Transcript of Episode 112: How to Intermittent Fast with Dr. Jason Fung
With Dr. Daniel Pompa, Meredith Dykstra, and special guest Dr. Jason Fung.
Meredith:
Hello, everyone, and welcome to Cellular Healing TV. This is episode 112, and we have Dr. Pompa here, and we have a very special guest today, Dr. Jason Fung. We’re going to talk about obesity, diabetes, fasting. Dr. Fung has a lot of expertise in these areas. Before we jump into the conversation, I’m going to tell you a little bit about him.
Dr. Jason Fung earned his medical degree at the University of Toronto, where he also completed his internal medicine residency before heading to the University of California at Los Angeles for his fellowship in nephrology. He currently practices as a kidney specialist in Toronto. During the course of treating thousands of patients, it became clear to Dr. Fung that the epidemic of Type 2 diabetes and obesity was getting worse. The prevailing dietary recommendations to reduce dietary fat and calories were clearly ineffective.
He founded the Intensive Dietary Management program to provide a unique treatment focus for Type 2 diabetes and obesity. Rather than focusing on medications, this clinic focuses on dietary changes that are simple, yet effective. In March, 2016 – just this month – Greystone Books will publish Dr. Fung’s first book, The Obesity Code, which explores the underlying hormonal imbalance that leads to obesity and recommends effective strategies that address the root cause of weight gain. I know you and Dr. Pompa are really in alignment on a lot of different areas. We’re so excited to have you on the show. Welcome, Dr. Fung.
Dr. Fung:
Thank you very much. Thanks for having me.
Dr. Pompa:
Yeah, Dr. Fung, we’re grateful that you came on the show. Our viewers are just – they’re already educated about a lot of the things that you say, not that it takes away from it by any means. It just excites me when I see a doctor who breaks out of the norm, so to speak, and ends up crossing into something that we both know is the answer to a growing epidemic of why people can’t lose weight, why people have hormone challenges, diabetes, thyroid conditions.
These conditions are costing our country, the world, greatly financially and taking people’s health, and yet we’re throwing more medication at it. We’re throwing even the dietary changes that are recommended, low-fat, low-calorie diets. I love that in your bio, that you said that frustrated you. Between the medications and the low-fat, low-calorie diets, wasn’t the answer. With that said, how did you go from there – obviously, you had medical training, and that’s your background – to where you are now with believing what we believe?
Dr. Fung:
It’s actually quite a interesting journey because it – I went through medical school, and I went through specialist training. For the first about seven or eight years of my practice, I was just treating people the same as most doctors. Weight loss was not something I thought about, really. I didn’t deal with it much. I told them to go see somebody to exercise a little more, eat a little less, look at the food guide, or whatever, national food recommendations.
It really was around the mid 2000s that things started to get interesting for me. What happened, of course, was that the Atkins diet was very popular somewhere around the 2000s. A lot of studies got launched just around that time, and they all got published somewhere around 2006 to 2008. They started appearing in The New England Journal of Medicine, which is really the top medical journal in the world.
What was really fascinating was that these diets were doing much better than our conventional recommended diets. The people who did these studies, a lot of them did them with the expectation that these Atkins dieters would do a lot worse, and here they were, doing much better, not just in terms of weight loss, but in terms of their entire metabolic profile. That was when I started to think about nutrition a lot because here’s a kind of very interesting paradox.
As I started to look deeper and deeper into this sort of thing, you realize that a lot of these kind of hand-me-down nutritional beliefs, they’re really just not true even from the very, very basics of what we know like calories in, calories out, which is something that we’re taught from kindergarten, almost. It’s all about calorie balance and all this kind of stuff. It’s just all wrong and just fascinating to me that we could get to this point where we are.
Dr. Pompa:
Absolutely.
Dr. Fung:
One of the biggest diseases that is affecting us, the entire premise of treatment is completely incorrect. That’s just unbelievable that that could be the case. It’s actually really interesting because if you look back, and I think that where we are comes from a kind of mistaken treatment paradigm. We’re stuck in this 19th century paradigm, where infectious disease was the major – in the 20th century, late 19th century, it was all infectious disease. That’s what’s killing people.
We went through a period where we had these antibiotics, and penicillin, and great medicines. Infectious disease just really got treated very well. We got into this treatment paradigm of one disease, one drug. We approached these diseases of the 21st century, which is obesity, Type 2 diabetes, and all its attendant diseases with the same paradigm. What drug can we give for this? It’s the wrong approach.
Dr. Pompa:
Yeah.
Dr. Fung:
These are dietary diseases, and therefore, we need to fix our diet and use dietary strategies, such as fasting, that we talked about that have been around forever, and use these strategies to attack the root cause of the problem, which is all dietary, instead of saying, “Oh, here’s a new drug for this.” You look around, and that’s all doctors talk about. “Oh, what’s the new drug for obesity?” I’m like, “That’s totally the wrong approach right from the get-go.” We don’t need a surgery for obesity. We don’t need drugs for obesity. We need to [00:06:43] diet.
Dr. Pompa:
That translates into even diabetes, and thyroid, and heart disease. Of course, there’s a time and a place for a medication, but again, if you don’t get to the cause, then what are you really solving? You’re not solving anything.
Dr. Fung:
Exactly. That’s the whole point of my book, The Obesity Code, was what’s really causing weight gain? I wanted to actually call the book The Etiology of Obesity. Etiology, for those who don’t know, is a medical term meaning, “What’s the cause of it?” It was too medical, so they nixed that title and said, “No. You can’t use it.” That was really what my original title was because I really wanted to say, “What is the cause of obesity?” If we get that question wrong, then we get everything wrong. The real problem is that our understanding of what causes obesity right now is too many calories. It’s all this calorie balance, this calorie paradigm, and it’s crazy. The calorie understanding has only been around for 50, or 60, or 70 years.
