The Bottom Line on Fasting

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In the past four Memos, I’ve focused on explaining fasting. The questions I left you with on Saturday were: “Is it worth it to fast? Is it effective? Is there science to support it?” The answer to all three is yes. I think it can be summed up in one quote from the reference.

“In response to starvation, mammalian cells enter either a non-dividing or a low-dividing state and invest energy resources in cellular protection against various insults.”

While the statement is complicated, it means that metabolism is decreased. That allows the body to shift energy sources from glucose to fat metabolites such as ketones. The body focuses on reducing the production of proteins that can be destructive, such as inflammatory hormones, thereby protecting cells. It also helps improve the immune system so it functions better. The stress of reducing food intake in a controlled fashion helps cells function better.

The research review is available for free; it goes into more detail but demonstrates that fasting is beneficial when used properly. The bulk of the research is on the two- to-five-day fast with fewer than 1,000 calories on the fast day; I’ll use a two-day version before my knee replacement next week to help my body prepare. Just be sure to check with your physician before you fast if you have any metabolic issues such as diabetes or if you take medications, both of which can be impacted by restricting food.

Wednesday is the final scheduled Insider call of 2021. This may be the time to join to help you achieve your health goals in 2022. Hope to see you (or hear you) at 9 p.m. Eastern Time.

What are you prepared to do today?

        Dr. Chet

Reference:Trends Endocrinol Metab. 2018 April; 29(4): 271–280.

Fasting: Two Approaches

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It’s time to get into some real fasting. While there’s nothing wrong with the abstinence approach, abstinence is not really fasting. I’m going to cover two different approaches. The first is known by the moniker 5:2. That means you eat reasonably five days out of the week and you fast two days per week. The second is a straight fasting approach of limiting calories per day that has been used in conjunction with cancer treatment. There’s no specified times to eat in either case, and you can drink any calorie-free beverages of your choosing.

The 5:2 Fast

The 5:2 fasting diet was originally developed about 10 years ago by a British physician/journalist. It’s become commercialized over the years with new additions and materials but essentially, this is how it works:

  • For five days a week, you eat your normal diet. The goal is to eat healthier, but there are no restrictions on the number of calories that you can eat.
  • For two nonconsecutive days of the week, you reduce your caloric intake to 750 calories per day, spread out over the day as you want. Again, the goal is to eat healthy food—and wouldn’t you know it, healthy food is generally low in calories! Your intake should include plenty of vegetables.

That’s it. It’s a way you can eat for the rest of your life if you want to. If you add some exercise and choose a better diet, you could lose weight and get some of the benefits I talked about in earlier Memos.

The Two- to Five-Day Fast

This approach is closer to a true fast than anything else because there are no gimmicks. The goal is to help the immune system and other organs by focusing less on growth and more on repair. This approach was developed by Dr. Valter Longo and has the most research behind it.

The goal is to eat healthy. A vegetarian approach with very low protein can make it very beneficial. Because this is a very low calorie fast, you have to check with your physician before you do it. Here we go:

  • Day 1
    Eat up to 1,200 calories, primarily from vegetables with some protein. Soups and broths make this approach easier. If you wanted to use shakes or smoothies, that’s acceptable as long as you stay under the 1,200 calories for the day.
  • Day 2 through Day 5
    On these days, your calories are restricted: 300 to 500 calories per day. The calories should come primarily from vegetables and again soups and broths are desirable.

When I use this approach, I generally do two days: one 1,200 calorie day and one 500 calorie day, and then eat normally the other five days. You have to be mentally ready if you’re going to do additional days. Eat when you want, whether a single meal or spread throughout the day. The choice is yours.

The Bottom Line

The last four Memos have talked about fasting and abstinence in relation to food intake. The question is why do this at all? Is there science to support it? Is it worth doing? That’s for next week.

What are you prepared to do today?

        Dr. Chet

Fasting: Abstinence Models

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How did you do on your 18:6 abstinence from food if you tried it? The ratio of abstinence to eating can vary. I asked you to try an 18:6 approach. Personally, I did fine—that’s just about my normal eating pattern anyway. I’m going to give you one version of an abstinence model today. I’ll give you two versions of a fasting model on Saturday.

