Megan Ramos

Humans have practiced fasting for centuries as part of religious rituals, but the medical community has shunned it as risky and dangerous. Megan Ramos, along with her co-founder Dr. Jason Fung, have embarked on a mission to change all that. At IDMProgram.com, Megan and Jason counsel patients how to use fasting safely to help with weight loss, diabetes, management, and overall health promotion. They recently published a case series showing how they can help people get off their insulin in as few as five days! But fasting can be a double edged sword with significant potential risks of hypoglycemia, loss of lean muscle mass, and feeling awful. Megan helps us understand how to overcome those concerns so that we can benefit from fasting in a safe and sustainable manner.

Food Appreciation through Fasting on Yom Kippur

I still remember Yom Kippur 2013. The year I had to fast.

 

I know I am “supposed” to fast every year, but in my mind that ship had sailed long ago. I am not the best rule follower, especially when I don’t see the purpose of the rule. What does not eating have to do with being a good person?

 

But in 2013, my son was old enough to ask, “Why isn’t daddy fasting for Yom Kippur like we are supposed to?” That was the end for me. I had to lead by example, and fast. Back then fasting was a four-letter word. It was something I was forced to do. It was uncomfortable, it made me grouchy, and it seemed like a waste of a day.

 

How times have changed. Now I practice intermittent fasting on a regular basis. I regularly experience the physical and psychological benefits, and I know that science supports even greater long-term benefits. Plus, it’s easy now. 

 

This year I learned that like with most things, I have started take fasting for granted.

 

A good friend of mine unknowingly reminded me of this when we met for lunch the day after Yom Kippur. He does not fast regularly, so the Yom Kippur fast is a big deal for him. I was fascinated listening to him describe his experience. His focus wasn’t the hunger, or lack of energy, or the headaches some people experience. Rather, his was the appreciation he had for cold, crisp water. The joy of his first taste of food in 24 hours. The smell, the texture, the flavors. He had taken food for granted and fasting helped him appreciate it all over again.

 

I felt the same appreciation as my friend when I did my five-day fasting mimicking diet. But on a regular day of fasting, I don’t experience the same appreciation. It made me wonder, why not? Why had I lost that heightened appreciation?

 

I eat high quality, minimally processed, real food that comes from the ground or from an animal. It is food as nature intended it to be. It nourishes my body and is delicious. I should celebrate it every day.

 

Yet, I learned that I can sometimes take my food for granted.

 

A prolonged period without it is a stark reminder of how much I should appreciate my food. But why don’t I appreciate it to the same degree every day?

 

This reminds me of the comedian, Louis CK, who tells the story of someone sitting next to him on the plane complaining that the WiFi wasn’t working at 30,000 feet in the air. The comedian responded that every time a plane takes off and is in the air, we should all scream “Holy $&!% we are flying! I mean literally flying!! Can you believe that?!?!?” Again, that is a perfect example of something we easily take for granted.

 

So, what is the secret? How do we not take for granted the things we experience every day, regardless of how amazing or awe inspiring they may be? How do we appreciate what can easily become mundane?

 

In our family, we say a short prayer every meal. Maybe prayer is the wrong word. It is more of a thank you. We try to remember to thank God for growing the food, the field workers for harvesting it, me or my wife for cooking it, and all of us for appreciating it. But I would be lying if I said that we did that at every meal.

 

We are quick to point out when something is from a factory or packaged in a box or bag.  That helps us recognize the simplicity and pleasure of eating real food (in fact, my kids were freaked out when they saw me eating food from a box during my 5-day FMD).

 

Yet I feel like there should be more. I feel like I still underappreciate the treasure that is our food. Is that setting too high of an expectation? Or should I strive for a greater appreciation?

 

What are your thoughts? What are your rituals? How to you remember to appreciate what you have? It doesn’t have to be just food either.  We should be thankful for anything we are fortunate enough to have. Please comment below so we all can benefit from our collective knowledge and experience.

 

For now, I am going to appreciate my freshly steamed veggies and my grass-fed steak. I don’t want to have to wait for my next FMD to appreciate that!

