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To prevent the body from adapting to the new weight-loss strategy and maintain weight loss requires an intermittent strategy, not a constant one. This is a crucial distinction. Restricting some foods all the time differs from restricting all foods some of the time. This is the difference between failure and success.
But studies of intermittent fasting show that cortisol levels are generally unaffected. Two weeks of intermittent fasting caused no increase in cortisol levels, and even a seventy-two-hour fast failed to raise cortisol levels significantly.
Changing either your fasting regimen or diet, 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 try eating only once a day, every day. Others try a continuous fast for an entire week. Any of these can be effective; the key is simply to change the fasting protocol.
In addition, insulin levels have an inverse correlation to memory—that is, the lower the insulin level, the more memory improves.
Figure 7.1. The multiple beneficial effects of fasting on various parts of the body. Source: Longo and Mattson, “Fasting: Molecular Mechanisms and Clinical Applications.”
For people with chronic inflammatory and/or neurological conditions, fasting can help accelerate autophagy and the body’s clearing-out of old, damaged tissue. The body engages in “housecleaning” all the time, but when it gets a break from the constant digestion of large amounts of food, it may be able to focus more energy on repair and restoration.
Autophagy also plays an important role in the prevention of Alzheimer’s disease. Alzheimer’s is characterized by the abnormal accumulation of amyloid beta (Aß) proteins in the brain, and it’s believed that these accumulations eventually destroy the synaptic connections in the memory and cognition areas.
Fasting can limit growth of glucose-dependent tumors. Fasting can also target inflammation that contributes to the initiation and progression of tumors. We showed that fasting or calorie restriction could significantly reduce distal tumor invasion in our preclinical models of brain cancer.
So why does fasting affect the liver’s production of cholesterol? As dietary carbohydrates decline, the liver decreases its synthesis of triglycerides—since excess carbohydrates are converted to triglycerides, the absence of carbohydrates means fewer triglycerides. Remember that triglycerides are released from the liver as VLDL, which is the precursor of LDL. Therefore, reduced VLDL eventually results in lowered LDL.
Overall, fasting produces significant improvements in multiple cardiac risk factors.
However, following some simple rules will make hunger much easier to handle. First, as mentioned above, artificial sweeteners can kick off the cephalic phase response, triggering hunger and insulin production, so I recommend avoiding them during a fast. There are certainly people who feel that adding sweeteners to their coffee helps them lose weight by increasing compliance with their fast, and if it works for you, great. But my best advice is to try to fast without the use of sweeteners. If you cannot do that, then try adding a small amount. However, if it makes fasting harder or prevents you
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I have reversed my insulin resistance with a fasting protocol of 18-hour fasts for 5 days followed by 2 days water-only fasting. I also water-only fast for 10–18 consecutive days every other month. After day 3, all hunger diminishes, ketones soar, and that’s when I feel invincible! I feel better at 51 than I ever felt at 21!
When people feel they cannot go beyond twenty-four hours of fasting, we sometimes advise them to try three to seven full days of fasting. This sounds completely counterintuitive. If you can’t go one day, how can you go seven days? This “hack” works because the extended fasting gives people the chance to experience how hunger can disappear without eating as the body learns how to metabolize its own fat. The long fast rapidly acclimates their bodies to fasting. Once they get over the first one or two days, hunger starts to disappear and they become reassured that they are not overwhelmed by
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It comes down to the fact that hunger is not determined by not eating for a certain period of time. Rather, it is a hormonal signal. It does not come about simply because the stomach is empty. When you avoid natural stimuli to hunger, such as the sight and smell of food, as well as the conditioned stimuli to hunger—specific mealtimes, movies, ball games, any event where you normally eat and have learned to expect food—you help avoid that hormonal signal. Fasting helps to break all the conditioned stimuli and thus helps to reduce, not enhance, hunger.
Others should be cautious when fasting but don’t necessarily need to avoid it. In the following situations, it is wise to seek the advice of a health-care professional before attempting therapeutic fasting: You have gout You are taking medications You have type 1 or type 2 diabetes You have gastroesophageal reflux disease
When body fat falls below 4 percent, the body is forced to use protein in order to feed itself.
One well-accepted definition of underweight is a BMI of less than 18.5. For a man who stands five-foot-ten, that would correspond to a weight of 129 pounds. I generally advise against any type of fasting at a BMI below 20, as the risk of complications rises dramatically, but it’s especially important to avoid longer fasts.