Two hundred years ago, people didn’t have bomb calorimeters. Nobody measured the calorie value of foods, and nobody had obesity. It’s not like people were – you look at 1930, 1940 America, people are not starving of hunger. It’s not that there was no food. There was plenty of food. There was just no obesity. That’s what we really have to know. Even fast forward, like 1960s. How many people are really dying of hunger in New York City? Almost none. Yeah, there’s some soup kitchens and so on, but it’s not like the widespread famine that you would see in biblical Egypt or something.
People talk about this whole thrifty genes and all this sort of stuff as if people are starving in 1960s United States. That didn’t happen, and yet there had no obesity. We had to find out what caused it. I think that, really, we started with the wrong thing, with the calories paradigm, that it’s a caloric imbalance rather than a hormonal imbalance. That’s where everything kind of fell off the tracks. Now, all our strategies are dealing with calories, but calories aren’t the problem.
Dr. Pompa:
I couldn’t agree more. If you look at the Diabetes Association diet, low fat, low calories, exercise more, and matter of fact, replace all your fats with margarine, man-made fats. Oh, and use artificial sweeteners. That’s the diet that they’re still [00:09:32]
Dr. Fung:
Yeah. Yeah.
Dr. Pompa:
Even when they do focus on, “Okay, let’s get to the diet,” they get it wrong, Doc, because this – I believe this stuff comes – it gets locked into government. I always have a saying that, “Once something gets into government, you almost can never back it up.”
Dr. Fung:
Yeah.
Dr. Pompa:
It’s like this low-fat, low-calorie message is something that if you turned your television on this morning, I promise you they’ll talk about a low-calorie, low-fat recipe of some sort.
Dr. Fung:
Yeah.
Dr. Pompa:
Every media outlet still talks about this faulted science, this junk science. Where did it come from? Now that it’s here, here we are. You said a key point, and I want you to expand on it. You and I both believe that the inability to lose weight or sudden weight gain, this is a hormone problem. I always say, “Look, we know that we could talk about food. We could talk about diet, but more specifically, this is a hormonal problem today.” Talk a little bit about that. How did we get here, and what do you mean by “hormone problem?”
Dr. Fung:
Yeah. If you want to prove causation, what you need to do is basically give people what you think is the causative agent and see if it causes it. That’s what we do all the time. When we prescribe insulin – so the major player here is insulin. When you give insulin to people, people gain weight. That’s the bottom line. Whether you think the mechanism is this or that, it doesn’t matter. When I prescribe insulin to people, people gain weight.
When I give drugs, such as sulfonylureas, which are diabetic medications, which also raise insulin, they gain weight. If I deal with the diabetes by prescribing something such as Metformin, which is a different diabetes drug that doesn’t cause that insulin surge, then they don’t gain weight. Here you have a direct correlation. Anybody who’s ever taken insulin or any family members, and every doctor already knows this, you give insulin, people come back and complain about their 20, 30 pound weight gain.
Dr. Pompa:
Their glucose is better. That’s what they think. The doctor goes, “Yeah, but look, your glucose looks better. Your blood looks better.” They’re going, “I’m gaining weight, and I still don’t have energy. I still don’t feel well.”
Dr. Fung:
Absolutely. That’s absolutely the wrong thing to do because the patients know it already. That’s what I always find funny is that the patients always come back, and they always say things like, “Doc, you’ve always told me that I need to lose weight to control this diabetes, yet you give me a drug, and I’ve gained 30 pounds. How is that good?” You say something like, “Oh, well, you have to because your glucose is too high,” or something like that. They already know.
There’s something going wrong here. They’re gaining weight, which leads them to take more insulin, which is going to make them gain more weight, which is going to lead them to take more insulin. That’s what happens. That’s exactly what happens. They’re in this downward spiral. They’re just getting worse, and worse, and worse. What we’re doing is actually making it worse. That’s the real problem.
The thing about Type 2 diabetes is that it’s really a disease of insulin resistance. That’s the actual disease. The problem is our treatment is based on lowering the blood sugar. We’re treating the symptom, and we’re not treating the disease. In fact, the disease does nothing but get worse. If you look at the typical history and the actual history of what happens, people get started on medication, then they get more medication, then more, then insulin, and then more, and more. Their diabetes is not getting better with treatment. It’s getting worse with treatment.
Dr. Pompa:
Absolutely.
Dr. Fung:
Even as the blood sugars are getting better, the diabetes is getting worse. It’s like alcoholism. If you take a couple shots of alcohol, those shakes go away, but it doesn’t mean your alcoholism is getting better.
Dr. Pompa:
Yeah.
Dr. Fung:
We’re treating the symptoms, but the disease is getting worse. That’s the real problem with the way we approach Type 2 diabetes and the related problem of obesity. It’s really a hormonal issue. Once you understand that – and this is what I get into in the book. If you look at low insulin, for example – if you take away insulin – like Type 1 diabetics, their insulin levels go very low. What happens to their weight?
You would predict if insulin is the major causative agent, that their weight should go way down, and that’s exactly what happens with Type 1 diabetes. The Type 1 diabetics actually know this. There’s an entire eating disorder called diabulimia, where patients will deliberately under-dose their insulin like dangerous, like crazy. Their sugars go up. They might get ketoacidosis. They could kill themselves. They do it because the weight comes way down. That’s the whole issue.
When you give insulin, weight goes up; when you take away insulin, weight goes down. Clearly, we have a causative relationship here that you don’t see in calories. If you think calories causes weight gain, you can give calories and see if they will gain weight on the long-term basis. They’ve done these deliberate forced feeding studies where people overeat. You gain weight for a little bit. There’s a few very famous ones done in the ‘60s, where they actually took college kids, and they said, “Just eat a lot of food because we want you to gain weight.”
