Fasting

With Jason Fung and Andrew Huberman

Following my recent book summary on obesity, I’ve been thinking more about the addictive technology woven into processed food:

As Kennedy said recently, the tobacco scientists were repurposed to the food industry and their addiction expertise was redirected to creating the most highly processed and addictive food the world has ever seen. We now live with the consequences of their “brilliance.”

We will adapt to anything, and I suspect that regular eating is an adaptation to plentiful food and plentiful marketing. But before food was plentiful, which in the context of human history was only yesterday, eating must have been very controlled. The norm would have been to not eat, until you could and were allowed.

So, I’ve been thinking about fasting, or “not eating.”

The following is a synthesis from two sources.

• Book: Complete Guide to Fasting by Jason Fung (JF)

• Podcast: Fasting for fat loss and health by Andrew Huberman (AH)

I think there is enough here to get the mind thinking about the subject.

With thanks to Fung and Huberman.

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50 Questions and Answers

Question 1: What is the difference between fasting and starvation? (JF)

Fasting is the voluntary abstention from eating for health, spiritual, or other reasons. It's a controlled and deliberate practice where food is readily available, but the person chooses not to eat. Starvation, on the other hand, is involuntary and occurs when there's a scarcity of food. The key difference lies in the element of control and choice.

Question 2: What is the history of fasting as a medical treatment? (JF)

Fasting has been used as a medical treatment for thousands of years. Ancient Greek physicians like Hippocrates recommended fasting for various ailments. In the early 20th century, doctors like Frederick Madison Allen and Elliott Joslin used fasting to treat diabetes before the discovery of insulin. Interest in therapeutic fasting waned with the advent of modern pharmaceuticals but has seen a resurgence in recent years as research has uncovered its potential benefits for conditions like obesity, diabetes, and neurological disorders.

Question 3: What are the different types of fasting protocols described? (JF)

Several fasting protocols are described: 1) Intermittent fasting, which includes methods like 16/8 (fasting for 16 hours, eating within an 8-hour window) and 20/4. 2) 24-hour fasts, typically done 2-3 times per week. 3) 36-hour fasts. 4) 42-hour fasts. 5) Alternate-day fasting. 6) Extended fasts of 7-14 days. 7) The 5:2 diet, where one eats normally for 5 days and restricts calories for 2 non-consecutive days.

Question 4: What is the significance of the 8-hour feeding window in time-restricted feeding studies? (AH)

The 8-hour feeding window has become significant in time-restricted feeding studies due to its demonstrated health benefits and practicality. Initially chosen for logistical reasons in mouse studies, this window has shown positive effects on weight loss, fat loss, organ health, and various metabolic factors in both animal and human studies. It appears to strike a balance between being long enough to allow sufficient nutrient intake while short enough to provide extended fasting periods, crucial for activating beneficial cellular processes.

Question 5: How does time-restricted feeding compare to other forms of intermittent fasting? (AH)

Time-restricted feeding is generally considered more sustainable than other forms of intermittent fasting, such as alternate-day fasting or extended fasts. While alternate-day fasting and longer fasts can produce more rapid effects on weight loss and blood glucose reduction, they are often more challenging to maintain long-term and may not be compatible with regular exercise or work schedules. Time-restricted feeding, particularly with an 8-hour window, appears to strike a balance between providing health benefits and being feasible for most people to adhere to consistently.

Question 6: What are the stages of fasting as described by George Cahill? (JF)

George Cahill described five stages of fasting: 1) Feeding, where blood sugar and insulin rise as food is absorbed. 2) The postabsorptive phase (6-24 hours), where blood sugar and insulin begin to fall. 3) Gluconeogenesis (24-48 hours), where the liver produces glucose from amino acids. 4) Ketosis (2-3 days), where the body starts breaking down fat for energy. 5) The protein conservation phase (5+ days), where the body minimizes protein breakdown and relies primarily on ketones and fatty acids for energy.

Question 7: What is the relationship between fasting and ketosis? (JF)

Fasting promotes ketosis, a metabolic state where the body primarily uses fat for fuel instead of glucose. During fasting, as glycogen stores are depleted, the body starts breaking down fat into ketone bodies. These ketones can be used for energy by most tissues, including the brain. Ketosis typically begins after about 2-3 days of fasting. The production of ketones may contribute to some of the benefits of fasting, such as improved mental clarity and reduced inflammation.

