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The information from this book is intended to describe the possible benefits of therapeutic fasting.
However, if you decide to treat your illnesses, do it under the supervision of your physician. Do not use
this book as a substitute for professional medical care or treatment.
Every effort has been made to ensure that the information contained in the book is complete and
accurate. However, the author is not engaged in rendering advice to the individual reader.
This book should not serve as a how-to guide for therapeutic, periodic, or intermittent fasting. If you
decide to follow such endeavors, do it under the supervision of a qualified physician.
Periodic Fasting - Repair your DNA, Grow Younger, and Learn to Appreciate your Food
No part of this book or e-book may be used or reproduced in any manner whatsoever without written
permission except in the case of brief quotations embodied in critical articles or reviews. For more
information, contact the author at http://cristivlad.com
Table of Contents
Foreword......................................................................................................1
Introduction.................................................................................................3
Acknowledgements..................................................................................165
References..................................................................................................169
Covers.........................................................................................................197
Foreword
Professor Richard David Feinman
This book will be a great help for its emphasis on the value of
fasting rather, as is so common, the warnings about the dangers of eating too
much. Cristi describes the evolution of his thinking and behavior from early
religious practice to the ketogenic diet and the values of the total-only water
fast. The evolutionary perspective and the rather surprising story of fasting in
the animal kingdom are well presented. The dental and anatomical evolution
as well as social influences puts this in a broad perspective.
In the end, the reader has an insight to the fast, how to get in and
how to re-feed. Encouraging for most of us is the history of fasters in history
including a discussion of Upton Sinclair who, like Cristi, gave us a blow-by-
blow. Of current interest, of course, is how we are going to prevent and cure
cancer and defy ageing with fasting and ketogenesis. There is a very good if
maybe overly optimistic picture of the potential here and the drift of current
as well as details of what to eat -- principles rather than recipes.
At the time of this writing (Jan. 2015), I was already fairly intimate
with the practices of periodic fasting and intermittent fasting. I had been
doing it for more than 12 months. This book is not about religious fasting,
though my childhood experience of fasting involves religious practices. It is
the starting point of the book.
The Christmas Fast runs every year from November 15th until
December 25th, while the Easter Fast is determined in a more complicated
way, but both of them last approximately 40 days.
As a child I found it very hard to believe that someone will not eat
for such a long period of time. My grandparents were following the usual
"Wednesdays and Fridays No Animal Products" protocol, so they suggested I
do the same, which I did without much discomfort.
My practice of religious fasting started becoming a challenge during
a Good Friday (which is also known as the Black Friday, Easter Friday, or
Holy Friday), the Friday before the Orthodox Easter [1]. My grandmother
used to fast for the entire day, until nightfall. She didn't consume water either.
She prayed various times throughout the day.
When I was a young kid we had the spring holiday around the Easter
Holiday. It usually lasted for two weeks: one week before Easter and one
week after Easter (Orthodox Easter). I used to spend those vacations in the
village. It was in my early teens when I decided to try to do the total fast of
The Good Friday.
Then I did it again next year, and the year after, and so on. Even
though I was hungry, I kept distracting myself with chores that had to be
done around the house. The evening meals usually consisted of French fries,
a salad, and some white bread spread with margarine and jam. It was totally
different than my current dietary regimen.
I decided to try to keep the entire fast (water + allowed foods). It was
tough because besides staying away from the restricted foodstuff (animal and
animal derived products), I also had to stop smoking (I was a heavy smoker
back then), stop drinking, stop using bad language, refrain from sexual
activities, and start praying everyday.
One cannot imagine the burden all those limitations had put on my
shoulders. I went through a period of deep inner change. I learned more about
my self than ever before. The first two weeks of no-smoking made my life
experience miserable. Then it got easier.
The saddest part was that once the fast was over, on Christmas Eve, I
jumped back all-in: started smoking again (even though I didn't feel the urge,
but I wanted to do it), started going out and partying like crazy, and started
consuming alcohol again...
