September 16, 2025 • 28 mins
Episode #223
In this Fasting Q&A episode, hosted by Coach Lisa Chance, Dr. Jason Fung answers questions from the TFM Community:
1. I am a healthy 46-year-old working to improve my sleep, so I want to take magnesium bisglycinate. My magnesium supplement actually contains 7 forms of magnesium, which is very convenient, but is it better to just take one form in one capsule for absorption or any other reason? [01:23]
2. Two-part question on TFM’s Fat Fasting
One: Vinegar is not on the list, but you have mentioned that we can eat salads. Would it be okay to make a dressing with a healthy oil and vinegar during a Fat Fast?
Two: I've seen some mention to only eat 3-4 of the allowed foods on a fat fast. Is this an alternative manner to step up one's game during a fat fast? [03:58]
3. I just read about a study on stem cell research. Could you elaborate further what this may mean for those with pancreas, liver, or kidney issues? [08:11]
4. Are there any research-based studies that fasting helps lower cholesterol? [09:55]
5. I’m on day four of a water fast and I am noticing a metallic taste in my mouth. Is this unusual? Why does it happen? [13:46]
6. I have various autoimmune conditions and it was suggested I consider going on LDN (low dose naltrexone), and that this can also help with weight loss. I’m wondering what your thoughts are on LDN for weight loss and, if I decided to start it, how I would incorporate it into my fasting schedule. [16:09]
7. What is the difference between The Dawn Phenomenon and Feet-to-Floor Syndrome? From what I can find they both cause a rise in morning blood sugar, one due to circadian rhythm and the other due to a stress response from getting the day started. Is there a different eating/fasting protocol that is best for one over the other, and how do you know which one you are experiencing? [18:14]
8. Is kidney disease the cause of interstitial cystitis and how do you treat it? [21:05]
9. I have high uric acid and also the APOE 4-4 gene. Would the 3T of lime juice recommended for high uric acid affect the neural autophagy I use as a prevention for the dementia risk? What is the best way to navigate fasting with these two needs? [21:59]
10. Are there any dangers to keeping blood sugars in a consistently low range (50-60’s mg/dl) if no symptoms of hypoglycemia are felt? [24:55]
11. In some fasting groups on-line, they are big into breaking fasts with watermelon and fruit juices. How do you feel about breaking fasts with these things? [25:39]
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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Summary Timestamps
00:00 Intro
01:23 Magnesium
03:58 Vinegar on a fat fast
04:56 Importance of monotony on a fat fast
08:11 Stem cell research
09:55 Fasting and cholesterol
13:46 Metallic taste in mouth on longer fasts
16:09 Low Dose Naltrexone
18:14 Dawn phenomenon vs feet-to-floor syndrome
21:05 Interstitial cystitis
21:59 High uric acid
24:55 Low blood sugar
25:39 Breaking fasts with fruit
Disclaimer
This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. You should always speak with your physician or other healthcare professional before doing any fasting, changing your diet, taking or adjusting any medication or supplements, or adopting any treatment for a health problem. The use of any other products or services purchased by you as a r
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
It's odd how much we obsess about
LDL, considering how much has been known that
it's a very relatively weak
indicator. I've tweeted out a couple
of articles in the New England Journal of
Medicine, which is considered sort of the
most important medical journal in
the world. They looked at a number of
factors, and, you know, there's been a couple
sites like this where they look at, you know,
(00:21):
what's the most important factor for heart
disease, for example?
Smoking is one of the most important,
diabetes is very, very close,
and LDL cholesterol had
almost no effect.
It was very striking.
Hypertension is sort of medium, but
it was very striking how little effect
lowering your LDL really had, considering
(00:42):
how much people obsess about it.
[music]
Welcome everyone to our monthly Q&A
with Dr. Jason Fung when he tackles
questions submitted by TFM Community
members. Hello to our podcast listeners
who will be able to listen to our Q&A
(01:03):
a few weeks after our Community members.
All right, so let's get started.
This first question says, "I am a
healthy 46-year-old working to improve
my sleep.
So I want to take magnesium
bisglycinate. My magnesium supplement
actually contains seven forms of
magnesium, including
(01:24):
malate, taurate, citrate,
and others, which is very convenient,
but is it better to take just one form
in one capsule for absorption?
I've heard that they are fighting for
receptor sites if I take several
different types at once."
In terms of magnesium, I don't know that
there's any studies of taking multiple
(01:46):
versus one. There was a study on different
types of magnesium and, really, the only
thing that stood out was there's one that
you should avoid, which is magnesium
hydroxide. Now, that's the cheap stuff.
A lot of places use these blends
and then they say, "Oh, there's all these
different ones, including magnesium oxide,"
(02:06):
but they don't tell you what percentage it
is. So I'm always thinking that, oh,
they're going to give you like 98% magnesium
oxide. So you know, if they don't tell
you what percentage then you don't know.
And that often gets stuck in there.
I know because my son takes magnesium
for cramps and stuff.
At Costco there's two; there's magnesium
(02:26):
oxide, which is half the price of the
magnesium bisglycinate.
And then I remember looking at a pharmacy
where there was one that's like a blend,
which included magnesium oxide.
So that's the worry if you take a bunch.
If you take a bunch that don't have magnesium
oxide, then you're probably fine.
The other thing is that certain magnesiums
might do better for you.
There may be some individual differences,
(02:49):
as in I might absorb this glycinate
better than malate or citrate or one of these
other things. But when you look at large
numbers of people, they're all relatively
good except for magnesium oxide, which
really, really is very, very low.
So I would see how it is.
If the blend has magnesium oxide, then
don't take the blend unless you know that
they're not giving you a lot.
(03:09):
If the bisglycinate doesn't-- and that
seems to be the most popular one these days.
If the bisglycinate doesn't work for you,
then you can switch to a blend or use one of
these other ones.
I'm glad you said that about experimenting,
you know, we're our own science experiment.
I always took magnesium L-threonate
for my migraines, and then I discovered
(03:29):
that actually, especially if I have
a migraine from barometric pressure change,
I do better with magnesium malate.
So it's like-- you know, just experiment.
Have fun with it, you know?
Keep track of it.
This next person has two questions about
fat fasting.
"Vinegar is not listed as
one of the options on TFM's fat
(03:51):
fast, but you've mentioned that we can eat
it with salads.
