Fasting - A History Dr Jason Fung

Part 11 of the fasting series now posted - Feast and Fast:

https://intensivedietarymanagement.com/feasts-and-fasts-the-cycle-of-life-fasting-part-11/

A brief guide to intermittent fasting:
http://authoritynutrition.com/intermittent-fasting-guide/

Dr Fung has posted Part 12 of his fasting series - Practical Tips for Fasting:
https://intensivedietarymanagement.com/practical-fasting-tips-part-12/

Indy51 wrote:Dr Fung has posted Part 12 of his fasting series - Practical Tips for Fasting:
https://intensivedietarymanagement.com/practical-fasting-tips-part-12/

Thanks Indy - I know many do find these videos a great help and resource

All the best Jan

I posted this on another forum in a thread on how we're going with managing diabetes longer term, so thought I'd add it as an update here as well:

I had my 3 year anniversary of diagnosis in March and 3 years following a LCHF diet in June. Still getting good A1c results and all other tests showing no complications. I'm overdue for an eye test, but haven't noticed any obvious deterioration since the last one 1.5 years or so ago.

Although there was no obvious carb creep as it was still in the 60g/day range whenever I checked, I did let my portion size get a bit out of hand and weight crept up to around 67kgs and despite the low carbing, I had never managed to normalise my fasting BG which could range from low 6's to high 7's. My liver dumps would also push me into high 7's/low 8's which was also concerning.

After watching a number of lectures/interviews with Prof Taylor, I figured I had never reached the personal visceral (pancreas/liver) fat threshold he talks about despite substantial weight loss when first diagnosed. I'd also never reached the 80cm recommended waist measurement.

Problem was, I never fancied the meal replacement Newcastle protocol because I thought the processed ingredients wouldn't do much for my touchy digestion and doubted sticking to something so severe for the length of time involved.

I also watched all of the Dr Jason Fung videos and read his blog posts about fasting and decided it was time to buckle down and try very hard to get my weight lower than it had been when I dieted after initial diagnosis.

So, back in March I started an intermittent fasting/compressed eating window regime of 16/8 hrs per day. I eat breakfast, eat my main meal around 2pm, sometimes have a mid-late morning snack if Í'm hungry, but try to never eat after 3pm till the following day - I've probably broken that routine maybe 5 times in the 144 days of following the regime. Still average between 30g to 60g of carbs a day, with rare days above that and I doubt I've ever gone over 100g in the 3 years of following LCHF. I've also gone back to keeping a food diary, weighing myself daily and counting calories and macronutrients. As tedious as that routine is, it does wonders for consistency and accountability. Most days I try to keep under 1500 cals, with occasional splurge days up to 2100 cals.

It took a while, but all my BG levels improved and my weight reduced. Once my weight got lower than it had been at my lowest weight since diagnosis (around 61kg) and waist measurement of 80cm, my fasting BG finally normalised. I very rarely get fasting above 6 now - usually anywhere from 4.9 to 5.9. So I assume I've finally managed to reach the 30% reduction of liver fat that Prof Taylor seems to think is the magic visceral fat loss for normalisation of fasting BG.

Because I was still having issues with spiking after meals even on low carb, I figured I must not have yet achieved the reduction of pancreatic fat that Prof Taylor says should occur around the 15% loss of body weight. So, I decided to continue with the IF regime for the forseeable future - apart from anything else, the experiment brought home to me just how little food is involved to reach the 1500 calories (or even 2000 for that matter) that make maintaining the weight loss feasible.

As of today, I've gone from 66.6 kgs in March to 58.6 kgs, my lowest weight since I don't know when. An overall loss of 8 kgs since March, but 20 kgs since diagnosis (78.6 kgs). Which is a percentage loss of around 25%!

BMI on diagnosis = 30.2
BMI in March = 25.6
Current BMI = 22.5

I'm guessing my personal fat threshold is at the very low end of normal BMI, so it's going to take discipline to stay that low - interestingly enough, for the first time in my life I'm around the same weight as my non-diabetic older sister so I'd say there's a strong genetic factor involved.