The variations are limitless, but the key point behind a ketogenic diet
is that it has to lead to the creation of ketone bodies (made in the liver as
byproducts of fat metabolism). The purpose of their presence is to supply
energy to the brain and other tissues and cells throughout the body in the
context of low-carbohydrate (glucose) supply.
The Christmas Fast went fine and I was very satisfied with the
results. So I considered "why not keep doing this protocol for the Easter
Fast?" which usually starts at the end of February or the beginning of March.
In April 2014 I was already some weeks-in the Easter religious fast
doing my keto-friendly fast. I decided I wanted to go hardcore. I felt that I
could do a total fast (only water) for a couple of days.
Of course, I may not have looked into the right direction. Maybe the
science was hidden somewhere or maybe my search tools were not good
enough to access it. I was barely scratching the surface, as you'll see in the
rest of this book.
That is a possible reason why I did not lose muscle mass. I did not
have any pre/post precise measurements of body composition because the
DXA scanner that I was using had not been calibrated properly and it was
outputting bogus results.
However, when the body is already adapted to using fat, it may not
experience glucose withdrawal and the switch between eating and fasting
may not be perceived. When I switched from eating to fasting, I didn't feel
any of the symptoms because I was fairly keto-adapted.
We mostly eat habitually and not because of real hunger. And this
could spill into disaster given the inappropriate hormonal context, when the
food that you eat keeps fueling a false hunger. You will read more on this
topic throughout the book.
I did not have too much time to become conscious of that. I was
busy, I was writing for my first book, I had a lot of stuff to do outside my
desk, and I also had to workout.
There was no hunger. I did consume water frequently but I did not
get obsessed with the importance of water consumption as many folks do. I
did not have problems during my workouts, and I did not feel like I was
going to black-out. In fact, I felt that my workouts were even better in the
fasted state with no prior/post workout supplements. Many would consider
this as heresy.
During my water fast I lost about 2kg or 4.41 pounds, some of which
may have been water, fat, and some muscle tissue. Muscle breakdown may
have contributed to a very small percentage of the daily energy needs, but the
net muscle breakdown could have been close to zero due to my keto-
adaptation status (muscles use ketones efficiently; ketones come from fat)
and due to the workouts that I did.
At some point in this book, I will talk about how during fasting,
human metabolism can create "sugar" from "fat" and how muscle loss is
minimized during fasting, as long as the body has sufficient fat tissue and as
long as other health parameters are fairly decent.
I learned from Professors Thomas Seyfried [3] and Valter Longo [4]
that if one engages in 7-10 days water fasting once a year, this would almost
completely reduce the risk of tumor overgrowth and cancer.
IER/IF and water fasting are two subjects that will heavily be
discussed in this book, both from a research perspective and a personal
perspective. We'll start with some history. Then we'll try to observe what
happens at sub-cellular and DNA levels when someone fasts.
How did we get here? How did we come to a time of consuming too
much, too frequently, and too metabolically deranging foodstuff, when food
was supposed to be thy medicine, as per Hippocrates' saying?
The regular feeding pattern that human beings adopt everyday is not
reflected by animals in the wild. Animals do not consume 3 meals + snacks
everyday. They most likely feed irregularly, when there is food available, and
sometimes according to a specific circa rhythm. This could be circadian
(daily cycle), circatidal (tidal cycle), circalunar (lunar cycle), and/or
circannual (annual cycle). The implications of each of these cycles go beyond
feeding patterns and encompass processes like breeding, hibernation,
migration, hormonal regulation, sleeping patterns, and others.
To clear things up, circa rhythms (often times seen as circadian
rhythms) refer to various biological rhythms that are shaped by
environmental cycles. The circadian (daily) cycle refers to biological
processes that occur under 24-hour regularity. One of the master controllers
of the circadian cycle is the light/dark periodicity. For example, in healthy
adult men, peak testosterone production usually occurs between 8 and 10
A.M. everyday. That is one of the reasons I always do blood samples for
Testosterone at this time of the day. Similarly, melatonin secretion usually
starts increasing between 8 and 10 P.M. everyday.