Would it be okay to make a healthy
dressing with a healthy oil
and vinegar during a fat fast?"
Yeah, so certainly you can use vinegar.
The reason it's not on there is that
a lot of the effect of the vinegar
seems to be that it blocks
(04:12):
the salivary amylases.
And so the amylases break down
carbohydrates. So when you take vinegar
with bread, for example (So say you
use olive oil and vinegar for bread, right?
You dip it. That's very traditional.), the
vinegar will block the salivary
amylases, which are the enzymes that start
the digestion of the carbohydrates.
(04:32):
So because you've slowed down the digestion,
the effect on your glucose and the effect on
your insulin is much less.
So if you're just not eating any
carbohydrates and you take the vinegar-- you
can take it anyway, it doesn't hurt you for
sure. But some of the benefits
that people talk about with the vinegar apply
when you eat it with carbohydrates, so,
again, it doesn't hurt you if you want to
(04:52):
take it just with the salad dressing, like
with some balsamic vinegar and so on.
They have a second question on fat fasting.
They said, "I've seen mention of only eating
three or four of the allowed foods on the fat
fast. Is this an alternative manner
to step up one's game during the fat fast?
Can I eat more or should I restrict
(05:13):
to three or four?"
The fat fasting that we recommend is
not just fat, but also
relatively monotonous too, right?
And the idea is that if you
limit it to a certain number of foods,
then you're going to take care of
the hunger without eating
for pleasure sort of thing, right?
(05:33):
So keeping it to a certain number
of foods limits this because there's
something called sensory-specific satiety,
which means that if you eat different foods,
you will be more hungry.
Like, if you eat only one thing,
and it could be anything-- This is the secret
of the-- they used to have this thing called
the rice diet, right?
This was from the 20s [sic, 1940s].
It's called the Kempner Rice Diet.
And what he did was he put people on white
(05:55):
rice and sugar [sic, rice and fruit - to treatrenal failure].
It was monotonous, but it was a lot
of carbs and people lost weight on it.
And people said, "Oh, therefore this proves
that you can lose weight," and then-- it
doesn't prove anything because you're simply
using a different thing.
If all you eat every single day for every
single meal is white sugar and white rice,
you're going to get tired of it so fast,
right? And then when they give you
(06:17):
the next meal of white rice and sugar,
you're going to be like, "Erm, no thanks.
I don't really want to eat it." So it's
really affecting the pleasurable side
of eating, the hedonic side of eating, as
opposed to the homeostatic
side, which is the hunger and, you know,
nutrients, and all this sort of thing.
So any monotonous diet, and it doesn't matter
(06:37):
what it is. So it could be any-- you
know, whether you limit it to vegetables,
or like veganism, or carnivore,
or whatever. When you limit the number of
things, you will tend to eat less.
That's just natural human nature
because of hedonic hunger.
So the whole point is that, even if
you do these sugar diets or white rice diets
(06:59):
and stuff, because of the monotony,
you can actually do quite well in it.
This is what I always think is funny because
the people are like always-- online, there's
always people that point out this Kempner
Rice Diet. And I'm always thinking, if you
think it's so good, go ahead and do it.
It's a terrible diet to follow.
Like, it's just a horrible, horrible diet
because you can't-- like, eating white rice
(07:19):
and sugar for every meal, every single day,
for like a week, you're just not going to eat
very much. So that part
of fat fastiing is cutting down the types
of-- the variety of foods so that
you are really focused on the hunger
as opposed to the eating pleasure of it.
You can do more.
If you do more, then sure, then go ahead.
(07:40):
Right? Why make it harder on yourself?
But the way it's originally sort
of meant to be is a relatively monotonous
diet. So it could be good food.
It could be avocados and bacon, for example.
But it's a relatively monotonous diet.
And it's meant to be a short term thing too.
This person sent in a research study,
and I looked at it. So it's actually a small
(08:01):
study, but they were asking about
a single infusion of stem-cell-based
treatment that could be a permanent solution
for insulin issues.
Can you talk to us about the latest
information on stem cells,
with either the pancreas, the liver, or
the kidney?
Yeah, I don't know of any.
(08:21):
Like, I'm not aware that there's any stem
cell treatments that are
really shown and widely accepted
as effective.
I know a lot of people who do stem cell
treatments, and mostly they go to places like
Costa Rica and India and stuff to do
them because it's not sort of licensed
in Canada, and I think not in the United
(08:43):
States either, because it seems like
everybody has to travel abroad to do them.
The scientific literature on these stem cell
therapies is relatively
small. I don't know that there's any proof
that they actually work.
It doesn't mean it doesn't work.
It just means that, until there's
good evidence that it works, then I can't
really recommend it.
(09:03):
Is it harmful? Not that I know of.
I mean, I know a lot of people (just
personally) who have said they've gone and
done it, and half really thought it was
useful and half didn't.
So I wonder if it's more of a placebo effect.
On the other hand, I'm willing to accept that
it could be a beneficial thing, but I just
don't know. So I can't really say for sure.
My guess is that the effect is going to be
(09:25):
quite small.
Where I've seen the success, and heard
of the success from my clients,
is with bone. That's different
it seems than these vital organs.
So we'll see.
We'll see what the future holds.
This person says, "Are there any
research-based studies that are showing
that fasting helps lower cholesterol?"
(09:47):
And I know you've done several articles on
this. They're also asking if those studies
differentiate between familiar high
cholesterol or not.
There are some studies.
So when you look at the cholesterol panel,
there's three things that they generally look
at which is the LDL (the so-called bad
cholesterol), the HDL (which is
the so-called good cholesterol), and then
(10:07):
the triglycerides.
The triglycerides and the HDL go hand
in hand. So they sort of are like a seesaw,
right? So when the triglycerides go up, the
HDL goes down.
When the triglycerides go down,
the HDL goes up.
There's really two, you know, major things.
So in terms of LDL, the so-called bad
cholesterol, fasting can lower the
cholesterol 10 to
(10:29):
25%. It's not a huge reduction
compared to like the statins or something,
obviously, because they're very targeted
treatments.
But on the other hand it can.
It tends to vary by person,
but it's sort of a small
to medium effect.
Some people get a larger effect, but it's not
a huge drop like you see with some of the
(10:50):
medications that have been developed.
