Episode #202
In this Fasting Q&A episode, hosted by Coach Lisa Chance, Dr. Jason Fung answers questions from the TFM Community:
- I’m curious if TFM intends or would consider a ‘fasting-mimicking protocol’ to be published for its members, possibly a TFM Quick Guide? [01:22]
- When I fast I find that I have trouble falling and staying asleep. Is it the hunger increasing my cortisol or the effect of ketones? What are your thoughts on valerian or kava tea to help with fasting insomnia? [02:54]
- What’s the latest research on autophagy? [05:12]
- What does research say about the relationship between the HDL/Triglycerides ratio and high coronary calcium scores? And, in general, what does the scientific literature say about potential interactions between statins and fasting regimens? [07:00]
- There is a hormonal cascade where our sex hormones are made from cholesterol. We know from member stories that female hormones become balanced on alternate day fasting regimen. In those success cases, how does alternate-day fasting affect the hormonal cascade so that it starts working properly again? [12:59]
- I was recently reading research that suggests that moderate weight gain during menopause, particularly in lean women, may offer a degree of protection against cardiovascular disease, due to the increased production of adipose-tissue-derived estrogen, which can partially compensate for the decline in ovarian estrogen levels following menopause. What are your thoughts on this? [15:27]
- Why might weight loss stall during a multi-day fast, even when following an extended-fasting protocol with proper hydration, electrolytes, and exercise? What factors could influence the rate of weight loss, and how can one determine if adjustments are needed? [19:02]
- Is there a problem with lowering metabolic rate during fasting? Do I need to worry about this? [21:13]
- The RR interval typically refers to the time between consecutive R waves in an electrocardiogram (ECG/EKG) and is a fundamental measurement in heart rate variability (HRV). Has the RR interval been studied in diagnosing gastroparesis, specifically for diabetes? [24:51]
LINKS
Cholesterol Ratio Calculator
https://www.omnicalculator.com/health/cholesterol-ratio
Longevity Summit video with Cynthia Thurlow on Dr. Fung’s YouTube channel.
A Conversation with Cynthia Thurlow | Jason Fung
https://youtu.be/YeELPeaQEFg?si=88JJWDzyzjDPGK76
Please note that you need to be a member of the TFM Community to submit questions to the Q&A webinars with Dr. Fung but you can submit questions to our regular Q&A episodes here: https://bit.ly/TFMPodcastQs
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
A lot of people, they want the high
metabolic rate because they want to
be able to eat and still lose weight, sort of
thing, or maintain their weight.
I'm still not entirely sure
that having a high metabolic rate is
actually a good thing.
It's just like if you have a car and
you're running the engine at a very high rate.
(00:20):
So you're going to use more gas, right?
That's fine.
And you're using more gas because your engine
is revving at a higher rate.
But what happens in the long term?
Does it wear out faster?
So that's always a worry.
So people are always-- they're so worried
about a low metabolic rate.
I'm not sure that that's a bad thing
(00:42):
in the long term from a longevity standpoint.
[music]
Hello, everyone, my name is Lisa Chance
and I'm here this month with our very own
Dr. Jason Fung.
Hi, Dr. Fung, how are you doing today?
I'm good, how are you?
I'm good. I'm glad spring is coming.
(01:03):
[laughter]
All right. So our first question is, "I'm
curious if TFM intends,
or would consider, doing
a fasting-mimicking protocol
to be published for its members,
possibly a TFM Quick Guide."
I know we have fat fast, both for plant-based
and omnivores.
(01:24):
Is this a possibility, Dr. Fung?
Yeah, I think that certainly we can do
that because the fasting-mimicking
diet has a lot of good science
behind it. So it's certainly great
to see the science and what they do as
a five-day-- it's not a full fast,
but it's sort of a modified fast.
(01:44):
What they do is they give you all the food and
stuff to take, so then that's fine.
The only major problem is it's expensive.
There's nothing wrong with the product.
I mean, it's a little bit processed, but it's
kind of pricey for five days.
Now, mind you, you get the foods, you don't
have to pay for food, but it is like 200+
dollars, Canadian dollars anyway.
(02:05):
I don't know the US price, but it's like 200
something. On the other hand, it is actually
covered by some HSA and so on, so
the cost can be deferred because I think
they're trying to get it covered as a medical
treatment, which it truly is actually.
So there's a lot of good things about it.
And I tried it. It's actually quite good.
The only downside is sort of cost and they're
trying to figure that out by getting-- seeing
(02:26):
if people-- you know, you can get insurances
to cover it and so on.
But I think that's something that we could
certainly do with the TFM is actually
put together something like that
so that we could all do it together.
So I think that's a great idea.
This next question is about
fasting insomnia.
They said when they do a NOMAD (no meals
(02:46):
a day), they find that they have trouble
falling asleep and staying asleep.
"Is it the hunger increasing my cortisol or is
it the effect of the ketones?" They're also
taking oral progesterone, melatonin,
and magnesium every night before going to bed.
They were wondering, specifically-- I know
you've talked about the counter regulatory
hormones before doctor, but
(03:08):
they were wondering what are your thoughts on
valerian tea or kava tea
to help with, specifically, fasting insomnia.
I don't have anything against the teas, I
actually haven't tried those myself.
But, again, insomnia is likely from
the counterregulatory hormones, particularly
the sympathetic nervous system.
(03:29):
So sympathetic tone goes up, and that's
noradrenaline and so on.
So, when you fast, your body actually
doesn't shut down, it actually ramps itself
up. So that's why it releases noradrenaline.
And sympathetic tone goes up because it's
releasing energy, right?
You're trying to move glucose from your
stored system (you know, like the liver) out
(03:50):
into the blood. So that's what the
counterregulatory hormones do.
So that makes you not sleepy because you have
energy, right? It's just like if you take
caffeine or something, which is, again, a
stimulant. It's a sort of a stimulant, so it's
gonna make you have trouble sleeping.
If these things help you, then that's great,
but, if you aren't able to sleep, sometimes
you just have to sort of go to bed later
(04:10):
or do something else.
I find that a little bit too, right?