The shift between phase II and phase III occurs in the context of
extremely reduced body fat which can be used for fuel. But in phase III, the
body starts breaking down protein at an accelerated pace. It is until a certain
point reversible, if re-feeding occurs. Phase III is critical because the body
starts becoming alerted, NPY (Neuropeptide Y) secretion increase
dramatically triggering hunger [7], making the subject (animal) seek for food
as its top priority. Phase III is the starvation phase. A similar tri-phase context
is observed for other species in the wild.
Moving on to more complex life forms, yet still very old, starvation
and dietary restriction studies made on Drosophila (fruit fly) show how these
model organisms develop a greater resistance to desiccation (extreme
dryness) and oxidative stress, concomitantly with experiencing prolonged
development and increased lifespan [21]. There is still much to learn about
many of the mechanism behind such adaptations during the survival mode.
In the rare cases when they were able to eat copiously, insulin was a
life saving factor. It allowed them to pack food as fat tissue through the
process of lipogenesis, the same tissue that would later provide them with
energy when food was scarce [17]. I'll get into more details on this topic later.
I wonder how many of them survived and how their physiology may
have been different than ours to allow them to thrive. Maybe the mechanism
of insulin resistance has been improved throughout their existence, but it has
not been perfected. After all, evolution is a non-stop process. I have some
doubts that, as being predominantly gatherers, they could eat so much to
trigger insulin resistance efficiently. Maybe this is one of the reasons they
have become extinct.
As Australopiths left the scene of evolution, a newer species started
appearing approximately 1.9 million years ago in Africa. They were the
Homo erectus species ('erectus', from Latin, meaning 'up-right'). Unlike the
Australopiths, Homo erectus started migrating across continents, they
evolved as more prolific hunters, but they were also gatherers because they
did not find wild game in all the places that they migrated to.
From what has been studied so far, the mean brain size of some
Australopithecus was 478 cc. In contrast, earliest Homo species had larger
brains, with an average of 700 cc, suggesting cooperative breeding, as well as
a wider access to energy rich foods and a possible carnivore diet [24].
However, these facts alone do not shed light on the feeding rhythmicity of the
species.
Perhaps, as one study points out, early hominids ate a lot of fish due
to its availability all year around. Steward (1994) refers to the fish remains
found in many early hominid sites [25]. Perhaps, as Strait (2014) suggests,
they ate many insects, given they were widely available and they serve a
substantial source of protein [26].
Or perhaps they mostly focused on food sources that came from fat,
as these were able to provide energy for longer periods of time. An
interesting study conducted by Ben-Dor et al. (2011) correlates the
disappearance of the elephant in the Levant (an area in S-W Asia) with the
increased energy needs of the Homo erectus [27].
The hunting process could last for hours or days in a row and the
body of these early hunters would most likely be in ketosis. The certainty of
being in ketosis increases if the hunting process lasts for more than 24 hours
(enough time for glycogen stores to become depleted and for the metabolism
to switch from primarily using glucose to primarily using fatty acids and
ketones). I assume they did not carry around energy bars in their pursuit for
energy-dense-energy-rich food sources (i.e. big mammals).
While the Australopith weighed around ~44 kg (97 pounds) and had
an average brain weight of 485 g (1.07 pounds), early Homo (up to Homo
erectus) weighed on average 57 kg (126 pounds) and had an average brain
weight of 805 g (1.77 pounds). This could also be a potential explanation for
the availability of higher energy foods. Yet, this does not provide clear
insight on the frequency of eating of these early species [27].
There are several Homo species between Homo erectus and Homo
sapiens sapiens (the modern man). Homo heidelbergensis, Homo
neanderthalensis, and Homo rhodesiensis are only three of them; however,
the only remaining one seems to be Homo sapiens sapiens (H. sapiens).