The major effect that you see with the
fasting is the drop in triglycerides,
which causes the rise in the HDL
(or good cholesterol). And in fact, if you
look at the those two (sort of
triglycerides/HDL versus LDL),
the triglycerides/HDL is actually much,
much more powerful as an indicator
(11:10):
of future coronary events.
And that's been known for like 25 years,
which is strange because I learned that in
medical school 25 years ago, but nobody
talks about that anymore.
That is, if you were to say, which one is
more important - to have a good LDL
or to have a good HDL?
It's very clear that it's much more important
to have a good HDL (or good cholesterol),
(11:31):
which is the same as the triglycerides.
And that can be changed with the diet
by cutting down the carbohydrates.
Then you lower your triglycerides by about 25
to 50%, and raise-- depending
on how much you limit your carbohydrates, of
course. And then you raise your HDL.
And as a marker, it's just
much, much more powerful.
It's odd how much we obsess about
(11:54):
LDL, considering how much has been known that
it's a very-- relatively weak
indicator. I've tweeted out a couple
of articles in the New England Journal of
Medicine, which is considered sort of the
most important medical in
the world. They looked at a number of
factors. And, you know, there's been a couple
sites like this where they look at, you know,
what's the most important factor for heart
(12:14):
disease, for example?
Smoking is one of the most important,
diabetes is very, very close,
and LDL cholesterol had
almost no effect.
It was very striking.
Hypertension is sort of medium, but
it was very striking how little effect
lowering your LDL really had, considering
how much people obsess about it and
(12:36):
how much all these sort of longevity
gurus and stuff say, "Oh, if you get your
cholesterol to zero, you'll live forever."
Not according to the research that
I've read. I don't think it plays zero
role, but I think it plays a relatively minor
role in the whole thing.
As in, I think cholesterol
is, like, you know, a tiny, tiny
(12:58):
percentage, and diabetes is this huge
percentage of risk.
Smoking, I think, of course, is-- you know,
everybody agrees you should stop smoking,
right? So that's a no-brainer.
But diabetes was right up there.
Was funny because I heard Dr. Ben Bikman say
on one podcast, "If your triglycerides:HDL
ratio is low," like less than 2, like,
you know, really low, he said, "and you
(13:20):
have high LDL, you're
going to live forever and not get
Alzheimer's." I
laughed over that. [laughing} I was like,"Yay!" [music]
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(13:41):
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(14:02):
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[music]
This person says that they have
been doing a four-day water fast,
and, every time they do so, they notice a
(15:05):
metallic taste in their mouth.
Is this common?
I think it happens.
I've heard it, although I don't know the
mechanism of it.
And there are some things that people notice
and I'm not sure why they happen, like I
noticed the color of my urine actually
changes a little bit.
It's a little odd, and I don't know if it's
due to the ketones or whatever it is,
(15:27):
but every time I do fasting, I do
see that the color is a little bit different.
And that happens every single time so I'm not
too worried about it anymore, but I'm still
not entirely sure why it looks- like the tone
of it is just much different than normal.
So, you know, I'm not sure about the metallic
taste in the mouth.
I'm pretty sure I've had that before too, but
it's not common for me, but I've heard it
(15:49):
as well. But I don't know the mechanism.
I don't know why that would be.
This person says, "I have various autoimmune
conditions (asthma, allergy,
eczema, possibly mast
cell activation syndrome) and it was
suggested that I consider going on
LDN (low dose naltrexone),
(16:10):
and that this can also help with weight
loss. But I'm wondering what your thoughts
are on LDN
and, if I decided to start, how would I
incorporate it into my fasting schedule?"
I can't speak to the specific case, but just
in terms of naltrexone, naltrexone is an
opiate antagonist, so it's used
predominantly for
(16:31):
opiate overdose.
So somebody comes in with a heroin overdose
or a morphine overdose or whatever, the
naltrexone reverses that.
So you can get very, you know, a decreased
level of consciousness with opiates.
So if somebody who overdoses on narcotics,
for example, and then you give it to them, it
reverses it. It's actually used for
weight loss sometimes.
(16:52):
There's been various studies on it and
it's been variably successful
because I think that some of the overeating
behavior is driven by
these reward pathways.
And that's why, when you block some of
the reward pathways, then people don't eat,
that is they're eating because they're
getting this sort of pleasurable/addictive
(17:14):
sort of feeling, right?
Similar to opiates.
So I think the naltrexone blocks
that pathway and therefore reduces
that sort of food addiction over eating
pathway. So therefore it's been
used for weight loss.
In fact in some studies
they've used it in drug trials, where they've
combined naltrexone with other things,
buproprion and various other things.
(17:36):
These are older weight-loss medications,
right? So that's probably the pathway.
How it helps in autoimmune disease I'm not
sure. However, there's nothing you
need to do specifically.
So if it reduces the food cravings, if
it reduces the food addictions, then you
just do the fasting just as usual.
There wouldn't be any need to change if you
are on that medication.
(17:57):
Great. Now this one I had
to look up and it is a thing.
It says, "What is the difference between dawn
phenomenon and feet-to-floor
syndrome?" I'd never heard of that before,
the feet-to-floor.
"From what I can find, they both cause
a rise in morning blood sugar,
one due to circadian rhythm and the other due
(18:19):
to stress response from getting the day
started. Is there a different eating
and fasting protocol that would be best for
one over the other?".
I had never heard of this before.
What is the feet-to-floor phenomenon?
The feet-to-floor phenomenon is
when you spike your blood sugar just
because you're starting the day.
So from what I've seen, timing is very
(18:41):
important. It can happen immediately upon
setting your feet on the floor, getting out
of bed, and becoming active.
So some think that it's because of the
physical stress response to movement and
activity, such as standing and walking,
that it triggers your sympathetic nervous
system response and releases
stress hormones as well as glucose.
(19:03):
That makes sense.
Yeah.
So it's basically along the same pathway,
right? So the circadian rhythm is that
you get a normal spike in cortisol
growth hormone and so on (these
counterregulatory hormones) at around
5 a.m..
And that's because your
body's like, "Okay, we need to get you ready
for the day." And the counterregulatory
(19:24):
hormones go up, which tell your body
basically to try and release some glucose so
that you're sort of fueled up for the day.