This guy, Dr. Ethan Sims, he had actually tried to do it in rats. He gave a lot of food, but he couldn’t force these rats to gain weight. He thought, “Okay, well, can I do it with humans?” All the college students thought, “Oh, yeah. No problem. Piece of cake.” What was fascinating was that those college kids just couldn’t gain weight. It was incredible. You’d force them to eat, and then they would eventually just stop. Then you couldn’t force them anymore.
Then he went to the jail, and he got a bunch of prisoners, and he forced them to eat as part of an experiment, which is quite funny. He watched them. He’d make sure that they didn’t exercise more, and he’d force them to eat. Some of these guys were eating 10,000 calories a day, and some of them, their weight went up. As soon as you stop forcing them to eat, their weight just came right back down to its original.
That’s interesting because if you’re saying that calories is what causes weight gain, but yet you give calories, and it doesn’t go up, then you don’t have that causal relationship there. The same works on the flip side.
Dr. Pompa:
That’s right.
Dr. Fung:
If you think that calories causes weight gain, take away calories, you should see weight loss, but you don’t. We all know this, right?
Dr. Pompa:
Yeah. Absolutely.
Dr. Fung:
Studies of caloric restriction are crazy because the failure rate is 98%.
Dr. Pompa:
You know where people get trapped in to where they believe it? I always like to say this: If people cut calories, there’s that beginning phase where they actually lose a little weight. I always say women, the most you could possibly lose is about 10 pounds, and then men, maybe a little more when they cut their calories way down, but what happens?
The complicated hormonal metabolism starts to drop, as well. Then the weight starts to come back on, or when you cut calories, you just can’t do that. You can’t just push food away. I always talk about this on other shows. Eventually, you start to eat again. Two ways, it fails. Either your body says, “No. Okay. We can’t just cut calories. We’re going to eat again.”
Ultimately, your metabolism goes lower and lower so ultimately, you never lose weight. You really never lose any weight long-term, but people hold onto that little short, little blip when they see themselves cut calories, and they see their weight drop slightly, probably water, some fat, some muscle, probably mostly muscle. The point is they see the scale go down, so they think it works, Doc.
Dr. Fung:
Yeah, absolutely. Every single diet study has shown this same thing. You see the very bottom at around six months, sometimes nine months, and then it always goes up. Every dieter knows this, of course. At six months, what happens is that you start to plateau, so you double up your efforts. You cut calories even more, and for a while, it works.
Again, you plateau, and then you start feeling like crap. You’re feeling cold, and you’re feeling hungry, and you think it’s all your fault. The problem is exactly what you said. The studies are very clear on this. When you cut your calories, your metabolism goes down. You start with 2,000 calories in and 2,000 out. You cut it to 1,500. You lose a little bit of weight. Great. Then your body just reduces it to 1,500 calories.
Dr. Pompa:
Exactly.
Dr. Fung:
Now, because you’re only burning 1,500 calories, you’re not – you’re cold. Your metabolism’s slowing down. The other thing that they have shown is that your hunger hormones go up; your satiety hormones go down, so you’re actually hungrier, not because you have no will power, but you’re actually hungrier because your hormones are telling you to gain that weight back. You’re hungrier, and your metabolism has slowed down. That’s kind of a double whammy that you’ll never get out of.
What happens, of course, is that you’re at 1,500 calories in, 1,500 out. You’re feeling like crap. You feel it’s not worth it. Then you go up to 1,700. Still less than you used to take, and the weight starts coming back. It goes right back up, and now your metabolism’s at 1,700. You feel like crap. Your weight goes back to what it was, and then everybody blames you for failing the diet. That’s the super-unfair part about weight loss is that all these dieters get blamed when we know exactly what’s happening. We know that it will happen for sure, and the weight loss –the studies of weight loss show that 98% of people fail.
One, why would we ever give advice that has a 98% failure rate, and two, it’s so unfair that when people fail, they get the blame instead of the advice getting the blame. Nobody ever says, “It’s because your stupid ‘eat less, move more’ advice was really bad. We knew it was bad, and we knew you’d fail.” Nobody ever says that. People say, “Oh, you fell off your diet.” It’s bound to happen, and that’s the real problem.
If you understand that what the issues is is really a hormonal issue, then you can say, “Well, now what we need to do is look for ways not to cut calories because it’s not a calorie problem. What we need to do is look for ways to lower insulin because that’s the real issue.” That’s what the strategies are, and both you and I use them all the time. Cutting out a lot of the sugars, and the refined grains, and the intermittent fasting is the main strategies. Those are strategies aimed at lowering insulin, not lowering calories.
Dr. Pompa:
You know, Doc, when I entered 50 years old, of course, everyone in this country has the adage that, “The older you get, the fatter you get.” I can tell you, at 50, I am leaner with lower body fat, with more energy, better brain than even when I was in my twenties. How is that possible? I’m very, very insulin sensitive. Wait. I’m very hormone sensitive because of the things that I practice that you just said.
I intermittent fast every day. By the way, at the end of my day, yeah, I probably eat less calories than everybody, but I promise you this, never once do I go, “Oh, I’m going to eat less at this meal.” Quite the opposite. I make sure I eat to full every time I eat.
When we look at these studies that people live longer when they eat less, we think that people in Okinawa are just simply pushing food away and eating until – it doesn’t work that way. The innate intelligence in the body goes, “I’m going to lower my metabolism. I’m starving. I’m starving. I’m starving.” My body knows it’s not starving because I’m eating big, full meals. However, I take 18 to 20 hours in between my dinner and my next meal day. That makes my cells very, very hormone sensitive and obviously, insulin.