Question 8: How does fasting affect insulin levels in the body? (JF)

Fasting leads to a significant decrease in insulin levels. When we don't eat, insulin levels drop, signaling the body to start burning stored energy. This drop in insulin is one of the most consistent hormonal effects of fasting. Lower insulin levels can improve insulin sensitivity, potentially benefiting those with insulin resistance or type 2 diabetes.

Question 9: How does fasting impact insulin resistance? (JF)

Fasting can significantly improve insulin resistance. By periodically lowering insulin levels, fasting helps break the cycle of constant high insulin exposure that leads to insulin resistance. During fasting, cells become more sensitive to insulin. This improved insulin sensitivity can persist even after the fast ends. Studies have shown that intermittent fasting can reduce insulin resistance more effectively than simple calorie restriction.

Question 10: How does time-restricted feeding affect insulin sensitivity and blood glucose levels? (AH)

Time-restricted feeding has been shown to improve insulin sensitivity and help regulate blood glucose levels. By limiting the feeding window, it reduces the frequency of insulin spikes and allows for longer periods of low insulin levels, which can enhance insulin sensitivity over time. Studies have demonstrated that time-restricted feeding can lead to decreased resting blood glucose levels and improved glucose tolerance, which are important factors in metabolic health and diabetes prevention.

Question 11: How does fasting impact basal metabolic rate? (JF)

Contrary to popular belief, short-term fasting does not decrease basal metabolic rate (BMR). Studies have shown that fasting for up to 4 days can actually increase BMR by up to 12%. This is likely due to the increase in norepinephrine levels, which prepares the body for action. The body does not enter a "starvation mode" during short-term fasting, but rather revs up metabolism to mobilize energy stores.

Question 12: How does fasting affect weight loss and fat loss? (JF)

Fasting can lead to significant weight loss and fat loss. It works by creating a calorie deficit and shifting the body's metabolism towards fat burning. During fasting periods, the body is forced to use stored fat for energy, leading to fat loss. Additionally, fasting can improve insulin sensitivity, which further promotes fat burning. However, the effectiveness of fasting for weight loss can vary among individuals.

Question 13: How does fasting compare to calorie restriction for weight loss? (JF)

Fasting has several advantages over traditional calorie restriction for weight loss. While both can lead to weight loss, fasting tends to preserve metabolic rate better than continuous calorie restriction. With calorie restriction, the body often adapts by lowering metabolism, making further weight loss difficult. Fasting, on the other hand, can actually increase metabolic rate in the short term. Additionally, fasting tends to be easier for many people to adhere to, as it doesn't require constant calorie counting or food restriction.

Question 14: How does fasting compare to bariatric surgery for weight loss? (JF)

Fasting can be seen as a non-invasive alternative to bariatric surgery. Both fasting and bariatric surgery work by severely restricting calorie intake, leading to rapid weight loss and improvements in metabolic health. However, fasting achieves this without the risks and complications associated with surgery. Studies have shown that fasting can produce similar or even better results than bariatric surgery in terms of weight loss and blood sugar control. Fasting is also more flexible and can be adjusted or stopped at any time, unlike permanent surgical interventions.

Question 15: What is the relationship between time-restricted feeding and brown fat? (AH)

Time-restricted feeding has been linked to an increase in brown fat stores. Brown fat, located between the shoulder blades and in the upper neck, creates a thermogenic effect that helps reduce other types of fat in the body. The increase in brown fat associated with time-restricted feeding is likely related to the rise in epinephrine and adrenaline levels during fasting periods. This relationship contributes to improved metabolic health and may help prevent conditions like non-alcoholic fatty liver disease.

Question 16: What role does ghrelin play in hunger during fasting? (JF)

Ghrelin, often called the "hunger hormone," stimulates appetite. Interestingly, during fasting, ghrelin levels don't continuously increase as one might expect. Instead, ghrelin follows a wave-like pattern, typically peaking around normal meal times and then subsiding. During extended fasts, ghrelin levels often peak in the first couple of days and then steadily decrease. This explains why many people find that hunger doesn't continuously increase during a fast, but rather comes in waves that pass.