I imagine the feet-to-floor is the same
thing. So as soon as you touch the floor, I
guess, then you trigger the same sort of
reaction, and it'll be the same - sympathetic
nervous system, cortisol, that kind of thing.
So it's sort of along that same pathway.
I don't think that there's anything
(19:45):
specifically you need to do for it.
I mean, if it's exaggerated, then,
you know, you may have to see about what else
can be done for it, but it seems to be
just a normal phenomenon.
If your blood glucose goes up without eating,
then really you're just releasing your body's
own stores of sugar.
You can push it back in, but it doesn't do
you any good in the long term.
(20:07):
One of the things they said that you could do
is do gentle stretching in the
bed before you get up.
Avoid jumping up and out of bed and going,
you know, full at it.
Also trying meditation first thing in
the morning to calm yourself.
Both of them do better if you get a regular
sleep pattern and do stress
(20:27):
management techniques, which I know you're
always, always recommending.
Yeah. I mean, it makes sense because it's--
again, you're trying to push yourself
more towards the parasympathetic system,
right? Meditation and stretching and all that
sort of stuff. Versus a sympathetic tone,
which is generally when your body is like,
"Oh, we need to get moving," right, which is
the sympathetic nervous system.
(20:49):
This person has a question in the Q&A box
they wanted to know about whether kidney
disease is the cause of interstitial
cystitis and how to treat it.
Have you ever heard of that?
Interstitial cystitis is different.
It's not a kidney disease, it's a bladder
disease. So cystitis refers to the bladder.
And it's this condition where you
get white cells in the urine and
(21:11):
inflammation, but it's not entirely clear
what's causing it.
So you can get bladder infections (and that's
cystitis from bacteria
usually, right?), but what interstitial
cystitis is not clear.
So I'm not a urologist, so I don't know too
much about it, but, from my general medical
training, it was one of these things that
happens over and over.
(21:32):
People get this interstitial cystitis.
People go in with a cystoscope,
they see this inflammation, but it's not
entirely clear what's causing it.
It doesn't affect the kidneys so much,
though.
This person says, "I recently learned that
I have high uric acid and
Megan Ramos suggested taking three
tablespoons of lime juice a day.
(21:53):
However, I forgot to mention to her that I
also have the APOE
4-4 gene, so I'm fasting
for neural autophagy and it's
very important to me.
How does the lime juice affect
the neural autophagy and how
do I navigate fasting with these two needs?"
For the autophagy, you generally want to be
(22:15):
in that longer 30-hour
window, 24 to 36-hour window
for fasting.
The problem is that most stuff goes down
during fasting, but uric acid can sometimes
go up, and it's thought to be the
reabsorption of some of the stuff
from the urine which causes it to go up.
So lime juice, you know, is one
(22:36):
of these sort of natural things that's
supposed to help get rid of the
acid and so on so that you don't reabsorb
it so much, so maybe the uric acid doesn't go
up as much.
It's possible that it works.
There's no harm in it, but it really doesn't
affect the fast in in any way, right?
There's very, very few calories in it.
There's no real carbohydrates in it.
It's just a lot of citric acid.
(22:58):
But the acidity may be beneficial so that,
you know, reabsorb so much of the uric acid
perhaps and keep that down.
So yeah, I think the lime juice could work.
And then for the neuro part, just try and get
in that 26, 30-hour sort of window
for the autophagy.
I think that's probably as good as it goes.
If you're really worried, then I actually
mostly advise people to do a mix of
(23:20):
the longer and the shorter fasting, because
you don't always know where your
benefits come in from.
So there are a lot of studies on five-day
fasst. You know, we do the five-day modified
fasts now in the Community, which I think is
very, very beneficial.
But there's actually more evidence with that
strategy in terms of all kinds
of diseases like cancer.
(23:40):
I mean, of course, diabetes and metabolic
disease, but in terms of aging, in terms of
cancers, in terms of inflammatory diseases.
So that's why if you don't know where--
because, you know, the data is relatively
new in fasting-- then it's
probably beneficial to (in addition to
the sort of daily fasts, you know, 24,
30 hours) every so often (as we're
(24:03):
doing now in the Community) do the longer,
five-day modified fast to make sure that
we're getting any benefits of the longer fast
as opposed to the shorter fast.
And the longer ones don't have to be zero
calories. They don't have to be zero.
They can be like, you know, 500 calories.
You're still going to get a lot of the
benefits. So, because-- if
you're worried about the Alzheimer's, the
(24:23):
APOE 4-4, and stuff, then you probably
want to do a mix so that you're getting-- to
be sure that you're getting any benefits of
both types.
Yes, and by the way, our five-day reset
was a big hit in the Community,
if you want to join us for that.
So this person says,
"Are there any dangers to keeping your
(24:44):
blood sugars in a consistently
low range (50s, 60s
and 70s) if you are having no
symptoms of hypoglycemia?"
There's no harm in it.
I mean, certainly 50s and 60s is--
if you're not eating a lot of carbohydrates,
that can be just normal, right?
Some people are just very low, but there's no
(25:05):
harm in keeping it down unless you're on
medications. If you're on medications, then
you shouldn't really be keeping it that low,
because then the worry is that you can
actually push it too low and you can get
hypoglycemic. But no, there's no harm in
doing it. Is there any benefit?
I don't know that there is, but there's
almost no studies pushing people that low
for long periods of time.
All right. This person says, "There
(25:26):
are a lot of big groups on the internet now
breaking fasts with watermelon
and fruit juices.
How do you feel about breaking fast
with these things?"
Just doing the fast is good.
I mean, watermelon and fruit probably
wouldn't be my sort of go-to
options. If you do it
and you like it and it makes it enjoyable,
(25:48):
sure. Everything's a trade off, right,
but carb-heavy foods is not really
what I would go for.
If you think about what's happening during
fasting, you're really trying to lower your
insulin levels and your insulin goes down.
Your body's going to release energy.
It's going to either burn your fat or burn
your sugar. If you eat relatively
(26:08):
low carb afterwards, then you're going to
continue in that sort of fat-burning mode or
ketosis.