Most definitions of fasting allow noncaloric drinks only. This means that water, tea, and black coffee are all allowed during fasting, but sugar, honey, fructose, agave nectar, and other sugars are prohibited.
“Green” juice fasting has recently surged in popularity. As you might guess from the name, this involves juicing green leafy vegetables, like spinach and kale. The resulting juice contains far less sugar than the juice of sweet fruits like oranges and apples. In addition, leafy vegetables contain little actual juice, so the leaves are often ground up and blended with the juice, which provides fiber and nutrients. Celery is often juiced in this mixture, too.
The popularity of “bulletproof coffee” has helped this trend. To make coffee “bulletproof,” you add fat in the form of coconut oil, medium-chain triglycerides (MCT oil), or butter from grass-fed cows. The high fat content of the coffee gives this drink a substantial number of calories (400 to 500 per cup, depending upon the recipe), so this would be more accurately termed a meal replacement. However, virtually all of the calories are
There are a number of purported benefits to the fat fast. Some claim that it helps weight loss as part of a ketogenic or very low carbohydrate diet, in which the body burns fat for energy.
To me, it is far simpler to follow five days of regular fasting per month.
All types of fasts can have therapeutic benefit. The key to therapy is prolonged therapeutic ketosis (blood ketones in the range of 3–6mM), together with reduced blood glucose levels (3–4 mM). Patients will need to use the Precision Xtra meter from Abbott to determine when they can enter the therapeutic zone. GKI ratios of 1.0 or below would best represent the therapeutic range.
I’ve lost over 50 pounds (went from 215 to 165) and maintained it. As a matter of routine, I eat LCHF and intermittent fast for a minimum of 18 hours, and I do a water-only fast for 2 to 3 days a week. I can’t say I enjoy the water-only fasts, but there’s no denying that they’ve helped me break through weight-loss plateaus. I find keeping busy is the best way to get through a water-only fast.
Water Be sure to stay well hydrated throughout your fast. Water, both still and sparkling, is always a good choice. Aim to drink two liters of water and other fluids daily. As a good practice, start every day with eight ounces of cool water to ensure adequate hydration. Add a squeeze of lemon or lime to flavor the water, if you wish. Alternatively, you can add orange slices, berries, or cucumber slices to a pitcher of water for an infusion of flavor. Diluted apple-cider vinegar in water may help lower your blood sugar. However, artificial flavors and sweeteners are prohibited.
Tea All types of tea are excellent choices, including green, black, oolong, and herbal. Green tea is an especially good choice during a fast: the catechins in green tea are believed to help suppress appetite. Teas can be blended together for variety and can be enjoyed hot or cold. Spices such as cinnamon or nutmeg add flavor. Herbal teas are not true teas because they do not contain tea leaves. However, they also are great for fasting. Cinnamon tea and ginger tea have both been used for their reputed appetite-suppressing power. Mint tea and chamomile tea are often used for their soothing
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Adding a small amount of cream or milk to your tea is acceptable
We often advise patients to go back to a classic water-only fast if they hit a stubborn weight plateau.
Coffee Coffee, both caffeinated and decaffeinated, is permitted during a fast. We also permit a small amount of cream or coconut oil to be added to coffee or tea. While this does technically mean it’s not a true fast, the effect is small enough that it seems to make no difference to the overall outcome of the fast. Furthermore, this flexibility may improve your ability to stick to the program. By “small amount,” we mean 1 to 2 teaspoons of cream or coconut oil—nowhere near the copious amounts of fat used in bulletproof coffee.
Coffee has many health benefits that are just being recognized—for instance, it may reduce the risk of type 2 diabetes and is a great source of antioxidants.
Vegetable broth is a suitable alternative, although bone broth contains more nutrients. All vegetables, herbs, and spices are great additions to bone broth, but do not add bouillon cubes, which are full of artificial flavors and monosodium glutamate.
We often advise people to add a good pinch of sea salt to their homemade bone broth. During longer fasts, it is possible to become deficient in salt since it is not taken with water, tea, or coffee, and salt deficiency can lead to dehydration. Sea salt also contains other trace minerals, such as potassium and magnesium, which may be particularly beneficial during fasting. (For shorter fasts, such as the twenty-four- and thirty-six-hour variety, it probably makes little difference.)
But many people have found that the broth makes a longer-duration fast much more bearable.
The term intermittent fasting simply means that periods of fasting occur regularly between periods of normal eating. How long each period of fasting lasts, and how long the period of normal eating lasts, can vary widely.