I don't ever plan on increasing carbs as I see that would be a quick and easy way to regain weight and undo all the good. I certainly don't care if I'm "cured" or not, but I very much doubt it. As long as I can keep non diabetic BG levels most of the time, I'll be happy.

Really looking forward to my next A1c to see if the intermittent fasting regime and consistently lower BG levels have an impact  

Indy51 wrote:I posted this on another forum in a thread on how we're going with managing diabetes longer term, so thought I'd add it as an update here as well:

I had my 3 year anniversary of diagnosis in March and 3 years following a LCHF diet in June. Still getting good A1c results and all other tests showing no complications. I'm overdue for an eye test, but haven't noticed any obvious deterioration since the last one 1.5 years or so ago.

Although there was no obvious carb creep as it was still in the 60g/day range whenever I checked, I did let my portion size get a bit out of hand and weight crept up to around 67kgs and despite the low carbing, I had never managed to normalise my fasting BG which could range from low 6's to high 7's. My liver dumps would also push me into high 7's/low 8's which was also concerning.

After watching a number of lectures/interviews with Prof Taylor, I figured I had never reached the personal visceral (pancreas/liver) fat threshold he talks about despite substantial weight loss when first diagnosed. I'd also never reached the 80cm recommended waist measurement.

Problem was, I never fancied the meal replacement Newcastle protocol because I thought the processed ingredients wouldn't do much for my touchy digestion and doubted sticking to something so severe for the length of time involved.

I also watched all of the Dr Jason Fung videos and read his blog posts about fasting and decided it was time to buckle down and try very hard to get my weight lower than it had been when I dieted after initial diagnosis.

So, back in March I started an intermittent fasting/compressed eating window regime of 16/8 hrs per day. I eat breakfast, eat my main meal around 2pm, sometimes have a mid-late morning snack if Í'm hungry, but try to never eat after 3pm till the following day - I've probably broken that routine maybe 5 times in the 144 days of following the regime. Still average between 30g to 60g of carbs a day, with rare days above that and I doubt I've ever gone over 100g in the 3 years of following LCHF. I've also gone back to keeping a food diary, weighing myself daily and counting calories and macronutrients. As tedious as that routine is, it does wonders for consistency and accountability. Most days I try to keep under 1500 cals, with occasional splurge days up to 2100 cals.

It took a while, but all my BG levels improved and my weight reduced. Once my weight got lower than it had been at my lowest weight since diagnosis (around 61kg) and waist measurement of 80cm, my fasting BG finally normalised. I very rarely get fasting above 6 now - usually anywhere from 4.9 to 5.9. So I assume I've finally managed to reach the 30% reduction of liver fat that Prof Taylor seems to think is the magic visceral fat loss for normalisation of fasting BG.

Because I was still having issues with spiking after meals even on low carb, I figured I must not have yet achieved the reduction of pancreatic fat that Prof Taylor says should occur around the 15% loss of body weight. So, I decided to continue with the IF regime for the forseeable future - apart from anything else, the experiment brought home to me just how little food is involved to reach the 1500 calories (or even 2000 for that matter) that make maintaining the weight loss feasible.

As of today, I've gone from 66.6 kgs in March to 58.6 kgs, my lowest weight since I don't know when. An overall loss of 8 kgs since March, but 20 kgs since diagnosis (78.6 kgs). Which is a percentage loss of around 25%!

BMI on diagnosis = 30.2
BMI in March = 25.6
Current BMI = 22.5

I'm guessing my personal fat threshold is at the very low end of normal BMI, so it's going to take discipline to stay that low - interestingly enough, for the first time in my life I'm around the same weight as my non-diabetic older sister so I'd say there's a strong genetic factor involved.

I don't ever plan on increasing carbs as I see that would be a quick and easy way to regain weight and undo all the good. I certainly don't care if I'm "cured" or not, but I very much doubt it. As long as I can keep non diabetic BG levels most of the time, I'll be happy.

Really looking forward to my next A1c to see if the intermittent fasting regime and consistently lower BG levels have an impact  

Brilliant weight loss Jill that should have improved the IR which is apparent from your fasting levels, that and your better BG levels should ensure a decent A1c

I agree about not being cured you may have gone into remission but reverting to a higher carb intake could undo all your hard work, I've noticed many of those who have used the Newcastle diet follow it up with LCHF which I think is a sensible option, to me ND is a short term fix not a cure.