So I normally go to sleep at a certain time,
12:30, but when I do the fasting,
sometimes I actually do have trouble falling
asleep too. So I actually sometimes stay up a
little bit, which always worries me because I
always think, "Oh, am I gonna be really tired
in the morning?" But it usually doesn't
work that way because I think I need a little
(04:32):
less sleep.
So, yeah, if those teas help you, then that's
great.
I would caution people, that if they're on
medications, to check with their doctor,
because sometimes if you're on blood thinners,
or diuretics, or any kind of
neurological one, those are a little stronger
teas I would check with your doctor, your
healthcare provider, just in case.
For me, the best things that work are blue
(04:53):
blockers. That's the thing I don't want to
use, but those are the things that help me the
most.
This person's next question is one
I'm very interested in.
"What's the latest research on autophagy,
Dr. Fung?"
There hasn't been too much lately.
I mean, the problem is it's always hard to
measure. So when do you know somebody's
going into autophagy?
(05:13):
So a lot of the data was in
yeast and other bacteria and so
on, and how much applies
to humans is unknown.
What people are sort of a bit more focused
on is the effect of fasting on
bigger-picture things, right?
Rather than the actual process of autophagy,
(05:33):
what you're starting to see now is data on
fasting, and things like
type 2 diabetes, and weight loss, and so
on because the whole field has not
been well-studied for so
long and fasting protocols are
all over the place.
But, yeah, I don't think that there's a lot
there because autophagy is more of a
(05:54):
mechanism rather than a disease so
it's like it's what's happening, and that's
all sort of
being worked out in those bacterias and yeast
rather than in humans, because it's a lot
harder to study in humans because there's
all different types of cells, right?
As opposed to these single-celled organisms,
there's liver cells and breast cells, and so
there's not as much-- but, all the time, what
(06:16):
we're seeing is data on fasting and
other diseases.
And a lot of it is showing what we sort of
expected it to show that, you know, if you get
rid of the metabolic disease, there's a lot of
benefits there.
It's interesting.
So I'll be honest here, I have
had to really reword this question because
it was really a medical question and
(06:38):
asking for medical advice, so I have
really re-worded this so that it's a general,
more general question.
So what does the research
say about the relationship between
HDL and triglyceride ratios?
This person scores around 0.77
on the ratio. So quite low, ideal would
(06:58):
be below 2.
But having a high coronary
calcium score, Agatston score?
Is that how you say it, Dr. Fung?
The typical cholesterol profile
will have LDL, which is what everybody
sort of focuses on because, if it's
high, they give you a lot of statins.
HDL and triglycerides tends to
(07:20):
go together. Low triglyceride
tends to go along with high HDL,
so, usually, they mean the same thing.
So the ratio is not something that I typically
look at. Most of the time, if you have a low
trigycyride, you'll have a higher HDL.
It's part of the mechanism.
Diet actually has very little to do with the
LDL, but the HDL and
(07:41):
the triglycerides is much more dependent on
the diet. So particularly carbs.
If you eat a lot of carbs, your triglycerides
tends to be higher.
And then when your triglycerides are higher,
your HDL tends to be lower.
So those things all go together.
I typically look at all of the panel rather
than that ratio specifically, but,
again, the most important
(08:01):
factor for heart
disease is not the LDL.
Everybody focuses on the LDL because that's
the one that's amenable to drug treatment,
so of course there's been billions of dollars
of marketing to sort of doctors
talking about the LDL cholesterol.
But, in fact, if you were to take a single
marker that is the most highly correlated
(08:23):
to future heart disease, it's actually HDL.
Because there's no drug to be marketed,
then it gets a lot less attention.
There in fact was a drug that was developed
to raise HDL, and of
course it actually didn't do anything.
It actually in-- like, if you took it, your
HDL was higher, but more people died
of heart disease and so on.
(08:44):
That's because the high HDL
is not good by itself.
The high HDl was good because
it was a marker for
lower triglycerides and less
metabolic disease.
So, raising it doesn't do anything
because it's just not taking care of the
actual problem. So if you have the metabolic
(09:06):
syndrome, then your HDL tends to
be low. So, if you then artificially raise
the HDL and you still have the metabolic
syndrome, well, it doesn't do anything.
You'd do just as badly as if you didn't bother
taking the drug. So the drug didn't work.
So it's not the HDL itself that's the problem.
It's the underlying cause of the low HDL,
which is the metabolic syndrome, which was
where the fasting really helped.
(09:26):
She's asking-- or he or she, I don't know
which one it is, is asking about the CAC
score. Now we just read the book, The
Great Cholesterol Myth.
We did it in January and February for
the TFM Book Club.
And I'm going to put the link to that in
the show notes where the thread is over
in the Community Forum.
And also a link to a cholesterol
(09:47):
ratio calculator if you guys want to use it.
But we did have a
member who came and shared that
she got a CAC score done about
four or five years ago and she's been doing
strict keto since then.
So her CAC was high, but she
did another CAC score and she
has had no more plaque buildup
(10:09):
since that time.
So that was really neat to hear, that
we're doing the right thing.
Yeah, exactly.
And the score, which is a measure of how
much plaque you have in the coronary
arteries, again, is a use as
a marker for risk of future heart disease.
Heart disease is caused by
(10:29):
lots of things, but metabolic syndrome is a
big factor. But there's others, right?
There's smoking, there's exercise, there's
genetics, there is sex, there's age, and lots
of other things too, inflammation and lupus
and all these things, they all cause it.
So it's not simply caused by
metabolic syndrome but is one of the biggest
risk factors, so therefore-- you
know, especially when we talk about risk
factors you want to really focus in on
(10:51):
reversible risk factors because, you know, you
can't change your genetics, right?
You can change your age or your sex, so
therefore, that sort of thing doesn't matter
so much because it's not anything you can do
anything about, but metabolic disease and
smoking are the two biggest reversible risk
factors and that's where you have to focus.
So by changing to a
ketogenic diet or a lower-carbohydrate diet,
(11:12):
being able to stabilize it, which is good
because, over time, what usually happens is it
gets worse. If it stayed the same, that's
actually very good.