Question 17: How does fasting affect appetite and hunger levels over time? (JF)

Initially, many people experience increased hunger when they start fasting. However, over time, appetite often decreases. This is partly due to hormonal changes - ghrelin tends to adjust to the new eating pattern. Many people report that hunger comes in waves rather than constantly increasing. Interestingly, during extended fasts, hunger often peaks around day 2 and then decreases. Long-term practice of intermittent fasting can lead to better appetite control and reduced overall food intake.

Question 18: What is the Dawn Phenomenon and how does it relate to fasting? (JF)

The Dawn Phenomenon is a natural rise in blood sugar that occurs in the early morning hours, typically around 4:00 AM. It's caused by the release of counter-regulatory hormones like growth hormone, cortisol, and glucagon, which prepare the body for waking. During fasting, this phenomenon can cause blood sugar to rise even though no food has been consumed. This is not a sign that fasting isn't working, but rather a normal physiological response as the body mobilizes stored glucose.

Question 19: What is the recommended protocol for starting and ending the daily feeding window? (AH)

The recommended protocol suggests avoiding food intake for at least 60 minutes after waking up and stopping food consumption 2-3 hours before bedtime. Ideally, the feeding window should be 8 hours long, though aiming for a 6-7 hour window can be beneficial as people tend to underestimate their actual eating duration. It's also important to maintain consistency in the timing of the feeding window across days, including weekends, to maximize the benefits of circadian rhythm regulation.

Question 20: What is the importance of consistency in maintaining a time-restricted feeding schedule? (AH)

Consistency is crucial in maintaining a time-restricted feeding schedule to maximize its benefits. Research has shown that irregular timing of the feeding window, even if the duration remains the same, can disrupt the positive effects on circadian rhythms and metabolic health. Shifting the feeding window by even a couple of hours on weekends, for example, can be equivalent to experiencing jet lag and may take several days for the body to readjust. Therefore, maintaining a consistent feeding window across all days of the week is recommended for optimal results.

Question 21: How does fasting affect muscle mass? (JF)

Contrary to popular belief, fasting does not cause significant muscle loss. The body preferentially burns fat for fuel during fasting, preserving muscle mass. This is due to increased growth hormone production during fasting, which helps maintain lean body mass. Studies have shown that alternate-day fasting over 70 days did not decrease fat-free mass (muscle and bone). However, it's important to note that in cases of extreme malnourishment or very low body fat, the body may begin to break down muscle for energy.

Question 22: How does protein consumption timing affect muscle growth in time-restricted feeding? (AH)

Protein consumption timing plays a significant role in muscle growth during time-restricted feeding. Research suggests that consuming protein early in the day, before 10:00 AM, can enhance muscle tissue maintenance and growth. This is due to the expression of the BMAL clock gene, which regulates protein synthesis pathways in muscle cells. Interestingly, the timing of resistance training appears less critical than the timing of protein intake for promoting muscle hypertrophy.

Question 23: What are the effects of fasting on hormones like growth hormone, testosterone, and cortisol? (JF/AH)

Fasting significantly increases growth hormone secretion, which helps preserve lean muscle mass and bone density. During a five-day fast, growth hormone secretion more than doubled. For testosterone, time-restricted feeding may lead to a significant decrease in free testosterone levels. However, it also results in a reduction of serum cortisol levels, which could potentially offset some effects of decreased testosterone. The overall hormonal impact appears to be complex and may depend on individual factors.

Question 24: How does fasting impact fertility and reproductive health? (AH)

Fasting's impact on fertility and reproductive health is related to its effects on body fat and hormone signaling. Adequate body fat is necessary for proper leptin signaling, which is crucial for maintaining ovulatory cycles in women and sperm production in men. Extreme restriction of feeding windows or caloric intake can potentially disrupt these processes. Therefore, it's recommended to maintain a reasonable feeding window (around 8 hours) to balance the benefits of fasting with the needs of reproductive health.

Question 25: How does fasting affect brain function and neurological health? (JF)

Fasting has several positive effects on brain function and neurological health. It increases the production of brain-derived neurotrophic factor (BDNF), which supports neuron growth and is important for long-term memory. Fasting also promotes the production of ketones, which can serve as an efficient fuel source for the brain. Studies in animals have shown that fasting can improve cognitive performance, increase neuroplasticity, and may even help protect against neurodegenerative diseases.

