be further from the
truth. There are hundreds of studies spanning
over 100 years and clinical experience spanning
5000 years that point to the fact that women and
men respond more or less equally except in an
already underweight situation.
This is an easy problem. Should anybody who is seriously
underweight, fast? Uuuhhh, NO. You don’t have to be a
genius to figure that out for yourself.
If you are severely underweight and you start fasting as a woman, you could become infertile, yes.
Consider the past 2000 years of human history. Are Muslim women ‘exempt’ from fasting? Are
Buddhist women ‘exempt’ from fasting. Are Catholic women ‘exempt’ from fasting? So we have
millions of person-years of practical experience with women and fasting. And there are no problems
in 99.9% of cases. In our own clinic, where we’ve treated close to 1000 patients, I have noticed no
significant difference between men and women. If anything, the women tend to do better. I should
mention here, too, that we have the highest success rates when husband and wife do the fasting together.
However, pregnant women are, in fact ‘exempt’ from fasting in almost all human religion.
As are children. In both situations, this makes entirely logical sense. These groups need adequate
nutrients for growth, and human cultures have always acknowledged this.
Let’s be clear here. The point is also made in that online post, that several problems come up with
fasting in women. Well, they come up with men and fasting, too. Sometimes women don’t lose
weight the way they want. Well, that happens with men, too. The post then mentions specifically
the problem of amenorrhea (the absence of a menstrual period in a woman of reproductive age) that arises in
fasting women when their body fat is too low. Well, low body fat is not a problem we should treat
with fasting. If amenorrhea or any other problems appear during fasting – You should stop
immediately. The “Women and fasting issue” is just another myth designed to discourage fasting.
Virtually all case series of the past 100 years have included both men and women.

Anyway, back to the
study of Dr. Gilliland. His
patients were hospitalized
into a metabolic ward
during the first 14 days
and only water, tea and
coffee were allowed.
A f t e r t h a t , they were
discharged and asked to
follow a 600-1000 calorie
diet. Funny enough, 2
patients asked(!) to be
readmitted for a second
14 day period of fasting
because they wanted
better results. Did it
work? Was there ever any
doubt?
Average weight loss was 17.2 pounds in 14 days. This is in excess of the roughly 1/2 pound per day
of fat loss seen in more prolonged fasting. This indicates that some of the initial early weight loss is
water weight. This is confirmed by the rapid regain of weight upon re-feeding.
It is important to understand this in order to avoid the disappointment that often
accompanies the rapid weight gain upon eating again.
That quick weight loss and regain is water weight and not a reflection that the fasting ‘failed’. 44 of
46 patients completed the 2 week fasting period. One of the patients developed nausea and had to
stop, and one simply decided against it and dropped out.
That’s a 96% success rate even for a regimen as long as a 2 week fast! This is our clinical
experience as well. People always think they cannot do it without ever having tried it a single time.
Once we start with fasting, patents in our Intensive Dietary Management (IDM) program quickly
realize that it’s actually quite easy.
However, after the
fasting period, patients
were instructed to go on
a low calorie diet. This
was terribly unsuccessful.
50% of patients did not
adhere to this diet over
the ensuing 2 year follow
up period. Instead of
applying successful
intermittent techniques,
they returned to the
unsuccessful constant
energy restriction we
discussed earlier, and
predictably the patients run
out of will-power to keep up
self-control in the face of
constant hunger.

The key point here is that the natural rhythm of life is Feast and Fast.
There are times that you should feast (weddings, birthday celebrations, religious holidays, etc.), and
there are times that you should be fasting. Intermittent. To constantly restrict your calorie intake for
years on end is unnatural and ultimately worse, unsuccessful.
Dr Gilliland found that Ketones appeared in the urine of patients starting on day 2 and persisted
throughout the fasting period. All 3 participating diabetic patients were totally off insulin by the end
of the 2 week fasting period. One patient with severe congestive heart failure was able to walk
without breathlessness by the end. This 2 week fast was clearly not harmful to the patients, as we
were led to believe, and were repeatedly told, but it was extremely beneficial for almost all patients.
Was it hard? In fact, Dr. Gilliland describes a ‘feeling of well being’ and ‘euphoria’ reported by
many patients. Hungry? Well, NO. “We did not encounter complaints of hunger after the first day.
We did not meet anorexia.” These experiences were echoed by other researchers of the time.
Dr. Drenick, from the VA centre in Los Angeles, also wrote extensively about therapeutic fasting.
His experience was published in 1968. This was a time of renewal of interest in fasting for weight
loss. He published his experience of 6 men and 4 women (yes, again there were women in the
study). Did it work? In one word, yes.
In Summary:
• Should women fast? Yes (but not when they are pregnant, or underweight with low body-fat)
• Should men fast? Yes
Continue here for Fasting part 11

Feasts and Fasts – The Cycle of Life (Part 11)
Feasts are an important part of life. This is a vitally important fact to acknowledge. That is, every
single important celebration is marked by feasting.
Eating is a celebration of life.
Any diet that does not acknowledge this fact is doomed to failure.
We eat cake on our birthday. We eat holiday feasts like Thanksgiving. We celebrate Christmas
dinner. We prepare wedding banquets. We go to a nice restaurant on our anniversary.
We don’t celebrate with a birthday salad only. We don’t prepare meal
replacement bars for weddings. We don’t eat Thanksgiving ‘green’
shakes. We need to acknowledge the fact that we have known all along,
but tend to ignore... that most weight gain is not the consequence of a
constant phenomenon of over-eating. It’s a problem with a largely
intermittent nature. With that insight, it becomes easier to see that a
lasting solution to weight gain should also be of an intermittent nature.
Weight gain naturally varies throughout life, and also throughout the year.
Certain periods of life are associated with increased weight gain. This includes adolescence, where
weight gain is part of normal development. This also includes pregnancy, another situation where
insulin plays a dominant role. Weight gain during pregnancy is normal. However, it also increases
the risk of obesity later in life as well – a demonstration of the time dependence of insulin and
obesity. This period of increased insulin effect (to help the body gain weight) may have lasting
effects.
The simplest way to study this question is to compare women who have had children with those
who have not. There are multiple problems with this approach since this is not a randomized group,
and those who have never had children (nulliparous) may differ from those who have had children.
For example, the stress of having children and associated sleep deprivation may have an effect.
However, a randomized study is out of the question, so this is the best data we will get.
10 year follow up data from the first National Health and Nutrition Examination Survey (NHANES
1971-75) was used in this paper from 1994. Overall, the women’s weight gain in those with
children compared to those nulliparous was 1.6 kg after adjustment. With 1, 2, and 3 children the
weight gain averaged 1.7kg, 1.7kg, and 2.2 kg respectively, so there is some evidence of “dose-
response”, ie. more pregnancies results in more weight gain.
That doesn’t seem so bad, does it? But the risk of gaining more than 13 kg was increased by 40-
60%! The risk of becoming overweight was increased by 60-110%. So, while the overall effect
seems modest, the health consequences may not be so. There seem to be some who are predisposed
to gain large amounts of weight with childbirth and many who go back to their pre-birth weights.
You probably know some yourself.
This is far from an isolated finding. In 1994, the Journal of the American Medical Association
published the CARDIA study which also showed a 2-3 kg weight gain over 5 years associated with
pregnancy. This happened in both blacks and whites. Waist to hip ratio also increased – an indicator
of visceral fat gain – the more dangerous type.
Menopause is also associated with significant weight gain. Women were measured during their
menopausal years and averaged 2.25 kg weight gain average. Along with this, the blood pressure,
serum cholesterol and fasting insulin tends to increase. In men, weight tends to increase in the years
after marriage. Married men tend to be fatter than unmarried ones. This does not seem to hold true
for women.

The main point is this:
Weight Gain is not always steady.
Also weight gain is largely a hormonal, not a caloric imbalance.
The hormonal changes of pregnancy and menopause can certainly precipitate large weight changes.
Trying to battle a hormonal problem with calorie-based weapons is a losing proposition.
Other life events often cause or are associated with weight gain. Smoking cessation is a major cause
of weight gain. In a NEJM paper in 1991, it was estimated that weight gains average 2.8 kg in men
and 3.8 kg in women after quitting to. However, some people have major weight gains of 13 kg or
more - 9.8% of men and 13.4% of women.
Even with a single year, the majority of weight gain happens in a short period of time. Let’s take a
closer look at where weight gain happens in a paper published in the New England Journal of
Medicine in 2000 called “A prospective study of holiday weight gain“. The holiday period of US
Thanksgiving to New Years covers roughly 6 weeks. Researchers repeatedly measured a sample of
200 US adults to see whether weight gain happened disproportionately during this time.
Average weight
gain over the
entire year
averages 0.2 -
0.8 kg per year.
This is close to
the 1-2 pound
per year average
that is commonly
quoted in the lay
press. In this
study the average
weight gain over
the entire year
was 0.62kg.
However, this weight gain is

not equally gained
throughout the year. In the
6 weeks of the holiday
period, roughly 2/3 of the
weight of the entire year was
gained (0.37 kg). In the
remaining 46 weeks of the
year, only 1/3 of the weight
is gained. There is a small
attempt to lose weight in the
immediate post-holiday
period, but this is clearly not
sufficient to offset the
holiday weight gain.

Another interesting finding was that those subjects who were already overweight or obese tended to
gain the most weight during the holiday period. This is probably not news to people. The fat get
fatter. Those who have struggled with weight for the longest, have the most trouble.
This is yet another example of the time-dependency of obesity. One of the major shortcomings of
the caloric theory is the overlooking of this important fact of life.
If weight gain is not uniform throughout the year, then weight loss efforts also need to vary. You
need a strategy of increasing weight loss at times and of weight maintenance at others. A constant
diet does not match the cycle of life... Feast and Fast.
There are times that you should eat a lot.
There will be other times that you should be eating almost nothing.
That is the natural cycle of life.
If we keep all the feasting (which western culture clearly does), but eliminate all the fasting (which
western culture also tends to do), then it is rather predictable what the result is... Weight Gain!!
In fact, religions have almost universally acknowledged this fact. There are many periods where
feasting is prescribed – Christmas for example. There are other periods of time where fasting is
prescribed – Lent, for example.
The ancient civilizations
and religions all knew this
simple rhythm of life.
When the harvest comes
in, you feast. But you will
fast often in the upcoming
winter. But now, in our
modern day of continuous
food availability, religions
have prescribed periods of
fea sting and fast ing.
Except that we have kept
mostly the feasts, but fear
the fasts. They have
become demonized. And
we have paid the price.
Type 2 diabetes has become an absolute epidemic in all age groups. It seems pretty obvious that
this is a balance problem. If you feast, you must fast. If you keep all the feasting and lose all the
fasting, you get fat. That’s really not so hard to understand, is it?
But what happens when you lose all the feasting, ie. if you live by a caloric restriction diet? Well,
then life becomes a little less special. If you are the guy at the wedding who won’t drink, who won’t
eat the cake, who won’t eat the full meal, who
won’t eat the appetizers – there’s a name for that
– the party pooper. And maybe you can keep it up
for 6 months, or 12 months. But forever? Heck,
not even the most extreme religions did that.
That’s pretty hard to do. Life is full of ups and
downs. Celebrate the ups because the downs are
right around the corner. But you must balance the
periods of eating a lot with periods of eating very
little. It’s all a matter of balance. Continue here for Fasting Part 12

Practical Fasting Tips (Part 12)
We’ve dealt now extensively with the science of fasting, but sometimes there are many practical
considerations that need exploring, too. Fasting, like anything else in life requires some practice. In
days past, when religious fasting was a communal practice, these sort of practical tips were passed
on from generation to generation. If not, friends would often have useful advice on how to handle
the fasting, because there are definitely some problems that commonly arise. However, with the
decline in the practice of fasting, these sorts of advice are often difficult to find.
What can I take in during fasting days?
There are many different rules for fasting. During Ramadan, for example, fasting is practiced from
sunrise to sundown and no food or beverages are taken. Other types of fasting will only restrict
certain types of foods – for example, abstaining from meat for a day. So there are no right or wrong
rules. What I describe is the fasting that we prescribe for health and weight loss, as we use in our
own Intensive Dietary Management program.
All calorie-containing foods and beverages are withheld during fasting. However, be sure to stay
well hydrated throughout your fasting. Water, both still and sparkling, is always a good choice. Aim
to drink two liters of water daily. As a good practice, start every day with eight ounces of cool water
to ensure adequate hydration as the day begins. Add a squeeze of lemon or lime to flavor the water,
if you wish. Alternatively, you can add some slices of orange or cucumber to a pitcher of water for
an infusion of flavor, and then enjoy the water throughout the day. You can dilute apple-cider
vinegar in water and then drink it, which may help with your blood sugars. However, artificial
flavors or sweeteners are prohibited. Kool-Aid, Crystal Light, or Tang should not be added to the
water.
All types of tea are excellent, including
green, black, oolong and herbal. Teas
can often be blended together for
variety, and can be enjoyed hot or cold.
You can use spices such as cinnamon
or nutmeg to add flavor to your tea.
Adding a small amount of cream of
m i l k i s a l s o a c c e p t a b l e . Sugar,
artificial sweeteners or flavors are
not allowed. Green tea is an especially
good choice here. The catechins in
green tea can help to suppress appetite.
Coffee, caffeinated or decaffeinated, is also permitted. A small amount of cream or milk is

acceptable, although these do contain some calories. Spices such as cinnamon may be added, but
not sweeteners, sugar or artificial flavors. On hot days, iced coffee is a great choice. Coffee has
many health benefits, as previously detailed.
Homemade bone broth, made from beef, pork, chicken or fish bones, is a good choice for fasting
days. Vegetable broth is a suitable alternative, although bone broth contains more nutrients. Adding
a good pinch of sea salt to the broth will help you stay hydrated. The other fluids — coffee, tea, and
water — do not contain sodium, so during longer fasting periods, it is possible to become salt-
depleted. Although many fear the added sodium, there is far greater danger in becoming salt
depleted. For shorter fasts such as the twenty-four- and thirty-six-hour variety, it probably makes
little difference. All vegetables, herbs or spices are great additions to broth, but do not add bouillon
cubes, which are full of artificial flavors and monosodium glutamate. Beware of canned broths: they
are poor imitations of the homemade kinds. (See below for a bone-broth recipe.)

Broth Recipe
Vegetables
Chicken, pork or beef bones
1 tbsp of vinegar
Sea salt, to taste
Pepper, to taste
Ginger, to taste
1. Water to cover
2. Simmer for two to three hours
until ready
3. Strain and de-fat
How do I break my fast?

Be careful to break your fast gently. There is a natural tendency to eat large amounts of food as
soon as the fast is over. Interestingly, most people don’t actually describe overwhelming hunger,
but more of a psychological need to eat. Overeating right after fasting may lead to stomach
discomfort. While not serious, it can be quite uncomfortable. Fortunately this problem tends to be
self-correcting.
Try breaking your fast with a handful of nuts or a small salad to start. Then wait for 15-30 minutes.
This will usually give time for any waves of hunger to pass, and allow you to gradually adjust.
Short duration fasts (24 hours or less) generally require no special breaking of the fast, but certainly
for longer fasts it is a good idea to plan ahead.
I get hungry when I fast. What can I do?
This is probably the number-one concern. People assume they’ll be overwhelmed with hunger and
unable to control themselves. The truth is that hunger does not persist, but instead comes in waves.
If you’re experiencing hunger, it will pass. Staying busy during a fast day is often helpful. Fasting
during a busy day at work keeps your mind off eating.
As the body becomes accustomed to fasting, it starts to burn its stores of fat, and your hunger will
be suppressed. Many people note that as they fast, appetite does not increase but rather starts to
decrease. During longer fasts, many people notice that their hunger completely disappears by the
second or third day.
There are also natural products that can help suppress hunger. Here are my top five natural appetite
suppressants:
1. Water: As mentioned before, start your
day with a full glass of cold water. Staying
hydrated helps prevent hunger. (Drinking
a glass of water prior to a meal may also
reduce hunger.) Sparkling mineral water
may help for noisy stomachs and
cramping.
2. Green tea: Full of anti-oxidants and
polyphenols, green tea is a great aid for
dieters. The powerful anti-oxidants may
help stimulate metabolism and weight
loss.