Some people have said they've had regression,
but even just staying stable is very good.
[music]
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(11:34):
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(12:17):
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[music]
(12:42):
This person says, "There is a
hormone cascade where our sex hormones
are made from cholesterol.
We know from member stories that
female hormones become balanced on
alternate-day fasting regimes.
In those successful cases, how
does alternate-day fasting effect
the hormonal cascade so that it starts
(13:03):
working properly again?"
With the hormones that you're talking--
estrogen, progesterone, and testosterone
are the sort of sex hormones.
And the effect of insulin
is mostly separate, but not
completely separate.
So insulin is more to do with
metabolism and so on, which
(13:25):
doesn't always impact, but they do interact.
So people who have-- in men, for example,
who have obesity, you can get
aromatization, so you turn some of the
testosterone into estrogen.
You get sort of feminization of the body, so
you got those sort of breast enhance-- you
know, the men get those little
breasts and so on because of the increased
(13:45):
estrogen.
You get the opposite, too, where high
levels of insulin can cause various things.
And the pathway is different, but you get that
in polycystic ovary syndrome
where you get the high insulin levels, which
causes the cysts to develop, and then
the increased testosterone so you get to hair
growth and the anovulatory cycles
(14:05):
that you see in polycystic ovary syndrome.
So there's a few different ways--
alternate-daily fasting, or other types of
fasting, can influence the
sex hormones in different ways.
Usually, for men, it would be the
testosterone increasing the sort of
fat cells which turn that testosterone into
estrogen, so higher estrogen than normal.
(14:25):
In women, you have higher testosterone
than normal, again, due to the influence of
the insulin. And then you get the cyst
development in the kidneys.
It's a little bit-- the actual pathways are a
little more complicated, but, essentially,
the men get more estrogen, which is bad, and
the women get more testosterone, which is bad
because they're not getting their proper
(14:46):
ratios of sex hormones and so on.
The women can get higher estrogen levels too,
but, again, that tends to be not so bad
because their estrogen levels are generally
higher anyway.
I highly recommend anybody listening to listen
to The Longevity Summit where you were
actually the host, and you talked with
Cynthia Thurlow.
So, yeah, and you talk to a little bit about
(15:07):
the female hormones and stuff.
That was good.
Okay, so it says,
"I was recently reading research
that suggested that moderate weight gain
during menopause, particularly in
lean women, may offer a degree of protection
against cardiovascular disease due
to the increased production of
adipose-tissue-derived estrogen,
(15:29):
which can partially compensate for the decline
in ovarian estrogen levels following
menopause. What are your thoughts on this?
May it be wise to welcome hormonal changes
in creating a protective role of fat
accumulation over the course of menopause
transition?
I appreciate your insights."
That's going to depend on where you're coming
(15:51):
from, right? So if you're very lean,
then-- so perimenopause is actually one of the
highest risk periods in a woman's
life for weight gain. So if you look at weight
gain, or fat gain specifically,
the menopausal period is the
highest. And there's changes over time during
the cycle, in terms of the estrogen and
(16:11):
progesterone, so, in fact, your appetite
actually goes up and down depending, which is
very interesting.
I was actually just looking at some data from
Lumen too, looking at the changes, not
only in hunger during the
cycle, but you actually change what you burn,
which is quite interesting. So in the first
part of the cycle you actually tend to burn
more carbs. The second part of cycle you tend
(16:31):
to burn more fat, which is very, very
interesting. And that's why Megan always says,
well, if you're going to fast, try and do it
in the first [half of your cycle] because
estrogen is building up.
Estrogen actually acts as a bit of an appetite
suppressant so your appetite goes down and you
can see it when you have to do big studies.
On average, people actually eat less and less
as they get to ovulation and then their
appetite goes up. So there's very interesting
(16:52):
data showing the effect of the sex
hormones on appetite.
During menopause-- so the three
years of perimenopause, which is the three
before menopausal, is-- again,
if you look at big studies, there's
actually an increase in weight just
specifically in that period of time.
And that's when estrogen tends to go down,
(17:15):
through menopause, right?
People think it's because estrogen overall
seems to suppress the appetite.
So that's why, during the cycle, as you get
higher estrogen levels, you actually eat less.
So if you look at how much people eat during
the cycle, it actually goes down.
From day one to ovulation, it actually goes,
down, down, down, down, down and then
progesterone goes up and then you eat more.
(17:36):
But if your estrogen is just going
down steadily, then you're losing
that sort of inhibitory effect and then you
may wind up eating more.
So, on average, people do gain weight in
perimenopause. A lot of people say it
anecdotally, and there's actually good data to
suggest that, yes, that is true and that's
a possible mechanism for that.
So, yes, if you're lean, then maybe
(17:58):
it might be good to gain some weight.
If you're not lean and you're overweight,
then, yeah, that's not such a good thing,
right? So it's certainly going to be where
you're coming from.
But that perimenopause period of
time is something that you really have to
watch. A lot of people have noticed it
themselves, but, on the other hand,
if you know that it's a high-risk period of
(18:18):
time that you want to really focus in on good
habits and fasting and so on.
I get several clients-- I would say almost
half of my clients that come in and say, "I've
never been fat a day in my life.
I'm going through menopause and I'm gaining
like crazy. What's going on?"
Yeah.
So cutting out the processed carbs helps a
lot. Sometimes they can just improve
(18:38):
their diet and stick to 24s
and stuff. And then they don't have the issue
that other people have that are low and
diabetic.
Completely.
So this person says,
"Why might weight loss stall during
a multi-day fast even when following
an extended fasting protocol with
proper hydration, electrolytes,
(19:00):
and exercise?
What factors could influence the rate
of weight loss and how can one determine
if and what adjustments need to be
made?"
Yeah, the weight is going to be quite variable
because, when you fast, there's a lot of
water loss.
So when you fast, insulin is gonna go down
and insulin is a hormone that tends
(19:21):
to make you retain water.
So, as your insulin goes down, it's actually
gonna lose-- you're gonna lose a lot water.
So there's an initial period of time where you
lose a lot of water, which is not a bad thing.