If you immediately break it, spike up your
insulin with a lot of sugary, simple
carbohydrates sort of thing, well, you're
going to stop any benefit dead in its tracks
because then you're going to flip up your
insulin to a higher level, which is
going to put you into sort of a fat-storing
(26:29):
mode, right? Because as soon as insulin goes
up, your body's like, "Hey, calories are
coming in. We need to store some of this for
later." If you like it, though, and
it makes everything good, then there's a
tradeoff there. So I'm not-- you
know, I'm never really against
anything if it works for you, right?
Because there's people who will swear that
it's great. And if that's what gets you
(26:50):
through and keeps youdoing the fasting, then,
hey, maybe that's what you need to do, but it
wouldn't be my choice of what to
eat afterwards.
I would tend to stick more with low carb
and so on.
You have a great article on glycemic
index versus glycemic load, so I know
it has a high glycemic index but a very
short glycemic load.
(27:11):
Now, if that leads to your advantage or not,
I don't know because I think if I spiked my
blood sugar like that, I
would want more.
[laughs] So I don't know.
Yeah. Certainly it's-- yeah.
I mean watermelon does that for me too
because, you know, it's so--
you know I really love watermelon, so when I
eat it I tend to keep eating it, right?
(27:32):
And luckily it's only in season for a very
short time. So you know, most of the
year I don't eat watermelon because it's not
very good, but you know...
I put it at the end of my meal like
you suggest - carb order.
[laughter] Dr. Fung has
a very good video on carb order.
Well, thank you very much, Dr. Fung, and I
(27:53):
will see you next month.
Okay.
Thanks, guys.
[music]
It's odd how much we obsess about
LDL, considering how much has been known that
it's a very relatively weak
indicator. I've tweeted out a couple
of articles in the New England Journal of
Medicine, which is considered sort of the
most important medical journal in
the world. They looked at a number of
factors, and, you know, there's been a couple
sites like this where they look at, you know,
(00:21):
what's the most important factor for heart
disease, for example?
Smoking is one of the most important,
diabetes is very, very close,
and LDL cholesterol had
almost no effect.
It was very striking.
Hypertension is sort of medium, but
it was very striking how little effect
lowering your LDL really had, considering
(00:42):
how much people obsess about it.
[music]
Welcome everyone to our monthly Q&A
with Dr. Jason Fung when he tackles
questions submitted by TFM Community
members. Hello to our podcast listeners
who will be able to listen to our Q&A
(01:03):
a few weeks after our Community members.
All right, so let's get started.
This first question says, "I am a
healthy 46-year-old working to improve
my sleep.
So I want to take magnesium
bisglycinate. My magnesium supplement
actually contains seven forms of
magnesium, including
(01:24):
malate, taurate, citrate,
and others, which is very convenient,
but is it better to take just one form
in one capsule for absorption?
I've heard that they are fighting for
receptor sites if I take several
different types at once."
In terms of magnesium, I don't know that
there's any studies of taking multiple
(01:46):
versus one. There was a study on different
types of magnesium and, really, the only
thing that stood out was there's one that
you should avoid, which is magnesium
hydroxide. Now, that's the cheap stuff.
A lot of places use these blends
and then they say, "Oh, there's all these
different ones, including magnesium oxide,"
(02:06):
but they don't tell you what percentage it
is. So I'm always thinking that, oh,
they're going to give you like 98% magnesium
oxide. So you know, if they don't tell
you what percentage then you don't know.
And that often gets stuck in there.
I know because my son takes magnesium
for cramps and stuff.
At Costco there's two; there's magnesium
(02:26):
oxide, which is half the price of the
magnesium bisglycinate.
And then I remember looking at a pharmacy
where there was one that's like a blend,
which included magnesium oxide.
So that's the worry if you take a bunch.
If you take a bunch that don't have magnesium
oxide, then you're probably fine.
The other thing is that certain magnesiums
might do better for you.
There may be some individual differences,
(02:49):
as in I might absorb this glycinate
better than malate or citrate or one of these
other things. But when you look at large
numbers of people, they're all relatively
good except for magnesium oxide, which
really, really is very, very low.
So I would see how it is.
If the blend has magnesium oxide, then
don't take the blend unless you know that
they're not giving you a lot.
(03:09):
If the bisglycinate doesn't-- and that
seems to be the most popular one these days.
If the bisglycinate doesn't work for you,
then you can switch to a blend or use one of
these other ones.
I'm glad you said that about experimenting,
you know, we're our own science experiment.
I always took magnesium L-threonate
for my migraines, and then I discovered
(03:29):
that actually, especially if I have
a migraine from barometric pressure change,
I do better with magnesium malate.
So it's like-- you know, just experiment.
Have fun with it, you know?
Keep track of it.
This next person has two questions about
fat fasting.
"Vinegar is not listed as
one of the options on TFM's fat
(03:51):
fast, but you've mentioned that we can eat
it with salads.
Would it be okay to make a healthy
dressing with a healthy oil
and vinegar during a fat fast?"
Yeah, so certainly you can use vinegar.
The reason it's not on there is that
a lot of the effect of the vinegar
seems to be that it blocks
(04:12):
the salivary amylases.
And so the amylases break down
carbohydrates. So when you take vinegar
with bread, for example (So say you
use olive oil and vinegar for bread, right?
You dip it. That's very traditional.), the
vinegar will block the salivary
amylases, which are the enzymes that start
the digestion of the carbohydrates.
(04:32):
So because you've slowed down the digestion,
the effect on your glucose and the effect on
your insulin is much less.
So if you're just not eating any
carbohydrates and you take the vinegar-- you
can take it anyway, it doesn't hurt you for
sure. But some of the benefits
that people talk about with the vinegar apply
when you eat it with carbohydrates, so,
again, it doesn't hurt you if you want to
(04:52):
take it just with the salad dressing, like
with some balsamic vinegar and so on.
They have a second question on fat fasting.
They said, "I've seen mention of only eating
three or four of the allowed foods on the fat
fast. Is this an alternative manner
to step up one's game during the fat fast?
Can I eat more or should I restrict
(05:13):
to three or four?"
The fat fasting that we recommend is
not just fat, but also
relatively monotonous too, right?
And the idea is that if you
limit it to a certain number of foods,
then you're going to take care of
the hunger without eating
for pleasure sort of thing, right?
(05:33):
So keeping it to a certain number
of foods limits this because there's
something called sensory-specific satiety,
which means that if you eat different foods,
you will be more hungry.