3. Cinnamon: Cinnamon has been shown to slow gastric emptying and may help suppress
hunger.(1) It may also help lower blood sugars and therefore useful in weight loss.
Cinnamon may be added to all teas and coffees for a delicious change.
4. Coffee: While many assume that caffeine suppresses hunger, studies show that this effect
is likely related to anti-oxidants. Both decaffeinated and regular coffee shows greater hunger
suppression than caffeine in water.(2) Given its health benefits, there is no reason to limit
coffee intake. The caffeine in coffee may also raise your metabolism further boosting fat
burning.
5. Chia Seeds: Chia seeds are high in soluble fiber and omega 3 fatty acids. These seeds
absorb water and form a gel when soaked in liquid for thirty minutes, which may aid in
appetite suppression. They can be eaten dry or made into a gel or pudding.
Can I exercise while fasting?

Absolutely. There is no reason to stop your exercise routine. All types of exercise, including
resistance (weights) and cardio, are encouraged. There is a common misperception that eating is
necessary to supply “energy” to the working body. That’s not true. The liver supplies energy via
gluconeogenesis. During longer fasting periods, the muscles are able to use fatty acids directly for
energy.
As your adrenalin levels will be higher, fasting is an ideal time to exercise. The rise in growth
hormone that comes with fasting may also promote muscle growth. These advantages have led
many, especially those within the bodybuilding community, to take a greater interest in deliberately
exercising in the fasted state. Diabetics on medication, however, must take special precautions
because they may experience low blood sugars during exercise and fasting. (See “What if I have
diabetes?” for recommendations, in next post.)
For more tips continue here for Fasting part 13

More Practical Fasting Tips (Part 13)
Will fasting make me tired?
In our experience at the Intensive Dietary Management Clinic, the opposite is true. Many people
find that they have more energy during a fast—probably due to increased adrenalin. Basal
metabolism does not fall during fasting but rises instead. You’ll find you can perform all the normal
activities of daily living. Persistent fatigue is not a normal part of fasting. If you experience
excessive fatigue, you should stop fasting immediately and seek medical advice.
Will fasting make me confused or forgetful?

No. You should not experience any decrease in memory or
concentration. The ancient Greeks believed that fasting
significantly improved cognitive abilities, helping the great
thinkers attain more clarity and mental acuity. Over the long
term, fasting may actually help improve memory. One theory is
that fasting activates a form of cellular cleansing called
autophagy that may help prevent age-associated memory loss.
I get dizzy when I fast. What can I do?

Most likely, you’re becoming dehydrated. Preventing this
requires both salt and
water. Be sure to drink plenty of fluids. However, the low-
salt intake on fasting days may cause some dizziness. Extra
sea salt in broth or mineral water often helps alleviate the
dizziness.
Another possibility is that your blood pressure is too low—
particularly if you’re taking medications for hypertension.
Speak to your physician about adjusting your medications.
I get headaches when I fast. What can I do?

As above, try increasing your salt intake. Headaches
are quite common the first few times you try a fast. It is
believed that they’re caused by the transition from a
relatively high-salt diet to very low salt intake on fasting
days. Headaches are usually temporary, and as you
become accustomed to fasting, this problem often
resolves itself. In the meantime, take some extra salt in
the form of broth or mineral water.
My stomach is always growling. What can I do?

Try drinking some mineral water.

Since I’ve started fasting, I experience constipation. What can I do?
Increasing your intake of fiber, fruits and vegetables
during the non-fasting period may help with constipation.
Metamucil can also be taken to increase fiber and stool
bulk. If this problem continues, ask your doctor to
consider prescribing a laxative.
I get heartburn. What can I do?

Avoid taking large meals. You may find you have a
tendency to overeat once you finish a fast, but try to just
eat normally. Breaking a fast is best done slowly. Avoid
lying down immediately after a meal and try to stay in an
upright position for at least one-half hour after meals.
Placing wooden blocks under the head of your bed to
raise it may help with night-time symptoms. If none of
these options work for you, consult your physician.
I take medications with food. What can I do during fasting?

There are certain medications that may cause problems on an empty stomach. Aspirin can cause
stomach upset or even ulcers. Iron supplements may cause nausea and vomiting. Metformin, used
for diabetes, may cause nausea or diarrhea. Please discuss whether or not these medications need to
be continued with your physician. Also, you can try taking your medications with a small serving of
leafy greens.
Blood pressure can sometimes become low during a fast. If you take blood-pressure medications,
you may find your blood pressure becomes too low, which can cause light-headedness. Consult
with your physician about adjusting your medications.
I get muscle cramps. What can I do?

Low magnesium levels, particularly common in diabetics, may cause muscle cramps. You may take
an over-the-counter magnesium supplement. You may also soak in Epsom salts, which are
magnesium salts. Add a cup to a warm bath and soak in it for half and hour. The magnesium will be
absorbed through your skin.
What if I have diabetes?

Special care must be taken if you are diabetic or are taking diabetic medications. (Certain diabetic
medications, such as metformin, are used for other conditions such as polycystic ovarian
syndrome.) Monitor your blood sugars closely and adjust your medications accordingly. Close
medical follow-up by your physician is mandatory. If you cannot be followed closely, do not fast.
Fasting reduces blood sugars. If you are taking diabetic medications, or especially insulin, your
blood sugars may become extremely low, which can be a life-threatening situation. You must take
some sugar or juice to bring your sugars back to normal, even if it means you must stop your fast
for that day. Close monitoring of your blood sugars is mandatory.
Low blood sugar is expected during fasting, so your dose of diabetic medication or insulin may
need to be reduced. If you have repeated low blood sugars it means that you are over-medicated, not
that the fasting process is not working. In the Intensive Dietary Management Program, we often
reduce medications before starting a fast in anticipation of lower blood sugars. Since the blood
sugar response is unpredictable, close monitoring with a physician is essential.

Monitoring
Close monitoring is essential for all patients, but especially, for diabetics. You should also monitor
your blood pressure regularly, preferably weekly. Be sure to discuss routine blood work, including
electrolyte measurement, with your physician. Should you feel unwell for any reason, stop your fast
immediately and seek medical advice. In addition, diabetics should monitor their blood sugars a
minimum of twice daily and recorded.
In particular, persistent nausea, vomiting, dizziness, fatigue, high or low blood
sugars or lethargy are not normal with intermittent or continuous fasting.
Hunger and constipation are normal symptoms and can be managed.
Top 8 Intermittent Fasting tips

1. Drink water: Start each morning with a full eight-ounce glass of water.
2. Stay busy: It’ll keep your mind off food. It often helps to choose a busy day at
work for a fast day.
3. Drink coffee: Coffee is a mild appetite suppressant. Green tea, black tea, and
bone broth may also help.
4. Ride the waves: Hunger comes in wave; it is not continuous. When it hits, slowly drink a glass of water
or a hot cup of coffee. Often by the time you’ve finished, your hunger will have passed.
5. Don’t tell anybody you are fasting: Most people will try to discourage you, as they do not
understand the benefits. A close-knit support group is often beneficial, but telling everybody you know
is not a good idea.
6. Give yourself one month: It takes time for your body to get used to fasting. The first few times you fast
may be difficult, so be prepared. Don’t be discouraged. It will get easier.
7. Follow a nutritious diet on non-fast days: Intermittent fasting is not an excuse to eat whatever you like.
During non-fasting days, stick to a nutritious diet low in sugars and refined carbohydrates.
8. Don’t’ binge: After fasting, pretend it never happened. Eat normally, as if you had never fasted.
The last and most important tip is to fit fasting into your own life! Do not limit yourself socially
because you’re fasting. Arrange your fasting schedule so that it fits in with your lifestyle. There will
be times during which it’s impossible to fast: vacation, holidays, weddings. Do not try to force
fasting into these celebrations. These occasions are times to relax and enjoy. Afterwards, however,
you can simply increase your fasting to compensate. Or just resume your regular fasting schedule.
Adjust your fasting schedule to what makes sense for your lifestyle.
What to expect
The amount of weight lost varies tremendously from person to person. The longer that you have
struggled with obesity, the more difficult you’ll find it to lose weight. Certain medications may
make it hard to lose weight. You must simply persist and be patient.
You’ll probably eventually experience a weight-loss plateau. Changing either your fasting or
dietary regimen, or both, may help. Some patients increase fasting from twenty-four-hour periods to
thirty-six-hour periods, or try a forty-eight-hour fast. Some may try eating only once a day, every
day. Others may try a continuous fast for an entire week. Changing the fasting protocol is often
what’s required to break through a plateau.
Fasting is no different than any other skill in life. Practice and support are essential to performing it
well. Although it has been a part of human culture forever, many people in North America have
never fasted in their lives. Therefore, fasting has been feared and rejected by mainstream nutritional
authorities as difficult and dangerous. The truth, in fact, is radically different.
Continue here for Fasting Part 14

The Fasting ‘Advantage’ (Part 14)
What is the advantage of using a strategy based on intermittent fasting versus simple dietary
changes alone – such as the LowCarb HighFat diets that we prefer? There are several good ones.
Reason #1 – Simplicity
When I started out my clinic, I tried to
persuade people to adopt the LCHF
diet. I was doing this for people of all
ages, of all nationalities. It is difficult
enough for a well educated English
speaking, computer literate person to
adopt a strict LCHF diet. This is hard
given all the conflicting advice flying
around the internet and the airwaves.
We would tell people to go Low Carb
and find food diaries full of whole
wheat bread and plates of pasta. Many people honestly did not understand the diet at all. I spent lots
of time and grey hair trying to change their diets, but many people simply did not understand.
Furthermore, their diets had not significantly changed in 40 years, and they were having a lot of
trouble changing it.
Since the Low Fat approach had been indoctrinated into them for the last 20 years, it was hard for
people to understand how to eat a diet high in natural fats, rather than the low fat fare they were
used to. Using a completely different approach such as fasting was much easier for people to
understand.
Fasting itself, is so simple that it can be explained in two sentences. Eat nothing including sugars or
sweeteners. Drink water, tea, coffee or bone broth. That’s it. Even with this simple method, we
(Megan, not actually me anymore) spend hours explaining ‘how to’ fast.
The most obvious benefit to simplicity, though is demonstrated by the startlingly simple graph
above. The simpler, the more effective. Amen.
Reason #2 – Cheap
While I may prefer patients to eat organic, local
grass fed beef and avoid the white bread and
processed foods, the truth is that these foods are
often 10 times the cost. Some people, simply
put, cannot afford to eat that well.
T h i s i s d u e t o t h e distorting effect of
government subsidies on cost of food. Since
grains enjoy substantial government subsidies, it
is far cheaper to make something out of flour
than whole foods. This means that fresh cherries
cost $6.99/ pound and an entire loaf of bread
will cost $1.99. Feeding a family on a budget is
a lot easier when you buy pasta and white bread.
But that does not mean they should be doomed to a lifetime of type 2 diabetes and disability.
Fasting is free. Actually, it is not simply free, but it actually saves people money, because you do
not need to buy any food.

Reason #3 – Convenience
While I may advise people to always eat a home cooked, prepared-from-scratch meal, there are
many people who simply do not have the time or inclination to do so. The number of meals eaten
away from home has been increasing over the past few decades. While there are many who try to
support the ‘slow food’ movement, it is clear that they are fighting a losing battle.
Don’t get me wrong, I love cooking as much as the next guy. But it just takes a lot of time. Between
work, writing, and taking my kids to school stuff and hockey, it just doesn’t leave a lot of time.
So asking people to devote themselves to home cooking, as noble as it may be, is not going to be a
winning strategy. Fasting, on the other hand is the opposite. You save time because there is no time
spent buying food, preparing, cooking and cleaning up. It is a way to simplify your life. I often skip
breakfast in the mornings. Man, the time saved! I often skip lunch, too. Man, the time saved! If time
is money….
Reason #4 – Cheat days

While I might advise people to never, ever again eat ice cream, I don’t think that is actually very
practical advice. Sure, you might be able to swear off of it for 6 months, or 1 year, but for life? And
would you really want to? Think about it. Think about the joy that some people get from savouring
an especially delicious dessert at a wedding feast. Do we need to deny ourselves that little bit of
pleasure forever? Let us all enjoy instead our birthday salad feast! Thanksgiving kale festival! All
you can eat Brussels-sprouts! Yes, life just got a little less sparkly. Forever is a long time.
Now, I am not saying that you can eat dessert every single day, but fasting gives you the ability to
occasionally enjoy that dessert, because if you feast, you can balance the scale by fasting. It is, after
all, the cycle of life. The reason these ‘cheat’ days are important is because it builds compliance.
Simply put, it makes the diet easier to follow and changes it into a lifestyle instead. We often
counsel that the most important aspect of fasting is to fit it into your life.

Reason #5 – Power
I often treat type 2 diabetic patients. Most of them
have had it for 10 years or more. So, of the obese
patients I treat, they are often the worst of the worst
in terms of obesity and insulin resistance.
Sometimes, even a strict LCHF diet is not strong
enough. The fastest and most efficient way to lower
insulin is intermittent fasting.
In the end, you must ask yourself this question. If
you do not eat anything for 1 week, do you think
you will lose weight? Even a child understands that
you must lose weight. It is almost inevitable. So its
efficacy is unquestioned.
There are only two remaining questions. First – is it
unhealthy? On the contrary, there are extraordinary
health benefits. Two – can you do it? Well, if you
never try it, you will never know. I think almost
everybody can do it.
Reason #6 – Flexibility
Fasting can be done at any time and in any place. Furthermore, if you do not feel well for any
reason, you simply stop. It is entirely reversible within minutes.
Consider bariatric surgery (stomach stapling). These surgeries are done so that people can fast for
prolonged periods of time. And they tend to work, at least in the short term. But these surgeries
have tons of complications, almost all of which are irreversible.
Furthermore, why would we assume that somebody cannot fast for 1 week or 1 month without ever
having tried it?
Reason #7 – Add to any diet

Here is the biggest advantage of all. Fasting can be added to any diet. That is because fasting is not
something you do, but something you do not do. It is subtraction rather than addition.
• You don’t eat meat? You can still fast.
• You don’t eat wheat? You can still fast.
• You have a nut allergy? You can still fast.
• You don’t have time? You can still fast.
• You don’t have money? You can still fast.
• You are travelling all the time? You can still fast.
• You don’t cook? You can still fast.
• You are 80 years old? You can still fast.
• You have problems with chewing or swallowing? You can still fast.
What could possibly be simpler?
Continue to Fasting Part 15 – Fasting and Muscle Mass

Fasting and Muscle Mass (Part 15)
It seems that there are always concerns about loss of muscle mass during fasting. I never get away
from this question. No matter how many times I answer it, somebody always asks,
“Doesn’t fasting burn your muscle?” Let me say straight up, NO.
Here’s the most important thing to remember. If you are concerned about losing weight and
reversing Type 2 Diabetes (T2D), then you should worry about insulin. Fasting and a LowCarb
HighFat (LCHF) diet will help you with that. If you are worried about muscle mass, then exercise –
especially focus on resistance exercises. OK? Don’t confuse the two issues. We always confuse the
two issues, because the calorie enthusiasts have intertwined them in our minds like hamburgers and
french fries.
Weight loss and gain is mostly a function of DIET. You can’t exercise your way out of a dietary
problem. Remember the story of Peter Attia? A highly intelligent doctor and elite level distance
swimmer, he found himself on the heavy end of the scale, and it was not muscle. He was
overweight despite exercising 3-4 hours a day. Why?
• Because muscle is about exercise, and fat is about diet. You can’t out-run a bad diet.
• Muscle gain/ loss is mostly a function of EXERCISE. You can’t eat your way to more muscle.
Supplement companies, of course, try to convince you otherwise. Eat creatine (or protein shakes, or
eye of newt) and you will build muscle. That’s plain stupid. There’s one good way to build muscle
– and that's exercise. So if you are worried about muscle loss – exercise. It ain’t rocket science. Just
don’t confuse the two issues of diet and exercise. Don’t worry about what your diet (or lack of diet –
i.e. fasting) is doing to your muscle. Exercise builds muscle., whether you are fasting or not. OK? Clear?
So the main question is this –
if you are fasting for long
enough, doesn’t your body
start to burn muscle in excess
of what it was doing
previously in order to
produce glucose for the body.
Hell, No.
Let’s look carefully at this
graph by Dr. Kevin Hall from
the NIH in the book
“Comparative Physiology of
Fasting, Starvation, and Food
Limitation”. Great title
guys... Amazon probably
couldn’t keep enough stock
on the shelves.
But anyhow, this is a graph of where the energy to power our bodies comes from, from the start of
fasting. At time zero, you can see that there is a mix of energy coming from carbs, fat and protein.
Within the first day or so of fasting, you can see that the body initially starts by burning carbs
(sugar) for energy. However, the body has limited ability to store sugar. So, after the first day, fat
burning starts.
What happens to protein? Well, the amount of protein consumed goes down. There is certainly a
baseline low level of protein turnover, but my point is that we do not start ramping up protein
consumption. When we are fasting, we don’t start burning muscle, we start conserving muscle.