The objective was to avoid food for 18 consecutive hours. The clock begins after your last meal the evening before. If you like to eat late or go out with the gang, that means that you might finish eating at 10 p.m. You wouldn’t eat again until at least two o’clock the following afternoon. Then you would have six hours to eat, ending at 8 p.m., and then the cycle begins again. Just to be clear: you don’t start the clock on the six hours for eating until you actually take your first bite of food. That’s why your last meal might have been 10 p.m. on one day because you didn’t start eating until 4 p.m., because let’s face it things don’t always go to plan.

The question: what do you eat during those six hours? Everybody seems to have an opinion. You could use a ketogenic or Paleolithic approach or you could eat a Mediterranean diet. You could also stuff yourself with all kinds of junk food. Regardless of which approach you decide to use, the goal is to eat better for maximum benefit. You can drink any calorie-free beverages of your choosing.

I’ll give you two different approaches for a fasting plan on Saturday. Until then, if you haven’t tried it, see how you do, with the same proviso for people with serious medical disorders.

What are you prepared to do today?

        Dr. Chet

Fasting vs. Abstinence

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Before I talk about the differences between fasting and abstinence, I want to make it clear that I’m in favor of both approaches when used wisely. I don’t think either is the way you should eat for the rest of your life, but if you have specific objectives to control your weight or to reduce your risk of degenerative disease such as cardiovascular disease, type 2 diabetes, and even reduce your risk of cancer, I think they both can be beneficial. Let’s look at the pluses and minuses of each.

Definitions

Fasting is a controlled reduction in the number of calories eaten in 24 hours.

Abstinence is the complete avoidance of food within a given time frame, whether that’s complete days or specific hours of the day.

Pluses and Minuses: Fasting Versus Abstinence

The pluses:

Both fasting and abstinence take in fewer calories than the body needs, which can help with weight loss if sustained long enough.

Fasting can help you handle hunger because you’re eating something eventually.

Fasting can also force your body to deplete all glycogen stores, depending on the source of the calories.

Abstinence forces the body to use all storage forms of sugars; then it uses stored fat as a fuel, increasing the supply of ketones for fuel.

When fasting, calories can be manipulated during the day to ensure you can eat before exercise if it’s required.

With abstinence, no thinking is necessary; you don’t eat anything when you’re abstaining from food.

The minuses:

With abstinence, you’re taking in no calories, so hunger can become an issue.

If you need to eat before you exercise, abstinence will limit the time of day you can exercise.

When fasting, deciding what to eat and when to eat it requires planning; that can be challenging for some people while making life easier for others.

There are more pluses and minuses for each approach, but I think that these are the most significant upsides and potential downsides of each.

The Bottom Line

As I said at the beginning, I’m in favor of both approaches. They both have merits and challenges—the key is using them wisely.

Next week, I’m going to give you examples of abstinence and fasting and how to use them. In the meantime, give the abstinence approach a ride around the block. Don’t eat for 18 consecutive hours on Sunday or Monday (that includes the time you’re asleep, limiting your eating to just six hours; you get to decide whether to eat the first six or last six consecutive hours you’re awake.) You also get to decide what you’re going to eat. Don’t try it if you have a severe metabolic disorder such as type 1 or uncontrolled type 2 diabetes.

What are you prepared to do today?

        Dr. Chet

The Fasting Dilemma

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I hope you all had a wonderful Thanksgiving. Because we’ve entered the “weight-gain portal” time of the year, let’s talk about the fasting craze that some people are doing and the rest are thinking about trying. As I see it, the problem is the lack of clarity in terminology and subsequently the execution of a fasting program. Terms such as “5:2” and “16:8” are thrown around. What exactly is a fast? What can it do for a person? What’s the best way to do a fast?

The problem begins with defining the term “fast”; there’s no consistent way the term is used, and that includes in the methodology of research studies. Fasting can mean avoiding all food and in some cases drink. That definition can describe fasts done for religious purposes as well as the fasts talked about for weight loss and controlling metabolism.

Another definition of fasting is severely reducing calories; if you lower your intake from 2,000 to 1,400 calories to lose weight, that’s a fast. If you’re drastically reducing calories for two to four days to help reset your immune system, that’s also a fast. But if you’re not consuming any calories, whether for a specific number of hours per day or a whole day, that’s more accurately called “abstinence from food.” Is that a big deal? Yes, and I’ll explain why on Saturday.