Like, if you eat only one thing,
and it could be anything-- This is the secret
of the-- they used to have this thing called
the rice diet, right?
This was from the 20s [sic, 1940s].
It's called the Kempner Rice Diet.
And what he did was he put people on white
(05:55):
rice and sugar [sic, rice and fruit - to treatrenal failure].
It was monotonous, but it was a lot
of carbs and people lost weight on it.
And people said, "Oh, therefore this proves
that you can lose weight," and then-- it
doesn't prove anything because you're simply
using a different thing.
If all you eat every single day for every
single meal is white sugar and white rice,
you're going to get tired of it so fast,
right? And then when they give you
(06:17):
the next meal of white rice and sugar,
you're going to be like, "Erm, no thanks.
I don't really want to eat it." So it's
really affecting the pleasurable side
of eating, the hedonic side of eating, as
opposed to the homeostatic
side, which is the hunger and, you know,
nutrients, and all this sort of thing.
So any monotonous diet, and it doesn't matter
(06:37):
what it is. So it could be any-- you
know, whether you limit it to vegetables,
or like veganism, or carnivore,
or whatever. When you limit the number of
things, you will tend to eat less.
That's just natural human nature
because of hedonic hunger.
So the whole point is that, even if
you do these sugar diets or white rice diets
(06:59):
and stuff, because of the monotony,
you can actually do quite well in it.
This is what I always think is funny because
the people are like always-- online, there's
always people that point out this Kempner
Rice Diet. And I'm always thinking, if you
think it's so good, go ahead and do it.
It's a terrible diet to follow.
Like, it's just a horrible, horrible diet
because you can't-- like, eating white rice
(07:19):
and sugar for every meal, every single day,
for like a week, you're just not going to eat
very much. So that part
of fat fastiing is cutting down the types
of-- the variety of foods so that
you are really focused on the hunger
as opposed to the eating pleasure of it.
You can do more.
If you do more, then sure, then go ahead.
(07:40):
Right? Why make it harder on yourself?
But the way it's originally sort
of meant to be is a relatively monotonous
diet. So it could be good food.
It could be avocados and bacon, for example.
But it's a relatively monotonous diet.
And it's meant to be a short term thing too.
This person sent in a research study,
and I looked at it. So it's actually a small
(08:01):
study, but they were asking about
a single infusion of stem-cell-based
treatment that could be a permanent solution
for insulin issues.
Can you talk to us about the latest
information on stem cells,
with either the pancreas, the liver, or
the kidney?
Yeah, I don't know of any.
(08:21):
Like, I'm not aware that there's any stem
cell treatments that are
really shown and widely accepted
as effective.
I know a lot of people who do stem cell
treatments, and mostly they go to places like
Costa Rica and India and stuff to do
them because it's not sort of licensed
in Canada, and I think not in the United
(08:43):
States either, because it seems like
everybody has to travel abroad to do them.
The scientific literature on these stem cell
therapies is relatively
small. I don't know that there's any proof
that they actually work.
It doesn't mean it doesn't work.
It just means that, until there's
good evidence that it works, then I can't
really recommend it.
(09:03):
Is it harmful? Not that I know of.
I mean, I know a lot of people (just
personally) who have said they've gone and
done it, and half really thought it was
useful and half didn't.
So I wonder if it's more of a placebo effect.
On the other hand, I'm willing to accept that
it could be a beneficial thing, but I just
don't know. So I can't really say for sure.
My guess is that the effect is going to be
(09:25):
quite small.
Where I've seen the success, and heard
of the success from my clients,
is with bone. That's different
it seems than these vital organs.
So we'll see.
We'll see what the future holds.
This person says, "Are there any
research-based studies that are showing
that fasting helps lower cholesterol?"
(09:47):
And I know you've done several articles on
this. They're also asking if those studies
differentiate between familiar high
cholesterol or not.
There are some studies.
So when you look at the cholesterol panel,
there's three things that they generally look
at which is the LDL (the so-called bad
cholesterol), the HDL (which is
the so-called good cholesterol), and then
(10:07):
the triglycerides.
The triglycerides and the HDL go hand
in hand. So they sort of are like a seesaw,
right? So when the triglycerides go up, the
HDL goes down.
When the triglycerides go down,
the HDL goes up.
There's really two, you know, major things.
So in terms of LDL, the so-called bad
cholesterol, fasting can lower the
cholesterol 10 to
(10:29):
25%. It's not a huge reduction
compared to like the statins or something,
obviously, because they're very targeted
treatments.
But on the other hand it can.
It tends to vary by person,
but it's sort of a small
to medium effect.
Some people get a larger effect, but it's not
a huge drop like you see with some of the
(10:50):
medications that have been developed.
The major effect that you see with the
fasting is the drop in triglycerides,
which causes the rise in the HDL
(or good cholesterol). And in fact, if you
look at the those two (sort of
triglycerides/HDL versus LDL),
the triglycerides/HDL is actually much,
much more powerful as an indicator
(11:10):
of future coronary events.
And that's been known for like 25 years,
which is strange because I learned that in
medical school 25 years ago, but nobody
talks about that anymore.
That is, if you were to say, which one is
more important - to have a good LDL
or to have a good HDL?
It's very clear that it's much more important
to have a good HDL (or good cholesterol),
(11:31):
which is the same as the triglycerides.
And that can be changed with the diet
by cutting down the carbohydrates.
Then you lower your triglycerides by about 25
to 50%, and raise-- depending
on how much you limit your carbohydrates, of
course. And then you raise your HDL.
And as a marker, it's just
much, much more powerful.
It's odd how much we obsess about
(11:54):
LDL, considering how much has been known that
it's a very-- relatively weak
indicator. I've tweeted out a couple
of articles in the New England Journal of
Medicine, which is considered sort of the
most important medical in
the world. They looked at a number of
factors. And, you know, there's been a couple
sites like this where they look at, you know,
what's the most important factor for heart
(12:14):
disease, for example?
Smoking is one of the most important,
diabetes is very, very close,
and LDL cholesterol had
almost no effect.
It was very striking.
Hypertension is sort of medium, but
it was very striking how little effect
lowering your LDL really had, considering
how much people obsess about it and
(12:36):
how much all these sort of longevity
gurus and stuff say, "Oh, if you get your
cholesterol to zero, you'll live forever."