When you look at my hormone levels, they’re very, very low. However, my cells hear them very well. I see two parts to this. Insulin – and I want you to discuss this – obviously, insulin’s connection with the cell, which we know inflammation and everything Americans do are driving that sensitivity to become less and less, and obviously, too many carbohydrates, driving glucose and insulin, making it less and less to be able to hear the hormone. Also a liver issue. The liver plays a big role in this liver problem, fatty liver. Discuss those two things because people are going to say, “Okay, what are the strategies that I can get my cells hearing insulin and lower my insulin?”
Dr. Fung:
Yeah. I think that’s the key idea here, and the fatty liver actually – and insulin resistance are very, very intimately tied. The idea is that insulin sensitivity and insulin resistance is very important because insulin is the major driver of obesity. One of the things that causes the insulin to stay high all the time is insulin resistance. If you have insulin resistance, then your body normally produces insulin to kind of overcome that resistance.
Dr. Pompa:
Our viewers and listeners, when we say this word, “Resistance,” folks, we’re talking about the cell not being able to hear insulin well. The receptor to insulin is blunted, and there’s multiple reasons, inflammation being one of them, but it can’t hear the message. Therefore, you need more and more of the hormone, insulin in this case, to get the message in the cell. Okay. I didn’t want to lose people on the “resistance” word.
Dr. Fung:
Yeah. That’s absolutely right. I actually have a different thought about what causes insulin resistance. If you look at insulin resistance or resistance in general, you can look at, say, antibiotics, and say, “What causes antibiotic resistance?” The body has a natural tendency to homeostasis, which is that it has a comfortable state. If you move out of it, yeah, it’ll kind of move back to that comfortable state.
If you subject the body to constant barrage of a hormone, any hormone, it will develop resistance. If you, for instance, take a drug – you can use nicotine, or you can use alcohol, or marijuana, or any of these drugs – the first time you give it, it has a great effect, whatever it is. You get very high or whatever it is. If you continue to use it constantly, what happens is that that effect goes down, and down, and down.
Dr. Pompa:
Dr. Fung, can I give my example there? Not to interrupt you, but I have to give the example. This is the example I always give, and Meredith’s laughing because she knows what I’m going to say. I have five kids, Doc. I always say it’s like yelling at your children. When you first start yelling, it works. They go, “Oh,” and they start listening. Then you notice that you’re yelling – you find yourself yelling louder and louder, and they’re listening less, and less, and less. By the time you’re screaming at your kids all the time, and they don’t even hear you anymore. [00:25:05] of what’s happening with hormones.
Dr. Fung:
Yeah. That’s right.
Dr. Pompa:
More and more insulin, we’re challenging insulin, at first, it works. Then it starts working less and less, and then more and more insulin. That’s the analogy I love to give.
Dr. Fung:
I love that analogy, actually, because that’s exactly what happens in the body. It’s not just for insulin, but it’s every hormone you can think of, even drugs.
Dr. Pompa:
Every hormone, every hormone.
Dr. Fung:
If you keep giving it all the time – it takes two things. It needs persistent levels and high levels. If you’re yelling with insulin or whether you’re yelling with cocaine, or marijuana, or whatever it is, your body eventually stops responding to it. That’s a natural, protective mechanism. It’s not used to these high levels, so it has to resist it. If you take the example of antibiotic resistance, you can – this is a situation in a lot of hospitals, where the antibiotics that we use are simply not effective anymore.
If you want to know why, it’s because we use too many antibiotics. That’s the idea. The natural response, though, is to use more antibiotics, just like more yelling. That’s not the answer. That’s actually the wrong answer because you can see that, to use your example, the more you yell, the less response you get. Exactly. It’s a vicious cycle because you yell more, they respond less, so you yell even more, and they respond even less. The actual answer is to use much less. Insulin is the same. Insulin resistance is actually caused by too much insulin, not only too high, but persistently high.
Dr. Pompa:
Absolutely.
Dr. Fung:
As you use insulin all the time, then your body becomes less sensitive to it. As you become less sensitive to it, or become more resistant, your body produces more insulin to overcome that resistance. That’s exactly the wrong response. You want to use less. You either have to cut down the amount, the level, or the persistence of those levels. That’s what the intermittent fasting does. It provides you with that long period of very low insulin. That means your body stays insulin sensitive, and that’s the key.
Dr. Pompa:
That’s right.
Dr. Fung:
If insulin resistance is what’s causing your high insulin level, it’s not your diet anymore. This is why people who have been obese for 20 years have a lot of trouble losing that weight. It’s a time-dependent phenomenon. This is what people have to understand. It’s the insulin resistance that is keeping your insulin levels high, but the answer is not to give more insulin, just like in diabetes. The answer’s not to give more.
The answer is to give much, much, much less. This is the thing: If you believe in calories or even if you just believe in carbohydrates, if it’s all carbohydrates or if it’s all calories that drives obesity, then it should be the same whether you want to lose weight and you’ve been overweight for 15 years or if you’ve been overweight for 15 days. You should be able to lose weight the same.
Dr. Pompa:
Absolutely.
Dr. Fung:
Everybody knows it’s not the same. The guy who’s been overweight for 15 days drops it like that. The guy who’s been overweight for 15 years has a hell of a time because they’ve been going around that insulin resistance insulin cycle – high insulin, insulin resistance cycle for so long that they need to get that fixed. That’s why the intermittent fasting is really such a powerful method because it’s not simply the diet.
Now, you’re dealing with – the diet is a major factor in keeping insulin levels high, but it’s the insulin resistance. That’s where we’ve gone off the track. If you go back to our dietary habits in the mid-‘70s, there was actually two major changes. One, we went to a very low-fat diet, which was a mistake because the fat has a lot of calories, so we said, “You should cut your fat,” and all this kind of stuff. Everything kind of knows about that already.