Reviews of fasting from the mid 1980s had already noted that “Conservation of energy and protein
by the body during fasting has been demonstrated by reduced… urinary nitrogen excretion and
reduced leucine flux (proteolysis). During the first 3 days of fasting, no significant changes in
urinary nitrogen excretion and metabolic rate have been demonstrated”. Leucine is an amino acid
and some studies had shown increased release during fasting and other had not. In other words,
physiologic studies of fasting had already concluded that protein is not ‘burnt’ for glucose.
It further notes that you
can get increased leucine
flux with no change in
urinary nitrogen excretion.
This happens when amino
acids are reincorporated
into proteins. Researchers
studied the effect of whole
body protein breakdown
with 7 days of fasting.
Their conclusion was that
“decreased whole body
protein breakdown
contributes significantly
to the decreased nitrogen
excretion observed with
fasting in obese subjects”.
There is a normal
breakdown of muscle
which is balanced by new
muscle formation. This
normal breakdown rate
slows to roughly 25%
during fasting.
The classic studies were done by George Cahill. In a 1983 article on “Starvation he notes that
glucose requirements fall drastically during fasting as the body feeds on fatty acids and the brain
feeds on ketone bodies significantly reducing the need for gluconeogenesis in the liver. Normal
protein breakdown is on the order of 75 grams/day which falls to about 15 – 20 grams/day during
starvation. So, suppose we go crazy and fast for 7 days and lose about 100 grams of protein. We
make up for this protein loss with ease and actually, far, far exceed our needs the next time we eat.
From Cahill’s study, you
can see that the urea
nitrogen excretion, which
corresponds to protein
breakdown, goes way, way
down during fasting/
starvation. This makes
sense, since protein is
functional tissue and there is
no point to burning useful
tissue while fasting when
there is plenty of fat around.
So, no, you don't ‘burn’
muscle during fasting, as
long as there's any fat left.

Where does the glucose come from
when you are fasting? Well, fat is
stored as triglycerides (TG). These
consist of 3 fatty acid chains
attached to 1 glycerol molecule. The
fatty acids are released from the TG
and most of the body can use these
fatty acids directly for energy.
The glycerol, goes to the liver,
where it undergoes the process of
gluconeogenesis and is turned into
glucose. So, the parts of the body
that can only use glucose have
enough of it. This is how the body is
able to keep a normal blood sugar
even though you are not eating
sugar. It has the ability to produce
its own glucose from stored fat.
Sometimes you will hear a dietician say that the brain ‘needs’ 140 grams of glucose a day to
function. Yes, that may be true, but that does NOT mean that you need to EAT 140 grams of
glucose a day. Your body will produce the glucose it needs from your fat stores. If you decide to
EAT the 140 grams of glucose instead, your body will simply leave the fat on your ass, hips, and
waist. This is because the body will always burn the sugar first, before turning to the fat.
But let’s look at some clinical studies in the real world. In 2010, researchers looked at a group of
subjects who underwent 70 days of alternate daily fasting (ADF). That is, they ate one day and
fasted the next. What happened to their muscle mass?
Their fat free mass started off at 52.0 kg and ended at 51.9 kg. In other words, there was no loss of
lean weight (bone, muscle etc.). There was, however, a significant amount of fat lost. So, no, you
are not ‘burning muscle’, you are ‘burning fat’. This, of course, is only logical. After all, why would
your body store excess energy as fat, if it meant to burn protein as soon as the chips were down?
Protein is functional tissue and has many purposes other than energy storage, whereas fat is
specialized for energy storage. Would it not make sense that you would first use fat for energy
instead of protein? Why would we think Mother Nature is some kind of crazy?

That would be kind of like storing firewood (fat) for heat. But as soon as you need heat, you chop
up your sofa (protein) and throw it into the fire. That is completely idiotic and that is not the way
our bodies are designed to work.
How, exactly does the body then retain lean tissue? This is likely related to the presence of growth
hormone. In an interesting paper, researchers had subjects fasting and then suppressed Growth
Hormone with a drug to see what happens to muscle breakdown. In this paper, they acknowledge
already 50 years ago that “Whole body protein decreases” when Growth Hormone (GH) is
suppressed during fasting. In other words, we have known for 50 years at least, that muscle
breakdown decreases substantially during fasting due to the presence of GH.
By suppressing GH during fasting, there is a 50% increase in muscle break down. This is highly
suggestive that growth hormone plays a large role in the maintenance of lean weight during fasting.
The body already has mechanisms in place during fasting to preserve lean mass and to burn fat for
fuel instead of protein.
So let me lay it out as simply as I can. Fat is, at its core essence, stored food for us to ‘eat’ when
there is nothing to eat. We have evolved our fat stores to be used in times when there is nothing to
eat for us on the outside. It’s not there for looks, OK? So, when there is nothing to eat (conscious
fasting), we ‘eat’ our own fat. This is natural. This is normal. This is the way we were designed.
And its not just us, but all wild animals are designed the same way. We don’t waste away our
muscle while keeping all our fat stores. That would be idiotic. During fasting, hormonal changes
kick in to give us more energy (increased adrenalin), keep glucose and energy stores high (burning
fatty acids and ketone bodies), and keep our lean muscles and bones (growth hormone). This is
normal and natural and there is nothing here to be feared.
So, I will say it here, yet again.
• No, fasting does not mean you burn protein for glucose. Your body will run on fat.
• Yes, your brain needs a certain amount of glucose to function. But no, you do not have to EAT
the glucose to get it there. Your body (liver) will produce the glucose you need from fat.
Continue to Fasting Part 16 –Fasting Lowers Cholesterol

Fasting Lowers Cholesterol – Fasting 16
How can you lower cholesterol without resorting to medications?
High cholesterol is considered a treatable risk factor for cardiovascular disease such as heart attacks
and strokes. There are many nuances to cholesterol which I do not want to get into, but traditionally,
the main division has been between Low Density Lipoprotein (LDL) or ‘bad’ cholesterol, and High
Density Lipoprotein (HDL) or ‘good’ cholesterol. Many people do not look so closely at total
cholesterol anymore, because there is both good and bad factions and therefore, the total cholesterol
gives us little useful information.
We also measure triglycerides, a type of fat found in the blood. Fat is stored in fat cells as
triglycerides, but also floats around freely in the body. For example, during fasting, triglycerides get
broken down into free fatty acids and glycerol. Those free fatty acids are used for energy by most of
the body. So triglycerides are a form of stored energy. Cholesterol is not. This substance is used in
cellular repair (in cell walls) and also used for making certain hormones.
One might (mistakenly) think that decreasing dietary cholesterol may reduce blood cholesterol
levels. However, 80% of the cholesterol in our blood is generated by the liver, so reducing your
intake of dietary cholesterol is quite unsuccessful. Studies going back to Ancel Key’s original
Seven Country Studies show that how much cholesterol we eat has very little to do with how much
cholesterol is in the blood. Whatever else he got wrong, he got this right – eating cholesterol does
not raise blood cholesterol, just like eating fat does not make you fat.
The next thought was that lowering dietary fat, especially saturated fats may help lower cholesterol.
While untrue, there are still many who believe this. In the 1960’s the Framingham Diet Study was
set up to specifically to look for a connection between dietary fat and cholesterol. Why haven’t you
heard of it, before? Well, the findings of this study showed no correlation between dietary fat and
cholesterol whatsoever. Because these results clashed with the prevailing ‘wisdom’ of the time, they
were suppressed and never published in a journal. Results were tabulated and put away in a dusty corner.
The Tecumseh study divided their subjects into 3 levels of blood cholesterol – low, medium and
high. Then, they looked at how much fat and cholesterol each group ate. It turns out that each group
pretty much ate the same amount of fat, animal fats, saturated fats and cholesterol. So, what they
demonstrated was that dietary intake of fat does not have very much to do with cholesterol at all.

Low fat and extremely low fat diets can lower the LDL (bad cholesterol) slightly, but they also tend
to lower the HDL (good cholesterol) so it is arguable whether things improve or not. Actually,
we’ve known that for quite some time. For example, here’s a study from 1995, where 50 subjects
were fed either a 22% or a 39% fat diet. Baseline cholesterol was 173 mg/dl. After 50 days of a low
fat diet, it plummeted to … 173 mg/dl. Oh. High fat diets don’t lower cholesterol either. After 50
days of high fat diets, cholesterol increased marginally to 177 mg/dl.
Millions of people try a low fat or low cholesterol diet without realizing that these have already
been proven to fail. I hear this all the time. Whenever somebody is told their cholesterol is high,
they say “I don’t understand. I’ve cut out fatty foods”. Well, reducing dietary fat will not change
your cholesterol. So, what to do? Statins, I guess?
“A little starvation can really do more for the average sick man than
can the best medicines and the best doctors” Mark Twain
Studies show that fasting is a simple dietary strategy that can significantly lower cholesterol levels.
Now, there are many controversies about lipids that I do not wish to get quagmired in. I’m only
going to discuss the conventional view of it. That is, many of the classic studies, such as the
Framingham study, have pointed out that there is a correlation between high levels of ‘bad’
cholesterol and cardiovascular disease. The higher the LDL, the more bad things happen.
HDL
‘Good’ cholesterol (HDL) shows an inverse relationship. High levels are protective. So the lower
the HDL, the higher the risk of CV disease. This association is actually much more powerful than
that for LDL, so let’s start here. However, it is clear that HDL is not causally related to CV events.
HDL is only a marker for disease.
Several years ago, Pfizer poured billions of dollars into researching a drug called torcetrapib
(a CETP inhibitor). This drug had the ability to significantly increase HDL levels. If low
HDL caused heart attacks, then this drug could save lives. Pfizer was so sure of itself, it
spent billions of dollars trying to prove the drug effective.
The studies were done. And the results were breathtaking. Breathtakingly bad, that is. The
drug increased death rate by 25%. Yes, it was killing people left and right like Ted Bundy.
Several more drugs of the same class were tested and had the same killing effect. Just one
more illustration of the Correlation is not Causation truth.
What happens to HDL
during fasting? You
can see from the graph
that 70 days of
alternate daily fasting
had a minimal impact
upon HDL levels .
There was some
decrease in HDL, but
it was minimal.

Triglycerides
The story of triglycerides (TG) is similar. While TGs may be correlated weakly to heart disease,
they do not cause it. There were several drugs that reduce TG to a much greater extent than the
cholesterol medications, the statins. Niacin was one such example. This drug would increase HDL
and lower TG without very much effect on the LDL.
The AIM HIGH study tested whether this would
have any benefit. The results were stunning.
Stunningly bad, that is. While they did not kill
people, they did not help them either. And there
were lots lot side effects. So, TG, like HDL is
only a marker not a causer of disease.
What happens to TG during fasting? There’s a
huge 30% decrease in TG levels (good) during
alternate daily fasting. In fact, triglycerides is
quite sensitive to diet. But it is not reducing
dietary fat or cholesterol that helps. Instead,
reducing carbohydrates seems to be the main
factor that reduces TG levels.
LDL
The LDL story is much more contentious. Certainly, there is a correlation between high LDL levels
and CV disease. However, the more important question is whether this is a causal relationship. The
statin drugs lower LDL cholesterol quite powerfully, and also reduces CV disease in high risk
patients. But these drugs have other effects, often called the pleiotropic (affecting multiple systems)
effects. For example, statins also reduce inflammation, as shown by the reduction in hsCRP, an
inflammatory marker. So, is it the cholesterol lowering or the pleiotropic effects that are responsible
for the benefits?
This is a good question to which I do not have an answer, yet. The way to tell would be to lower
LDL using another drug and see if there are similar CV benefits. The drug ezetimibe in
the IMPROVE-IT trial also had some CV benefits, but they were extremely weak. To be fair, the
LDL lowering was also quite modest.
A new class of drugs called the PCSK9 Inhibitors has the power to reduce LDL a lot. The question,
though is whether there will be any CV benefit. Early indications are quite positive. But it is far
from definitive. So the possibility exists that LDL may play a causal role here. This is, after all, why
doctors worry so much about keeping LDL down.
What happens to LDL levels
during fasting? Well, they go
down. A lot. Over the 70 days
of alternate daily fasting, there
was about a 25% reduction in
LDL (very good). To be sure,
drugs can reduce them about
50% or more, but this simple
dietary measure has almost half
the power of one of the most
powerful classes of
medications in use today.

In combination with the reduction in body weight, preserved fat-free mass, and decreased waist
circumference, it is clear that fasting produces some very powerful improvements in these cardiac
risk factors. Don’t forget to add in the reduced LDL, reduced Triglycerides and preserved HDL.
But why does fasting work where regular diets fail? Simply put, during fasting, the body switches
from burning sugar to burning fat for energy. Free fatty acids (FFA) are oxidized for energy and
FFA synthesis is reduced (body is burning fat and not making it). The decrease in triacylglycerol
synthesis results in a decrease in VLDL (Very Low Density Lipoprotein) secretion from the liver
which results in lowered LDL.
The way to lower LDL is to make your body burn it off. The mistake of the low fat diet is this –
feeding your body sugar instead of fat does not make the body burn fat – it only makes it burn
sugar. The mistake of the Low Carb High Fat diet is this – giving your body lots of fat makes it burn
fat, but it will burn what’s coming into the system (dietary fat). It won’t pull the fat out of the body.
Here’s the bottom line for those big-picture, spare-me-the-details kind of folks. Fasting has the following
effects:
• Reduces weight
• Maintains lean mass
• Decreases waist size
• Minimal change in HDL
• Dramatic reductions in TG
• Dramatic reductions in LDL
That’s all good. Whether this will all translate into improved cardiac outcomes, I don’t have the
answer for you. My guess is Yes.
However, fasting always boils down to this. There’s all these benefits. There’s very little risk. What
do you have to lose (other than a few pounds)?
For people worried about heart attacks and strokes, the question is not “Why are you
fasting?”, but “Why are you NOT fasting?”
Continue to Fasting part 17 – Fasting and Hunger

Fasting and Hunger – (Part 17)
Does fasting increase your hunger to unimaginable and uncontrollable dimensions?
This is often how fasting is portrayed, but is it really true? From a purely practical standpoint, it is
not. From my personal experience with hundreds of patients, one of the most consistent, yet
surprising things reported is the reduction, not an augmentation of hunger. They often say things
like, “I thought I would be consumed by hunger, but now I only eat 1/3 of what I used to, because I
am full!” That’s great, because now you are working with your body’s hunger signalling to lose
weight instead of constantly fighting it.
The number 1, most common misperception of fasting is that it will leave us overwhelmed with
hunger and therefore prone to severe overeating. Thus you get pronouncements from ‘experts’ like
“Don’t even think about fasting, otherwise you will be so hungry that you will stuff your face full of
Krispy Kreme donuts”. Funny enough, these ‘experts’ often have zero experience with fasting
either personally or with clients. So why does it seem so reasonable?
Approximately 4-8 hours after we eat a meal, we start to feel hunger pangs and may become
slightly cranky. Occasionally they are quite strong. So we imagine that fasting for a full 24 hours
creates hunger sensations 5 times stronger – and that will be intolerable. But this is exactly what
does NOT happen. Why?
Hunger is, in fact, a highly suggestible state. That is, we may not be hungry one second, but after
smelling a steak and hearing the sizzle, we may become quite ravenous. Hunger is also a learned
phenomenon, as demonstrated by the classic experiments of Pavlov’s dogs – known in psychology
as Pavlovian, or classical conditioning.
In the 1890s, Ivan Pavlov

was studying salivation in
dogs. Dogs will salivate
when they see food and
expect to eat
(unconditioned stimulus –
UCS ) – tha t is , thi s
reaction occurs naturally
and without teaching. In
his experiments, lab
assistants would go in to
feed the dogs and the dogs
soon began to associate lab
coats (Conditioned
Stimulus - CS) with eating.
There is nothing
intrinsically appetizing
about a man in a lab coat
(yummy!), but the
consistent association
between the lab coat and
food paired these two in
the dog’s mind.
Very soon, the dogs began to salivate at the sight of the lab coats alone (having now been
conditioned) even if food was not available. Ivan Pavlov, genius that he was, noticed this
association and started to work with bells instead and before you know it, he was packing his bags
to Stockholm to get his Nobel Prize and taste some of those oh-so-delicious Swedish meatballs.