You know, a lot people have a little bit of--
you know, they feel less bloated, they feel a
lot better about it, right?
But what you can get is a very, very quick
weight loss at the beginning, which then,
as it sort of evens out, then you
(19:44):
may retain a bit of water.
So, you know, obviously, if you're eating zero
calories, your body cannot burn zero
calories, right? There's just no possible way
to do that.
So you still need to lose some body
fat, but it may be sort of balanced by
regaining a little bit of the weight and so
on as water weight, right?
And that's why the day-to-day fluctuations are
(20:06):
not always accurate.
And some people say, "Well, you know, I
haven't eaten and I haven't lost any further
weight." It's like, maybe because if you lost
a lot at the very beginning, now it's just
sort of evening out and your body's just
reaching an equilibrium, maybe overshot
a little bit, and then that's why the weight
is not always the most accurate thing
to be monitoring.
(20:27):
I was surprised when-- I think it was last
year, I did six months of therapeutic
fasting. I had gained some weight after my
aunt died, so I did six months of therapeutic
fasting. And when I stopped and
went to TRE, no snacking, two
meals a day I continued to lose
weight. It was like it carried on
over. And so I was really pleased
(20:48):
with that because I hadn't done that the first
time I lost my weight.
So I was like, "Oh, something changed in my
metabolism." Matter of fact, one of the
questions in the Q&A box is, "Is there
a problem with lowering your metabolism
when fasting?
Do I need to worry about this?"
That's a good question because, for a lot of
people, they want a high metabolic
(21:10):
rate, you know, because they want to
be able to eat and still lose weight sort of
thing or maintain their weight.
I'm still not entirely sure
that having a high metabolic rate is
actually a good thing because it's
just like if you have a car and you're
running the engine at a very high rate.
So you're gonna use more gas, right?
(21:31):
That's fine.
And you're using more gas because your engine
is revving at a higher rate,
but what happens in the long term?
Does it wear out faster?
So that's always a worry.
So people are always-- they're so worried
about a low metabolic rate.
I'm not sure that that's a bad thing
in the long-term from a longevity standpoint,
(21:53):
because, you know, you may be putting less
wear on your body by running it at a
slower rate. Yes, you can't eat as much and
you'll have to eat less because you're burning
less, but you can
try to control your metabolic rate.
But you have all these people who are-- you
know these people, who are always trying to
stoke your metabolic rate and all this sort of
(22:14):
stuff. And it's like, yeah, I'm not sure that
it's good. You know, the best advice I can
really say is that stick to a natural diet,
stick to healthy fasting period,
and you'll probably do better.
If your metabolic rate happens to be high or
low, well then that's fine.
I would accept it. But if it's low, I wouldn't
necessarily think that that's something that
you have to correct.
(22:36):
I mean, there are ways you can
try to bring it up. We know that, right?
When you go on calorie-reduced diets, for
example, your metabolic rate tends to fall.
If you overeat, you can raise it, but
I'm not sure that that's something that
should be tampered with because I'm not
entirely convinced that a low metabolic rate
isn't actually good for you.
(22:57):
Like, I look at all these-- I have a ton of
patients, like these elderly patients--
a lot are oriental just because that's my
practice population, but they're in like their
nineties and stuff.
Then really they eat very, very little,
but they're not gaining weight, they're not
losing weight. So, clearly, their metabolic
rate is quite low, but, you know,
they're like in their nineties and looking
(23:17):
really good.
And I'm thinking, maybe that's a good
thing. Like if you think about the
hundred-year-olds and stuff, because I
actually just recently had a couple of sort
of extended relatives who had their 100th
birthday, and they're never overweight,
they're never like super active, they're
always like, you know-- it seems to
me that their metabolic rate is actually quite
(23:38):
low, because they're cold,
they're always wearing a vest, they're always
moving slowly.
So it's like, okay, you're clearly not
revving your system and burning a lot of fuel,
but I'm just wondering if that
is an issue or not.
I probably wouldn't worry about it because
it's possible it may be a good thing and by
tampering it you may not.
(23:59):
I know some of the Blue Zones people
eat OMAD.
You know, Megan warns about doing too many
OMADs in the week, but that's if you're trying
to lose weight.
But people who are already-- they're at their
ideal weight and they live in these Blue
Zones, they're eating real food, whole foods,
and they're doing basically one meal a day,
that's a different story.
That's a different population.
(24:19):
Exactly, because if you're doing a lot of
OMADs and you are trying to lose weight
because of metabolic syndrome, then you need
to get that down, right?
In which case, then, yes, maybe a higher
metabolic rate at that time may be good for
you, but, exactly, its...
I should clarify, OMAD is one meal a day.
So just for those of you who are...
Yeah.
And this was another long question, and they
were asking about the RR interval.
(24:41):
And I finally figured out that they were
talking about heart rate variability.
And as a cardiac nurse, I can tell you that
this is in its infancy.
It's on a lot of the gadgets (24:48):
your watches
and your Oura rings and things like that.
And the ideal way to do it would be to
take you in, put you on a table, hook you up
to a 12-lead EKG.
That's how you really find out what your heart
rate variability is.
It's showing your gas and your break ability,
your stress response.
To press the gas when you need it, to press
(25:08):
the brake when you need it.
And so it is-- for me, it's
a good reflection of my whole lifestyle
intervention and what is helping with
that. But this person is specifically
asking if there any
things with gastric emptying
scans. Are they considered the
standard test for gastroparesis
(25:30):
with these RR interval studies?
May there be a better alternative to
diagnosing gastroparesis
in this? So I know this kind of-- especially
with diabetic...
Yeah, it's not really my area.
So gastroparesis, there are various tests.
Basically, you swallow something (which is
usually tagged) and then you follow it and see
(25:51):
how long it takes to sort of get through the
GI system.
That's to do with the stomach.
The heart rate variability is more the-- like
if your heart rate sometimes is very slow and
very fast, that's a huge variability opposed
to somebody else who's always at like 72, and
next day is 72, and the next day is 73, right?
So it's just that heart rate variability is--
you know, I'm not sure.