Until a few years ago it was strongly believed that the modern
human appeared ~200,000 years ago somewhere in Africa and only much
later they migrated outside Africa [30]. There are various theories that try to
explain how modern humans emerged. One of them is The Multiregional
Evolution Theory hypothesizing that we are the product of gene flow among
Asian Homo erectus, European Homo neanderthalensis and African Homo
erectus ergaster [31]. I love the thought of being, partially, a Neanderthal.
Some theories and fair logic would focus on the social perspective of
Australopiths, early Homo and modern Homo. Australopiths were
predominantly foragers and gatherers and it is thought that they did not
organize themselves in groups or tribes. They did not have to cooperate for
hunting and they may have not been developed enough (in terms of brain
size) to support cooperation. They were in-between late primates and early
Homo species, but their feeding patterns may resemble, to a higher extent, a
vegetarian approach.
From both social and feeding perspectives, Homo erectus and later
Homo species (including H. sapiens - us) developed hunting habits possibly
because of their bigger brain size, but it could also be the other way around.
They may have had bigger brain size because of the higher energy content of
their feeding. One thing has to be kept in mind: these processes took place
over thousands and hundreds of thousands of years; each small adaptation
could have lasted a very long period of time.
Higher-order Societies
This was the time when my grandparents were still strong and
active. Daily duties consisted of feeding and taking care of farm animals, as
well as working the land. Corn was (to a certain extent) used to feed the
chicken once or twice a day, while the rest of the time they were running free
on the field eating grass and worms. Pigs were also left loose during the day
and sometimes I had to take care of them. It was one of the jobs I hated most.
It would not be unsafe to correlate this with the way of life of early
humans living in agricultural societies approximately 10,000 years ago. Such
living allowed for eating everyday at least once or twice. This does not mean
that everybody did the same. Many may have, but many have not. One could
only consider the different societal classes that were existent from the very
beginning: the poor may not have had the same "luxury" to eat twice or three
times a day.
Even with the agricultural way of life on our shoulders for ~10,000-
11,000 years, we were doing mostly fine. People did not suffer from modern
diseases until concentrating in big cities in the late 19th century, which is
why I can consider my early life in the village as being quite healthy, given
the type of food and the frequency of eating. I was a bit overweight but I was
not obese. And most of the folks were not obese either. We were active, we
did not have too much EMF radiation (electromagnetic field radiation), we
did not have too much exposure to artificial light, and we slept well. The
picture is quite different in a modern city life.
Chapter 2
Remember, these early humans were most likely eating energy rich
food whenever they were able to hunt, while the rest of the time they may
have been feeding on lower energy foods or fasting, given the circumstances.
The situation has probably changed as hunter gatherer tribes have settle down
into villages and towns and started cultivating the land.
Yet, there is evidence that some folks have deliberately practiced
energy restriction and fasting even when agricultural societies emerged.
Seneca's Letters
Take, for example Seneca, who lived between ~4 B.C. to ~65 A.D.
In his letters to Lucilius he often urged for "laying down the law to the soul,
and bit it be alone in refraining from pleasures just when the whole mob has
let itself go in pleasures" [34].
"Set aside a certain number of days, during which you shall be content with
the scantiest and cheapest fare, with coarse and rough dress, saying to
yourself the while: "Is this the condition that I feared?"[34].
In these words one may see that foodstuff restriction is not carried
out for the sake of ailment alleviation alone (in fact, he does not even
mention fasting as a cure), but to prove oneself that sobriety and modesty
(through a minimal lifestyle) can bring as much joy as the life of a wealthy
(financially) person would bring. Moreover:
"Let the pallet be a real one, and the coarse cloak; let the bread be hard and
grimy. Endure all this for three or four days at a time, sometimes for more, so
that it may be a test of yourself instead of a mere hobby.
Then, I assure you, my dear Lucilius, you will leap for joy when filled with a
pennyworth of food, and you will understand that a man's peace of mind does
not depend upon Fortune; for, even when angry she grants enough for our
needs."[34].
I interpret this as a call to experiencing the richness of life by
removing or reducing much of the comforts that they had. Living on
pennyworth of food for a certain number of days, wearing coarse cloak and
sleeping on a hard pallet will allow one to be satisfied with the minimum and
will bring infinite joy when granted with access to a wealthier living.