Not according to the research that
I've read. I don't think it plays zero
role, but I think it plays a relatively minor
role in the whole thing.
As in, I think cholesterol
is, like, you know, a tiny, tiny
(12:58):
percentage, and diabetes is this huge
percentage of risk.
Smoking, I think, of course, is-- you know,
everybody agrees you should stop smoking,
right? So that's a no-brainer.
But diabetes was right up there.
Was funny because I heard Dr. Ben Bikman say
on one podcast, "If your triglycerides:HDL
ratio is low," like less than 2, like,
you know, really low, he said, "and you
(13:20):
have high LDL, you're
going to live forever and not get
Alzheimer's." I
laughed over that. [laughing} I was like,"Yay!" [music]
[promotion] Are you new to fasting and just
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(13:41):
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We can help you learn the necessary skills,
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(14:02):
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This option allows you to get the support
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(14:23):
working on the things that you're working on.
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(14:45):
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get to meet with a coach and see
if coaching is the right thing for you.
[music]
This person says that they have
been doing a four-day water fast,
and, every time they do so, they notice a
(15:05):
metallic taste in their mouth.
Is this common?
I think it happens.
I've heard it, although I don't know the
mechanism of it.
And there are some things that people notice
and I'm not sure why they happen, like I
noticed the color of my urine actually
changes a little bit.
It's a little odd, and I don't know if it's
due to the ketones or whatever it is,
(15:27):
but every time I do fasting, I do
see that the color is a little bit different.
And that happens every single time so I'm not
too worried about it anymore, but I'm still
not entirely sure why it looks- like the tone
of it is just much different than normal.
So, you know, I'm not sure about the metallic
taste in the mouth.
I'm pretty sure I've had that before too, but
it's not common for me, but I've heard it
(15:49):
as well. But I don't know the mechanism.
I don't know why that would be.
This person says, "I have various autoimmune
conditions (asthma, allergy,
eczema, possibly mast
cell activation syndrome) and it was
suggested that I consider going on
LDN (low dose naltrexone),
(16:10):
and that this can also help with weight
loss. But I'm wondering what your thoughts
are on LDN
and, if I decided to start, how would I
incorporate it into my fasting schedule?"
I can't speak to the specific case, but just
in terms of naltrexone, naltrexone is an
opiate antagonist, so it's used
predominantly for
(16:31):
opiate overdose.
So somebody comes in with a heroin overdose
or a morphine overdose or whatever, the
naltrexone reverses that.
So you can get very, you know, a decreased
level of consciousness with opiates.
So if somebody who overdoses on narcotics,
for example, and then you give it to them, it
reverses it. It's actually used for
weight loss sometimes.
(16:52):
There's been various studies on it and
it's been variably successful
because I think that some of the overeating
behavior is driven by
these reward pathways.
And that's why, when you block some of
the reward pathways, then people don't eat,
that is they're eating because they're
getting this sort of pleasurable/addictive
(17:14):
sort of feeling, right?
Similar to opiates.
So I think the naltrexone blocks
that pathway and therefore reduces
that sort of food addiction over eating
pathway. So therefore it's been
used for weight loss.
In fact in some studies
they've used it in drug trials, where they've
combined naltrexone with other things,
buproprion and various other things.
(17:36):
These are older weight-loss medications,
right? So that's probably the pathway.
How it helps in autoimmune disease I'm not
sure. However, there's nothing you
need to do specifically.
So if it reduces the food cravings, if
it reduces the food addictions, then you
just do the fasting just as usual.
There wouldn't be any need to change if you
are on that medication.
(17:57):
Great. Now this one I had
to look up and it is a thing.
It says, "What is the difference between dawn
phenomenon and feet-to-floor
syndrome?" I'd never heard of that before,
the feet-to-floor.
"From what I can find, they both cause
a rise in morning blood sugar,
one due to circadian rhythm and the other due
(18:19):
to stress response from getting the day
started. Is there a different eating
and fasting protocol that would be best for
one over the other?".
I had never heard of this before.
What is the feet-to-floor phenomenon?
The feet-to-floor phenomenon is
when you spike your blood sugar just
because you're starting the day.
So from what I've seen, timing is very
(18:41):
important. It can happen immediately upon
setting your feet on the floor, getting out
of bed, and becoming active.
So some think that it's because of the
physical stress response to movement and
activity, such as standing and walking,
that it triggers your sympathetic nervous
system response and releases
stress hormones as well as glucose.
(19:03):
That makes sense.
Yeah.
So it's basically along the same pathway,
right? So the circadian rhythm is that
you get a normal spike in cortisol
growth hormone and so on (these
counterregulatory hormones) at around
5 a.m..
And that's because your
body's like, "Okay, we need to get you ready
for the day." And the counterregulatory
(19:24):
hormones go up, which tell your body
basically to try and release some glucose so
that you're sort of fueled up for the day.
I imagine the feet-to-floor is the same
thing. So as soon as you touch the floor, I
guess, then you trigger the same sort of
reaction, and it'll be the same - sympathetic
nervous system, cortisol, that kind of thing.
So it's sort of along that same pathway.
I don't think that there's anything
(19:45):
specifically you need to do for it.
I mean, if it's exaggerated, then,
you know, you may have to see about what else
can be done for it, but it seems to be
just a normal phenomenon.
If your blood glucose goes up without eating,
then really you're just releasing your body's
own stores of sugar.
You can push it back in, but it doesn't do
you any good in the long term.
(20:07):
One of the things they said that you could do
is do gentle stretching in the
bed before you get up.
Avoid jumping up and out of bed and going,
you know, full at it.
Also trying meditation first thing in
the morning to calm yourself.
Both of them do better if you get a regular
sleep pattern and do stress
(20:27):
management techniques, which I know you're
always, always recommending.
Yeah. I mean, it makes sense because it's--
again, you're trying to push yourself
more towards the parasympathetic system,
right? Meditation and stretching and all that
sort of stuff. Versus a sympathetic tone,
which is generally when your body is like,
"Oh, we need to get moving," right, which is
the sympathetic nervous system.
(20:49):
This person has a question in the Q&A box
they wanted to know about whether kidney
disease is the cause of interstitial
cystitis and how to treat it.
Have you ever heard of that?
Interstitial cystitis is different.