(26:12):
It's in its infancy because it appears
to be important in that people who have a
high variability may be at higher
risk. However, it's probably not
the heart rate itself.
It's like, why is your heart rate going fast
and slow and fast and slow?
What's causing that? And then what can you do
about it, right, because that's the real
issue. And so we're not at
(26:34):
the point where we can say, "Okay, your
heartrate variability is high.
Therefore, this is what's causing it
and this is what you can do about it." We're
sort of at the stage where we're saying,
"Well, is this the real important thing?
How important is it? Does it give us
additional information?" as opposed
to what we get already from things
like the A1C, and waist circumference,
(26:54):
and all that sort of thing.
So that's where we are in terms of heart rate
variability. Gastroparesis is sort of a
separate topic.
Diabetics get it a lot and, in terms of
diagnosis, usually you can make it
clinically, but, you know, for the other one,
it's definitely something else.
I look forward to asking you more questions
next month.
Thank you, Dr. Fung.
(27:15):
Take care.
A lot of people, they want the high
metabolic rate because they want to
be able to eat and still lose weight, sort of
thing, or maintain their weight.
I'm still not entirely sure
that having a high metabolic rate is
actually a good thing.
It's just like if you have a car and
you're running the engine at a very high rate.
(00:20):
So you're going to use more gas, right?
That's fine.
And you're using more gas because your engine
is revving at a higher rate.
But what happens in the long term?
Does it wear out faster?
So that's always a worry.
So people are always-- they're so worried
about a low metabolic rate.
I'm not sure that that's a bad thing
(00:42):
in the long term from a longevity standpoint.
[music]
Hello, everyone, my name is Lisa Chance
and I'm here this month with our very own
Dr. Jason Fung.
Hi, Dr. Fung, how are you doing today?
I'm good, how are you?
I'm good. I'm glad spring is coming.
(01:03):
[laughter]
All right. So our first question is, "I'm
curious if TFM intends,
or would consider, doing
a fasting-mimicking protocol
to be published for its members,
possibly a TFM Quick Guide."
I know we have fat fast, both for plant-based
and omnivores.
(01:24):
Is this a possibility, Dr. Fung?
Yeah, I think that certainly we can do
that because the fasting-mimicking
diet has a lot of good science
behind it. So it's certainly great
to see the science and what they do as
a five-day-- it's not a full fast,
but it's sort of a modified fast.
(01:44):
What they do is they give you all the food and
stuff to take, so then that's fine.
The only major problem is it's expensive.
There's nothing wrong with the product.
I mean, it's a little bit processed, but it's
kind of pricey for five days.
Now, mind you, you get the foods, you don't
have to pay for food, but it is like 200+
dollars, Canadian dollars anyway.
(02:05):
I don't know the US price, but it's like 200
something. On the other hand, it is actually
covered by some HSA and so on, so
the cost can be deferred because I think
they're trying to get it covered as a medical
treatment, which it truly is actually.
So there's a lot of good things about it.
And I tried it. It's actually quite good.
The only downside is sort of cost and they're
trying to figure that out by getting-- seeing
(02:26):
if people-- you know, you can get insurances
to cover it and so on.
But I think that's something that we could
certainly do with the TFM is actually
put together something like that
so that we could all do it together.
So I think that's a great idea.
This next question is about
fasting insomnia.
They said when they do a NOMAD (no meals
(02:46):
a day), they find that they have trouble
falling asleep and staying asleep.
"Is it the hunger increasing my cortisol or is
it the effect of the ketones?" They're also
taking oral progesterone, melatonin,
and magnesium every night before going to bed.
They were wondering, specifically-- I know
you've talked about the counter regulatory
hormones before doctor, but
(03:08):
they were wondering what are your thoughts on
valerian tea or kava tea
to help with, specifically, fasting insomnia.
I don't have anything against the teas, I
actually haven't tried those myself.
But, again, insomnia is likely from
the counterregulatory hormones, particularly
the sympathetic nervous system.
(03:29):
So sympathetic tone goes up, and that's
noradrenaline and so on.
So, when you fast, your body actually
doesn't shut down, it actually ramps itself
up. So that's why it releases noradrenaline.
And sympathetic tone goes up because it's
releasing energy, right?
You're trying to move glucose from your
stored system (you know, like the liver) out
(03:50):
into the blood. So that's what the
counterregulatory hormones do.
So that makes you not sleepy because you have
energy, right? It's just like if you take
caffeine or something, which is, again, a
stimulant. It's a sort of a stimulant, so it's
gonna make you have trouble sleeping.
If these things help you, then that's great,
but, if you aren't able to sleep, sometimes
you just have to sort of go to bed later
(04:10):
or do something else.
I find that a little bit too, right?
So I normally go to sleep at a certain time,
12:30, but when I do the fasting,
sometimes I actually do have trouble falling
asleep too. So I actually sometimes stay up a
little bit, which always worries me because I
always think, "Oh, am I gonna be really tired
in the morning?" But it usually doesn't
work that way because I think I need a little
(04:32):
less sleep.
So, yeah, if those teas help you, then that's
great.
I would caution people, that if they're on
medications, to check with their doctor,
because sometimes if you're on blood thinners,
or diuretics, or any kind of
neurological one, those are a little stronger
teas I would check with your doctor, your
healthcare provider, just in case.
For me, the best things that work are blue
(04:53):
blockers. That's the thing I don't want to
use, but those are the things that help me the
most.
This person's next question is one
I'm very interested in.
"What's the latest research on autophagy,
Dr. Fung?"
There hasn't been too much lately.
I mean, the problem is it's always hard to
measure. So when do you know somebody's
going into autophagy?
(05:13):
So a lot of the data was in
yeast and other bacteria and so
on, and how much applies
to humans is unknown.
What people are sort of a bit more focused
on is the effect of fasting on
bigger-picture things, right?
Rather than the actual process of autophagy,
(05:33):
what you're starting to see now is data on
fasting, and things like
type 2 diabetes, and weight loss, and so
on because the whole field has not
been well-studied for so
long and fasting protocols are
all over the place.
