Month: September 2019

Intermittent or Periodic fasting: a powerful tool for addressing insulin resistance – Quite a few of these specialists make reference to the benefits of both intermittent and periodic fasting, which I tried really hard to ignore at first.  The idea of intentionally not eating sounded painful and stupid, and I really had no interest in it. 

My basic thought – “I love food.  Are you are suggesting that I intentionally not eat for how long?  No way, you’re nuts!”

I previously hated the idea of even missing a snack, never mind missing a whole meal.  However, since quite a few knowledgeable specialists/researchers go out of their way to incorporate this into their lifestyle, I figured that there must be something real going on there.  I finally decided to educate myself a little on the topic and was amazed by how much sense it made in regards to metabolism and insulin sensitivity (with what is known to date).  There is a lot of new research around fasting, with many studies just beginning, and surely a whole lot more discover.  While a few pathways and mechanisms have been elucidated, many more are likely involved.  Some important known effects of longer-term fasting (approx. > 3days):  greatly reduced insulin levels, gastrointestinal healing, gut microbiota alterations/balancing, dampened mTOR activity (reducing excess growth signaling), increased sirtuin activity (improving gene expression and silencing – some slowing aging benefits).  You may not know what these last two are, but be assured that this is desirable (periodically) for adults.  Plus, you get the added benefit of losing weight.

Anyways, I eventually tried it out a few times and found it really wasn’t all that torturous.  Initially just skipping breakfast seemed like a long fast, but it was manageable, and I slowly worked my way up to longer multi-day fasts.   I’ve since worked a 24hr fast into my routine every week or two (which now days barely phases me), and a few occasional longer fasts.  The freedom to not have to drop everything and eat just because its lunch or dinner time is so liberating.  And to make it through, however long I need to, calm and content, not shaky, weak, edgy, or enraged; that is a gift that was unforeseen to me.  The term generally used to describe this state would be metabolically flexible – meaning someone who can quickly and easily use alternate sources of stored energy such as fatty acids and ketones in addition to glucose.

The more I learn about the biological mechanisms currently known to be involved, the more I find myself a big supporter of fasting.  Who would have thought?  However, the real surprise is how many different pathways it affects.  The human body is an extremely complex universe of intertwined systems, and somehow fasting is able to help bring things back towards balance in multiple systems all at once.  Almost as if it were a natural state of being that we should be experiencing somewhat frequently.  What a crazy thought.  Right?

Even though fasting has been known to have health benefits for thousands of years, this is a new field when it comes to research in studying the mechanisms and pathways/targets of fasting, and so far looks very promising as a treatment for auto-immune diseases, cancer, and many other conditions.  While time-restricted feeding may be an effective strategy for weight loss and correcting metabolic issues such as T2 diabetes, longer fasting periods, like somewhere in the range of 3-7 days or more will likely be required for targeting other pathways involved in treating cancer and auto-immune issues.  I recall fasting being mentioned as a first-line treatment for epilepsy (followed by a strict classical ketogenic diet) back before the modern medication era, so apparent neurological protective pathways are invoked as well.

To clear up the terminology as I understand it:  definitions are a little murky (and everything is relative), generally anything less than 24 hours is considered time-restricted eating (TRE), though some people who only eat once a day most days may still consider 24hrs as a form of TRE.  Intermittent fasting is typically a specific regimen such as fasting every other day for a couple weeks.  Periodic fasting is generally longer 2-7 days or more, and sometimes may be done for several weeks (under medical supervision), but done at less frequent intervals, say once every 1-6 months.  Longer fasting periods will produce greater results, but at greater risk of adverse effects, and require greater care in exactly how to break the fast.  Starting with a longer fast is not wise.  Like anything, if you don’t know what you are doing, start small and work your way up.  No one takes up running by doing a marathon, well at least if they plan on not dying in the process.

Some fasting plans allow some caloric intake on fasting days, say 25%, which sounds like trouble to me, as this opens up room for error and cheating.  Did you eat 500 calories of sugar, or was it almost pure fat (like butter)?  Was it really just 500 calories? Was it all at once, or was it little bits throughout the day?  By eating at all, you are changing your body’s metabolic response to lack of food energy, and likely not in a good way if you are going to continue restricting food access.  If you are not eating, then just don’t eat.  Is eating just a few bites of food actually satisfying when you are hungry?  Not to me.  When I’m breaking a fast, I’m eating till I’m full.  If hunger pains are killing you, then take a spoonful of coconut oil or a tablespoon of butter; not a true fast, but at least it will have minimal effects on insulin.  If that still seems intolerable, then consider going low carb first.  Getting insulin under control with a low carb diet can make fasting much easier and less painful by allowing you quicker access to your fat stores.