By pairing bells and food, the dogs began to anticipate food (salivate) at hearing bells alone without
the food. This was the Conditioned Response
The applicability of this Psychology 101 lesson to hunger is obvious. That is, we can become
hungry for many reasons – some of which are natural (external stimulus like the smell and sizzle of
a steak, internal mechanisms like a steep drop of blood glucose levels) and others which have
become conditioned into us. These conditioned responses can be very powerful and cause great
hunger. If we consistently eat breakfast every single morning at 7:00, lunch at 12:00 and dinner at
6:00pm, then the time of day itself becomes a conditioned stimulus for eating. Even if we ate a huge
meal at dinner the night before, and would not otherwise be hungry in the morning, we may become
‘hungry’ because it is 7:00. The Conditioned Stimulus (time of 7:00) causes the Conditioned
Response (hunger).
Similarly, if we start to pair the act of watching a movie with delicious popcorn and sugary drinks,
then the mere thought of a movie may make us hungry even though we have already eaten dinner
and would normally not be hungry. The movie is the conditioned stimulus. Food companies, of
course, spend billions of dollars trying to increase the number of CS that will make us hungry.
The Conditioned Response is hunger – for popcorn, chips, hot dogs, sodas, etc.
Food at the ballgame! Food with movies! Food with TV! Food in between halves of kids soccer!
Food while listening to a lecture! Food at the concerts! You can eat with a goat. You can eat on a
boat. You can eat in a house. You can eat with a mouse. Conditioned responses, every one....
How to combat this? Well, intermittent fasting offers a unique solution. By randomly skipping
meals and varying the intervals that we eat, we can break our current habit of feeding 3 times a day
(or more), come hell or high water. We no longer have a conditioned response of hunger every 3-5
hours. We would no longer become hungry simply because the time is 12:00. Instead, we would
still get the unconditioned response of hunger, but not the conditioned one. That is, ‘you get hungry
because you are hungry’, rather than ‘you get hungry because it’s noon’.
Similarly, by not eating throughout the entire day, we can break any associations between food and
anything else – TV, movies, car rides, ball game etc. Here’s the solution. Eat only at the table. No
eating at your computer station. No eating in the car. No eating on the couch. No eating in bed. No
eating in the lecture hall. No eating at the ball game. No eating on the toilet. (OK, that last one is
gross, but I’ve seen it!).
Our current Western food environment, of course, strives to do the opposite. There is a coffee shop
or fast food restaurant on every corner. There are vending machines in every nook and cranny of
every building in North America. In every conference, even at the Canadian Obesity Network, each
break time is greeted by fattening muffins and cookies. Ironic and funny, if not so heartbreaking.
(Yes, we are doctors that treat obesity. Oh look, a muffin! I’ll just eat it in the lecture hall even
though I’m not really hungry!)
One key advantage of fasting is the ability to
break all these conditioned responses. If you
are not accustomed to eating every 4 hours,
then you will not start salivating like Pavlov’s
dog every 4 hours. If we are conditioned this
way, no wonder we find it increasingly difficult
to resist all the McDonald’s and Tim Horton’s
stores while walking around. We are
bombarded daily with images of food,
references to food, and food stores themselves.
The combination of their convenience and our
ingrained Pavlovian response is deadly and
fattening.

In breaking habits, you must understand that going cold turkey is not often successful. Instead, it is
far better to replace one habit with another, less harmful habit. For example, suppose you have a
habit to munch while watching TV – chips or popcorn or nuts. Simply quitting will make you feel
that something is ‘missing’. Instead, replace that habit of snacking with a habit of drinking a cup of
herbal or green tea. Yes, you will find this weird at first, but you will feel a lot less like something is
‘missing’. So, during fasting, you may, instead of completely skipping lunch, drink a large cup of
coffee. Same at breakfast. Or perhaps replace dinner with a bowl of homemade bone broth. It will
be easier in the long run. This is, of course, the same reason that people who want to quit smoking
often chew gum.
Social influence can also play a large role in eating. When we get together with friends, it is often
over a meal, over coffee, or some such dietary event. This is normal, natural and part of human
culture worldwide. Trying to fight it is clearly not a winning strategy. Avoiding social situations is
not healthy either.
So what to do? Simple. Don’t try to fight it. Fit the fasting into your schedule. If you know you are
going to eat a large dinner, then skip breakfast and lunch. One of the easiest ways to fit fasting into
your life is to skip breakfast, since that meal is very uncommonly taken with others and, during
working days is easy to skip without anybody noticing. This will quite easily allow you to fast for
16 hours (16:8 protocol). Also, unless you go out to lunch every day with the same crowd, lunch is
also quite easy to miss without anybody noticing during the work day. This allows you to ‘slip in’ a
24 hour fast without any special effort.
So, in essence, there are two major components to hunger. The unconditioned biological stimuli –
that is, the part that will normally stimulate hunger naturally (smells, sights, and tastes of food) and
the conditioned stimuli (learned – movie, lecture, ball game). These CS do not naturally stimulate
hunger, but through consistent association, have become almost as powerful.
That is, the movie, the TV, the sight of McDonalds, the sound of a jingle etc. They have become
hopelessly intertwined, but they are by no means irreversibly so. Simply change out the response
(drink green tea instead of eat popcorn). Fasting helps to break all the conditioned stimuli, and thus
helps to reduce, not enhance hunger. Hunger is not so simple as your stomach being ’empty’.
So – here’s the real question – does

fasting lead to over-eating? This
was answered in a study published
in 2002. 24 healthy subjects
underwent a 36 hour fast and then
caloric intake was measured. At
baseline, subjects ate 2,436 calories
per day. After a 36 hour fast, there
was an increase in caloric intake to
2914 calories. So there was a
degree of over-eating – almost
20%. However, over the 2 day
period, there was still a net deficit
of 1,958 calories over 2 days. So the amount ‘over’ eaten did not nearly compensate for the period
of time fasting. They conclude that “a 36 hour fast... did not induce a powerful, unconditioned
stimulus to compensate on the subsequent day through massive over-eating.”
Here’s the ‘spare me the details’ bottom line:
NO, fasting does not lead to overeating. NO, You will NOT be overwhelmed with hunger.
Continue to Fasting Part 18 – Cephalic Phase Response and Hunger

Cephalic Phase Response and Hunger (Part 18)
The relationship between fasting and hunger is, without doubt, the Number-One concern we hear.
Overcoming hunger seems a daunting task, stemming from a misunderstanding of actual hunger.
This is mildly ironic, since my guess is that 95% of us have never, truly been hungry in the sense of
starvation, where we did not know when we would be able to eat again. However, I also understand
that hunger is one of the most basic human drives/instincts known as the 3 F’s (food, fluids, and
procreation).
We saw in our last post that much of what we perceive as hunger is actually a learned behaviour,
and as such, can be ‘unlearned’. Breaking all the conditioned stimuli of food will help reduce
hunger cues. However, there is also a natural need and desire for food. There are unconditioned
stimuli – those signals for us to eat – smell, touch, taste, sight of food. The hunger response starts
well before food is ingested, and is highly dependent upon hormonal stimuli (gherelin, peptide YY,
cholecystokinin, leptin etc). For example, you might think the smell of food increases hunger. But
what if you had just stuffed yourself at the All-You-Can-Eat Buffet? The smell of french fries then
is likely to make you queasy, not hungry.
But, if you are susceptible, then hunger
starts in the mind. This is known as the
cephali c phas e res ponse ( C P R ) .
‘Cephalic’ refers to the brain – so these
are measurable physical responses to the
suggestion of food and they last for about
10 minutes. The most obvious of these is
the Pavlovian response that we discussed
previously. Salivation increases
immediately upon the expectation, not the
actual delivery of food. Interestingly, the
amount of salivation increases when
people are shown a picture of a lemon
compared to other foods, so clearly the
CPR is ‘learned’.
Pancreatic fluid and bicarbonate are also
secreted into the stomach well before
any food is received. The pancreas also
starts to ramp up insulin production and
secretion before there is any change in
blood glucose levels. Post-prandial
thermogenesis – the body heat produced
after meals – is also increased. These are
measurable responses - although much
weaker - even in anticipation of food
even if no meal is taken afterwards.
The purpose of CPR is to help
synchronize the gut response and the
incoming food bolus – think of it as gut
pre-conditioning. If you deliver food
directly into the stomach, there is no
preparation and subsequent blood sugars
are much higher as the body has not had
a chance to produce insulin in advance.

Of interest is the fact that sweetness itself is not sufficient to start the cephalic response. An
unflavored artificial non caloric sweetener by itself did not stimulate insulin secretion. However,
when paired with flavour, it may start the cephalic phase, even if the gastric phase does not proceed
(because it has no calories or bulk).
So, why is this relevant?
First, there is controversy whether you can use non-nutritive sweeteners during fasts (Splenda etc.)
Even though there are no calories, this does not negate the cephalic phase response. If the flavour
and the sweetener is enough to start the CPR (diet soda, for example), then this will naturally
stimulate hunger and the desire to eat. So, yes, artificially sweetened food can make you hungry.
Diet sodas, in my opinion, are generally not helpful to efforts to fast or lose weight. Recent
randomized controlled studies back up the point that diet drinks may sabotage weight loss efforts
despite the large decrease in consumed sugars. Of course, common sense would have told you the
same thing. If sweeteners were the answer, we would not have this obesity epidemic, would we?
It’s not like people aren’t eating artificial sweeteners. How many people do you know that have
tried artificial sweeteners? 95% of everybody? How many people lost significant weight? Maybe
2%? There’s your answer right there. The proof is in the pudding. In our IDM program, we prohibit
the use of all artificial sweeteners.
However, if the flavouring is weak and CPR is not activated, then the use of artificial sweeteners
may be OK. There are certainly those that argue that sweeteners help them lose weight by
increasing compliance. If so, great. My best advice is to try to fast without the use of artificial
sweeteners. If you cannot, then you can try adding a small amount. However, if it makes fasting
harder, or prevents you from seeing results, then stop.
The second practical implication of the CPR is that we must remove ourselves from food stimuli.
Trying to cook a meal while fasting is almost unbearably difficult. To see and smell the food
without being able to eat it is always hard. This is not simply a matter of weak willpower. Our
cephalic phase responses are fully activated. To stop there is like trying to stop a piranha feeding
frenzy. Or like trying to stop peeing once you started. (This is actually the way you are supposed to
do a urine test). If you can take yourself out and away from food stimuli, then keeping to a diet or a
fast is so much easier. This, of course is the reason you should not shop for food when hungry, or
keep cookies/ snacks in the pantry.
That is why one of our most important tips for fasting is to stay busy. I often fast during workdays,
because it fits easily into my schedule. I simply work through lunch. By staying busy, I don’t even
remember to be hungry. My cephalic phase response has not been activated. If somebody were to
put food in front of me, I often cannot resist. But if there is only a pile of paperwork, I just plow
right through and forget to be hungry. Then, I get to go home early because I just saved an hour or so.
Hunger comes in waves
We often imagine that hunger will build and build until it is unbearable
and we need to stuff ourselves with Krispy Kreme donuts. However,
this is not the case at all.
Hunger comes in waves. You just need to ride out the waves.
Remember a time when you skipped lunch. At first, you get hungry.
It’s 12:00 noon, but perhaps you are caught up in a meeting and can’t
get away. The hunger builds and builds, but there’s nothing to be done.
The Boss is such a jerk! But what happened at 1:00 or 1:30 or so? The
hunger entirely dissipates. The wave has passed. By dinner time, you
might remember you missed lunch and eat.

What’s the best way to pass the wave? I find that drinking a cup of green tea or coffee is enough.
By the time I’ve finished my cup of green tea, the hunger has passed and I’ve gone onto the next
thing to do that day.
Hunger is not predetermined by not eating for a certain period of time. Hunger is a
hormonal signal. It does not come about simply because the stomach is ’empty’.
Why is this important? Because that explains how people can fast for days without being hungry.
This is a consistent finding throughout the scientific literature on fasting as well as in our own IDM
program.
For example, Dr. Gilliland, in his description of total fasting found that:
A feeling of well-being is certainly engendered in this way and may amount to
euphoria. We did not encounter complaints of hunger after the first day.
Jeez! People weren’t hungry and actually felt ‘euphoric’ during 14 days of fasting. In fact, some felt
so good, they wanted to continue. This was echoed by the experience of Dr. Drenick, of UCLA.
Hunger comes quite strongly during the first 1-2 days of fasting. After that, the hunger just subsides
and then goes away. Some people speculate that the ketones are actively suppressing appetite.
This explains our response to people who feel they cannot go beyond 24 hours of fasting. We advise
them to try 3-7 full days of fasting. Why would we do that? Well, this rapidly gets their bodies used
to fasting. By getting over the first 1-2 days, hunger starts to disappear and they become reassured
that they are not ‘overwhelmed’ by hunger. Most patients feel that day two is the worst. Once they
know this and expect it, they are usually able to handle it.
So, the bottom line?
Hunger is a state of mind, not a state of stomach.
Continue to Fasting Part 19 – Circadian Rhythms and Fasting

Circadian Rhythms and Fasting (Part 19)
It is sometimes useful to consider things from an evolutionary standpoint. We can look back at early
humans and make some general recommendations. Granted, there is little or no tangible proof
possible, but the exercise is still useful and interesting.
There is often great debate about whether we should be eating constantly, or occasionally. For
example, Dr. Yoni Freedhoff recommends, in his book, The Diet Fix to eat as soon as you get up
and then every 2.5 hours or so during the day. On the other hand, Intermittent Fasting proponents
would say that it is quite sufficient to eat once a day or even once every other day. So what’s the
truth? First, let me say that there are people who use both systems and do well. But which system
make more sense?
Let’s consider our cousins – the omnivorous wild mammals.
It is virtually unheard of, in the natural world, to require feeding 3 times per day, every day in order
to stay healthy. Most omnivorous large mammals eat considerably less frequently than that. We can
excuse herbivores, because of the low caloric density of their food, they often require constant
grazing – think cows and sheep. Grass, for example has very low caloric density. Much of the grass
is indigestible and passes through the cow to exit as manure.
Most carnivores, such as lions and wolves will eat only several times per week or even several
times per month. Sometimes this is because food is scarce, but even in times of plenty, it’s probably
because food is not so easily available. Catching a zebra is much harder than catching a bag of
cheetos. This also likely has something to do with caloric density, since most of the animal foods
are absorbed by our bodies.
We’ve all seen those TV shows with lions and tigers all around a herd of zebra sleeping away in the
hot African sun. Well, those lions were not hungry and therefore did not eat. One meal per week
seems to do just fine for them. If a hippo carcass happens to wash up on shore, sure,they’ll eat. So,
we can conclude that eating several times per day is not a necessity for omnivores and carnivores. If
humans do it anyway, they are not solely driven to eat by nutrient deficiency.
Physical and mental capacity is not impaired by a lion’s week long ‘fast’. If fasting made them
sluggish and stupid, well the lion species would not have survived very long. No, the long interval
between meals does not impair them in any significant manner. They ate a large meal – storing
much of the calories in their bodies and then are using these stored calories to survive. It’s normal.
Mammals have adaptations that allow them to survive with an intermittent food supply. That is, the
body has a way of storing food energy, so that a lion can eat once a week. This goes for humans as
well. The main way to do this is to store glycogen in the liver (stored sugar) and then to store
triglycerides in fat tissue. When you eat, you are putting food energy into your stores. When you
fast, you are pulling food energy out.