The second change that nobody ever talks about is that we went from an average of three meals a day, breakfast, lunch, dinner. I grew up in the ‘70s. You tried to have a snack, and your mom said, “Forget it. You’re going to ruin your dinner.”
Dr. Pompa:
Absolutely.
Dr. Fung:
Now, we’ve gone, in the mid-2000s, to an average of five to six meals a day. You look at your kids, and they’re all breakfast, snack, lunch, snack, dinner, snack. That’s normal, and that’s the average. That’s insane. Now, we’ve actually set into motion the exact two things that we need for insulin resistance. We need high levels, which we’ve done that with very high insulin foods like refined grains. We’ve cut out the fat and eat more bread. That’s the base of the food pyramid was the bread.
Dr. Pompa:
That’s right.
Dr. Fung:
The second thing we did, which is what you need for resistance, is the persistence of those levels. Now, people say, “You got to eat the minute you wake up. Breakfast is the most important meal of the day.”
Dr. Pompa:
Absolutely.
Dr. Fung:
Eat five, six times a day, constantly snack, so now, you’ve got not only the high levels, but you’ve got the persistently high levels. Now, you have set the stage for insulin to be high, insulin resistance to be high, and you’re a sitting duck for obesity and Type 2 diabetes. The answer is to do what you do, which is give your body a break.
You think about it. Suppose you’re in a dark room. You go out in the sunlight, and you’re blinded. It’s so bright. After five minutes, it’s normal. That’s the thing. When you are in the dark and you suddenly get that bright light, it’s got a huge effect on you. If you then go back in the dark, the next time the bright light comes in, it’s going to have a huge effect. That’s what our body does. It keeps, not just insulin, but all hormonal levels very low.
You can look growth hormone. You can look at parathyroid hormone, melatonin. All the levels are practically undetectable. Then you get a burst, and then that’s it. Then they go back down to very low levels. That’s the way our body is designed. If you sit in the dark and you get that bright light, great effect. Go back to the dark, and then next time, bright light, you get great effect.
If you simply give that bright light all the time, it just loses all its effect, and that’s what we’ve done. Instead of insulin goes high and then low, and then high, and then low, we just keep it high all the time.
Dr. Pompa:
Absolutely. That’s a great analogy.
Dr. Fung:
That’s the problem.
Dr. Pompa:
Yeah. That’s a great analogy. The five, six meals a day thing, again, it’s one of those things that people do it at first, and they go, “Oh, that helped.” They lose a little weight because their cells have zero hormonal ability to burn fat for energy. When they eat more often, they’re not burning as much muscle. They get a little spike in their metabolism a little bit, and they go, “Oh, that kind of worked.”
Long-term, you’re dying sooner. I always say if you want to age faster than anybody, raise your glucose and insulin continually. That’s what you do. Guess what? The best way to do that is eat five, six meals a day. That’s [00:32:27] aging prematurely.
Dr. Fung:
Yeah. That’s the whole thing with the mammalian target of rapamycin and autophagy that we talked about. The biggest stimulant to autophagy, which is kind of this cellular cleansing process, is not eating. It’s actually the protein. The protein actually stimulates this – stops us from clearing out these old, damaged, subcellular organisms. People knew.
The funny part, I think, is that people have known this for thousands of years. If you go back and look at all major religions, they all have periods of fasting, all of them, prolonged periods of fasting, 40 days and 40 nights.
Dr. Pompa:
Bingo!
Dr. Fung:
It’s crazy that they knew this.
Dr. Pompa:
Doc, look at the cultures that live the longest. The Hunza people and all these people, they say it’s not even what they’re eating to why they’re living so long disease-free; it’s the fact that they’re not eating for so many times of the year, whether they run out of food, whether the seasons change. In the Hunza period, they call it Starvation Spring.
It’s like those fasting moments in the time people were eating was completely different then. They didn’t have access to food all day. Food was precious. They would go out hunting all day. They wouldn’t eat but maybe one, two meals a day. That’s basically what we’re emulating when we’re intermittent fasting. We’re emulating what cultures did for thousands and thousands of years and lived long doing it.
When we hear these studies of eating less calories and living longer, it really, Doc, should be eating less often and living longer. Would you agree with that?
Dr. Fung:
Absolutely. Nobody in history has decided to calorie-restrict by eating small, frequent meals. The much easier thing to do is to cut out a bunch of meals. Why would you want to cook, and clean, and prep six times a day when you could do it once a day? Isn’t it make a lot more sense from a logistical standpoint?
The other thing that’s crazy, and I see this all the time because we do a lot of fasting in our clinic, as well, is that people come back, and they say, “You know, I didn’t think it – I thought it’d be terrible, but it’s actually really, really easy.” Once you get into that mode of not eating, you don’t – there’s no inertia there. The inertia is not to do it. It’s kind of like my son. You can’t get him into the bath, but when he’s in the bath, you can’t get him out of the bath.
Dr. Pompa:
I like that. Yeah.
Dr. Fung:
Same thing. When you start eating, it’s just really hard to stop. If you start by not eating, you might as well just ride that until it’s time. It’s a lot easier.
Dr. Pompa:
Look, the last two days – I always pick one day a week where I fast for 24 hours. I go dinner to dinner. The other days, I’m typically doing between 18 and 20 hours. The day before yesterday, I was so busy, I went on and on in my day, my day, my day. I realized it had been 24 hours, and I didn’t eat. I didn’t eat all day. Yesterday, the same thing. I went two days where I didn’t eat for 24 hours. The day before and yesterday, I went 24 hours, and I wasn’t hungry. I never thought about food. I had pure energy. My brain worked good.