This is so good to read Jill ('Indy') and well done on the weight loss.  

Reading other blogs / forums I think many may also agree with you when you say " I've also gone back to keeping a food diary, weighing myself daily and counting calories and macronutrients. As tedious as that routine is, it does wonders for consistency and accountability "

Thanks for sharing.

All the best Jan

Well done Jill you are certainly strong willed and dedicated. You know I am not a fan of fasting, but as you have proved, together with Dr.Jason Fung, it is great tool in the box for some people and works very well. Thinking about your post as I type this, I have to admit I do eat when I am not hungry, just out of habit at times. Like it's breakfast time so it's time for breakfast, or what are we having for dinner because it's dinner time. We only eat two meals a day, very rarely any snacks what have you mid day. I suppose the bottom line for us lucky people is we have never been truly hungry in our lives when you think about it. Maybe that's played a part, but only a part, of the reasons some of us became type two diabetics.

Anyway, very well done and thank you for your ongoing loyalty and support.

The latest in Dr Fung's fasting series now posted: Part 14, The Fasting Advantage:

https://intensivedietarymanagement.com/the-fasting-advantage-part-14/

I never deliberately fasted, but on the low fat diet I HAD to eat every couple of hours or so.

Now I routinely go 6 - 8 hours and sometimes longer without any need to eat. So my body is fasting for me <G> this suggests deliberately emulating what a healthy body does naturally is probably a good plan. It seems to be working for you and I've seen it work for others.

How are your ketones? I use the Mk 1 nose and reckon if my pee niffs of ketones first thing in the morning but not during the rest of the day then I'm probably generating them at the same rate I'm using them.

I'm not regularly testing ketones (peeing on ketostix never appealed, blood strips are too expensive and I'm not interested enough to fork out for a Ketonix) but when I did, I usually found them to be higher at night. I'm pretty sure I've got at least trace ketones most days, because I rarely go above 60g carbs. But it's not something I've really been that fussed about tracking. My Fasting BG has always been my biggest concern and it reacts quite strongly the next day if I push the carbs too hard.

I recently tried an experiment of eating two mini choc bars about 45 minutes before my main meal to prime the insulin - it worked really well to push my post prandial level lower/quicker, but the next day my fasting level suffered. So back to the usual routine.

Try just the one, I've had some success with a SMALL carb preload before eating out, or Christmas dinner, just enough to get the insulin running before the main meal. Then if I walk IMMEDIATELY after eating it will knock back a spike quite drastically.

I suspect tricking your system like that other than occasionally is probably not a good long term plan though.

I don't agree with his last post than fasting is superior to LCHF, low calories diets(that is what he is doing) have a abysmal historic record of failure. In diabetes you need a long term plan that works an that is LCHF. Also not everything is about insulin resistance I have read many comments of people struggling with his regimen that are probably insulin deficient. First you need to checks your fasting insulin and C-peptide levels to understand whether you are still producing enough insulin or your pancreas is already burned out(most diabetics have some, there are people with insulin resistance that never develop diabetes and obese that aren't insulin resistant). There is a HOMA formula will estimate how much insulin resistance you have and pancreas function % working.

If you don’t have access to these tests another option is to test your ketones and blood glucose levels to establish the ratio of glucose to ketones, which can also help you estimate your insulin levels. High insulin and high blood glucose means that you are insulin resistant . Low insulin and high blood glucose means that you are insulin deficient and your pancreas is not producing enough insulin. Fasting can be a short term hack that can help some lose weight and temporarily improve your numbers but it is not a long term solution to diabetes and can have negative long term effects.

I only believe in a way of eating that can be comfortably maintained over time ie passes the test of time. I have reached a stage where I can do all my eating in a 8 hour time frame and then go 16 hours without any more food. So far the results seem good, weight, BG, cramping, oedema, BP. I realise that it may be easier now, during the hot summer months. Still need to hurdle the "cold" winter period.