It’s inconceivable that mammals are designed with this amazing system for storing food energy and
yet it still being necessary to eat every couple of hours to stay healthy. That’s like building an
amazing pool and spa, and then arbitrarily deciding that you can’t get wet after all.
Hunter-gatherer societies, as well as wild animals virtually never got the problems of obesity,
diabetes or cardiovascular disease, even during times of plenty. It is estimated that animal foods
provided about 2/3 of their calories. So, for all the modern teeth gnashing about meat and saturated
fats, it seems that our ancestors had little problems eating them. It should also be noted that many
societies ate carbohydrate based diets (eg. Kitavans and Okinawans) and also had no problems with
obesity. It seems to be a modern problem, and I suspect that refined grains and sugar play an
overwhelming role here.
Things started to change about 10,000 years ago with the agricultural revolution. Early man started
to farm instead of hunting, which led to a greater reliability of food... allowing a typical pattern of
eating 2-3 times per day to emerge. Even with that, there was little obesity until relatively recently
(1970’s in the USA).
So, it is certainly possible to eat meat and have little diabesity. It is also possible to eat
carbohydrates and have little diabesity. The problem, (Nutritionism’s Greatest Blunder) is focusing
obsessively on macronutrient content (how much fat, how much carbs). It’s the insulin response that
matters, not the macronutrient breakdown. The toxicity lies in the (industrial-) processing of the
food, not the food itself. So highly refined and processed grains and sugars (with all their mitigating
fibre and fat removed), as well as vegetable oils are the real problem, not carbs and fats.
Circadian Rhythms
Circadian rhythms are predictable, 24 hour self-sustained changes in behaviours, hormones,
glandular activity etc. Most hormones of the body, including growth hormone, cortisol and
parathyroid hormone are secreted in a circadian rhythm. These rhythms have evolved to respond to
differences predominantly in ambient light determined by the season and time of day (which
governs food availability). These patterns are seen in virtually all animals from flies to humans, and
it is estimated that 10% of a given organism’s genes show circadian changes.
The master circadian clock is the suprachiasmatic nucleus (SCN). It is believed that food was
relatively scarce in Paleolithic times and predominantly available during daylight hours. This is
mostly because humans hunt and eat by day and once the sun went down, well, you just couldn’t
see the food in front of your face. Other animals are nocturnal and may very well have circadian
rhythms more suited to eating at night, but not humans.
So, is there a difference
between eating during the day
and eating at night? Well, the
studies are few, but perhaps
suggestive. One very
interesting study compared the
ef f ec t o f e a t i ng a l a r ge
breakfast versus a large dinner.
While there are many
association studies, this is one
of the few intervention studies
done in humans as opposed to
mice. Most have favoured
eating breakfast, or eating
earlier in the day, although
most studies have too many
confounders to be truly useful.

So what this study did was to randomly assign two groups of overweight women to eating a large
breakfast (BF group) or a large dinner (D group). Both ate 1400 calories/day, and the macronutrient
composition of each diet was matched – only the timing of the largest meal was changed. While
both groups lost weight, the BF group was clearly superior for both weight loss and waist size
(important measure of visceral fat) by almost 2.5 times (-8.7 kg vs -3.6 kg).
So why there such a huge difference in weight gain? Well, this further graph may explain things a
bit. The graph shows the insulin response to meals. The BF group had more insulin in the morning
while the D group had more at night, as expected. However, by totalling the Area Under the Curve
(AUC – graph to the far right) you can see that overall, the dinner group had a much larger rise in
insulin. This is fascinating. The same total calories led to more insulin secretion simply based on meal timing.
An earlier, smaller 1992 study had shown much the same thing. In response to the same meal given
either early or late in the day, the insulin response was 25-50% greater in the evening.
Weight gain, of course is driven by insulin. So, while the carbohydrates and calories were identical
in both groups, the corresponding insulin response was not identical, translating into more weight
for the D group, because their insulin response was bigger. This illustrates the very important point
that obesity is a hormonal, not a caloric imbalance. This study has profound implications over meal
timing. There is certainly the well known association of night shift work and obesity. However, this
may also have to do with the increased cortisol response due to disturbed sleep.
Now, this does not necessarily mean that you must eat a large meal as soon as you wake up. But it
means that...
perhaps eating a large meal in the evening (after the sun goes down) may cause a
much larger rise in insulin than eating that same meal during daylight hours.
The problem with breakfast is generally that we are in a hurry in the morning and tend to eat very
highly refined carbohydrates (toast, cereal, bagels etc) which tend to also stimulate insulin severely.
But waiting until noon to have a large lunch as your main meal seems to be a good solution. This
also avoids the ‘rushing out the door’ or ‘grabbing a muffin’ sort of response to the exhortation to
‘eat breakfast – it’s the most important meal of the day’.
Folk wisdom, of course, also advises to avoid eating large meals in the evening. The reason offered
usually is something along the lines of “If you eat just before bed, you don’t get a chance to burn it
off and it will all turn to fat”. Maybe not technically true, but perhaps there is something here.
Eating late at night seems to be especially obesogenic (causing obesity).

There is also a natural circadian
rhythm to hunger. After all, if it was
simply due to food intake, we would
consistently be hungry in the
morning after the long overnight
fast. But personal experience and
studies confirm that paradoxically,
hunger is lowest in the morning.
This is ‘paradoxical’ because the
morning time meal follows the
longest period of the day without
food. Breakfast is typically the
smallest, not the largest meal of the
day. This indicates that there is a
circadian rhythm that is independent
of the eat/fast cycle.
Ghrelin, the hunger hormone, shows a marked circadian rhythm with a low at 08:00 in the morning.
Interestingly, with fasting, ghrelin peaks at day 1-2 and then steadily falls. This aligns perfectly with
what is seen clinically, where hunger is the worst problem on fasting day 1-2. Many people on
longer fasts report that hunger typically disappears after day 2.
Hunger typically falls to its lowest level at 7:50 am and peaks at 7:50 pm.
Understand once again, that these are natural rhythms that are inherent in our genetic makeup. If
you take away all external stimuli, these rhythms still persist. What does it mean that hunger is
lowest in the morning? One implication is that hunger is not so simple as ‘the longer you don’t eat,
the more hungry you’ll be’. No, there are many more subtle inputs and hormonal regulation of
hunger plays a key role.
However, the studies are conflicting. NHANES data on evening eating failed to show any
association between late eating and weight gain, as might have been predicted. Nevertheless, the
possibility that eating during daylight hours results in less insulin secretion must be considered.

So, what’s the practical implication? At 08:00 in the morning, our hunger is suppressed actively by
our circadian hormonal rhythm. It seems counter-productive to force oneself to eat. What’s the
point? Eating does not produce weight loss. Forcing ourselves to eat at a time when we are not
hungry is not likely to be a successful strategy.
However, eating late at night also seems to be a poor strategy. Hunger is increased maximally at
approximately 7:50 pm at the same time that insulin will be maximally stimulated by foods. This
means higher insulin levels for the same amount of food intake. This higher insulin level will
naturally drive weight gain. This is the typical pattern of eating in North America, where dinner is
the main meal. This is mostly driven, not by health concerns, but by the hours of the working and
school day. This also leaves shift workers at a particular disadvantage. They tend to eat larger meals
later in the evening, leading to higher insulin.
So the optimal strategy seems to be eating a large meal in the mid-day – sometime between 12:00
and 3:00pm and only a small amount in the evening hours. Interestingly, this is the typical
traditional Mediterranean eating pattern. They have traditionally eaten a large lunch, followed by a
siesta and then a small, almost snack sized ‘dinner’. While we often think of the Mediterranean diet
as healthy due to the foods, the timing of the meals may also play a role.
One final word of advice – We should DEFINITELY all take siestas.

Even better, take a siesta by the lake in a hammock.

Re-feeding syndromes and Fasting (Part 20)
Complications with “re-feeding” were first described in severely malnourished Americans in
Japanese prisoners of war camps in World War 2. It has also been described upon treatment of long
standing anorexia nervosa, and alcoholic patients. It is important to have an understanding of these
syndromes if you are attempting an extended fast – usually greater than 5-10 days at a time. Re-
feeding refers to the period of time immediately after an extended fast when you are just starting to
eat again. We’ve touched upon this briefly with ‘how to break a fast’. The two main syndromes are
refeeding syndrome and refeeding edema.
In 2003, David Blaine, the magician,

emerged from a 44 day water only fast.
Opinions abounded regarding whether
or not he was cheating, although he
was in plain sight the entire time.
Doctors recorded every measurement
they could think of afterwards during
his hospitalization. He lost 24.5 kg
(25% of his body weight) and his
body mass index (BMI) dropped from
29 to 21.6. Blood sugars and
cholesterols were normal. Free fatty
acids were high (expected during
fasting).
He developed both refeeding
syndrome and edema after this stunt.
His phosphorus levels fell and
required intravenous replenishment.
Re-feeding Syndrome
Re-feeding syndrome has been defined as the “potentially fatal shifts in fluids and electrolytes that
may occur in malnourished patients”. The key clinical marker of this is hypophosphatemia – very
low phosphorus levels in the blood. However, lowered potassium, calcium, and magnesium in the
blood may also play a role. Calcium, phosphorus and magnesium are all primarily intra-cellular ions
– that is, they are kept inside the cells and blood-levels (which are measured outside of cells) tend to
be quite low compared with concentrations inside cells.
Adults store 500-800 grams of phosphorus in the body. Approximately 80% of the phosphorus in
our bodies is held within the skeleton and the rest in soft tissues. Almost all of the phosphorus is
inside the cells, rather than outside, in the blood. The blood level of phosphorus is very tightly
controlled and if it goes too high or low, can cause real problems. Average daily intake of
phosphorus is 1g/day, meaning that it often requires many months of undernutrition to produce
these syndromes. Protein rich foods, as well as grains and nuts are good sources of phosphorus. 60-
70% of the phosphorus is absorbed, mostly in the small intestine.
Much of the calcium, phosphorus and magnesium in our bodies is stored in the bones. If the body
needs more or these intracellular ions, it will take it from the bone ‘stores’. If there is too much,
these get deposited into the bone.

During prolonged malnutrition, blood levels of phosphorus remain normal and the deficit is taken
from the bones. This can last for a very long time, as was proven with severe malnutrition imposed
on the Japanese prisoners of war during World War 2.
But there are some problems that can happen once food is given, particularly carbohydrate
containing foods. During the refeeding period, insulin and other hormones are activated. This
causes the movement of the major intracellular ions (phosphorus, potassium, calcium and
magnesium) into the cells. However, due to overall depletion of body stores, this becomes excessive
and too little of these ions are left in the blood. This is what causes the major symptoms of the
re - feeding syndrome, some of which can be fatal in rare cases.
Phosphorus is used in all cells for energy. The basic unit of energy (ATP) contains 3 phosphorus
molecules so severe depletion of phosphorus may cause your entire body to ‘power down’. This
typically happens when the serum phosphorus level drops below 0.30 mmol/L. The symptoms
include muscle weakness as well as breathing difficulty as the diaphragm (the large muscle
powering the lungs) weakens. Outright muscle breakdown (rhabdomyolysis) has been described, as
well as heart dysfunction (cardiomyopathy).
Magnesium is a co-factor in most enzyme systems in the body and severe depletion can result in
cramps, confusion, tremor, tetany (spasms) and occasionally, seizures. Cardiac rhythm
abnormalities are also described – classically the pattern known as Torsades de Point. Most
magnesium (about 70%) taken orally is not absorbed but excreted unchanged in the faeces.
Potassium may also be shifted into cells, leaving dangerously low levels in the blood. This, too can
cause heart rhythm disturbances or even outright cardiac arrest.

Insulin stimulates glycogen, fat and protein synthesis which requires many ions like phosphorus,
magnesium, and cofactors like thiamine. The insulin surge puts an enormous demand on
phosphorus stores which have been depleted. In essence, the stores of all these intracellular ions has
been severely depleted and once the signal is given to replenish, too much phosphorus is taken out
of the blood leading to excessively low levels.
So you can see that one of the key pre-requisites for re-feeding syndrome is severe, prolonged
malnutrition. How common is it? A study of over 10,000 hospitalized patients only found an
incidence of 0.43%. These are the sickest of sick people, but still re-feeding syndrome was found
only so rarely. And this is actually on overestimate since it also included diabetic ketoacidosis,
which is a different mechanism entirely. The main groups that had this disease? Severe
malnourishment and alcoholics.
Re-feeding syndrome is most often described in the situation of parenteral (intravenous) re-feeding
in the intensive care unit. These patients are often intubated and cannot eat for weeks. In the setting
of relative malnourishment, extremely calorically dense and nutrient rich fluids are introduced
directly into the vein. A setup for re-feeding syndrome.
So, let's be clear here, the main risk factor for re-feeding syndrome is prolonged malnutrition.
When we use fasting as a therapeutic tool, most people have never missed a single meal in over 25
years! So prolonged malnutrition is hardly the situation that we deal with currently. However, it is
important to understand that patients that are severely underweight or malnourished for any
reason... should not fast. This is important because re-feeding syndrome is mostly found in the
condition of starvation (uncontrolled, involuntary restriction of food) or wasting (starvation to the
point of severe malnutrition) rather than fasting (controlled, voluntary restriction of food).
Vitamin deficiencies have also been described, again mostly with prolonged malnutrition. The most
important is thiamine, which is an essential coenzyme in carbohydrate metabolism. Typically, this
has been described in alcoholics with the syndromes of Wernicke’s encephalopathy (ataxia,
confusion, visual disturbances) and Korsakoff’s syndrome (memory loss and confabulation).

Confabulation is a symptom whereby people have a complete lack of short term memory. They
therefore ‘make up’ everything when they are talking because they have no memory. There is no
intent to deceive. Traditionally, it has been taught to treat alcoholics and other malnourished people
with thiamine (intravenous if needed) before treating hypoglycaemia. Theoretically, the
introduction of glucose may stimulate acute thiamine uptake and then precipitating Wernicke’s.
Re-feeding Oedema
Insulin acts on the proximal tubule in the kidney to reabsorb sodium and water. Higher insulin
levels will result in salt and water retention. Low insulin levels will result in loss of salt and water
by the kidney. This has been well described for over 30 years.
During fasting, insulin levels go down quite significantly. This may lead to loss of salt and water. In
some extreme cases there is up to 30 pounds of water weight lost, as George Cahill described in his
article “Starvation“. The body is not able to hold on to salt and water due to low insulin levels.
During re-feeding, especially with carbohydrates, insulin levels start to go back up, and the kidney
starts to hold onto salt and water extremely tightly. Sodium excretion may fall to less than 1 mEq/day.
In extreme cases, you may actually see gross oedema. This can occur as the legs and feet start to
become very swollen. Occasionally retention of fluid in the lungs leads to congestive failure in
those with heart disease.This has been called ”Re-feeding Oedema”.
Treatment
Obviously the mainstay of treatment is prevention. Box 3 identifies those at risk of re-feeding
syndrome. Obviously the key here is to avoid fasting a malnourished person, but that should have
been pretty obvious already.
The mainstay of treatment is to start re-feeds very slowly. Generally this means 50% of the needed
food intake to start with and then a slow increase in that rate, if no problems are found. Going easy
on high-glaecymic foods is advisable, too. This is reflected in the traditional advice to break a fast
gently. This is more important the longer the duration of the fasting period. We have often seen
people who eat too much as soon as the fasting period is over. Most complain that the food gives
them a stomach-ache, but this usually passes quite quickly. I’ve never seen or treated re-feeding
syndrome personally, and I hope never to need to.