It's not a kidney disease, it's a bladder
disease. So cystitis refers to the bladder.
And it's this condition where you
get white cells in the urine and
(21:11):
inflammation, but it's not entirely clear
what's causing it.
So you can get bladder infections (and that's
cystitis from bacteria
usually, right?), but what interstitial
cystitis is not clear.
So I'm not a urologist, so I don't know too
much about it, but, from my general medical
training, it was one of these things that
happens over and over.
(21:32):
People get this interstitial cystitis.
People go in with a cystoscope,
they see this inflammation, but it's not
entirely clear what's causing it.
It doesn't affect the kidneys so much,
though.
This person says, "I recently learned that
I have high uric acid and
Megan Ramos suggested taking three
tablespoons of lime juice a day.
(21:53):
However, I forgot to mention to her that I
also have the APOE
4-4 gene, so I'm fasting
for neural autophagy and it's
very important to me.
How does the lime juice affect
the neural autophagy and how
do I navigate fasting with these two needs?"
For the autophagy, you generally want to be
(22:15):
in that longer 30-hour
window, 24 to 36-hour window
for fasting.
The problem is that most stuff goes down
during fasting, but uric acid can sometimes
go up, and it's thought to be the
reabsorption of some of the stuff
from the urine which causes it to go up.
So lime juice, you know, is one
(22:36):
of these sort of natural things that's
supposed to help get rid of the
acid and so on so that you don't reabsorb
it so much, so maybe the uric acid doesn't go
up as much.
It's possible that it works.
There's no harm in it, but it really doesn't
affect the fast in in any way, right?
There's very, very few calories in it.
There's no real carbohydrates in it.
It's just a lot of citric acid.
(22:58):
But the acidity may be beneficial so that,
you know, reabsorb so much of the uric acid
perhaps and keep that down.
So yeah, I think the lime juice could work.
And then for the neuro part, just try and get
in that 26, 30-hour sort of window
for the autophagy.
I think that's probably as good as it goes.
If you're really worried, then I actually
mostly advise people to do a mix of
(23:20):
the longer and the shorter fasting, because
you don't always know where your
benefits come in from.
So there are a lot of studies on five-day
fasst. You know, we do the five-day modified
fasts now in the Community, which I think is
very, very beneficial.
But there's actually more evidence with that
strategy in terms of all kinds
of diseases like cancer.
(23:40):
I mean, of course, diabetes and metabolic
disease, but in terms of aging, in terms of
cancers, in terms of inflammatory diseases.
So that's why if you don't know where--
because, you know, the data is relatively
new in fasting-- then it's
probably beneficial to (in addition to
the sort of daily fasts, you know, 24,
30 hours) every so often (as we're
(24:03):
doing now in the Community) do the longer,
five-day modified fast to make sure that
we're getting any benefits of the longer fast
as opposed to the shorter fast.
And the longer ones don't have to be zero
calories. They don't have to be zero.
They can be like, you know, 500 calories.
You're still going to get a lot of the
benefits. So, because-- if
you're worried about the Alzheimer's, the
(24:23):
APOE 4-4, and stuff, then you probably
want to do a mix so that you're getting-- to
be sure that you're getting any benefits of
both types.
Yes, and by the way, our five-day reset
was a big hit in the Community,
if you want to join us for that.
So this person says,
"Are there any dangers to keeping your
(24:44):
blood sugars in a consistently
low range (50s, 60s
and 70s) if you are having no
symptoms of hypoglycemia?"
There's no harm in it.
I mean, certainly 50s and 60s is--
if you're not eating a lot of carbohydrates,
that can be just normal, right?
Some people are just very low, but there's no
(25:05):
harm in keeping it down unless you're on
medications. If you're on medications, then
you shouldn't really be keeping it that low,
because then the worry is that you can
actually push it too low and you can get
hypoglycemic. But no, there's no harm in
doing it. Is there any benefit?
I don't know that there is, but there's
almost no studies pushing people that low
for long periods of time.
All right. This person says, "There
(25:26):
are a lot of big groups on the internet now
breaking fasts with watermelon
and fruit juices.
How do you feel about breaking fast
with these things?"
Just doing the fast is good.
I mean, watermelon and fruit probably
wouldn't be my sort of go-to
options. If you do it
and you like it and it makes it enjoyable,
(25:48):
sure. Everything's a trade off, right,
but carb-heavy foods is not really
what I would go for.
If you think about what's happening during
fasting, you're really trying to lower your
insulin levels and your insulin goes down.
Your body's going to release energy.
It's going to either burn your fat or burn
your sugar. If you eat relatively
(26:08):
low carb afterwards, then you're going to
continue in that sort of fat-burning mode or
ketosis.
If you immediately break it, spike up your
insulin with a lot of sugary, simple
carbohydrates sort of thing, well, you're
going to stop any benefit dead in its tracks
because then you're going to flip up your
insulin to a higher level, which is
going to put you into sort of a fat-storing
(26:29):
mode, right? Because as soon as insulin goes
up, your body's like, "Hey, calories are
coming in. We need to store some of this for
later." If you like it, though, and
it makes everything good, then there's a
tradeoff there. So I'm not-- you
know, I'm never really against
anything if it works for you, right?
Because there's people who will swear that
it's great. And if that's what gets you
(26:50):
through and keeps youdoing the fasting, then,
hey, maybe that's what you need to do, but it
wouldn't be my choice of what to
eat afterwards.
I would tend to stick more with low carb
and so on.
You have a great article on glycemic
index versus glycemic load, so I know
it has a high glycemic index but a very
short glycemic load.
(27:11):
Now, if that leads to your advantage or not,
I don't know because I think if I spiked my
blood sugar like that, I
would want more.
[laughs] So I don't know.
Yeah. Certainly it's-- yeah.
I mean watermelon does that for me too
because, you know, it's so--
you know I really love watermelon, so when I
eat it I tend to keep eating it, right?
(27:32):
And luckily it's only in season for a very
short time. So you know, most of the
year I don't eat watermelon because it's not
very good, but you know...
I put it at the end of my meal like
you suggest - carb order.
[laughter] Dr. Fung has
a very good video on carb order.
Well, thank you very much, Dr. Fung, and I
(27:53):
will see you next month.
Okay.
Thanks, guys.
[music]
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