If you can get a full lipid panel, trigs/HDL ratio is a good estimation of insunlin resistance. In UK numbers below about 1.3 is good, 1.4 upwards shows increasing IR.

Mine was 7, now around 1.

Agree that fasting isn't a long term solution but may help in the short term, there's nothing as sustainable as LCHF. For no paticular reason I believe that keeping my metabolism on its toes is good, some days I'll go 9 - 10 hours between breakfast and a big meal, other days I may have two or three small meals.

There is lots of research on how badly physically and mentally people can get ruined from starving. The potential draw backs are many and well know from thyroid problems, lost of muscle mass, electrolyte imbalances even resulting in dead, very high blood sugars resulting in ketoacidosis(if low insulin producing pancreas) and even you can become even fatter due to changes in metabolism to store more fat and less lean tissues, etc.. . It should not be taken lightly.

chris c wrote:If you can get a full lipid panel, trigs/HDL ratio is a good estimation of insunlin resistance. In UK numbers below about 1.3 is good, 1.4 upwards shows increasing IR.

Mine was 7, now around 1.

Agree that fasting isn't a long term solution but may help in the short term, there's nothing as sustainable as LCHF. For no paticular reason I believe that keeping my metabolism on its toes is good, some days I'll go 9 - 10 hours between breakfast and a big meal, other days I may have two or three small meals.

My last trigs/HDL ratio was 0.622, but as now my surgery only test for HDL and TC I wont be able to calculate that anymore can only go for HDL/TC ratio.

Good cholesterol ratios calculator here: http://www.hughcalc.org/chol-si.php

yoly wrote:There is lots of research on how badly physically and mentally people can get ruined from starving. The potential draw backs are many and well know from thyroid problems, lost of muscle mass, electrolyte imbalances even resulting in dead, very high blood sugars resulting in ketoacidosis(if low insulin producing pancreas) and even you can become even fatter due to changes in metabolism to store more fat and less lean tissues, etc.. . It should not be taken lightly.

Yes, but the intermittent fasting regimes Dr Fung and many others (like Brad Pilon and Michael Mosley etc) are talking about are not the same thing as starvation diets. You're comparing apples and oranges.

They are also not the same thing as long term calorie restriction like the Keys and other starvation studies. You can do intermittent fasting without calorie restriction - eating the same amount of calories in a compressed eating window.

Indy51 wrote:

yoly wrote:There is lots of research on how badly physically and mentally people can get ruined from starving. The potential draw backs are many and well know from thyroid problems, lost of muscle mass, electrolyte imbalances even resulting in dead, very high blood sugars resulting in ketoacidosis(if low insulin producing pancreas) and even you can become even fatter due to changes in metabolism to store more fat and less lean tissues, etc.. . It should not be taken lightly.

Yes, but the intermittent fasting regimes Dr Fung and many others (like Brad Pilon and Michael Mosley etc) are talking about are not the same thing as starvation diets. You're comparing apples and oranges.

They are also not the same thing as long term calorie restriction like the Keys and other starvation studies. You can do intermittent fasting without calorie restriction - eating the same amount of calories in a compressed eating window.

It's a gimmick but the effects are the same, you are eating a restricted low calorie diet. The gurus can fool people that it is something radically different but the effects and results are the same. Is not a panacea and should be use modestly and with medical supervision if you health permits. Indy51 I am not against any regimen if it's working for you fantastic. What I don't like is the hype and the guru type culture that mislead people giving false hope on believing on "cures", "reversing" easy solution with a wrong interpretation of the science on diabetes and is causes. Calorie restriction can have its benefits but is not without risks and is hard long term on the body if isn't done with care. I don't think that Fung is careful enough in making people aware of the risks and he has a very limited understanding of diabetes with a very narrow focus on the science, it is not his speciality he is a nephrologist.