So... What happened in the Blaine fast? Why did Blaine develop re-feeding syndrome?
There were some differences in the fasting done by Blaine and the ones we use in the IDM
program. First, it was a water only fast. Generally, we only use those in severe cases. We allow the
use of bone broth during fasts, which is not technically a fast, but provides phosphorus and other
proteins and electrolytes. This reduces the chances of developing the refeeding syndrome.
Second, you can see that Blaine is suspended in a Plexiglas box for the duration of his fast. He is
not able to do any of his usual activities and does not even stand up for 44 days. This is far more
than a fast. His muscles and bones will actually develop significant atrophy during that period. He
was losing far more than fat. He lost significant lean weight – muscle and bone, but this was NOT
due to fasting. It was due to being cooped up in a box for 44 days.
During fasting, we encourage our patients to do all their usual activities, especially their exercise
program. This helps to maintain their muscles and bones.

Obesity – Solving the Two-Compartment Problem (Part 21)
One of the major mistakes made by the Calories-IN / Calories-OUT (CICO) hypothesis is the
presumption that energy is stored in the body as a single compartment. They consider that all foods
can be reduced to their caloric equivalent and then stored in a single compartment in the body
(Calories IN). The body then uses this energy for basal metabolism and exercise (Calories OUT).
This model looks something like this: All energy is stored in that one compartment (the bath-tub)
However, this model is a complete fabrication. It does not exist. This
known mis-understanding has led to general acceptance of the CICO
theorem. According to this model, by reducing the amount of calories
going in, or increasing the amount going out, you may reduce the amount
of body energy stored as fat.
Of course, this Eat Less, Move More (or Caloric Reduction as Primary = CRaP)
strategy has a known success rate of about 1% or a failure rate of roughly
99%. This does not deter any of the medical or nutritional authorities to
question the sagacity of their advice, though.
To better understand how energy is stored in the body, it is more accurate
to use a two compartment model. Dr. Kieron Rooney’s diagram
demonstrates that the body is able to derive energy from 3 sources –
glucose (carbs), fat or protein. However, protein is not stored as an energy
source and is only used when there is excessive dietary protein after which
it is turned to glucose.

So, this leaves two potential fuel sources – glucose and fat – and these are stored in different
compartments. Glucose is stored in the liver as glycogen – a molecule that is composed of long
chains of sugars. This is easily accessible to the body, but there is a limited amount that is able to be
stored (sufficient only for about one to two days). After that threshold is reached, the body stores
fat. Think of glycogen like a refrigerator. It is very easy to move food in and out of the fridge, but
the storage space is limited.
Body fat is much more difficult to access, but you may store (almost) unlimited amounts. Dietary
fat is directly added to the body’s fat stores. Excessive carbohydrates are turned into fat by the
process known as De Novo Lipogenesis (DNL). Think of body fat as a freezer that you store in your
basement – you can store lots of food in the freezer but it is more difficult to get at it compared to
the fridge. You can also store more than 1 freezer in the basement, if you need more space.
When you eat, the body stores
energy. When you don’t eat
(fast), the body must take stored
energy from the body to burn
for fuel. But it does not take
equal amounts from both
compartments (fat and
glycogen). Glycogen is burned
first and almost exclusively
until it is finished – this
glycogen-phase can last for 24
to 48 hours of pure fasting.
This is logical, since it is much
easier for the body to get at the
glycogen. Think about it this
way. If you buy groceries, you first store it in the fridge. Once it is full, then you start to store it in
the freezer. When it comes to taking food out to eat, you start by eating the food in the fridge.
Only after almost all the glycogen is already burned for energy does the body turn to its stores of
fat. Similarly, only when the food in your fridge is pretty much gone do you want to go downstairs
to that cold dark basement to get food from the freezer. It takes more effort. Therefore You do not
burn equal amounts of glucose and fat. For example, if your glycogen ‘fridge’ is full, you will not
use any of your fat in the ‘freezer’. If you need 200 calories of energy to go for a walk, you take that
exclusively out of the glycogen with none of the fat being burned.
The two compartments for
energy are not burned
simultaneously, but
sequentially. In the human
body model, You actually
need to empty out the fridge
before you can start using the
food in the freezer. In
essence, the body can either
burn sugar or fat, but not both.
This is controlled partially by
insulin, and also directly by
t h e Randle cycle – described
in 1963 which is also
sometimes called the glucose
- fatty acid cycle.

In isolated heart and skeletal
muscle cell preparations,
Randle and his colleagues
were able to show that cells
that were using glucose for
energy were inhibited from
using fat and vice versa
without any interference
from insulin or other
hormones. This biochemical
mechanism directly forbids
the body from using both
fuels at once. You either
burn sugar or fat, but not
both at the same time. You
can see from the diagram
that using glucose
eventually leads to the
production of Malonyl-CoA
which inhibits the use of fat
(LCFA – Long Chain Fatty Acid).
So, why can’t you lose weight using the CICO method? Because it is based on the incorrect idea
that all calories are equal. When you store food energy (calories), it is stored as sugar (glycogen) in
the ‘fridge’ and fat in the ‘freezer’. But you must burn through all the sugar first before you can
start burning fat.
So, now you want to lose body fat. The first thing you need to do is clear out the sugar in your
refrigerator. However, if you are continually filling up your fridge 3-6 times a day with sugar, then
you will never start burning the fat in the freezer. The CICO method ignores the two compartment
problem and pretends that all calories are stored equally and burned equally (single compartment),
even though this has been known to be false for at least 50 years. This is the equivalent of the
standard calorie restricted diet of eating 3-6 meals a day with a relatively high carbohydrate (50-
60%) content.
You might imagine that since you are filing up the fridge with less glucose (you are restricting
calorie intake after all), it will eventually empty... and you should start burning fat and lose weight.
However, this does not happen. Why? Because, as you start putting less food in the fridge, your
body senses that and starts to get antsy. So, first it starts to make you hungry all the time, and you
want to eat more. Fighting this hunger urge is not pleasant, but even if you manage to control your
cravings, you still lose. Because, if you don’t fill up the fridge sufficiently, the body will adjust by
decreasing your basal metabolism so that it is burning less energy (and in addition to hunger you
will now also feel cold, because the easiest way for the body to save energy is to lower body-
temperature.
What’s the solution? First, you could follow a Low Carb, High Fat (LCHF) diet. By severely
restricting the amount of carbohydrates, we keep our glucose fridge empty. Now any energy that is
needed must come out of the fat freezer. This essentially turns the two compartment problem into a
single compartment problem. But because LCHF is also in essence a caloric restriction approach,
the body still might react with hunger and decreased basal metabolism... which is one of the more
unpleasant ways to lose weight, and carries a high risk of failure.

Second, you could try
intermittent fasting (IF). Fasting
essentially burns through all the
stored sugars in the fridge
quickly. Will you get hungry?
Yes, probably. But no more than
if you eat very little. And if you
push through that first wave of
hunger (best by distracting
yourself with work), your body
will be forced to burn fat for
energy. Most importantly, your
metabolism will not slow down
during fasting, because of the
compensatory hormonal changes
happening (adrenalin surge).
After a few days of fasting,
hunger will also be suppressed –
the mechanism is unknown, but
likely related to the ketone
production.
The bottom line is this. You can store energy in the form of sugar or fat. In the fasted state – you
can either burn sugar or fat for energy, but not both. If you are continually supplying your body
with sugars (carbs), it will not burn fat until all sugar is gone, and on top of this, it will burn less of
it, if you restrict calorie intake.
Outright Fasting rather than caloric restriction provides a very quick way to start burning fat. It
provides a solution to the two compartment problem. The reason why the Calorie pundits never
understand why their model doesn’t work is because they have fundamentally mis-understood the
problem as a single compartment.
There is one more critical input into the system.
How easy is it to get food energy from the freezer? If the freezer is locked away in the basement
behind steel gates and barred, then it will be very difficult to get the fat out. What’s the main
hormone that controls it? The answer is… insulin. (Actually, insulin is the answer to most of the
questions on this blog)
It’s well known that insulin inhibits lipolysis. That’s a fancy way of saying that insulin stops fat
burning. Well, that’s normal. Insulin goes up when you eat, so it tells the body to start using the
incoming food energy and stop using the fat in the freezer.
So, if your insulin is high from insulin resistance, you may find that your body is not able to get at
the fat in the freezer. So, as you lower the incoming calories (Caloric Reduction as Primary strategy
– i.e. “Eat Less”) your body is still unable to get any fat to burn, due to the high insulin levels. So it
compensates by reducing caloric expenditure. Hence basal metabolism falls.
If you are 8 years old, your insulin resistance is minimal and fasting insulin is low. That means it’s
really easy to get at the fat in the freezer. It’s like the freezer is right beside the fridge. Easy Peasy.
So, if you simply reduce calories, your body can easily compensate by getting some fat out of the
freezer.
This explains the time dependence of obesity. That is, those that have been obese for a long time
have a much, much harder time losing weight. Because their insulin resistance is high causing them
to have elevated insulin levels all the time.

The Biggest Loser Diet – Eat Less Move More’s Bigger
Badass Brother (Part 22)
The Biggest Loser is a long running American TV reality show that pits obese contestants against
one another in a bid to lose the most weight. The show regularly comes under fire from physicians
and other health professionals for its over the top portrayal and its fat shaming tactics. A bit of a
surprise, then, at how high this diet actually scored in the 2015 USA Today’s rank of best diets to
follow. The Biggest Loser Diet scored #3 under the Best Weight Loss category. Shocking.
Nevertheless, like a horrific train wreck, it is difficult to avoid watching this show at times and this
is why it continues to air new episodes.
First, a bit of background on
the actual diet and exercise
regimen. Classic Eat Less,
Move More. Surely something
like this is a good thing, right?
What could go wrong? All the
‘experts’ recommend this
weight loss regimen. Well, Kai
Hibbard, the winner of season
three is quoted as saying, “It
was the biggest mistake of my
life”. Season two’s Suzanne
Mendonca says that the reason
there’s no reunion show is that
“We’re all fat again”. Much of
this ‘reality’ series is actually
fairly scripted, but this is not
the first or last reality series to
have that fault.
Luckily, there have been some serious studies done on The Biggest Loser contestants. Dr. Ravussin
and Kevin Hall published some fairly extensive metabolic testing on 16 of these contestants. There
was a dietary intervention combined with an exercise component. The exercise consisted of 90
minutes per day of vigorous circuit training +/- aerobic training for 6 days a week. This part is often
depicted on television, along with some rather questionable fat shaming/ yelling/ screaming by the
personal trainers. The exercise portion sometimes far exceeded the allotted time. The fact that vomit
buckets were regularly used is an indication that these contestants were pushed quite hard. During
their stay on the ranch the minimum time doing physical activity was 2 hours per day.
The dietary component consisted of a calorie restricted diet which was calculated as being about
70% of their baseline energy requirements. Calorie counts often run to 1200 – 1500 per day but it
depended upon baseline weight. At baseline, the average weight was 149.2 kg (329 pounds) with a
BMI of 49.4. By week 30 (the end of the show’s season), the average weight had dropped to 91.6
kg (202 pounds) – 127 pounds on average! Body fat had dropped from 49% to 28%. Wow. That’s
good. Really really good.
The benefits went beyond that. Measurements of blood glucose, insulin sensitivity had improved.
Much of the weight lost was fat, not muscle. This is likely due to the intensive exercise regimen
undertaken. While there was some loss of lean mass, it was not much and the majority of the rather
impressive weight loss was, indeed fat.

So, essentially the Biggest Loser diet is Caloric Reduction and Increased Exercise. It’s no wonder
the ‘experts’ at US News love this diet. It is the same “Eat Less Move More” approach espoused by
nutritional authorities everywhere. The Biggest Loser is simply Eat Less Move More on mega doses
of steroids. It is the same essential diet, just bigger and badder. Eat Less Move More – looks OK,
but a little wimpy. The Biggest Loser Diet – total badass.
These results are starting to look pretty damn good. So why did all those Biggest Loser contestants
gain all their weight back after 6 months? Why do almost all the other Eat Less Move More patients
gain all their weight back after 6 months? This is essentially the same question. The simple answer
is that metabolic adaptations cause that regain. Specifically, metabolism slows down in response to
Caloric Reduction. You start to burn less energy. Your metabolism shuts down.

Let’s see what happened to the Biggest Losers. Virtually all of the contestants slowed down their
Resting Metabolic Rates (RMR). The energy they use over 24 hours doing no exercise drops
significantly. This is energy that is needed to keep the heart pumping, the lungs breathing, your
brain thinking, your kidneys detoxing, your body-temperature, etc. – your basic metabolism. It
drops. Like a piano out of a 20 storey building.
To give you a sense of the magnitude of the drop, from start to week 30, the RMR dropped by
789 calories on average. Now that’s not quite accurate, because as your body weight drops, the
RMR is also expected to drop. That is, carrying around all that extra fat still takes some energy. If
you correct for this weight loss related drop in RMR, though, there is still an excess of 504 calories
drop. That is, their metabolism is burning 500 calories less per day than expected correcting for
their new, lower weight.
But can’t you make up for this decreased in RMR by increasing exercise? Well, no. Despite a
massive increase in the amount of exercise performed by contestants, it was simply not enough to
overcome the drastic slowdown in metabolism.
Once you stop having Jillian Michaels screaming in your ear about how she doesn’t care if you die
on the treadmill, the amount of exercise gradually decreases which further exacerbates the weight
regain. From week 6 to week 30, physical exertion goes down. But resting energy expenditure (your
metabolism) continues its slide downhill. A double whammy.
As you start burning less energy at rest and burn less energy doing exercise, you get the very
familiar weight plateau. The weight loss simply stops because your body has shut down to match
the lowered caloric intake. Once expenditure drops below intake, you start the even more familiar
weight regain. Ba Bam! Weight regain. Goodbye reunion show.
So, here’s the thing. All of this is completely predictable. Since the Caloric Reduction as Primary
strategy has a known 99% failure rate, it’s no surprise that the Biggest Loser diet should also have a
similarly dismal outlook.

So are we doomed to a life of muffin tops? Hardly. There’s another strategy that seems to be far
more successful. The gastric bypass – Intermittent Fasting’s bigger, badder surgical cousin. These
are stomach stapling surgeries that basically force people to fast. The fasting is not quite
intermittent, but rather continuous for several months, until the stomach re-expands. The difference
is that the forced fasting allows for the numerous hormonal adaptations that keep resting metabolic
rates elevated and preserve lean muscle. We’ve talked (incessantly) about the hormonal adaptations
to fasting that seem to be highly beneficial. Decreased insulin. Increased growth hormone.
Increased adrenalin. These help maintain resting metabolism so that energy expenditure does not
decrease.
Hey! We should compare the two strategies directly! Luckily, that study has already been done.
Researchers matched 13 gastric bypass patients with 13 Biggest Loser contestants. They lost a
similar amount of weight, although the Biggest Loser contestants maintained their lean mass much
better – likely due to intensive exercise. So they should do better, right?
Not at all.
By six months, the Biggest Loser group had significantly dropped their metabolic rate. While the
bypass group did also do so initially, by 12 months the metabolic rate had gone right back up to
normal.
Other studies support the metabolic benefit of intermittent severe caloric reduction. Looking at the
long term metabolic effect of bariatric surgery, researchers found that 14 months after surgery, the
total energy expenditure had dropped by 25%. However, when compared against the expected
decrease due to the weight loss, there was no decrease in RMR. As I’ve mentioned before – the
difference between daily Caloric Reduction and intermittent fasting is that the hormonal adaptations
of calorie reduction leads to reduce energy expenditure of your body, whereas the hormonal
adaptations of IF maintain – if not increase – the basic metabolic rate.
This makes a huge difference to the long term outcome of patients. If you reduce your metabolism
by 500 calories per day, that means that you are going to be feeling cold, lethargic, and tired
because your body has started to shut down.