What are you prepared to do today?

        Dr. Chet

Happy Thanksgiving

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Paula, Riley, Jamie, and I would like to wish every one of you a Happy Thanksgiving. Normally, we would send these good wishes next week, but after a battle with brain cancer, Jamie’s sister passed away on Thursday leaving behind two young children. With the activities associated with passings, it seemed fitting to take care of family needs next week.

At times like these it can be hard to feel thankful, but we’ll always remember the time we had with Nicki and all the love she shared with Jamie and Riley. I know that many of you will remember Nicki and her family in your prayers, and we’re grateful for that as well.

While you spend time with family and friends, remember that life is short no matter how long you live. Take the time to appreciate all those people in your life, family or not, and let them know it.

One of the things that you can do is to begin or continue to work on being the best version of yourself. You may or may not live one second longer, but you will be able to live every day you’re alive. That means the time you spend with those you love and who love you may be even better.

I’ll see you in the next Memo on the 30th. Insiders, I’m still available when you need me.

What are you prepared to do today?

        Dr. Chet

Cancelled!

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Thank you all for the prayers, good thoughts, and well wishes. I’m going to hang on to them for a while. My surgery was cancelled for this morning; Paula and I didn’t find out until we arrived at the hospital at 7:30 to check in. I was not alone. My surgeon had three surgeries cancelled for today; multiply that by many surgeons times several days, and you get an idea of how many people were disappointed. The surgery will be rescheduled for a date to be determined.

Why was it cancelled on such short notice? Because the hospital was overrun with COVID hospitalizations over the weekend. They have sufficient staff but no beds, even for an outpatient knee replacement surgery such as mine. I don’t know what it’s like where you live, but there’s a significant COVID resurgence in Michigan with no end in sight.

I’ll keep doing the prehab and be even better prepared when the knee replacement is rescheduled. I hope the reader who has had her aortic aneurism surgery postponed for the third time lives until her rescheduled surgery.

I looked at the data again since we got home: over 80% of those hospitalized haven’t been vaccinated. Take it from someone who understands the science—get vaccinated. It’s not a guarantee, but it puts the odds in your favor and helps all the people who need hospital beds.

What are you prepared to do today?

        Dr. Chet

Prehab Is Over

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One of the tests I took in preparation for surgery was to measure my levels of Staphylococcus aureus. In this case, they tested the nasal area, a common area for this serious pathogen. The test came back at zero. I was pleased because for the past three years I’ve been taking a Bacillus probiotic called Bacillus coagulans. You can check out the research by reading this Memo from 2018. It doesn’t mean I couldn’t get an infection, but zero is a good starting point.


Now on to Surgery

I’ve stretched and strengthened my legs about as much as I can in preparation for my knee replacement. My core is as strong as it ever has been. I’ve gotten as fit as I can within the limitations my knee has given me. As I said a while ago, the more pain you put in before the surgery, the less you’ll have after the surgery.

We’ll put that to the test beginning Monday afternoon. Many, many surgeries have been cancelled here in Grand Rapids because the hospitals are overrun with COVID patients; if I had not prepared by being a regular exerciser and doing the prehab, I might have had to spend the night rather than having outpatient surgery, and then my surgery might have been cancelled, too, but we got confirmation Friday that it’s on.

I’m really eager to get this done and get on with life; I’m ready for rehabilitation. My goal is to walk into the hospital and then to walk out. The medical staff probably won’t allow that but as long as I know I could, that’s fine with me.

Thanks for all the prayers and good wishes—keep them coming. I won’t write Tuesday’s Memo until I’ve recovered from the anesthesia and taken the first steps. I still plan on doing the Insider Conference call on Wednesday night so all Insiders will get the first-hand Dr. Chet version of the knee replacement experience.

What are you prepared to do today?

        Dr. Chet

Building a Healthy Microbiome

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After last week’s Memos on the importance of a healthy microbiome and immune health, let’s review how to have a healthy microbiome to protect your brain and boost your immune system.

First, eat a mostly plant-based diet: some raw, some cooked, some fermented. The raw will give you probiotics and fiber. The cooked, especially whole grains and beans, will give you fiber. The fermented such as sauerkraut and yogurt will give you even more probiotics.

