A patient may have made my 2019! She came to see me for the
first time in April. She was already doing a great job with weight loss on her own
but looking to optimize. She had been diagnosed with diabetes, so she has what
we call “metabolic disease” and she was seeing an endocrinologist.
We got into a discussion about a theory on weight loss that
I’m very excited about, but truthfully, has little evidentiary support:
Intermittent fasting. I read The Obesity Code in 2 days while I was
nursing my second while on maternity leave. I had recently certified in obesity
medicine, in what was something of a whirlwind. I went to an introductory class
and literally saw the science of my lifelong struggle with trying to maintain a
healthy weight being researched and used to treat what had become an epidemic
in our country. I began studying immediately and became certified. What we
knew, is that the age-old “wisdom” of calories in-calories out just wasn’t effective,
because our bodies are very smart and learn to adapt. We had been blaming and
stigmatizing people for something that wasn’t their fault—something that was
behaving as much like an independent disease as diabetes or hypertension and is
modulated by hormones and brain functions and instincts. However, where I
remained frustrated was that when it came to the practical portion of a medical
weight loss plan, calories were still the mainstay.
NOT SO WITH THIS BOOK! This book utilized the hormone theory
that we had to learn to certify in obesity medicine—the hormone theory that is
becoming so important for the new medications that we are using to treat
obesity. When I tried to get my patients to understand their diet plans from a
calorie perspective, there would ALWAYS be a loophole, but there doesn’t seem
to be a loophole with this theory. REMEMBER THOUGH, it IS a theory, and
what we must remember with moving forward with this type of diet is that much
like the calorie theory of calories in-calories out, theory doesn’t always
translate into practice. The more we learn, this too, may prove to have its own
pitfalls. For now, it’s very promising. And my patient’s FIFTY, that’s right
FIVE ZERO, pound weight loss since April, is one example of how this can be
effective if you use the understanding of the theory to help you make healthier
choices all the way around.
It is important to note that she DID not stick to his SUPER
LOW CARB diet, nor does she fast for entire days. She uses the more common-sense approach of a
16:8 fast and remembers what she learned about how her hormones respond to
certain foods and uses this to make healthful choices on a regular basis, and
she has seen her body respond beautifully.
Not is her blood sugar average in normal range, but I had to stop her blood pressure medication because her blood pressure has been dropping too low. Can I tell y’all how much joy it gives me to STOP MEDICATIONS?! So, what are we talking about here?
Insulin Resistance
So the basics of the theory rest on this: insulin is a storage
hormone, that in excess, causes the majority of our problems with metabolic
syndrome, and helps make obesity a chronic health problem. Much of our
counseling in recent years to combat obesity has been the opposite of common
sense in say, the 1950s which was 3 square meals, early dinner, no snacking. We
became a society that snacked all the time on refined foods, much of which contained
very refined carbohydrates which caused our bodies constant exposure to
insulin. This led to insulin resistance.
To understand Insulin resistance, I’ll compare it to alcohol tolerance. If you have one glass of wine, and you don’t drink, that glass of wine might really affect you. But what if you drink a glass nightly? Now you have to have two glasses to feel the same effects that one glass did. Now what if you have 2 regularly? Now you need 3-4 to feel the same effects that that one glass had at the beginning.
In insulin resistance, our bodies have been exposed to non-stop insulin, because we are always in a fed state—always snacking, always eating, and always causing an insulin release. So, our bodies don’t respond to the same amounts of insulin to move the sugar—it needs more. This (in theory) caused the type 2 diabetes epidemic. However, insulin is still telling our bodies to hold on to all those calories that it’s storing, it’s not letting the calories be used for anything—this (in theory) caused the obesity epidemic. It’s a storage hormone. But when you’re in a fasting state, insulin levels fall, and lets those calories, or sugar, in the cell, be burned, like they’re supposed to.
Thought behind it:
What Dr. Fung proposes in this book is that if you keep your body in a state with insulin removed for long enough, you develop sensitivity to insulin again, and you reverse the dysfunction that the resistance to insulin causes. You have smaller amounts of insulin around, so you’re storing fewer calories. You not only reverse obesity, but you reverse metabolic syndrome and constant hunger as well. Believe me, I have not done this topic justice AT ALL. I am far oversimplifying for the sake of space—the man wrote a book, and this is a blog. You should definitely buy the book if you want to understand the full theory behind this. But know this about intermittent fasting: IT will not work if you are drinking sweet drinks or artificially sweetened drinks in the fasting state. IT will not work if you snack between meals. This type of diet is all about resetting the hormones, and it will not work if you try to game the system. The more you know about WHY you are doing what you are doing, the more likely you are to get it right. *Please note, his theory is just one and the latest theory in intermittent fasting. For a great, short article on some interesting research on intermittent fasting, click here.
Warning:
If you have ANY chronic health issues, this is NOT something
you should try without close follow up with your doctor. You may have to stop
some of your medications. Your health problem may not allow for this type of
lifestyle (for instance, right now, with my migraines, it’s not something I’m
trying to do, though I don’t know I’d always be limited from something like a
16:8).
16:8
The schedule above suggests that you have an 8-hour window daily that you eat, and you do not eat for 16 hours daily. This tends to be what I most often suggest as a lifestyle as it makes the most practical sense to me. It’s probably just what our bodies are craving. It could look like eating from 5 am to 1pm (I wouldn’t suggest this) or 8 am to 4pm (more reasonable) or 1 pm to 9pm (again, a little extreme). Any of these work though, and you can pick a time that fits best with your lifestyle (i.e. family dinner for people with children, work schedule, evidence that eating earlier is better for LDL cholesterol).
24/30-hour fast
Some people participate in longer fasts. The important. A 24
hour fast would begin at the close of dinner one day and end with the start of
dinner the following day (so you would skip breakfast and lunch of one day)
while a 30 hour day is more what you would think of as a full day fast.
Fasting
The key to fasting, whether 16, 24, or 30 hours, is HYDRATION, HYDRATION, HYDRATION. You can have liquids including water, unsweetened tea or coffee, and broth including small amounts of bone broth. Up to 2 teaspoons of heavy whipping cream are acceptable additions to beverages, but no artificial sweeteners as these cause insulin spikes although they do not cause sugar spikes. This is all that you have during the fasting period and between the three square meals during fed periods.
So these are the basics. Honestly, you can combine this thought process with whatever healthful diet you would typically be eating otherwise, plant-based, low carb, ketogenic, or low fat. This is more about understanding the importance of timing when eating meals. As I’ve previously stated, I am no one-size-fits-all physician. I do not know that this is something that will work for everyone. I do know that with everything I know about obesity, and with the research that is being done on this topic, it is a very promising theory, that shouldn’t be ignored as we continue to understand the complexities of our health.
As always, I look forward to questions/comments on this topic! Discussion drives learning.
(Update 1/5/2020: More benefits discussed briefly here.)
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