But, yeah, I don't think that there's a lot
there because autophagy is more of a
(05:54):
mechanism rather than a disease so
it's like it's what's happening, and that's
all sort of
being worked out in those bacterias and yeast
rather than in humans, because it's a lot
harder to study in humans because there's
all different types of cells, right?
As opposed to these single-celled organisms,
there's liver cells and breast cells, and so
there's not as much-- but, all the time, what
(06:16):
we're seeing is data on fasting and
other diseases.
And a lot of it is showing what we sort of
expected it to show that, you know, if you get
rid of the metabolic disease, there's a lot of
benefits there.
It's interesting.
So I'll be honest here, I have
had to really reword this question because
it was really a medical question and
(06:38):
asking for medical advice, so I have
really re-worded this so that it's a general,
more general question.
So what does the research
say about the relationship between
HDL and triglyceride ratios?
This person scores around 0.77
on the ratio. So quite low, ideal would
(06:58):
be below 2.
But having a high coronary
calcium score, Agatston score?
Is that how you say it, Dr. Fung?
The typical cholesterol profile
will have LDL, which is what everybody
sort of focuses on because, if it's
high, they give you a lot of statins.
HDL and triglycerides tends to
(07:20):
go together. Low triglyceride
tends to go along with high HDL,
so, usually, they mean the same thing.
So the ratio is not something that I typically
look at. Most of the time, if you have a low
trigycyride, you'll have a higher HDL.
It's part of the mechanism.
Diet actually has very little to do with the
LDL, but the HDL and
(07:41):
the triglycerides is much more dependent on
the diet. So particularly carbs.
If you eat a lot of carbs, your triglycerides
tends to be higher.
And then when your triglycerides are higher,
your HDL tends to be lower.
So those things all go together.
I typically look at all of the panel rather
than that ratio specifically, but,
again, the most important
(08:01):
factor for heart
disease is not the LDL.
Everybody focuses on the LDL because that's
the one that's amenable to drug treatment,
so of course there's been billions of dollars
of marketing to sort of doctors
talking about the LDL cholesterol.
But, in fact, if you were to take a single
marker that is the most highly correlated
(08:23):
to future heart disease, it's actually HDL.
Because there's no drug to be marketed,
then it gets a lot less attention.
There in fact was a drug that was developed
to raise HDL, and of
course it actually didn't do anything.
It actually in-- like, if you took it, your
HDL was higher, but more people died
of heart disease and so on.
(08:44):
That's because the high HDL
is not good by itself.
The high HDl was good because
it was a marker for
lower triglycerides and less
metabolic disease.
So, raising it doesn't do anything
because it's just not taking care of the
actual problem. So if you have the metabolic
(09:06):
syndrome, then your HDL tends to
be low. So, if you then artificially raise
the HDL and you still have the metabolic
syndrome, well, it doesn't do anything.
You'd do just as badly as if you didn't bother
taking the drug. So the drug didn't work.
So it's not the HDL itself that's the problem.
It's the underlying cause of the low HDL,
which is the metabolic syndrome, which was
where the fasting really helped.
(09:26):
She's asking-- or he or she, I don't know
which one it is, is asking about the CAC
score. Now we just read the book, The
Great Cholesterol Myth.
We did it in January and February for
the TFM Book Club.
And I'm going to put the link to that in
the show notes where the thread is over
in the Community Forum.
And also a link to a cholesterol
(09:47):
ratio calculator if you guys want to use it.
But we did have a
member who came and shared that
she got a CAC score done about
four or five years ago and she's been doing
strict keto since then.
So her CAC was high, but she
did another CAC score and she
has had no more plaque buildup
(10:09):
since that time.
So that was really neat to hear, that
we're doing the right thing.
Yeah, exactly.
And the score, which is a measure of how
much plaque you have in the coronary
arteries, again, is a use as
a marker for risk of future heart disease.
Heart disease is caused by
(10:29):
lots of things, but metabolic syndrome is a
big factor. But there's others, right?
There's smoking, there's exercise, there's
genetics, there is sex, there's age, and lots
of other things too, inflammation and lupus
and all these things, they all cause it.
So it's not simply caused by
metabolic syndrome but is one of the biggest
risk factors, so therefore-- you
know, especially when we talk about risk
factors you want to really focus in on
(10:51):
reversible risk factors because, you know, you
can't change your genetics, right?
You can change your age or your sex, so
therefore, that sort of thing doesn't matter
so much because it's not anything you can do
anything about, but metabolic disease and
smoking are the two biggest reversible risk
factors and that's where you have to focus.
So by changing to a
ketogenic diet or a lower-carbohydrate diet,
(11:12):
being able to stabilize it, which is good
because, over time, what usually happens is it
gets worse. If it stayed the same, that's
actually very good.
Some people have said they've had regression,
but even just staying stable is very good.
[music]
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(11:34):
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(11:55):
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the pitfalls that have kept you feeling stuck
and develop new responses to triggers
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Join me at TFM for my Self-Sabotage
Workshop that begins in May.
The links are in the show notes.
(12:17):
You can also enjoy 10% off
any of the workshops and masterclasses
we are offering from now until November
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This includes the 3-pack and 6-pack
bundles, as well as the All Access
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PODCAST10.
[music]
(12:42):
This person says, "There is a
hormone cascade where our sex hormones
are made from cholesterol.
We know from member stories that
female hormones become balanced on
alternate-day fasting regimes.
In those successful cases, how
does alternate-day fasting effect
the hormonal cascade so that it starts
(13:03):
working properly again?"
With the hormones that you're talking--
estrogen, progesterone, and testosterone
are the sort of sex hormones.
And the effect of insulin
is mostly separate, but not
completely separate.
So insulin is more to do with
metabolism and so on, which
(13:25):
doesn't always impact, but they do interact.
So people who have-- in men, for example,
who have obesity, you can get
aromatization, so you turn some of the
testosterone into estrogen.
You get sort of feminization of the body, so
you got those sort of breast enhance-- you
know, the men get those little
breasts and so on because of the increased
(13:45):
estrogen.