Suppose you start by eating 2000 calories per day. Using Eat Less Move More, you reduce that to
1500 calories per day. Pretty soon, your body is only burning 1500 calories per day. You feel lousy.
So, as you increase your calories slightly to 1700, you are still eating less than you used to. But now
you are gaining weight. Your body weight goes back up to its original weight as your friends and
family silently accuse you of cheating on your diet.
Notice that we are not breaking any ‘Laws of Thermodynamics’. Calories In - Calories Out still
holds. The point, of course, is that Calories Out is the far more important and decisive factor.
However, we focus obsessively on Calories In, which is largely useless. Reducing “calories IN”
across the board only reduces “calories OUT”.... while reducing calories through intermittent
fasting does no such thing.
So, what can we learn from the disaster known as The Biggest Loser? Or the even bigger disaster
know as Eat Less, Move More (Caloric Reduction as Primary – aka CRaP)?
1. The Biggest Loser diet is the bigger badass brother of Eat Less, Move More.
2. Eat Less Move More – Proven failure. The Biggest Loser – Proven failure on steroids.
3. Bariatric surgery is the bigger badass brother of Intermittent Fasting
4. Bariatric surgery – proven success, but with surgical complications.
Intermittent Fasting – proven success over thousands of years. No surgical complications.
Pretty clear to me which diet I would choose….

Fasting and Exercise (Part 23)
Is it possible to exercise while fasting?
This is a common question we hear all the time. People think that food gives them energy and
therefore it will be difficult to fast and exercise at the same time. Some people with physically
demanding jobs feel that they could not fast and work properly. What’s the truth?
Well, let’s think about this logically for a second. When you eat, insulin goes up telling your body
to use some of that incoming food energy immediately. The remainder is stored as sugar (glycogen
in the liver). Once the glycogen stores are full, then the liver manufactures fat (so called DeNovo
Lipogenesis). Incoming dietary protein is broken down into component amino acids. Some is used
to repair body-proteins, but excess amino acids are also turned into glucose. Incoming dietary fat is
absorbed directly by the intestines. It doesn’t undergo any further transformation and is directly
stored as fat by the body.
Insulin’s main action is to inhibit lipolysis. This means that it blocks fat burning. The incoming
flood of glucose from food is sent to the rest of the body to be used as energy.
So what happens
during a fast? Well,
it’s just the process in
reverse. First, your
body burns the stored
sugar, then it burns
the stored fat. In
essence, during
feeding you burn food
energy from incoming
food. During fasting,
you burn energy from
your stored food
(sugar and fat, but
there's not much
stored sugar).
Note that the amount of energy that is used by and available to your body stays about the same. The
basal metabolic rate stays the same. This is the basic energy used for vital organs, breathing, heart
function etc. Eating does not increase basal metabolism except for the small amount used to digest
food itself (the thermic effect of food).
If you exercise while
fasting, the body will start
by burning sugar.
Glycogen is a molecule
composed of many sugars
all put together. When it
comes time to use it for
energy, the liver simply
starts breaking all the
chains to release the
individual sugar molecules
that can now be used for
energy.

As mentioned before, short term storage of food energy (glycogen) is like a refrigerator. The food
energy goes in and out easily, but there is limited storage. Long term storage (fat) is like a freezer.
Food is harder to get to, but you can store much more of it. If you eat 3 times a day, it’s like you go
shopping for food 3 times a day and any leftovers get stored in the fridge. If there is too much for
the fridge, it goes into the freezer.
So what happens during fasting and exercise? Well,
the body simply pulls energy out of the ‘fridge’.
Since you have enough glycogen stored up to last
over 24 hours on a regular day, you would need to
do some serious exercise for a long time before you
could exhaust those stores.
Endurance athletes occasionally do hit this ‘wall‘,
where glycogen stores run out. Perhaps there is no
more indelible image of hitting the wall as the 1982
Ironman Triathlon where American competitor
Julie Moss crawled to the finish line, unable to
even stand. Athletes also term complete exhaustion
of short term energy stores ‘bonking’. Some of you
may think ‘bonking’ refers to other activities done
on all fours, but this is a nutritional blog!
So, how do you get around that? Glycogen stores are not enough to power you through the entire
IronMan race. However, you know at the same time, that you are still carrying vast amounts of
energy in the form of fat. All that energy is stored away and not accessible during exercise. But the
only reason it cannot be used is because your body is not adapted, yet, to burn fat.
By following a very low carbohydrate diet, or ketogenic diet, you can train your body to burn fat.
Similarly, by exercising in the fasted state, you can train your muscles to burn fat. Now, instead of
relying on limited but easily accessible glycogen only during the IronMan competition, you are
powered by almost unlimited energy drawn directly from your fat stores.
Studies are starting to demonstrate the benefits of such training. For example, this study looked at
muscle fibres both before and after training in the fasted state. This means that you fast for a certain
period of time, usually around 24 hours and then do your endurance or other training. The
combination of low insulin and high adrenalin levels created by the fasted state stimulates adipose
tissue lipolysis (breakdown of fat) and peripheral fat oxidation (burning of fat for energy). Other
studies had already shown that breakdown of intramyocellular lipids (IMCL – fat inside the muscle)
is increased by training in the fasted state. Six weeks of training in the fasted state also induced a
greater increase of fatty acid binding protein and uncoupling-protein-3 content in muscle.
What does this mean in plain English? It means that our bodies have the wonderful ability to adapt
to what’s available. When we fast, we deplete much of the stored sugar (glycogen). Our muscles
then become much more efficient at using fat for energy. This happens because muscle ‘learns’ how
to use the fat as energy by increasing the
amount of proteins that metabolize that
fat. In other words, when exercised in the
fasted state, our muscles learn to burn
fat, not sugar.
Looking at muscle cells before and after
exercise in the fasted state, you can see
that there are more muscle bundles, but
also that there is a deeper shade of red,
indicating more available fat for energy.

Legendary exercise physiologist and physician Tim Noakes of Cape Town, South Africa has led the
way in understanding the benefits of low carbohydrate diets for elite level athletes. Many national
level teams (such as the Australian cricket team) are now applying these lessons to crush their
competition. Legendary NBA players such as LeBron James, Kobe Bryant and Carmelo Anthony
are turning to low carbohydrate, high fat diets to slim down and prolong their careers.
You can be damn certain that these elite level
athletes would not be doing this Low Carb mumbo
jumbo and training in the fasted state malarky if it
had any detrimental effect on their athletic
performance. Quite the contrary. Hall of Fame NBA
player Steve Nash does not eat simple carbs at any
cost. Drinking sugary Gatorade? Not bloody likely to help.
Another study looked at the effects of a 3.5 day fast
on all different measures of athletic performance.
They measured strength, anaerobic capacity and
aerobic endurance. All of these measures did not
decrease during the fasting period.
The body simply switches from burning sugar to burning fat. But, for endurance athletes, the
increase in available energy is a significant advantage, since you can store infinitely more energy in
the form of fat rather than sugar. If you are running ultra marathons, being able to utilize your
almost unlimited fat energy instead of highly limited glycogen energy will mean that you won’t
‘bonk’ and that might just win you that race.
During the period where you are adjusting to this change, you will likely notice a decrease in
performance. This lasts approximately 2 weeks. As you deplete the body of sugar, your muscles
need time to adapt to using fat for energy. Your energy, your muscle strength and overall capacity
will go down, but they will recover. So, LCHF diets, ketogenic diets and training in the fasted state
may all have benefits in training your muscles to burn fat, but they do require some time to adapt.
Consider an analogy. Imagine
that our bodies are fuel tankers.
We drive these large tankers
around, but only have a limited
amount of gas in the gas tank.
After the gas tank runs out, we
are stuck on the side of the road
calling for help. But wait, you
might say. That’s ironic. You
are carrying an entire tank of
gas, but ran out of gas. How is
that so? Well, that gas is not so
easily accessible.
In the same manner, we carry around huge stores of energy as fat. But our muscles are trained to
run on sugar, and they run out of energy, so we need to continually refuel despite the large tank of
fuel stored as fat.
So, what’s my best advice on physical exertion and fasting? Don’t worry about it.
Do everything you normally do also during fasting. If you normally exercise, or even if you don’t,
you can still do it during fasting. Whether you fast for 24 hours or 24 days, you can still exercise.
Your muscles may take up to 2 weeks to become fat-adapted, though. During the first 2 weeks of
fasting, you may need to take it a little easy, but you should quickly recover after that.

Fasting and Brain Function (Part 24)
How does fasting affect brain function?
There is very little reliable human data, but some very interesting animal data, as recently reviewed.
There are many potential benefits. While I tend to focus on weight loss and type 2 diabetes, there
are many other benefits, including autophagy (a cellular cleansing process), lipolysis (fat burning),
anti-ageing effects and anti-seizure effects.

From an evolutionary standpoint, we can look at other mammals for some clues. In many mammals,
the body responds to severe caloric deprivation with a reduction in the size of all organs with two
prominent exceptions – the brain and the male testicles. This suggests that cognitive function is
highly preserved.
This makes quite a lot of sense from an evolutionary standpoint. Suppose you had some trouble
finding food. If your brain started to slow down, well, the mental fog would make it that much
harder to find food. Our human brainpower, one of the main advantages we have in the natural
world, would be squandered, if it were dependent on constant food intake. No, the brain maintains
or even boosts its abilities, if deprived of external food. In stories of Japanese prisoners of war in
World War II (“Unbroken” by Laura Hillenbrand), many have described the amazing clarity of
thought that often accompanies starvation.
The preservation of the size of the testicles is also a significant advantage in trying to pass on our
genes to the next generation.
In all mammals, one of the highly preserved behavioural traits is that
mental activity increases when hungry and decreases with satiation.
Of course, we have all experienced this. Sometimes this is
called ‘food coma’. Think about that large Thanksgiving
turkey and pumpkin pie. After that huge meal, are we
mentally sharp as a tack? or dull as a concrete block? How
about the opposite? Think about a time that you were really
hungry. Were you tired and slothful? I doubt it. Your senses
were probably hyper-alert and you were mentally sharp as a
needle. That is to say that there is likely a large survival
advantage to animals that are cognitively sharp, as well as
physically agile during times of food scarcity.
Studies have also proven that mental acuity does not decrease with fasting.
One study compared cognitive tasks at baseline and after a 24 hour fast. None of the tasks –
including sustained attention, attentional focus, simple reaction time or immediate memory were
found to be impaired. Another double-blinded study of a 2-day 'almost total’ caloric deprivation
found no detrimental effect even after repeatedly testing cognitive performance, activity, sleep and
mood.
When we say we are ‘hungry’ for something (hungry for power, hungry for attention), does it mean
we are slothful and dull? No, it means that we are hyper-vigilant and energetic. So, fasting and
hunger clearly activate us towards our goals.
People always worry that fasting will dull their senses,
but in fact, it has the opposite, energizing effect.
These sorts of results are easy to see in animal studies. Ageing rats that were started on Intermittent
Fasting (IF) regimens markedly improved their scores of motor coordination and cognitive tests.
Learning and memory scores also improved after IF. Interestingly, there was increased brain
connectivity and new neuron growth from stem cells. This is believed to be mediated in part by
BDNF (Brain Derived Neurotrophic Factor). In animal models, both exercise and fasting
significantly increase BDNF expression in several parts of the brain. BDNF signalling also plays a role in
appetite, activity, glucose metabolism and autonomic control of the cardiovascular and gastrointestinal systems.
There are also very interesting mouse models of neuro-degenerative diseases. Mice maintained on
IF, compared to normal mice, showed less age related deterioration of neurons and less symptoms
in models of Alzheimers disease, Parksinon’s and Huntington’s disease.

In humans, the benefits to the brain can be found both during fasting and during caloric restriction
(CR). During exercise and CR, there is increased synaptic and electrical activity in the brain. In a
study of 50 normal elderly subjects, memory test results improved significantly with a 3 months of
CR (30% reduction in calories).
Neurogenesis is the process where neural stem cells differentiate into neurons that are able to grow
and form synapses with other neurons. Both exercise and CR seem to increase neurogenesis via
pathways including BDNF.
Even more interestingly, the

level of fasting insulin seems
to have a direct inverse
correlation to memory as
well. That is, the lower you
are able to drive down fasting
insulin, the more
improvement on memory
score that is seen.
Increased body fat (as
measured by BMI) has also
been linked to decline in
mental abilities. Using
detailed measurements of
blood flow to the brain,
researchers linked a higher
BMI to decreased blood flow
to those areas of the brain
involved in attention,
reasoning, and higher
function.

Intermittent fasting provides one compact method of decreasing insulin, while
also decreasing caloric intake.
Alzheimer’s disease (AD) is characterized by the abnormal accumulation of proteins in the brain.
There are 2 main classes – amyloid plaques and neurofibrillary tangles (tau protein). The symptoms
of AD correlate closely with the accumulation of these plaques and tangles. It is believed that these
abnormal proteins destroy the synaptic connections in the memory and cognition areas of the brain.
Certain proteins (HSP-70) act to prevent damage and misfolding of the tau and amyloid proteins. In
mouse models, alternate daily fasting increased the levels of HSP-70. Autophagy removes these tau
and amyloid protein when they are damaged beyond repair. This process, too, is stimulated by fasting.
There is substantial evidence that risk of AD is related to obesity. A recent population based twin
study demonstrated that weight gain in middle age predisposes to AD.
Taken together, this suggests a fascinating possibility in the prevention of Alzheimer’s disease.
Over 5 million American have AD and this number will likely increase rapidly due to the ageing
population. AD creates significant burdens upon families that are forced to care for their afflicted
members.
Certainly fasting may have significant benefits in reducing weight, type 2 diabetes along with its
complications – eye damage, kidney disease, nerve damage, heart attacks, strokes, cancer.
However, the possibility also exists that fasting may prevent the development of Alzheimer’s
disease as well.
The mechanism of protection from AD through fasting may also have to do with autophagy – a
cellular self cleansing process that may help removed damaged proteins from the body and brain.
Since AD may result from the abnormal accumulation of Tau protein or amyloid protein in the
brain, fasting may provide a unique opportunity to rid the body of these abnormal proteins. We will
cover autophagy in the next part.

Fasting and Autophagy (Part 25)
What is autophagy? The word derives from the Greek auto (self) and phagein (to eat). So the word
literally means “to eat oneself.” Essentially, this is the body’s mechanism of getting rid of all the
broken down, old cell machinery (organelles, proteins and cell membranes) when there’s no longer
enough energy to sustain it. It is a regulated, orderly process to degrade and recycle cellular
components.
There is a similar, better known process called
apoptosis also known as programmed cell death.
Cells, after a certain number of division, are
programmed to die. While this may sound kind of
macabre at first, realize that this process is essential
in maintaining good health. For example, suppose
you own a car. You love this car. You have great
memories in it. You love to ride it.
But after a few years, it starts to look kind of beat
up. After a few more, it’s not looking so great. The
car is costing you thousands of dollars every year to
maintain. It’s breaking down all the time. Is it better
to keep it around when it’s nothing but a hunk of
junk? Obviously not. So you get rid of it and buy a
snazzy new car.
The same thing happens in the body. Cells become old and junky. It is better that they be
programmed to die when their useful life is over. It sounds really cruel, but that’s life. That’s the
process of apoptosis, where cells are pre-destined to die after a certain amount of time. It’s like
leasing a car. After a certain amount of time, you get rid of the car, whether it’s still working or not.
Then you get a new car. You don’t have to worry about it breaking down at the worst possible time.
The same process also happens at a sub-cellular level. You don’t necessarily need to replace the
entire car. Sometimes, you just need to replace the battery, throw out the old one and get a new one.
This also happens in the cells. Instead of killing off the entire cell (apoptosis), you only want to
replace some cell parts. That is the process of autophagy, where sub-cellular organelles are
destroyed and new ones are rebuilt to replace it. Old cell membranes, organelles and other cellular
debris can be removed. This is done by sending it to the lysosome which is a specialized organelle
containing enzymes to degrade proteins.
Autophagy was first described in 1962 when researchers noted an increase in the number of
lysosomes (the part of the cell that destroys stuff) in rat liver cells after infusing glucagon. The
Nobel prize winning scientist Christian de Duve coined the term autophagy. Damaged sub cellular
parts and unused proteins become marked for destruction and then sent to the lysosomes to finish
the job.
One of the key regulators of autophagy is the kinase called mammalian target of rapamycin
(mTOR). When mTOR is activated, it suppresses autophagy, and when dormant, it promotes it.
We all need some amount of Autophagy to stay healthy... and nutrient deprivation is the key
activator of autophagy.
Remember that glucagon is kind of the opposite hormone to insulin. It’s like the game we played as
kids – ‘opposite day’. If insulin goes up, glucagon goes down. If insulin goes down, glucagon goes
up. As we eat our insulin goes up and glucagon goes down. When we don’t eat (fast) insulin goes
down and glucagon goes up. This increase in glucagon stimulates the process of autophagy. In fact,
fasting (raises glucagon) provides the greatest known boost to autophagy.