Oftentimes, when you eat, the blood rushes to your stomach. Your parasympathetic nerve system kicks in, and you [00:35:58] that sluggish down. It’s like when I’m at my busiest, and I need my brain the most, I simply don’t eat. Matter of fact, how many hours do you go? What’s your intermittent fasting schedule?
Dr. Fung:
I typically go 24 hours a couple times a week, although it really depends. It depends on how busy I am. When I get really busy, I really just do it a lot more because it saves me 45 minutes at lunchtime.
Dr. Pompa:
It’s massive, the amount of time you have when you’re not eating. My son didn’t eat yesterday. He was like, “Dad, I didn’t realize how much eating bogs me down.” I’m like, “Yeah, exactly, son.”
Dr. Fung:
Not just that, but people worry about not having energy and this whole – there’s a whole thing that, “I won’t be able to concentrate.” It is really funny that people think that. It’s pretty obvious that if you don’t eat, your brain actually works better. If you think about it, you had a giant Thanksgiving dinner. Are you really super sharp, or are you sluggish on the couch watching television? It’s pretty clear that eating a lot doesn’t really make you mentally very sharp.
On the other hand, when you say that someone is really hungry for something, they’re hungry for power, hungry for this, hungry for that emotion, does it mean they’re sluggish and have no energy? No. When you’re hungry for something, it means you have a lot of energy, and you’re willing to do what it takes. That’s what the body does. It actually fuels you.
They’ve done so many studies on this fasting. It’s been well established for 50 years. Your noradrenaline levels go up; your growth hormone levels go up, and your metabolism doesn’t go down. You’re actually more energetic. At the beginning of the – everybody worries about this metabolic slow-down that you see with the chronic calorie reduction.
You don’t see that with the fasting because even though you could fast for four days, and the resting metabolic rate at the end of the four days is actually 15%, 14% higher than it was at the beginning. Your metabolism’s actually revving up. What you’ve done is you’ve switched energy sources from food to fat, and that’s all it’s doing. That’s all it’s doing.
Dr. Pompa:
Yeah. It is the opposite. Most days, then, you’re eating one to two meals a day, and you’re going – how long do you go in between?
Dr. Fung:
I rarely eat breakfast. I eat breakfast on the weekends now, but –
Dr. Pompa:
One day a week, I call it my feast, where I actually purposely eat more, again, emulating our ancestors. I purposely, on Saturdays, eat breakfast, lunch, and dinner. I try to eat more. By the way, it’s hard for me.
Dr. Fung:
Actually, I find the same. On the weekends, I find that I’m not actually hungry, but I do eat because my family is there, and I usually eat breakfast. There are social things that go along with it. It’s nice. This is what I say about fasting. You really have to find what fits into your life. What fits into my life may not fit into somebody else’s life. On Saturdays and Sundays, it’s a little less busy, so it’s nice to enjoy that time in the morning and have a little bit of something with the kids and stuff – with my wife and the kids. I like that, so I have something. I find that oftentimes, I’m not hungry, but once I start, I can eat a full breakfast. That’s what I mean that sometimes, it’s just easier to go right through.
Dr. Pompa:
Absolutely.
Dr. Fung:
I do, but Monday through Friday, I almost never eat breakfast anymore. It’s really easy because then when you skip lunch, you’ve gone 24 hours. Some weeks, I wind up doing it four out of the five days. Again, it’s mostly because – it depends on my work schedule. When I get really busy, then I know that those are days that I’m going to – it’s not worth it for me. The body gets so used to it.
It gets so easy to skip that meal that it’s far more precious to me to get that 45 minutes or an hour and get home a little earlier. It’s far more precious to me than eating something. It just doesn’t matter that much, whereas that 45 minutes is hard to get back. That’s every day, Monday, Tuesday, Wednesday, Thursday – that’s three, four hours of extra time that I have to do stuff. On days that it’s not that busy, then I’ll eat more, but again, it depends a lot on social –
Dr. Pompa:
I think we’re emulating feast and famine, and I think there’s benefit to both. I believe the fast reminds our bodies that we have plenty and to burn fat. I think it makes us more of a fat burning machine. When the body says, “Hey, we’re not starving, here,” it’ll burn its fat with ease. The body, I believe, can create some blunting of the insulin receptor if it thinks it’s starving, and that’s not a good thing because it’ll want to hold on. I believe that one day or two of feasting is a really good thing, and the fast.
Here’s what I would ask, though. I would ask that, what do you say to the people who go, “Oh! I just can’t go without food. I get dizzy.” Right, Meredith? We hear that all the time. “I get dizzy. I get” – but you and I know that eventually, the body shifts. I call it the desert island experience. If I put you on a desert island, you’d have those days, but eventually, you could go with one meal a day or no food, and you would be just fine. What do you say to that?
Dr. Fung:
We warn people ahead of time that the first few times that they do this, it’s going to feel really bad.
Dr. Pompa:
Absolutely.
Dr. Fung:
It’s the same for ketosis. People talk about a keto-flu and all this sort of stuff. As you make that shift in your metabolism, one, it takes a bit of time, but during that time, you have to understand that things are – it’s not abnormal [00:42:03]. If they do it twice, and the first one was kind of bad, and the second one was kind of bad, they were really hungry, they would say, “Oh, I can’t do this.” They give up.
Look. You got to give your body a chance. If you want to learn to play the piano, you don’t give up after two times. It’s like, “Oh, I tried to play the piano twice, and I can’t play this Beethoven piece.” That’s kind of ridiculous, right? It’s the same thing. You have to let your body get used to it. We warn them ahead of time, even before they start it. Most people do fine once they get started. Then they have to find their niche because there’s – it’s funny because some people feel great with the 24 or 36 hours, and some people find that they do way better with long fasts, like periodic five-day, seven-day fasts.