I want to clarify I have investigated and have keep up to date about fasting a longtime back well before Fung posted his videos. I was in the forum of CRON Calorie Restriction with Optimal Nutrition many years ago. I have followed the research of Frontera, Longo, Varady on fasting and alternate intermittent fasting as way of affecting aging and the diseases of aging. I am very familiar with the real positives and possible drawbacks of fasting. I have seen the long term results of people trying to incorporate many variations of this type of regimen and what it can result in. Also have investigated most of the research on low calories diets as a treatment for weight lost and diseases like diabetes. I am not trying to discourage anyone from trying fasting as an alternative for better health, just be conscious of what you are doing, be sure you are getting optimal nutrition and beware of any the potential side effects that may take a long time to manifest.

yoly, could you share with us what the "possible drawbacks" and "long term results" of fasting are/might be? My husband, following my encouragement, so I feel responsible, has just started doing 16/8 fasting for three or four days each week. Basically he skips breakfast, but has a highly nutritious lunch and dinner. Or are you talking about the really hard core stuff - water only for days at a time?
Sally

graham64 wrote:
My last trigs/HDL ratio was 0.622, but as now my surgery only test for HDL and TC I wont be able to calculate that anymore can only go for HDL/TC ratio.

Good cholesterol ratios calculator here: http://www.hughcalc.org/chol-si.php

Annoying isn't it? It's obviously to save money, and also I suspect they assume you'll have high trigs because everyone on a low fat diet does.

We used to get MEASURED LDL which was interesting as mine fell midway between the standard Friedenwald and the Iranian equation which is more accurate with low trigs.

http://homepages.slingshot.co.nz/~geoff36/LDL_mmol.htm

They changed labs and now LDL is calculated. The nurse was adamant I could no longer have ANY lipid test because I was on a statin. The GP has more sense IF you can ever get to see her.

Mind, they do test trigs in some places, I recall a patient being told unless she agreed to eat a high carb diet she would no longer be treated "and we can tell if you're complying because your trigs will go up"


another words fail me moment

Sally wrote:yoly, could you share with us what the "possible drawbacks" and "long term results" of fasting are/might be?  My husband, following my encouragement, so I feel responsible, has just started doing 16/8 fasting for three or four days each week.  Basically he skips breakfast, but has a highly nutritious lunch and dinner.  Or are you talking about the really hard core stuff - water only for days at a time?
Sally

It all depend on many factors so I can't comment on anyone in particular but the more extreme the regimen the more possibilities for negative side effects. The human metabolism is complex, more so if you have diabetes there are many contra regulatory mechanism operating and not everyone will respond the same to fasting. I really don't want to comment much more on this I have mention a few in a previous post and I don't want to be too negative I just wanted make everyone aware of the potential side effects so no one take a cavalier approach to their health so I will just mention some briefly. First it will do physical and mental harm on people with obsessive-compulsive tendencies you can see a lots of these in comments on people doing this type of regimens they try to do it longer, harder trying to achieve perfection without regard to health. Some factors such as heat, heavy exertion and compromised health can make fasting lethal in just a few hours. There are also many short-term side effects of fasting. Some can develop headaches, dizziness, lightheadedness, fatigue, low blood pressure and abnormal heart rhythms. You can have an impaired ability to conduct certain tasks, such as operate machinery or drive a vehicle. Fasting could also cause flare ups of certain conditions such as gout or gallstones. Some possible long term side effects are can damage the immune system, it can also negatively affect many of the body's organs, including the liver and kidneys. Fasting could interfere with vital bodily function. It could also create potentially dangerous nutrients deficiencies in some individuals.

There will always be people who take things to extremes - that's just human nature. Every topic can't be approached from the standpoint of whether or not someone will go overboard with it.

There are also new studies coming out about specific advantages of intermittent fasting (especially the 8-10 compressed eating window version) for encouraging a healthy microbiome. It's an evolving field of study and like everything else in life, will not be suitable for everyone. The caveat emptor principle applies to everything in life.

Thanks for replying, Yoly. I must admit I'm tending to agree with Indy on this one: there will always be some people who will take things too far, do things in silly ways at the wrong time. Just like alcohol. I think we all need to try and bring a bit of intelligence to things we do, times not to fast may be if pregnant, about climb Everest, fly a 747 half way round the globe …… We also need to consider other aspects of our own health and drugs, do these rely in some way on a very regular food intake? But for most of us overfed, over weight people, skipping the occasional meal is surely not going to send us to an early grave and it might just help us keep going a little longer.
Sally