Question 26: What is autophagy and how does fasting promote it? (JF)

Autophagy is a cellular cleansing process where cells break down and recycle old, damaged components. Fasting is a powerful stimulator of autophagy. When we fast, insulin levels drop and mTOR (a key regulator of cell growth) becomes dormant. This triggers the cell to start breaking down old cellular machinery. Autophagy is crucial for cellular health and may play a role in preventing diseases like cancer and Alzheimer's.

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Question 27: How does fasting impact heart health? (JF)

Fasting can have several positive effects on heart health. It can lower blood pressure, reduce LDL cholesterol and triglyceride levels, and increase HDL cholesterol. These changes can significantly reduce the risk of cardiovascular disease. Fasting also promotes autophagy in heart cells, which may help maintain heart health. Additionally, the weight loss and improved insulin sensitivity associated with fasting can indirectly benefit heart health by reducing risk factors for heart disease such as obesity and diabetes.

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Question 28: How does fasting affect type 2 diabetes? (JF)

Fasting can have significant benefits for type 2 diabetes. It lowers insulin levels and improves insulin sensitivity, addressing the root cause of the disease. Fasting periods allow blood glucose levels to drop, giving the pancreas a rest from constant insulin production. Many patients have been able to reduce or eliminate their diabetes medications through fasting protocols. In some cases, fasting has even led to the reversal of type 2 diabetes. However, diabetic patients should only fast under close medical supervision due to the risk of hypoglycemia.

Question 29: How does time-restricted feeding impact non-alcoholic fatty liver disease? (AH)

Time-restricted feeding has shown promising effects in preventing and potentially reversing non-alcoholic fatty liver disease (NAFLD). While the gut microbiome doesn't seem to be directly related to NAFLD as previously thought, time-restricted feeding appears to increase brown fat stores, which are inversely correlated with NAFLD. By promoting the development of brown fat, which increases thermogenesis and helps reduce other fat deposits, time-restricted feeding may help combat this increasingly prevalent liver condition.

Question 30: What are the effects of time-restricted feeding on gut health and the microbiome? (AH)

Time-restricted feeding has shown positive effects on gut health and the microbiome. It can improve the gut microbiome composition and help treat conditions like irritable bowel syndrome and other forms of colitis. By impacting the expression of clock genes, time-restricted feeding influences the mucosal lining of the gut. It appears to reduce levels of lactobacillus, which in high amounts is associated with metabolic disorders, while promoting the growth of beneficial gut microbiota like acetobacter, which supports healthier intestinal function.

Question 31: How does fasting affect electrolyte levels in the body? (JF)

Contrary to common belief, fasting does not typically cause significant electrolyte imbalances in healthy individuals. The body has mechanisms to conserve essential electrolytes during fasting. Sodium and chloride levels are usually maintained through decreased urinary excretion. Potassium, calcium, magnesium, and phosphorus levels generally remain stable. However, during prolonged fasts, some individuals may benefit from electrolyte supplementation, particularly sodium and magnesium. Drinking bone broth during a fast can help maintain electrolyte balance.

Question 32: What role does hydration play in time-restricted feeding? (AH)

Hydration plays a crucial role in time-restricted feeding. Drinking water does not break a fast and is encouraged during fasting periods to maintain hydration. Proper hydration can help manage hunger and support the body's functions during fasting. Adding a small amount of salt to water can help stabilize blood volume and alleviate some of the side effects of fasting, such as lightheadedness or difficulty concentrating, especially for those who consume caffeine, which can have a diuretic effect.

Question 33: What is the role of bone broth in fasting protocols? (JF)

Bone broth plays a supportive role in many fasting protocols. It provides essential minerals and electrolytes, which can help prevent dehydration and electrolyte imbalances during fasting. The gelatin in bone broth may help reduce hunger pangs. While technically not calorie-free, the minimal calories in bone broth don't significantly impact the benefits of fasting for most people. Bone broth can make longer fasts more manageable and may help prevent some of the potential side effects of fasting, such as headaches or fatigue.