 

Thanks for reading

Bret Scher, MD FACC

 

 

Why a Fasting Mimicking Diet (FMD) is the Key to Longevity

 

I found it! I found the one thing vegans, vegetarians, carnivores, paleo and keto enthusiasts can all agree with.

 

Fasting is possibly the most important intervention for longevity.  The science supports it, and now it is gaining popularity among the masses.

 

Yet the question remains, how do we best accomplish fasting? What’s the best duration, frequency, and does it have to be a complete water fast? Or can it be a calorie restricted fasting mimicking diet (FMD)?

 

Just when I thought I found a consensus; the details rear their ugly heads to divide us once again. But there is hope! The hope comes from realizing that there is more than one way to accomplish a goal.

 

Health Benefits of Long Term Calorie Restriction

Some would say you can accomplish the key to longevity with drugs like metformin, others say time restricted eating is the way to go. All of those have tremendous potential, but when it comes to science backed interventions, longer term calorie restriction takes the cake (sorry for the pun).

 

Even though it is challenging to perform, long term trials with calories restriction in humans, the consensus is clear- some version of calorie restriction helps us live healthier. Calorie restriction increases autophagy, lowers stimulation of key nutrient sensors and growth factors like IGF-1, mtorc1 and AMPK, improves insulin and glucose sensitivity, and more.

 

But who wants to live their life restricting their calories all the time? That is a miserable way to live. Therein lies the power of intermittent fasting. We don’t have the exact methodology down to a science, but it seems that a five day fast 2-3 times per year can have significant health benefits. Now that is something people can do without being miserable!

 

Making Fasting Easy

 

Even then, however, fasting is challenging. Personally, I have a hard time getting past day 3 in a water-only fast and have noticed the same in a number of my Boundless Health Program clients. Then I found the Fasting Mimicking Diet from L-Nutra.

 

They made fasting easy (at least easier)! In brief, for $250 they send you five boxes each with everything you will eat for the day. Day 1 is about 1,000 calories and days 2-5 are around 700 calories. It is a mix of bars, soups, olives, crackers and a glycerin-based drink in addition to a daily vitamin supplement. It is all veggie and nut based, low protein, and fairly palatable as far as processed and packaged “food” goes.

 

And here is the best part. It is backed by research. Valter Longo, one of the world’s leading longevity researchers, happens to be one of the company cofounders.  They have peer-reviewed studies demonstrating decreased IGF-1, improved insulin sensitivity, improved CVD risk factors, and possibly the biggest benefit of all with improved stem cell regeneration.

 

Science backed, convenient, and potential for improved longevity? I was sold and knew I had to try it. Here are some of my take home lessons from the Five-Day Fasting Mimicking Diet.

 

General FMD Takeaways

 

  • Overall I had a positive experience, but I am quick to admit that this isn’t the “best” way to fast. If you can safely do a water only fast for five days, go for it! It’s much cheaper and has all the benefits without any question. Just make sure you are doing it safely, preferably under the guidance of your healthcare provider or experts such as those at IDMProgram.com.
  • You can do your own fasting mimicking diet. I didn’t love how the food was processed, packaged food-like-products. In fact, it freaked out my kids that I was eating packaged food from a box. They have probably never seen me do that before, and they have heard me denounce such fake food for years. You should have seen their faces when I sat down to dinner with my box of “food”! If you have the time and energy, you could likely recreate this program with real food.
  • ProlonMD is the most convenient way to go. Once I got past the processed nature of it, I realized: What could be easier than simply opening the box and knowing exactly what you are eating for the day? No preparing, no planning, no shopping.  This is the biggest benefit to L-Nutra’s program. I loved the convenience. It made it easy to stick with and easy to implement.