Second, fast once in a while. I covered this in Memos from June, so you can re-read the Memos on fasting and microbiome health.

Third, reduce your refined carbohydrate and sugar intake. Simply put, they provide the bad microbes with the food they need to overtake the good bacteria. Good bacteria need fiber from foods or supplements, so make sure you’re getting 25–30 grams per day.

My knee replacement surgery is scheduled in six days, so I’ve been working on preparing my body to defend against staph infections. I’ll talk about that in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Science at Work

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The challenge this week was to watch two video podcasts, think about what you heard, and then provide comments and questions. For those of you who did it, thank you. For those that didn’t, I recommend that you take some time this weekend and listen to them. I’m going to share my thoughts but there’s so much information, I’ll hit only the highlights. Suffice it to say, based on the questions, there are many subjects that will need to be explained. That will take months to research and present in Memos and Insider conference calls in a way that’s understandable.

The point of the interviews with Dr. Jay Lombard was to find out the relationship between the microbiome and pathogenic bacteria and neurodegenerative disorders (NDD). That includes everything from Alzheimer’s disease to depression to Parkinson’s disease. Here are the three things that stood out to me out of the many concepts presented.


Three Things I Learned

Leaky Brain Theory
The prevailing thought is that the blood-brain barrier prevents almost everything from entering the brain via a series of tightly packed blood vessels and cells. Nutrients are let through along with some medications, but bacteria are thought to be barred.

But evidently the toxins of some pathogenic bacteria are able to cross this barrier and affect the production of the proteome, an organism’s complete set of proteins. Remember the tau mice from last week’s Memos? The bacterial toxins impact the way the tau and other proteins are folded, which renders them unusable, thus resulting in misshapen structures that can contribute to NDD depending on which proteins are affected.

Antibiotic-induced Reduction in Fevers
In the treatment of patients with NDD, one characteristic that most seemed to share is the inability to get significant fevers with infections. The cause appears to be chronic use of antibiotics over a lifetime which somehow reduces the ability of the immune system to create high fevers. The rise in temperature is a natural part of the immune system when dealing with infections; without it, the immune system will not be as effective at combating viruses or bacteria.

Heat-Shock Proteins
Think of heat-shock proteins as the “cleaners” of the body. One of their functions is to collect the misshapen proteins and take them to the organelles inside a cell; that’s where they’re taken apart and the amino acids reused. If you can’t generate a fever that’s high enough, they can’t do that job as well.

There were several other items on my list, but those were the most profound. The first question in your mind is most likely “What can I do about these?”


How Science Works

The reason I chose to focus on Dr. Lombard with the purpose of showing how science works was two-fold. First, he asked good questions. Many physicians would think “How can I fix this?” and stop there. What Lombard and Hyman asked was “What caused this?” or “How did this happen?” You find that out only by asking the right questions of patients.

The second is that Lombard went to the current research to find out if there were any answers, and he discovered where he might have been incorrect because someone had tested it. Remember that in the first interview he was sure that the bacteria C diff was related to ALS; two years later he found that there was more than a single pathogen that could be related to ALS and other NDDs. He learned and adapted his hypothesis: that’s how science is supposed to work. Instead of spending time heading in the wrong direction, science guides the research he’s currently doing so that eventually he may discover effective treatments for these neurological conditions.


The Bottom Line

If you haven’t watched the video podcasts, I urge you to do that; you’ll learn much more than by reading my review. More than that, you’ll have more questions. One of the things both Drs. Lombard and Hyman agreed on is that “we know close to nothing.” I agree wholeheartedly. When you begin by asking the right questions, you have a chance of finding out the answers. Another point they agree on is that there’s no single cause of any NDD. There are multiple factors that contribute; finding out what they are may help develop effective treatments by focusing on a potential cause.

For those of you who want answers, whether about what I’ve written or about the many other things covered in the podcasts, I’ll write more as time goes on to satisfy that “What should I do now?” question. Obviously, you’ll want to keep your microbiome as healthy as possible (a search for the term microbiome on drchet.com will point you in the right direction); beyond that I have questions I need answers to before I can provide more answers for you. I’m on it and when I know, so will you.

What are you prepared to do today?

        Dr. Chet