Dr. Jason Fung has a lot more information and explanations for the therapeutic use of fasting for targeting T2D on his blog (see links further below), and I highly suggest watching a few of his videos. He also has a few books that present the information in a more organized format.  His clinical work has repeatedly demonstrated that fasting can be a very effective tool in reversing the condition of insulin resistance (hyperinsulinemia)/type 2 diabetes.

I found that to be very true for me being on a very low carb diet:  a couple years ago for our health screening at work, after fasting for the 12 hours, I decided to try it out and skip breakfast completely.  It was already 9 am, but could I make it till noon without eating anything?  I was very surprised at how I didn’t really feel hungry at all.  I had been dialing down the sugar and processed carbs for a couple of years, and what a difference from the experience of going hungry previously.  I wasn’t tempted to snack, and I wasn’t cranky, in a bad mood, or tired; and it didn’t even trigger a migraine or anything.  In the following months, I skipped quite a few more morning meals and felt just fine. (I now understand that this is really just time-restricted eating, but at the time it felt monumental).  A few little moments of hunger, here and there, but nothing difficult or torturous.  After a while, I was skipping breakfast more often than not, and I eventually noticed that I felt considerably more tired on the days that I did eat breakfast, so my new breakfast time became noon-1 pm most days.  Once in awhile I will still eat early or 3 meals in a day, but not too often.

Currently, since I only eat twice a day most of the time, a 24hr fast just means skipping lunch, so pretty darn easy to me.  Sometimes I do it intentionally for metabolic health, while other times I’m just too busy and don’t want to lose all that time from eating and digesting, especially when working on big house projects.  It’s nice to have the flexibility of not eating and remaining productive, all without biting anyone’s head off. 

While I typically do at least one 24hr fast every week or two, I haven’t been as disciplined in working in longer fasts – a few 48hrs, and one 52hr, 3-day, and 4-day fast.  My goal is to do a 5-7 day fast a couple of times a year, but that’s pretty tough when you have a wife who cooks delicious food, and kids to cook for.  The smell while cooking, or licking peanut butter or whatever off your fingers when making breakfast or packing lunches… and suddenly I remember I’m fasting for the next X-many days.  Fun is the one thing that fasting is not, but neither is work, yet I see the necessity in continuing that pursuit as well.

Over time I’ve skipped a lot more meals because I’m just not always that hungry anymore.  There are some benefits to exercising in the fasted state too, so just because you’re active doesn’t mean you have to eat, but it does take some time for your body to adjust.  Again, start off slow/easy and work your way up to more intense activity.  From my own personal experience, a few ultimate Frisbee games were probably not the best type of exercise opportunity to start with (in one game my heart was pounding so hard that I was getting a bit concerned, but we were shorthanded, so I had to keep running).  One great thing about exercising in the fasted state – you know exactly where your energy is coming from – primarily stored body fat.

Dr. Fung has been utilizing fasting for quite a while, and he discusses the many benefits of fasting on his blog.  Dr. Attia and many others have also eventually delved into this potent therapy as well.  One rather notable benefit is to increase the rate of autophagy (recycling old degenerative cellular components and other dysfunctional proteins), and the role this can play in regenerating our mitochondria and other cellular structures, which is thought to play a critical role in preventing cancer and many other degenerative diseases.  Longer fasting periods are known to affect many hormones and nutrient levels that are beneficial in fighting already established cancers.  https://idmprogram.com/fasting-and-autophagy-mtor-autophagy-1/

Although it could be the increase in sirtuin activity helping to better regulate epigenetic expression that could be a big player in fighting cancer too.

If you have any interest in fasting, read this first!!!  https://idmprogram.com/1-rule-fasting/

Fasting should not cause muscle wasting.  Dr. Fung thinks this is possibly due to an increase in growth hormone that occurs during fasting, which may have the effect of preserving muscle mass.  Or perhaps sufficient circulating fatty acids and certain amino acids provide your muscle with what it needs to survive, and then your liver kicks out the glucose required for any exercise you pursue.  (It’s always kinda cool to see my glucose go from about 70 to 110 before and after exercise during a multiple-day fast).  Your body is fine-tuning to be more efficient, not to self-destruct.  Once you have burned through your glycogen reserves, it will take most energy requirements from fat stores, and target unnecessary protein for any protein needs.  Why burn muscle, when there is loose skin, cellulitis, dysfunctional cells, organelles, and accumulated junk protein that is readily available. 