You get the opposite, too, where high
levels of insulin can cause various things.
And the pathway is different, but you get that
in polycystic ovary syndrome
where you get the high insulin levels, which
causes the cysts to develop, and then
the increased testosterone so you get to hair
growth and the anovulatory cycles
(14:05):
that you see in polycystic ovary syndrome.
So there's a few different ways--
alternate-daily fasting, or other types of
fasting, can influence the
sex hormones in different ways.
Usually, for men, it would be the
testosterone increasing the sort of
fat cells which turn that testosterone into
estrogen, so higher estrogen than normal.
(14:25):
In women, you have higher testosterone
than normal, again, due to the influence of
the insulin. And then you get the cyst
development in the kidneys.
It's a little bit-- the actual pathways are a
little more complicated, but, essentially,
the men get more estrogen, which is bad, and
the women get more testosterone, which is bad
because they're not getting their proper
(14:46):
ratios of sex hormones and so on.
The women can get higher estrogen levels too,
but, again, that tends to be not so bad
because their estrogen levels are generally
higher anyway.
I highly recommend anybody listening to listen
to The Longevity Summit where you were
actually the host, and you talked with
Cynthia Thurlow.
So, yeah, and you talk to a little bit about
(15:07):
the female hormones and stuff.
That was good.
Okay, so it says,
"I was recently reading research
that suggested that moderate weight gain
during menopause, particularly in
lean women, may offer a degree of protection
against cardiovascular disease due
to the increased production of
adipose-tissue-derived estrogen,
(15:29):
which can partially compensate for the decline
in ovarian estrogen levels following
menopause. What are your thoughts on this?
May it be wise to welcome hormonal changes
in creating a protective role of fat
accumulation over the course of menopause
transition?
I appreciate your insights."
That's going to depend on where you're coming
(15:51):
from, right? So if you're very lean,
then-- so perimenopause is actually one of the
highest risk periods in a woman's
life for weight gain. So if you look at weight
gain, or fat gain specifically,
the menopausal period is the
highest. And there's changes over time during
the cycle, in terms of the estrogen and
(16:11):
progesterone, so, in fact, your appetite
actually goes up and down depending, which is
very interesting.
I was actually just looking at some data from
Lumen too, looking at the changes, not
only in hunger during the
cycle, but you actually change what you burn,
which is quite interesting. So in the first
part of the cycle you actually tend to burn
more carbs. The second part of cycle you tend
(16:31):
to burn more fat, which is very, very
interesting. And that's why Megan always says,
well, if you're going to fast, try and do it
in the first [half of your cycle] because
estrogen is building up.
Estrogen actually acts as a bit of an appetite
suppressant so your appetite goes down and you
can see it when you have to do big studies.
On average, people actually eat less and less
as they get to ovulation and then their
appetite goes up. So there's very interesting
(16:52):
data showing the effect of the sex
hormones on appetite.
During menopause-- so the three
years of perimenopause, which is the three
before menopausal, is-- again,
if you look at big studies, there's
actually an increase in weight just
specifically in that period of time.
And that's when estrogen tends to go down,
(17:15):
through menopause, right?
People think it's because estrogen overall
seems to suppress the appetite.
So that's why, during the cycle, as you get
higher estrogen levels, you actually eat less.
So if you look at how much people eat during
the cycle, it actually goes down.
From day one to ovulation, it actually goes,
down, down, down, down, down and then
progesterone goes up and then you eat more.
(17:36):
But if your estrogen is just going
down steadily, then you're losing
that sort of inhibitory effect and then you
may wind up eating more.
So, on average, people do gain weight in
perimenopause. A lot of people say it
anecdotally, and there's actually good data to
suggest that, yes, that is true and that's
a possible mechanism for that.
So, yes, if you're lean, then maybe
(17:58):
it might be good to gain some weight.
If you're not lean and you're overweight,
then, yeah, that's not such a good thing,
right? So it's certainly going to be where
you're coming from.
But that perimenopause period of
time is something that you really have to
watch. A lot of people have noticed it
themselves, but, on the other hand,
if you know that it's a high-risk period of
(18:18):
time that you want to really focus in on good
habits and fasting and so on.
I get several clients-- I would say almost
half of my clients that come in and say, "I've
never been fat a day in my life.
I'm going through menopause and I'm gaining
like crazy. What's going on?"
Yeah.
So cutting out the processed carbs helps a
lot. Sometimes they can just improve
(18:38):
their diet and stick to 24s
and stuff. And then they don't have the issue
that other people have that are low and
diabetic.
Completely.
So this person says,
"Why might weight loss stall during
a multi-day fast even when following
an extended fasting protocol with
proper hydration, electrolytes,
(19:00):
and exercise?
What factors could influence the rate
of weight loss and how can one determine
if and what adjustments need to be
made?"
Yeah, the weight is going to be quite variable
because, when you fast, there's a lot of
water loss.
So when you fast, insulin is gonna go down
and insulin is a hormone that tends
(19:21):
to make you retain water.
So, as your insulin goes down, it's actually
gonna lose-- you're gonna lose a lot water.
So there's an initial period of time where you
lose a lot of water, which is not a bad thing.
You know, a lot people have a little bit of--
you know, they feel less bloated, they feel a
lot better about it, right?
But what you can get is a very, very quick
weight loss at the beginning, which then,
as it sort of evens out, then you
(19:44):
may retain a bit of water.
So, you know, obviously, if you're eating zero
calories, your body cannot burn zero
calories, right? There's just no possible way
to do that.
So you still need to lose some body
fat, but it may be sort of balanced by
regaining a little bit of the weight and so
on as water weight, right?
And that's why the day-to-day fluctuations are
(20:06):
not always accurate.
And some people say, "Well, you know, I
haven't eaten and I haven't lost any further
weight." It's like, maybe because if you lost
a lot at the very beginning, now it's just
sort of evening out and your body's just
reaching an equilibrium, maybe overshot
a little bit, and then that's why the weight
is not always the most accurate thing
to be monitoring.