 

Day-By-Day Thoughts

 

  • Day one was a breeze. The novelty, the excitement of the experiment, plus 1,000 calories made it easy with minimal hunger or cravings. The bar is tasty (although a little sweet for me), I love the olives, the soups are palatable, and the kale crackers are pretty tasty too.
  • Day two was still pretty easy. The novelty was still there, hunger increased a little but was completely manageable. Since I had started already in ketosis, I found I quickly went deeper into ketosis and noticed improved focus and thinking, and my energy level was still great. Plus, I slept much deeper starting day two.
  • Day three was the toughest. Just as it is for me with water fasts, day three is the big hurdle. But it was a much smaller hurdle since I still had some calorie intake.  The novelty was wearing off at this point and I was tiring of the processed food. Watching my family eat scrambled eggs, veggies and avocado for dinner made me crave real food! I knew for maximal benefit I had to charge through, and thus I was motivated to continue.
  • Day four was pretty easy once again. I was deeper in ketosis, my hunger abated, and I knew the toughest part was behind me.  I even went to the gym and felt pretty good lifting (at about 80% intensity).
  • Day five was again easy during the day, but that evening I was done. It wasn’t that I was overly hungry or tired, I just missed real food! Watching my family eat real veggies, real salmon, real avocado, real nuts… I didn’t want to do it any longer!!! But I only had 12 hours to go so I hung in there.
  • Day six was the refeeding day, and I took it easy and gradual and had no trouble. I did try to go for a mountain bike ride with my usual weekend crew and they kicked my tail feathers! They all thought I was crazy to come out considering my caloric restriction, and they were right. But I am glad I tried, and I’ll be back next week to show them who is boss!

 

Specific Thoughts:

  • We have a complicated relationship with food- The taste, the texture, the enjoyment, the anticipation, and the disappointment are such strong feelings and connect to so many emotions. It’s clear that what we eat is only part of the equation. Why we eat is a much stronger and more difficult issue to understand. I am a big proponent of everyone doing a five day fast or FMD simply for the psychological awareness that results.
  • Our portion sizes are out of control- Really! They are seriously out of control. I pride myself in having already known that and taken steps to make sure my portion sizes are controlled. But eating the tiny portions in the FMD and not being that hungry when I was done brought this in to a whole new light. I have heard it and said it many times. We should eat until we are 80% full and then stop. After doing the FMD, I think we should stop when 60% full. I know that is near impossible to feel and measure, but the point is the same. We need to drastically cut our portion sizes down, get rid of the multiple serving buffet, and understand that we will be just fine with the smaller portions.
  • Hunger is relative- Anyone who practices time restricted eating and short fasts knows that hunger is a feeling we can easily tolerate. Five days of calorie restriction highlights that point even more.  We don’t need to reach for snacks every time we feel a pang of hunger. Rather, we can still perform at high mental levels despite mild hunger.
  • Ketosis is awesome– I have been in ketosis for the better part of a few years, and consistently in ketosis for at least six months, so I went into this experiment thinking I would not get much benefit from the ketosis part of the FMD. But the FMD brought me even further into ketosis, to levels I haven’t achieved on my own. And I felt it. I was hyper-focused, I slept like a baby, and I simply felt sharper.  That has encouraged me to find ways to intermittently go deeper into ketosis to get those benefits on a more regular basis.
  • Athletic performance is better than therapy– The one part that kind of stunk with the calorie restriction was the hit my athletic performance took. The humbling mountain bike ride with my friends was a stark reality check. It was completely expected, but it still hurt. It highlighted for me the psychological importance of feeling great, performing well, and pushing my physical limits. It’s better than therapy. I love it. I thrive off it. And I hate it when I don’t get it. I am now more thankful than ever for my physical abilities, and you can bet I am going to kick @$$ next time I ride with my buddies. They better watch out (I hope they don’t read this)!
  • We can do anything when there is a clear start and stop day– Overall the fasting mimicking diet was not that difficult. That being said, there were definitely a few tough times when I wanted to break it. Knowing that it would only last five days, and I only had to do it 2-3 times per year made it much easier to tolerate. Temporary pain is much easier than pain without an end.

 

Are you interested in Fasting, but are unsure where to start, or want to learn more of the benefits? If so, my free Full Guide to Fasting E-Book is for you!

 

 

This E-Book discusses the benefits of fasting, an overview of different types of fasting, and a guide on how to fast correctly, so that you can see the best results.

Thanks for reading.

Bret Scher, MD FACC

www.LowCarbCardiologist.com

 

 

Does Fasted Cardio increase Fat Burning?

There is a lot of information out there around fasted cardio and fat burning. I’ve personally received a number of questions about whether or not fasted cardio increases fat burning, and I wanted to review the existing literature as well as add my thoughts.