(Neat random info – while the maternal and paternal contributions towards nuclear DNA may be relatively evenly matched, cellular components such as mitochondria and other organelles are typically maternal in origin.  There have been some reported instances of paternal mitochondria being passed on, but they are said to be rare.)

Other areas of benefit concerning fasting – https://www.the-scientist.com/features/running-on-empty-31436  a pretty good review, however, the author’s assertion that intermittent fasting (IF) “is just caloric restriction in disguise” is just plain wrong.  The biochemical patterns induced by IF and periodic fasting is completely different than traditional caloric restriction, and the responding metabolic effect is also very different.  Chronic caloric restriction tends to lower metabolic rate (at least when done with a high-carb diet), whereas period fasting does not (upon refeeding).  If you keep track of glucose and ketones during a fast, (for a healthy individual) you will see a dramatic shift occur somewhere in the 2 to 3 day mark where glucose levels drop way down and ketones levels rise significantly.  Not sure when and to what extent that will happen in someone with hyperinsulinemia/T2 diabetes.  This shift in energy substrate utilization is unique to fasting, and will never happen if you are still eating small amounts of food (even on a ketogenic diet).  Metabolic changes due to fasting are said to last multiple weeks, so clearly quite the powerful tool.

Also not quite accurate in that review, as I mentioned above, more effective IF would require no nutrient intake during fasting periods (i.e. water, black coffee, plain tea only).  Rhonda Patrick has a couple of good interviews with Valter Longo and also with Dr. Guido Kroemer discussing other benefits of fasting on autophagy and cancer.

To my limited knowledge, fasting is the only way known to rejuvenate the immune system, for which it can be effective at reducing auto-immunity issues without sacrificing overall immune function.  Some part of this impoved immunity is likely by allowing the full gastro-intestinal tract to repair and recover – improving gut barrier function.

NOTE: true fasting is referring to the absence of nutrients, so all these trendy cleanses using veggie smoothies and juice fasts are not going to work as effectively, if at all.  While there is some controversy as to whether black coffee or plain tea is acceptable in regard to inducing autophagy, certainly for weight loss and fat burning purposes there should be no concern for most people.  Although if you notice it affecting your blood sugar, then maybe you are one of the few that should avoid that as well.

There is some indication that something in coffee (caffeine, possibly the polyphenols, etc.) actually stimulates autophagy, and therefore would be expected to further enhance the process https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111762/pdf/cc-13-1987.pdf.  While being a mouse study, the fact that increased coffee consumption has been positively correlated with many health benefits and/or reduced risk for many conditions could be seen as evidence that this may be a conserved pathway for humans through which it’s acting.  When it comes to cancer cells this becomes a little complicated, as autophagy can be a lifeline for some cancer cell lines, and a death sentence for others (in vitro), which makes it a little less clear as to if coffee increasing autophagy would be a good thing or not, or if it would even make a difference?  I don’t think we know the answer to this at this point.

Another coffee consideration – from my own personal experience – if you drink lots of coffee, then don’t just stop or slow way down during a long fast.  Caffeine withdrawal is quite unpleasant.  No reason to add adverse side effects to an already not all that pleasant experience.  Maybe taper off slowly before fasting if you really want to go all out with strict water-only fasting.

I would also throw ketone salts, MCT and partial MCT oils in here for consideration as well. They certainly make 24 hr fasts much easier for me, so if you are having trouble with sticking to it, maybe give it a try.  You won’t lose weight as quickly, but it will increase your ketone supply, as well as reduce hunger.  In general, I like to use these before exercise or after a poor night of sleep for an easier source of energy.  If you are mostly fasting for improving insulin sensitivity and liver health, then they are probably ok.  Will they affect sirtuin activation levels?  Someone out there probably knows the answer to that, but I do not.

Time-restricted eating (TRE) is another approach to improve insulin sensitivity.  Very easy to do, and quite effective.  Regardless of what you eat, this is a great tool to help improve general health and many metabolic markers for risk.  The basic idea that you eat all your food (and beverages that affect glucose/insulin) in a smaller window of the day (ideally within 6 to 8 hours), and the rest of the day you don’t eat. (NO snacking outside of window).  Some fairly well-controlled studies have been done eating the same food but restricting the eating window, and indicate some benefit in regard to biomarkers related to metabolic health, even while eating a standard American diet (i.e. lots of processed crap food).  To be more effective, this eating window should be during your active part of the day.  Eating later at night has possible mechanisms that inhibit weight loss and can negatively impact metabolic markers.  Another benefit of TRE is that if you are only eating for a short window of the day, it becomes difficult to over-consume, so no need to worry about portion sizes.  Perhaps better to emphasize that if you are doing strict TRE, you should NOT restrict quantity, but rather eat until satisfied (within reason – if you are full then quit eating). 