Fasts can range from twelve hours to three months or more. You can fast once a week or once a month or once a year. Shorter fasts are generally done more frequently, even daily, while longer fasts—twenty-four to thirty-six hours is the most common duration—are usually done two to three times per week. Prolonged fasting may range from one week to one month.
In the IDM Program, shorter regimens are generally used by those mostly interested in weight loss rather than in treating type 2 diabetes, fatty liver disease, or other metabolic diseases.
16-Hour Fasts This regimen incorporates a sixteen-hour period of fasting into your daily meal schedule. For example, you might fast from 7 p.m. to 11 a.m. daily. You could also say that you have an eight-hour eating window every day. For that reason, it is sometimes called time-restricted eating. On this schedule, most people skip the morning meal every day. But how many meals you eat within that eight-hour window is your choice. Some people choose to eat two meals during that window and others eat three.
The daily sixteen-hour fast certainly has more power than the daily twelve-hour fast, but it should be combined with a low-carbohydrate diet for the best effect.
20-Hour Fasts: “The Warrior Diet” In his 2002 book The Warrior Diet, Ori Hofmekler stresses that the timing of meals matters almost as much as their composition—as I discussed earlier, both the “when to eat” and “what to eat” questions are important, but “when” is seriously underappreciated. Hofmekler, drawing upon inspiration from ancient warrior tribes such as the Spartans and Romans, devised a “warrior diet” in which all meals are eaten in the evening during a four-hour window. This results in a twenty-hour fasting period each day. Hofmekler’s diet also emphasizes natural, unprocessed foods
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Ghrelin, the hunger hormone, rises and falls in a natural circadian rhythm, with a low at 8:00 a.m. and a high at 8:00 p.m. Correspondingly, hunger typically falls to its lowest level at 7:50 a.m. and peaks at 7:50 p.m. These are natural rhythms inherent in our genetic makeup.
So the optimal strategy seems to be eating the largest meal in the midday, sometime between noon and 3:00 p.m., and only a small amount in the evening hours.
However, I always monitor patients’ blood pressure, vital signs, and blood work very closely. I cannot stress enough that if you do not feel well at any point, you must stop fasting. You can be hungry, but you should not feel sick.
During longer fasts, the reduced intake of food often lowers blood glucose. If you take the same dose of medication as you would on a normal eating day, there is a high risk of becoming hypoglycemic, which is very dangerous. Symptoms of hypoglycemia include confusion, sweating, and tremors. You may also experience a feeling of hunger, shakiness, or weakness. Left untreated, it may advance to loss of consciousness, seizures, and, in extreme cases, death.
24-Hour Fasts A twenty-four-hour fast involves fasting from dinner to dinner, or breakfast to breakfast, whatever you prefer. For example, if you finish dinner at 7 p.m. on day 1, you would then fast until having dinner at 7 p.m. on day 2. Despite the name, you do not actually go a full day without eating, since you are still taking one meal on the fasting day. In essence, you are eating a single meal for that day.
You could follow this regimen daily, although most will get good results doing a twenty-four-hour fast two to three times per week.
Eat, Stop, Eat, recommends using a twenty-four-hour fast twice a week.
Three 24-hour fasts spread throughout the week works for me. It’s actually not a big deal merely missing a meal or two. And I know that most of the fast happens when I am sleeping. I eat my meal in the evening on the fast day and it’s interesting to note that I enjoy it so much more because I am properly hungry—just as nature intended.
I would have them try 24-, 36-, and 48-hour fasts. Probably not much longer than that, but probably with some frequency (2 days every week or every 2 weeks, for 6 weeks, and then rest). As long as they were exercising and performing substantial movement throughout the day, they would be burning fat, utilizing ketones, and possibly even building muscle.
36-Hour Fasts In a thirty-six-hour fast, you do not eat for one entire day. For example, if you finish dinner at 7 p.m. on day 1, your fast would begin immediately after— you skip all meals on day 2 and not eat again until breakfast at 7 a.m. on day 3. That totals thirty-six hours of fasting. In our IDM Program, we use thirty-six-hour fasts, on a three-times-a-week schedule, with patients who have type 2 diabetes. We continue this schedule until the desired results are achieved: the patient is able to go off of all diabetes medication and has reached the desired weight.
Most of my patients feel best when they start with a longer fast of 2–4 days to get their gastrointestinal symptoms under control. Then they can periodically fast for a half day or full day as needed for maintenance, maybe once a week or a few times a week.