 

Understanding Articles and Studies

 

I recently came by an article on Medium that reviewed recent studies about fasted cardio and concluded that fasted exercise does not reliably increase fat burning. Paradoxically, they did include a review of 27 studies that concluded “there was a significant increase in fat oxidation during a fasted state.” However, all the other studies reviewed concluded the opposite.

 

Their conclusion? “Fasted cardio does not work. At best it delivers results comparable to fed state exercise. At worst, it decreases intensity and performance, lowering total energy expenditure, and resulting in less overall fat loss. Fasted cardio seems to be more effort than it’s worth. It includes a lot of extra work without any added benefits.”

 

Is that true? Should we forget about exercising in a fasted state since it has no benefit?

 

No! The key is understanding who was investigated in those studies and if the results apply to you.

 

To their credit, they start the article by saying, “the body is a complex and dynamic system working on many variables. Simply exercising on an empty stomach may not be enough to increase fat loss.”

 

The Respiratory Quotient

 

That statement I can agree with.  The body is complex and dynamic. In general, the body will use available glucose and glycogen first for energy. If those are in short supply, only then will the body change to fat burning.  We can measure this by the respiratory quotient or RQ (see this video I did with Ken Nicodemus to learn more about cardiorespiratory testing and RQ).

 

If someone is eating a high carbohydrate diet, they are a requisite carbohydrate burner. Simply fasting for 12 hours is inadequate to turn them into a fat burner for a 60-minute exercise.

 

If, however, someone is following a healthy low carb lifestyle and has adapted to becoming a fat burner, then an overnight fast can greatly enhance the fat burning capacity of exercise.

 

The aforementioned studies, therefore, need to control for baseline diet and RQ, as that will greatly affect one’s ability to burn fat.

 

 

Duration of Exercise in a Fasted State

 

Also, duration of exercise matters. Longer exercise durations that deplete glycogen stores can help you transition to fat burning. This can be difficult, however if you have not cycled in and out of fat burning mode before as there is an adjustment period.

 

What’s the take home?

 

Be a fat burner at baseline. The better you burn fat at rest, the better you will burn it with exercise. If you follow a low carb lifestyle with time restricted eating and/or intermittent fasting, then you will train your body to burn fat. Exercising in a fasted state will enhance this capacity.

 

Hello fitness, good bye body fat.

 

Do you exercise in a fasted state? Let us know your experience and how it works for you!

 

Thanks for reading,

 

Bret Scher, MD FACC

www.LowCarbCardiologist.com

5 Reasons We All Should Fast, and 1 Reason Why We Shouldn’t

I wanted to write this article to address a question I hear often:

Do I need to Fast to Be Healthy?

 

In short, probably. But what exactly does that mean?

 

Thanks in large part to Dr. Jason Fung and others, intermittent fasting (IF) has emerged from the shadows of the health movement to now being discussed every day on social media, as if we have been doing it for decades.

 

And here’s the secret: We actually have been doing it for decades. In reality, it’s more like centuries.

 

Think of how we evolved. There wasn’t a convenience store, grocery store, restaurant, or fast food joint on every corner.  We had to hunt and forage for our food. That took time and was sometimes unsuccessful. The natural result, therefore was periods of eating interspersed with periods of fasting.

 

Modern society is a far cry from that evolutionary period, as we now have a 24/7 eating cycle with late night taco runs, vending machines and snacks available at a moment’s notice, and misguided advice that we need to eat every two hours to stimulate our metabolism and lose weight (awful advice with no scientific backing, mostly promoted by snack food companies).  We have plenty of reason to believe this constant eating cycle has contributed to our current obesity/diabetes/insulin resistance epidemic.

 

The good news is that we can reverse that trend. We can reverse it by bringing back fasts.

 

What exactly is fasting?

 

First we need to define what fasting means, and what time restricted eating means. Time Restricted Eating (TRE), means eating only in a specific time window, and not eating the rest of the day. For instance 18:6 means not eating for 18 hours straight, then eating over a 6-hour period. This can be 12:12, 16:8, 18:6 or even 22:2. They key is that you have an extended period of time each day when you are not consuming calories.