Personally, this just seems like the most natural way to eat less.  No one wants to quit eating if they are still hungry; better to just eat less often.  Going longer before eating isn’t actually all that hard to do, and I typically find that I get much less tired after eating if I have been fasting for longer (provided that I don’t binge on processed carbs).

While there isn’t really any data that I’m aware of that could indicate if an early eating window or middle of the day is better or worse, it does seem that eating later into the night may have some negative consequences.  This seems to go along with what some of our grandparents might have told us, with the probable mechanism being disturbed sleep quality, which can alter cortisol and insulin levels and sensitivities.  Realistically digestion is exhausting, and it requires organs like your liver, pancreas, and parts of your brain to be active regulating digestion when they may need to be doing other activities to recuperate and prepare for the next day.  The idea that missing half a night’s sleep causes a great reduction in insulin sensitivity, suggests to me that the body knows it was not fully able to prepare what it needed to, and therefore is taking corrective action to cope with the situation.  Is this to spare glucose for the brain?  What about glucose metabolism is so exhausting?  Perhaps enzyme levels or general ATP stores… I’ve lots of questions and few answers for this issue.  My personal experimentation has indicated that I do better fasting most of the day and taking MCT oil throughout on days that I get crappy sleep.  It seems to help with brain energy and reduce cravings, but not too much help with the sluggish feeling of exercising when overtired.

Some good discussion on the latest research regarding TRE:  https://www.foundmyfitness.com/episodes/satchin-panda, https://www.foundmyfitness.com/episodes/satchin-round-2

So a big take away here is that skipping meals is not only ok, but it can actually improve health.  But this would require you to fully skip the meal, and not eat any junky snacks instead.  If you do have to snack, make sure it is low in sugar and refined carbs, meaning higher in fat and protein.  It may not quench that thirst for sugar, but that’s when you realize it’s not really hunger that you are fighting, but rather sugar addition, which will get easier in time.

Snacking:  Our current culture is really pushing this idea of snacking as being something good or necessary.  For some reason we have developed such an aversion to hunger nowadays, as if that feeling is somehow going to digest our own stomach.  In the period of my lifetime, I have seen snacks go from something that will ruin your appetite or just not considered necessary, to something schools are requiring – a “healthy” snack for the morning and afternoon.  WTF?  What’s next, a continuous I.V. drip of dextrose?  Hmm, wonder why we keep getting fatter?  There really is no other logical explanation than that we have been brainwashed by the food industry so that they can sell more product.  When I was in grade school we didn’t have snack time at school.  Nobody needed them.  We were fine all the way till lunchtime.  Now we are growing nice little piggybanks for big pharma.  Did someone order some T2 diabetes?  Coming right up!  However, I will concede that when you are insulin resistant, hunger is much more intense and unpleasant, which is another very good reason to avoid this death spiral.

Historically snacking had never before been viewed as healthy (go ask the elderly if you are doubtful), and from an insulin response point of view, it can be very harmful, cranking up insulin exposure, and thereby increasing the degree of insulin resistance.  While ideally we would like to get to a point where we rarely snack, it’s not so easy if we are starving by 10 am.  Until you have improved your insulin sensitivity and can readily access your fat stores for energy, you probably are going to keep getting hungry between meals, so try to get snacks that have the least effect on insulin (no/low sugar and carbs, and higher in fats).  They may not always satisfy that craving that you have for something sweet, but at least you won’t be hungry.  Plan ahead and bring something with you, because there is probably nothing in the vending machine that meets that criteria, and gas station convenience stores are pretty lacking as well.  Eventually, once you are more insulin sensitive, if you eat a breakfast that is more truly healthy, you probably won’t even feel hungry until close to lunchtime or later.

A truly healthy snack – a healthy (low processed carb) snack might be a quick and easy substitute for a meal if you are not very hungry.  Sometimes after a long day at work, the idea of cooking anything just seems very unattractive when hunger is relatively low. Something little is usually all I need to make it through the evening provided I ate a big lunch.