Question 34: What are some tips for breaking a fast properly? (JF)

Breaking a fast properly is crucial to avoid digestive discomfort and maximize the benefits of fasting. Key tips include: 1) Break the fast gently with a small meal or snack. 2) Wait 30-60 minutes before eating a larger meal. 3) Avoid overeating. 4) Choose easily digestible foods. 5) Chew thoroughly. 6) Stay hydrated. For longer fasts, it's especially important to ease back into eating gradually. Soups, broths, and light foods are often recommended for breaking extended fasts.

Question 35: What is refeeding syndrome and who is at risk? (JF)

Refeeding syndrome is a potentially dangerous condition that can occur when nutrition is reintroduced too quickly after a period of malnutrition or fasting. It's characterized by severe electrolyte imbalances, particularly involving phosphorus, magnesium, and potassium. Those at highest risk are severely malnourished individuals, such as those with anorexia nervosa, chronic alcoholism, or long-term starvation. For most people practicing therapeutic fasting who are not malnourished to begin with, refeeding syndrome is not a significant concern. However, caution should be exercised when breaking extended fasts.

Question 36: How do exercise and physical activity interact with time-restricted feeding? (AH)

Exercise and physical activity interact with time-restricted feeding in several ways. Light activity after meals can aid in glucose clearing and accelerate the transition to a fasted state. High-intensity interval training can have different effects on blood glucose depending on when it's performed - increasing glucose levels when done early in the day and decreasing them when done later. The timing of exercise relative to the feeding window can also impact hunger levels and adherence to the fasting schedule.

Question 37: What are the effects of time-restricted feeding on athletic performance? (AH)

The effects of time-restricted feeding on athletic performance can vary depending on the individual and the type of activity. Some studies on elite athletes, such as cyclists, have shown that time-restricted feeding can be compatible with high-level performance and may even offer some benefits. However, it's important to consider factors such as protein timing for muscle growth and maintenance, as well as energy availability for training. Athletes may need to adjust their feeding window to align with their training schedule and nutritional needs.

Question 38: What is the role of glucose clearing in time-restricted feeding? (AH)

Glucose clearing plays a crucial role in transitioning from a fed to a fasted state in time-restricted feeding. Activities like light exercise or a 20-30 minute walk after meals can accelerate glucose clearing and gastric emptying. High-intensity interval training can also impact blood glucose levels, with different effects depending on the time of day it's performed. Understanding glucose clearing helps individuals optimize their fasting periods and potentially extend the benefits of the fasted state.

Question 39: How does time-restricted feeding impact sleep quality and duration? (AH)

Time-restricted feeding can positively impact sleep quality and duration by aligning eating patterns with the body's natural circadian rhythms. By avoiding food intake 2-3 hours before bedtime, it allows the body to transition into a fasted state during sleep, which is beneficial for various cellular repair processes. This practice can also help prevent disruptions to sleep caused by late-night eating. Additionally, the regulation of circadian genes through time-restricted feeding may contribute to more stable sleep-wake cycles.

Question 40: How does time-restricted feeding affect energy levels throughout the day? (AH)

Time-restricted feeding can influence energy levels throughout the day, though individual experiences may vary. Many people report increased mental clarity and sustained energy during fasting periods once they've adapted to the schedule. This may be due to more stable blood sugar levels and improved metabolic flexibility. However, during the initial adaptation period, some individuals might experience temporary dips in energy. The placement of the feeding window can also affect energy patterns, with some people finding they have more consistent energy when eating earlier in the day.

Question 41: How does time-restricted feeding impact circadian rhythms and gene expression? (AH)

Time-restricted feeding has a profound impact on circadian rhythms and gene expression. It helps synchronize the body's internal clock genes, which regulate about 80% of genes in the body. By restricting feeding to specific times, it creates a more regular and stable circadian rhythm, leading to proper timing of gene expression. This synchronization affects various physiological processes, including metabolism, hormone production, and cellular repair mechanisms, contributing to overall health improvements.

Question 42: How does fasting impact inflammatory markers in the body? (AH)

Fasting has been shown to reduce inflammatory markers in the body. Studies have demonstrated decreases in pro-inflammatory markers such as TNF alpha, IL-6, and IL-1 when following a time-restricted feeding schedule. This reduction in inflammation is likely due to the extended periods of fasting, which allow the body to engage in cellular repair processes and reduce the constant stress of digestion. The anti-inflammatory effects of fasting contribute to its overall health benefits.