This is in essence a form of cellular cleansing. The body identifies old and substandard cellular
equipment and marks it for destruction. It is the accumulation of all this junk that may be
responsible for many of the effects of ageing.
Fasting is actually far more beneficial than just stimulating autophagy. It does two good things. By
stimulating autophagy, we are clearing out all our old, junky proteins and cellular parts. At the same
time, fasting also stimulates growth hormone, which tells our body to start producing some new
snazzy parts for the body. With Fasting we are really giving our bodies the complete renovation.
You need to get rid of the old stuff before you can put in new stuff. Think about renovating your
kitchen. If you have old, crappy 1970s style lime green cabinets sitting around, you need to junk
them before putting in some new ones. So the process of destruction (removal) is just as important
as the process of creation. If you simply tried to put in new cabinets without taking out the old ones,
it would be pretty ugly. So fasting may actually reverse the entire ageing process by
getting rid of old cellular junk and replacing it with new parts.
Autophagy is a highly regulated process. If it runs amok, out of control, this would be detrimental,
so it must be carefully controlled. In mammalian cells, total depletion of amino acids is a strong
signal for autophagy, but the role of individual amino acids is more variable. However, the plasma
amino acid levels vary only a little. Amino acid signals and growth factor/ insulin signals are
thought to converge on the mTOR pathway – sometimes called the master regulator of nutrient
signalling.

So, during autophagy, old junky cell components are broken down into the component amino acids
(the building block of proteins). What happens to these amino acids? In the early stages of
starvation, amino acid levels start to increase. It is thought that these amino acids derived from
autophagy are delivered to the liver for gluconeogenesis. They can also be broken down into
glucose through the tricarboxylic acid (TCA) cycle. The third potential fate of amino acids is to be
incorporated into new proteins.
The consequences of accumulating old junky proteins all over the place can be seen in two main
conditions – Alzheimer’s Disease (AD) and Cancer. Alzheimer’s Disease involves the accumulation
of abnormal protein – either amyloid beta or Tau protein which gums up the brain system. It would
make sense that a process like autophagy that has the ability to clear out old protein could prevent
the development of AD.
What turns off autophagy? Eating. Glucose, insulin (or decreased glucagon) and proteins all turn off
this self-cleaning process. And it doesn’t take much. Even a small amount of amino acid (leucine)
could stop autophagy cold. So this process of autophagy is unique to complete fasting – something
S not found in simple caloric restriction or dieting, not even those extreme low calorie diets.
h
a There is a balance here, of course. You get sick from too much autophagy as well as too little.
r Which gets us back to the natural cycle of life – feast and fast.... instead of constant dieting with
e caloric restriction, but never any real fasting.
t Intermittent Fasting allows for cell growth during eating, and cellular cleansing during
h fasting – a healthy balance, and after all ...
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Power: Fasting vs Low Carb (Part 26)
What’s the difference in power between fasting and LowCarb High Fat (LCHF)? Sometimes it feels
like arguing whether Batman or Superman is more powerful (Superman, of course). But they’re
both superheroes, and the point of both these dietary superhero regimens is to lower insulin. This
stems from a rational examination about the causes of obesity and type-2 diabetes. You need to
understand the aetiology of obesity (the underlying cause) if you are to have any hope of treating it.
For decades, we have laboured under the false assumption that excessive calories caused obesity.
However, overfeeding and underfeeding studies clearly proved this hypothesis wrong. If calories
caused obesity, then overfeeding calories should cause obesity. It did, but only in the short term.
Long term, weight went back to normal. Underfeeding calories on the other hand, should lead to
permanent weight loss. But it did not. The failure rate of this Caloric Reduction as Primary strategy
is an abysmal 99%.
Using a more rational model of obesity as a hormonal disorder (mainly insulin, but also cortisol)
leads to the hypothesis that increasing insulin should lead to lasting weight gain. Decreasing insulin
should lead to weight loss. And guess what? It worked just as advertised. (See the Hormonal
Obesity series for a full description).
So, if we understand that excessive insulin causes weight gain, then the treatment is quite clear and
just really damned obvious. You don’t need to decrease calories, although there is some overlap.
You need to decrease insulin to cause weight loss. Both LCHF diets and fasting accomplish this
goal. Refined carbohydrates are the biggest stimulus to insulin, so reducing carbs reduces insulin.
Protein, especially animal proteins also raise insulin, so keeping protein moderate and fats high is
another way to keep insulin levels down. Fasting, by restricting everything, also keeps insulin
down. A ‘fat fast’ ie. eating nothing except pure fat, may also accomplish the same thing, but
studies are sparse.

But which diet is better? LCHF or Fasting? A comparison of power shows that fasting wins every
time. In this study of a carbohydrate free diet versus fasting in type-2 diabetics, you can see that
carb-free does extremely well. If we compare the glucose response of Carb-Free versus a Standard
Diet, you can see that blood sugars come way down. But fasting does even better.
If you are trying to lower blood glucose, nothing really beats fasting. After all, you can’t go lower
than zero. Even then, the carb-free diet does remarkably well – giving you 71% of the benefits of
the fasting, without actual fasting. The standard diet was 55% carbohydrate and 15% protein, and
30% fat – not far off of what most dieticians and Dietary Guidelines recommend. You can see how
shitty it is for actual blood glucose control.
The carb-free diet is <3% carbs (that is ketogenic or ultra-low carb), 15% protein (moderate) and
82% fat. LCHF pretty much says it all. The calories delivered were 25 kcal/kg (1750 calories for a
70 kg man) in 3 meals – this was the same between the standard and carb-free diets. So the benefits
of carb restriction on blood glucose were NOT simply due to calorie restriction. This is useful
knowledge, considering how many ill informed idiot doctors and dieticians keep saying ‘It’s all
about the calories’. Actually, in this study, it had nothing at all to do with the calories.

Anybody who still believes that ‘It’s all about the calories’ despite 50 years of
unrelenting failure of the Caloric Reduction as Primary (CRaP) model either has not
thought about things very hard or is simply not all that intelligent. Yes. If a strategy
such as CRaP fails for 50 years, we should be changing our strategy. It doesn’t take
Albert Einstein to tell us that is the very definition of insane.
This graph is pretty sobering. Looking at the Standard Diet (ADA recommended), you can see how
high those peaks of glucose really get. You might rightfully ask yourself, if the good folks at the
ADA knows that their diet sends blood sugars skyrocketing upwards, why on earth would they
recommend it? Are they trying to kill us? Unfortunately, the answer is yes. They are trying to kill
you. Not intentionally, but with their ignorance. All that money showered upon them from Big
Food and Big Pharma have something to do with it, too.
But what if carb-free just isn’t enough? I have lots of patients who limit their carbohydrates, but still
have elevated blood sugars. How do you get more power? Sorry, Batman, it’s time to call in
Superman. In a word, we need Fasting.
The study results are even more impressive when you look at insulin levels. This is very important
because blood glucose levels are not the main driver of obesity and diabetes. Insulin is the main
driver. The entire strategy of weight loss hinges upon lowering insulin.
Looking at total area under the curve, you can see that carb-free diet can reduce insulin by roughly
50%, but you can go another 50% by fasting. That’s power.

This makes sense, of course. A carb free diet will still contain some protein which will increase
insulin. The only way to get lower would be to eat 100% fat – which is largely an artificial
construct. That is, we don’t generally eat pure olive oil as a meal or pure lard. “Bulletproof Coffee”
(essentially strong coffee mixed with oil and butter) is certainly a great ‘hack’ but it’s hardly been
tested by thousands of years of human history and millions of people. Fasting has survived this test
of time. It is Anti-Fragile. How? The more we eat processed and ultra-processed garbage and
pretend it is food, the more we need to fast. If you eat a lot of fast food (foods that are ultra-
processed and send insulin skyrocketing) the more you need to fast (bring those insulin levels back
down).
And NOTHING beats fasting for bringing down insulin. It is simply the fastest and most efficient
method of reducing insulin. Luckily, it’s also not as hard as most people believe it to be.
What about glucagon? Remember that glucagon is sort of the opposite of insulin. One of insulin’s
main physiologic role is to suppress glucagon. Dr Roger Unger did much to explore the biological
role of glucagon and often considered it the most important. However, in this study, it had no
clinical relevance at all. In dealing with patients, glucagon also plays little or no role.
Let me explain. Insulin causes weight gain – so giving insulin causes weight gain. Does reducing
glucagon cause weight gain? Not really. Does increasing glucagon cause weight loss? Not really.
Sure, glucagon plays a primary role in rat livers, but I don’t really care. I care about humans.
The bottom line of this study is to reinforce what we knew already. Insulin is the primary (but not
the only) driver of obesity. Therefore, for most people, reducing insulin is the best method of
treating obesity. Carb free diets are a powerful method of reducing insulin. But if that doesn’t work,
then intermittent fasting offers an even more powerful strategy.
In type-2 diabetes, you can reduce blood sugars by 50-70% by carb free diets. You can reduce it
another 30% with fasting. So, if we already know how to reduce blood sugars in T2D with dietary
strategies – why do we need medications at all? Here’s the answer, of course....You don’t.
Type-2 Diabetes is an entirely reversible disease.

The Complete Guide to Fasting – Now Available
I’m happy to finally be able to say that my book The Complete Guide to Fasting is now available in
Canada and the United States. The Kindle version should be available very soon, and the
audiobook will be released in several months.
I co-authored this book with Jimmy
Moore, who has written several
international best-sellers already –
Cholesterol Clarity, Keto Clarity and
The Ketogenic Cookbook. I first met
Jimmy in Cape Town, South Africa
during the Low Carb Summit in 2015.
Jimmy was familiar with fasting, having
tried it a few times himself and also
writing about it very briefly in Keto
Clarity.
Most of the speakers there follow the
Low Carb, High Fat or Ketogenic
approach, but I tend to use incorporate
intermittent fasting quite extensively in
my Intensive Dietary Management
(IDM) program. There are many
synergies between the two approaches.
Both have the goal of lowering insulin,
which I believe to be the key driver of
obesity. However, intermittent fasting
tends to be more powerful than LCHF
diets since it restricts everything. Also,
people who follow ketogenic diets find
that fasting is quite a natural extension
of their diet. Since their body is already fat-adapted, there is a far easier transition to fasting and
most people find that it is very easy.
Further, fasting brought many advantages not found in traditional diets. It was very easy to
understand. It had a long history – the oldest dietary intervention. It was free (actually saves
money). It doesn’t take time (it actually saves time – cooking, cleaning, shopping). It was powerful.
It was simple (just don’t eat).
We’ve been using intermittent fasting in the IDM program for
over 5 years and have supervised over 1000 patients with this
approach with tremendous success. It’s not an approach that
everybody likes, but it represents an important option for those
willing to give it a try. There are virtually no other clinics in
the world that offer this detailed knowledge of fasting. I
suspect that we have more experience with fasting than
anybody else in the world. By a factor of 4 or 5.
After the conference, I started talking with Jimmy, who
became interested in fasting again and thought he might give it
a more serious try. I had just finished writing The Obesity
Code. While it did mention fasting in the last chapter, the focus
of that book was understanding the underlying causes of
obesity. There were still many things people kept asking.

How to fast. Common problems. Who should not fast. Different types of fasting. Different lengths
of fast. Will I lose muscle. Will I go into starvation mode. There were endless questions not
answered by my first book. These were issues that Megan Ramos, my IDM program director and I
deal with daily.
One day, Jimmy asked me what was the best book to read about intermittent and extended fasting.
I’ve read everything available. I’ve read all the studies. I’ve read everything online. This is not
actually very difficult because there is really nothing out there. So, that’s what I told him. There
were basically no good books on intermittent fasting. Some books dealt with fasting from a spiritual
perspective. But there was nothing that a regular person could go to their bookstore and buy a book
that discussed fasting as a therapeutic option in a serious manner. So we decided that we needed to
write it.
We scoured the globe for the other leading experts, including Mark Sisson, Robb Wolf, Abel James,
Megan Ramos, Amy Berger, and Dr. Thomas Seyfried, who all agreed to lend their expertise to this
important venture. Together, we’ve put together what I believe to be the definitive guide to fasting,
the ‘Bible’ of fasting that will be able to guide many people through this journey.
Fasting Resources
I believe this book will be a tremendous resource, but there are also many great fasting resources
available online, as well. By far the most useful is the page ‘Intermittent Fasting for Beginners‘ on
www.dietdoctor.com which is completely free.
On my blog, www.intensivedietarymanagement.com, I have written an extensive series of posts on
fasting starting with part 1, a history, and lasting 26 parts so far. All that information is completely
for free, if you can put up with my occasional ‘salty’ language and propensity to say exactly what I
think.
For subscribers of dietdoctor.com, however, there is a 9 part detailed fasting series of videos that
will guide you step-by-step through fasting. I travelled to Sweden to film this series with Andreas
and I’m very proud of it. The video series presents all the information clearly, concisely, and with
beautiful graphics and video production. It’s some of the best work I’ve done. Andreas and his team
helped refine the video and we did take after take. It was exhausting, but the finished product is
quite remarkable and not available anywhere else in the world. For a mere $9/ month, I cannot think
of anything that will improve your health more. You can even try it for a month for free. You can’t
get much better than that.
Also on the subscriber side of www.dietdoctor.com, I answer reader questions. I cannot legally
answer personal medical or dietary questions, but general questions that are not addressed
elsewhere, I am quite happy to answer them within a few days (usually).
If you think you need a personal dietary counsellor to help you achieve your goal, I’ve also set up a
program for that, too. You can join at www.intensivedietarymanagement.com/join to connect with
one of our counsellors who have guided hundreds of patients through LCHF diets and fasting. There
is a fee for this service, but we’ve kept it as low as possible ($500 Canadian per year). We provide
this program online, so it can be delivered anywhere in the world. We have literally more
experience with helping people fasting than anybody else in the world.
Together, we are dedicated to healing the world, one person at a time. We’ve put enormous
resources online, mostly for free, along with books, videos, blogs, and even personal coaching.
There is nothing to stop you from taking back control of your health from the drug companies and
the charlatans who have ruined it. It’s a revolution – the nutrition revolution!

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2nd Document of the Fasting Series by Dr.

Women and Fasting (Part 10)

Fasting Series Part 10-26 page 1 of 65

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Continue here for Fasting part 11

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However, this weight gain is

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Coffee, caffeinated or decaffeinated, is also permitted. A small amount of cream or milk is

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How do I break my fast?

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Can I exercise while fasting?

For more tips continue here for Fasting part 13

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Will fasting make me confused or forgetful?

I get dizzy when I fast. What can I do?

I get headaches when I fast. What can I do?

My stomach is always growling. What can I do?

Fasting Series Part 10-26 page 11 of 65

I get heartburn. What can I do?

I take medications with food. What can I do during fasting?

I get muscle cramps. What can I do?

What if I have diabetes?

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Top 8 Intermittent Fasting tips

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Reason #4 – Cheat days

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Reason #7 – Add to any diet

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Continue to Fasting Part 16 –Fasting Lowers Cholesterol

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Continue to Fasting part 17 – Fasting and Hunger

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In the 1890s, Ivan Pavlov

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So – here’s the real question – does

Continue to Fasting Part 18 – Cephalic Phase Response and Hunger

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Continue to Fasting Part 19 – Circadian Rhythms and Fasting

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One final word of advice – We should DEFINITELY all take siestas.

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In 2003, David Blaine, the magician,

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