Dr. Pompa:
I agree with that. Yeah. Uh-huh.
Dr. Fung:
I say, “It doesn’t matter to me. If you like this, then do it. If you like the other, do it as long as you’re getting your results.” When people really have trouble, I actually have them sometimes – what I ask them to do, and not all of them do it, obviously. I say, “What you should do is go for a long period, like five or seven days. That’s going to force your body” – that’s kind of like the desert island. You’re forcing your body to actually do it. It takes a bit of motivation, and it takes a bit of people who are willing to do it, but when they do that, their bodies usually make that adjustment. You kind of force your body to say, “Look, it’s not coming, okay? There’s no food coming. You better start shifting your metabolism.” Then when it does, they find it much easier. Also, if they’re kind of in that low carb – people who are eating a lot of low-carb, ketotoic diets, they actually do much better. They find the fasting really easy. It’s kind of a natural segue when they’re already in that high-fat diet. They actually do very – they switch over very well. Sometimes, the other thing is to switch them to that diet first.
Dr. Pompa:
Just take it in steps. That’s what we do. We switch their diet oftentimes to what I call a cellular healing diet, to, oftentimes, a ketosis, a more advanced cellular diet, and then we start the fasting. You’re exactly right. It’s like these people that say, “I have hypoglycemia. I can’t do it.” Oh. I have the cure. Don’t eat. “What? That’s the – I can’t not eat.” It’s like, “No. Just not eat.” Day three, day four, magic happens every time.
Eventually, the body goes, “Okay, I’m not going to die, so I’m going to switch my DNA. I’m going to turn genes off and turn some on.” All of a sudden, guess what. It starts utilizing fat for energy because it will not die. It will do everything to survive, even burn fat. Imagine that. It is remarkable, that adaptation that occurs in everybody. That’s why – you’re right – some of those longer block fasts are what you need to – eventually, every fast, they get more and more efficient at becoming fat burners.
Dr. Fung:
Yeah. The switch is easier so that even if they do feast, then they can very quickly go back and start burning fat again. I tell them that that’s what we want the body to do. Fat is nothing more than stored food energy. If you’re constantly putting food in, it’s not going to burn the fat because it has no reason to.
Dr. Pompa:
Yeah, absolutely. You know what? The body does get more and more efficient with every restricted state, whether it’s daily intermittent fasting or whether it’s block fasting, more and more efficient. I believe that when we fix that cellular energy problem, then we fix the majority of conditions that we’re seeing today, even brain fog, obviously, the inability to lose weight, whether it’s thyroid, diabetes, all these hormonal problems. The cell becomes more sensitive to the hormones. The cell becomes more efficient at utilizing fat, which burns cleaner than glucose.
Everything starts to change. Doc, we see it all the time. We are just so privileged to have you on this show, and just that fact that seeing somebody doing what we do. I call these things ancient healing strategies. All we’re doing is emulating, really, what our bodies are genetically set up to do.
Dr. Fung:
Yeah. That’s what I say, too. Sometimes, I call it the ancient secret because it’s been around forever. It’s a secret because everybody tells you not to do it, yet it’s exactly what you need to do. We tell people the opposite. “Oh, eat all the time,” like that’s going to really work, right?
Dr. Pompa:
Yeah. I have something that I call the 180 degree solution. What it means is if you just watch the media, read everything that everyone says about health, do the opposite, and somehow, you hit it right every time. “Oh, eat low fat?” Try high fat. “Eat low calorie?” Forget about low calorie. Eat until full. Basically, every message that comes across is wrong. “Fasting’s dangerous. Fasting’s bad.” Actually, fasting’s great. “Eat a big breakfast.” Don’t eat breakfast at all. We can just continue to go through – “Eat five, six meals a day.” Try eating one.
Dr. Fung:
That’s what I said, too. I said I should call this the Costanza diet [00:47:28] Jerry Seinfeld episode, where he did the opposite, and he did [00:47:34]
Dr. Pompa:
You know what’s funny? Someone told me the – about that episode, where everything was opposite. I said, “I’m going to play that at one of my seminars, the Costanza thing.” Everything’s opposite. You know, we stand different, Doc, but we have a message that ultimately will – could end an epidemic. The healthcare crisis, it’s not a better insurance or government-controlled program. It’s what you and I are talking about. It’s what we’re doing in our clinics and teaching doctors to do. This is it.
This is the answer, and it stands 180 degrees opposite of everything people are hearing from their doctors, from the media, from the government. We just got to get more of us preaching this message, no doubt. Promote your book, The Obesity Code. I actually love the name, Doc, because the obesity code, I believe it is a genetic code, and we could change that code by the things that we’re talking about, like intermittent fasting. Do you have a copy to hold up?
Dr. Fung:
Oh, I don’t have one here. I should have brought one.
Dr. Pompa:
Everyone will remember the name, Obesity Code. I’m sure you could buy it on Amazon, right?
Dr. Fung:
Yeah. It’s available everywhere now, so on Amazon. It’s in the bookstores, so anywhere you go, you should be able to get it now.
Dr. Pompa:
Listen, we appreciate your work. I’m sure we’ll have more requests to have you back on and continue some of these conversations. Meredith, let me turn it over to you because – Meredith, matter of fact, she just got done doing a four-day water fast herself last week.
Dr. Fung:
Wow! Amazing.
Dr. Pompa:
Meredith, let me turn it back over to you.
Meredith:
Oh, thanks. Yeah. It was my first water fast. I had done some broth fasting and fasting on whey water, but I’d been a little intimidated by the water. I found it to be much easier than a lot of the other fasts that I had done, so I’m excited to do a longer water fast. I do intermittent fasting daily. Practice a lot of what you guys preach, of course.