Question 43: What is the impact of time-restricted feeding on oxidative stress? (AH)

Time-restricted feeding has been shown to decrease oxidative stress in the body. Oxidative stress is a state of imbalance between free radicals and antioxidants, which can lead to cellular damage. By allowing for extended periods of fasting, time-restricted feeding gives the body more time to engage in cellular repair processes. This includes the upregulation of antioxidant defense systems and the clearance of damaged cellular components, which collectively contribute to a reduction in overall oxidative stress.

Question 44: What are the potential benefits of time-restricted feeding for cognitive function and mood? (AH)

Time-restricted feeding may offer benefits for cognitive function and mood. The clarity of mind that many people report during fasting periods could potentially contribute to improved cognitive function. Additionally, the regulation of circadian rhythms and reduction in inflammatory markers associated with time-restricted feeding may indirectly support better cognitive function and mood stability. The increase in brain-derived neurotrophic factor (BDNF) during fasting periods may also contribute to improved brain health and cognitive function.

Question 45: How does time-restricted feeding impact longevity and lifespan? (AH)

While long-term studies on humans are still ongoing, time-restricted feeding is associated with several factors that could potentially contribute to increased longevity. These include improved metabolic health, reduced inflammation, enhanced cellular repair processes (such as autophagy), and better regulation of circadian rhythms. The positive effects on liver health, insulin sensitivity, and the potential for reducing age-related diseases suggest that time-restricted feeding could have beneficial impacts on overall lifespan and healthspan.

Question 46: What are some common myths about fasting? (JF)

Common myths about fasting include: 1) It puts you in "starvation mode," slowing metabolism. 2) It causes muscle loss. 3) It leads to low blood sugar. 4) It results in overeating when the fast ends. 5) It deprives the body of nutrients. Research debunks these myths, showing that short-term fasting actually increases metabolism, doesn't cause significant muscle loss in most people, and doesn't necessarily lead to overeating. While nutrient intake is reduced during fasting, the body has mechanisms to conserve essential nutrients.

Question 47: What are some potential risks or side effects of fasting? (JF)

While fasting is generally safe for most healthy individuals, it can have some side effects. These may include headaches, dizziness, fatigue, and irritability, especially in the beginning. Some people may experience constipation due to reduced food intake. In rare cases, fasting can exacerbate gallstone problems. For people with certain medical conditions, such as type 1 diabetes or pregnancy, fasting can be dangerous. It's important to note that most side effects are temporary and often resolve as the body adapts to fasting.

Question 48: What are the potential risks or drawbacks of time-restricted feeding? (AH)

While time-restricted feeding offers many benefits, there are potential drawbacks to consider. For some individuals, particularly those with high stress levels or intense training regimens, very short feeding windows (less than 8 hours) might lead to increased stress hormones or reduced testosterone levels. There's also a risk of overeating during the feeding window, especially with 4-6 hour windows, which could negate weight loss benefits. Additionally, time-restricted feeding may not be suitable for everyone, such as those with certain medical conditions or specific nutritional needs.

Question 49: How does fasting affect blood pressure? (JF)

Fasting can lead to a reduction in blood pressure. This effect is partly due to the decrease in insulin levels, as insulin promotes salt and water retention in the kidneys. When insulin levels drop during fasting, excess salt and water are excreted, potentially lowering blood pressure. Weight loss associated with fasting can also contribute to blood pressure reduction. However, people on blood pressure medications should be monitored closely during fasting, as their medication dosage may need to be adjusted to prevent hypotension.

Question 50: What considerations should diabetics take when fasting? (JF)

Diabetics, especially those on medication, need to be extremely cautious when fasting. Blood sugar levels can fluctuate dramatically during fasting, risking both hyper- and hypoglycemia. Diabetics should only fast under close medical supervision. Frequent blood glucose monitoring is essential. Medication dosages, particularly insulin, often need to be adjusted during fasting periods. Type 1 diabetics generally should not attempt extended fasts. For type 2 diabetics, fasting can be beneficial but requires careful management and should be implemented gradually.

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