 

More extensive fasts, 24-72 hours or even longer, are really what we refer to when we say intermittent fasting. For this explanation, I will refer to extended fasts and TRE together as they have similar benefits. I will explore the differences and go into more scientific detail in a future post.

 

Here are the top 5 reasons we should all fast

 

1.    Fasting is the most efficient way to lose weight.

Forget the fat burning foods, forget the cleanses and detoxes. Not eating is the key to losing weight. But do it intermittently. That’s why it’s called intermittent fasting. Chronic calorie restriction doesn’t work long term since it forces our bodies to reduce our resting metabolic rate (RMR), thus stalling weight loss and increasing frustration. Intermittent calorie restriction, on the other hand, allows for weight loss without changing our RMR, the key to healthy and successful long-term weight loss.

 

2.    IF is a great way to lower insulin.

It just makes sense. If there is no food coming in, there is no need for insulin to rise. Insulin will stay at its low steady basal rate, and there will be no elevations or spikes. That keeps the area under the curve low, right where we want it. Low insulin means we can mobilize our fat stores, and possibly more importantly, it protects us from the harmful long-term effects of hyperinsulinemia.

 

3.    Intermittent Fasting is the key to longevity.

The one consistent finding in longevity research, from single cell organisms up to primates, is that calorie restriction works. But as we have learned from chronic calorie restriction experiments in humans, it’s not so clear cut. First, its miserable and most people would rather die younger that live longer with chronic calorie restriction. Agree?

Second, our bodies adapt to chronic calorie restriction and thus make it difficult to maintain the health benefits. Intermittent calorie restriction, on the other hand, has the promise of all the longevity benefits without all the baggage that comes with it. The fountain of youth only helps if we like how it tastes.

 

4.    It’s easy!

What’s easier than skipping breakfast? No planning, no shopping, no cooking, no cleaning. Simply walk out the door.  In our hectic everyday lives, we should welcome anything that takes less time and makes our lives a little easier. Fasting does exactly that. Just make sure you bring a water bottle with you wherever you go, and maybe some sea salt to put in your water. Stay well hydrated and enjoy the simplicity.

 

5.    There are many ways to make fasting work for you.

 There is more than one way to have a successful fast. As mentioned previously, 18:6 can work wonders for most people. For those who are more adventurous, a 72-hour water fast can have amazing results. And there is everything in between. Just follow the simple rules of staying hydrated, paying attention to how you feel, avoiding anything with calories, and even avoiding calorie-free sweeteners. The rest of the details can be individualized to fit your life and your goals.

 

The Top Reason Why You shouldn’t fast

 

Fasting can work wonders for most people, but it can also be dangerous for others. If you take medications for diabetes, hypertension or other medical conditions and you’re trying to fast on your own, don’t do it! Fasting can cause significant harm in these circumstances if not done with proper precaution. That doesn’t mean it can’t be done. In fact, it can still be incredibly beneficial. Just make sure you are working with an experienced clinician who can help coach you through it safely.

 

Here’s one last bonus tip.

 

Don’t give in to temptation once the fast is over.

 

How you break your fast can be just as important as how you fast.

 

  1. Break the fast with a small low carb snack such as bone broth
  2. Have your first meal an hour or two after your snack
  3. Resist the urge to “reward” yourself with high carb foods or junk food. Your gastrointestinal system isn’t ready for that. Plus, why work so hard to keep insulin low if you are just going to spike it when you are done? Stick to your usual, healthy, high quality low-carb fare.
  4. Resist the urge to increase your calorie intake to “make up” for the fast. If anything, the first 12 hours should have fewer calories than your usual eating pattern, slowly returning to normal (not supra-normal) over the next 24 hours.

 

Pretty easy, right? I am a big fan of simple, safe and effective. When done right, intermittent fasting hits all three criteria.

 

Is intermittent fasting right for you? It may just be.

If you are interested in Fasting, but are unsure where to start, or want to learn more of the benefits, my free Full Guide to Fasting E-Book is for you!

 

 

This E-Book discusses the benefits of fasting, an overview of different types of fasting, and a guide on how to fast correctly, so that you can see the best results.

Thanks for reading,

Bret Scher, MD FACC

Founder, Boundless Health

www.LowCarbCardiologist.com

 

 

 

Bret Scher, MD FACC

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