I had a lot of different questions, but just – we’re coming up on the end of the hour, so I know we don’t have much time. I’m just kind of curious, as a kidney expert, what you have to say as far as fasting and electrolyte balance. I know that that’s something that people ask a lot about. I took electrolytes, kind of a concentrated electrolyte balance, when I was doing my water fast. I was wondering if you could speak to that a little bit.
For alternate daily fasting and shorter periods – so I kind of break it at around 24, 36 hours, I generally don’t worry about it. Now, I measure it all the time in my – in the lab for our patients because people are worried about it, but it just about never is an issue. There is only one electrolyte that many people are deficient in, which is the magnesium. That gives, sometimes, a lot of muscle cramps. Not very dangerous, but it gives a lot of muscle cramps, and people don’t feel so well. That is the one that many people are deficient in, but it’s not really due to the fasting. They’re just deficient in it anyway.
A lot of Type 2 diabetics are deficient in it, so we do have some strategies for magnesium replacement. That’s the only one that I actually find quite a bit of, but I find it before we even do the fasting. The fasting doesn’t really make it any worse; it certainly doesn’t help. I just about never have a problem.
Now, you have to be a little bit more careful if people have advanced heart disease or advanced kidney disease. I don’t use it for advanced kidney disease just because there is a little bit more problems with it. Yeah, I don’t really worry about the electrolytes. I measure them just to make sure that people are staying hydrated and all this kind of stuff. Measure their kidney function, make sure they’re doing okay. Other than that, I don’t worry about it. For long-period fasts, like a week or more, then I’ll have people take a general multivitamin, and that’s about it.
Dr. Pompa:
Yeah. Then it’s enough to replace – we just have people take some sea salt, simple as that, which maintains – helps maintain the electrolytes. Yeah. No, that’s great. Great question.
Meredith:
Thanks, Dr. Fung. We so appreciate having you on today. Just to kind of finish up, I wondered if you had two or three takeaways for our audience if they wanted to start to implement some of these strategies.
Dr. Fung:
Yeah. I think the main takeaways, in terms of weight loss, is one, first of all, understand that this is a hormonal imbalance and not a caloric imbalance. If you understand that, then you know how to fix it. If the problem is too high in insulin, well, your strategy is, “How am I going to lower it?” One, you don’t want to eat foods that really stimulate insulin. That’s mainly the sugar and the refined grains, so bread, and pasta, and all those things that used to be on the bottom of that food pyramid. That’s one thing. That’s the ‘what to eat’ question.
The second question is really when to eat. Again, if you understand that insulin depends on both the high levels, but the persistence at those levels, then you want to have long periods of time where your levels are low. You want to do some intermittent fasting. It doesn’t have to be long. You could do 18 hours a day. Lots of people do that or even longer. Twenty-four hour periods, maybe twice a week is another popular strategy, or you could just do long periods, like seven days once in a while. That will work just as well.
These cleanses like Beyonce does, the Master Cleanse, which is – you have a little bit of funny stuff with lemon juice and so on. Essentially, it’s a fast. You could do that, too. Whatever it is that you want to do, you want to break that insulin resistance because that is one of the key problems that you can’t just deal with in terms of the ‘what to eat’ question. There’s always two questions: what to eat and when to eat. Both of those questions, in order to be successful – and I think that’s why a lot of diets fail because they only talk about what to eat.
We’re mostly in agreement. Nobody says you should eat white bread anymore, even the low-calorie people or low-fat people. Nobody says, “Oh, yeah. Go eat a lot of white bread.” Nobody says that anymore, right? We’re more or less in agreement on what to it. It’s the ‘when to eat’ question that we’ve really got wrong. The six, seven times a day, it’s all wrong. We have to really get people thinking about that more and saying, “Well, if you understand that it’s about too much insulin, now figure out what to eat. Figure out when to eat and implement the strategy that works best for you and that fits into your life.”
It’s not going to be the same for everybody. Some people say, “Oh, I do this and this. I do 18/6 every day.” They say, “Is that okay?” I’m like, “Well, are you losing weight?” “Yeah, I’m losing weight steadily.” Then that’s great. There’s nothing wrong with it. Now, if you start to plateau, then you’ve got to change it up. Other people won’t do so well on that strategy, and I’ll change it up. Again, you have to find what works for you in your life. Again, it’s the fasting – if you’re eating dinner – if you like to eat dinner with your family, and then you start doing these three-day fasts or five-day fasts, and it’s disrupting your family life –
I had one guy who used to not go to a social event. He’d usually get together with his buddies for lunch every day, and he’d not do that because he was – that’s not the idea. The idea to fit it around – you have to fit it in.
Dr. Pompa:
Absolutely.
Dr. Fung:
Don’t cut yourself off because you’re doing the fasting. It’s part of your life. Fit it in because there’s lots of opportunities to do so. That’s the key to doing it. Find what works for you. Find the strategy that works for you. There are general guidelines that I lay out, but I don’t use prescription so much because everybody’s so different, right?
Dr. Pompa:
Great. Thank you, Doc. We really appreciate it. What a great alignment we have with you and your message and ours. Awesome. Thank you.
Dr. Fung:
Thank you.
Meredith:
Thank you so much, Dr. Fung. Thanks, everyone, for watching. It was an awesome episode, jam-packed with information. Dr. Fung, we’ll have to keep in touch and maybe have you back on the show in the future.
Dr. Fung:
All right. Thank you.
Meredith:
Check out his book, The Obesity Code. It’s out now, March, 2016, so check it out. His website is IntensiveDietaryManagement. All right, everyone. We’ll catch you next time.