(20:27):
I was surprised when-- I think it was last
year, I did six months of therapeutic
fasting. I had gained some weight after my
aunt died, so I did six months of therapeutic
fasting. And when I stopped and
went to TRE, no snacking, two
meals a day I continued to lose
weight. It was like it carried on
over. And so I was really pleased
(20:48):
with that because I hadn't done that the first
time I lost my weight.
So I was like, "Oh, something changed in my
metabolism." Matter of fact, one of the
questions in the Q&A box is, "Is there
a problem with lowering your metabolism
when fasting?
Do I need to worry about this?"
That's a good question because, for a lot of
people, they want a high metabolic
(21:10):
rate, you know, because they want to
be able to eat and still lose weight sort of
thing or maintain their weight.
I'm still not entirely sure
that having a high metabolic rate is
actually a good thing because it's
just like if you have a car and you're
running the engine at a very high rate.
So you're gonna use more gas, right?
(21:31):
That's fine.
And you're using more gas because your engine
is revving at a higher rate,
but what happens in the long term?
Does it wear out faster?
So that's always a worry.
So people are always-- they're so worried
about a low metabolic rate.
I'm not sure that that's a bad thing
in the long-term from a longevity standpoint,
(21:53):
because, you know, you may be putting less
wear on your body by running it at a
slower rate. Yes, you can't eat as much and
you'll have to eat less because you're burning
less, but you can
try to control your metabolic rate.
But you have all these people who are-- you
know these people, who are always trying to
stoke your metabolic rate and all this sort of
(22:14):
stuff. And it's like, yeah, I'm not sure that
it's good. You know, the best advice I can
really say is that stick to a natural diet,
stick to healthy fasting period,
and you'll probably do better.
If your metabolic rate happens to be high or
low, well then that's fine.
I would accept it. But if it's low, I wouldn't
necessarily think that that's something that
you have to correct.
(22:36):
I mean, there are ways you can
try to bring it up. We know that, right?
When you go on calorie-reduced diets, for
example, your metabolic rate tends to fall.
If you overeat, you can raise it, but
I'm not sure that that's something that
should be tampered with because I'm not
entirely convinced that a low metabolic rate
isn't actually good for you.
(22:57):
Like, I look at all these-- I have a ton of
patients, like these elderly patients--
a lot are oriental just because that's my
practice population, but they're in like their
nineties and stuff.
Then really they eat very, very little,
but they're not gaining weight, they're not
losing weight. So, clearly, their metabolic
rate is quite low, but, you know,
they're like in their nineties and looking
(23:17):
really good.
And I'm thinking, maybe that's a good
thing. Like if you think about the
hundred-year-olds and stuff, because I
actually just recently had a couple of sort
of extended relatives who had their 100th
birthday, and they're never overweight,
they're never like super active, they're
always like, you know-- it seems to
me that their metabolic rate is actually quite
(23:38):
low, because they're cold,
they're always wearing a vest, they're always
moving slowly.
So it's like, okay, you're clearly not
revving your system and burning a lot of fuel,
but I'm just wondering if that
is an issue or not.
I probably wouldn't worry about it because
it's possible it may be a good thing and by
tampering it you may not.
(23:59):
I know some of the Blue Zones people
eat OMAD.
You know, Megan warns about doing too many
OMADs in the week, but that's if you're trying
to lose weight.
But people who are already-- they're at their
ideal weight and they live in these Blue
Zones, they're eating real food, whole foods,
and they're doing basically one meal a day,
that's a different story.
That's a different population.
(24:19):
Exactly, because if you're doing a lot of
OMADs and you are trying to lose weight
because of metabolic syndrome, then you need
to get that down, right?
In which case, then, yes, maybe a higher
metabolic rate at that time may be good for
you, but, exactly, its...
I should clarify, OMAD is one meal a day.
So just for those of you who are...
Yeah.
And this was another long question, and they
were asking about the RR interval.
(24:41):
And I finally figured out that they were
talking about heart rate variability.
And as a cardiac nurse, I can tell you that
this is in its infancy.
It's on a lot of the gadgets (24:48):
your watches
and your Oura rings and things like that.
And the ideal way to do it would be to
take you in, put you on a table, hook you up
to a 12-lead EKG.
That's how you really find out what your heart
rate variability is.
It's showing your gas and your break ability,
your stress response.
To press the gas when you need it, to press
(25:08):
the brake when you need it.
And so it is-- for me, it's
a good reflection of my whole lifestyle
intervention and what is helping with
that. But this person is specifically
asking if there any
things with gastric emptying
scans. Are they considered the
standard test for gastroparesis
(25:30):
with these RR interval studies?
May there be a better alternative to
diagnosing gastroparesis
in this? So I know this kind of-- especially
with diabetic...
Yeah, it's not really my area.
So gastroparesis, there are various tests.
Basically, you swallow something (which is
usually tagged) and then you follow it and see
(25:51):
how long it takes to sort of get through the
GI system.
That's to do with the stomach.
The heart rate variability is more the-- like
if your heart rate sometimes is very slow and
very fast, that's a huge variability opposed
to somebody else who's always at like 72, and
next day is 72, and the next day is 73, right?
So it's just that heart rate variability is--
you know, I'm not sure.
(26:12):
It's in its infancy because it appears
to be important in that people who have a
high variability may be at higher
risk. However, it's probably not
the heart rate itself.
It's like, why is your heart rate going fast
and slow and fast and slow?
What's causing that? And then what can you do
about it, right, because that's the real
issue. And so we're not at
(26:34):
the point where we can say, "Okay, your
heartrate variability is high.
Therefore, this is what's causing it
and this is what you can do about it." We're
sort of at the stage where we're saying,
"Well, is this the real important thing?
How important is it? Does it give us
additional information?" as opposed
to what we get already from things
like the A1C, and waist circumference,
(26:54):
and all that sort of thing.
So that's where we are in terms of heart rate
variability. Gastroparesis is sort of a
separate topic.
Diabetics get it a lot and, in terms of
diagnosis, usually you can make it
clinically, but, you know, for the other one,
it's definitely something else.
I look forward to asking you more questions
next month.
Thank you, Dr. Fung.
(27:15):
Take care.
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