The Temptation of Jesus
Then, we can all recollect the writings of the Bible, in Matthew 4:2,
about the Temptation of Jesus:
"Then Jesus was led up by the Spirit into the wilderness to be tempted by the
devil. And after He had fasted forty days and forty nights, He then became
hungry."[35]
In his early life, due to his lifestyle, Luigi may have suffered from
colic and gout, "a stomach generally out of order...and a perpetual thirst"
[37]. One of the leading physiologic philosophies of this man was that he
should allow himself no more food than his stomach can easily digest, often
times leaving the table at the point of feeling good but not full or satiated.
It took Luigi almost a year until he started feeling entirely free from
all his ailments. Some other strategies that he implemented are:
"I have carefully avoided, as far as possible, all extreme heat, cold,
extraordinary fatigue, interruption of my usual hours of rest, and staying
long in bad air" [36].
Dear Luigi, you would be surprised of the modern human who almost 365
days a year prefers living in a cozy environment, sleeps poorly, and breathes
an air that is dozens of times more polluted than yours.
Living in the 15th century makes Luigi smarter than many followers
of the conventional medicine today [36]:
"...he who thus lives, cannot be sick, or but seldom, and for a short time,
because, by regular living, he destroys every seed of sickness, and thus, by
removing the cause, prevents the effect..."
"I eat as follows: bread, panado, eggs (the yolk), and soups. Of flesh meat, I
eat kid and mutton. I eat poultry of every kind; also of sea and river fish.
Some men are too poor to allow themselves food of this kind, but they may do
well on bread (made from wheat meal, which contains far more nutriment
than bread made from fine flour), panado, eggs, milk, and vegetables."
In Discourse 3 [36]:
"My Lord, to begin, I must tell you, that being now at the age of ninety-one, I
am more sound and hearty than ever, much to the amazement of those who
know me."
"I solemnly assure all mankind that I really enjoy a great deal more than I
can mention, and that I have no other reason for writing, but that of
demonstrating the great advantages, which arise from longevity, and such a
life as I have lived.
I desire to convince men, that they may be induced to observe these excellent
rules of constant temperance in eating and drinking, and therefore, I never
cease to raise my voice, crying out to you, my friends, that your lives may be
even as mine"
Thanking Luigi, I say that the time has come for me to build upon
his life-long experiment by studying and practicing caloric restriction, and, at
the same time, optimizing (as much as possible) the nutritional protocol so
that it can encompass nutritious-rich-energy-rich foods.
Jumping through time until the early 20th Century, I will introduce
the experiments of Upton Sinclair on periodic and prolonged fasting.
Some other folks wrote to him how they were motivated to fast after
reading his articles; they shared their experiences in great detail and thanked
him for his careful guidance. Upton condensed all these letters along with his
own experience in a book entitled The Fasting Cure [42]. As I have done
with Luigi Cornaro's life-long calorie restriction journey, I will further
describe and interpret Upton's book along with quotes from it so you get a
better picture of the fasting practices from the early 1900s.
"I cannot take any case but my own, because there is no case about which I
can speak with such authority."
Upton spent his childhood without having too many cares in the
world. In his own words [42]:
One day Upton heard the story of a woman who during her life
suffered from "sciatica and acute rheumatism; from a chronic intestinal
trouble which the doctors called "intermittent peritonitis"; from intense
nervous weakness, melancholy, and chronic catarrh, causing deafness." and
who was, until recently, a bed-ridden invalid. She was the same woman to
join him on horseback riding up Mount Hamilton in California. To his
amazement, the woman claimed that when she took the ride she "had not
eaten a particle of food for four days previously!" [42].
This was the first real encounter of Upton with the practice of
fasting. Seeing the changes which this woman went through, he decided he
would try to fast for a couple of days.
As one might suspect, it was not easy in the beginning. Upton felt
the same disturbing hunger I felt when I tried doing my first Good Friday
fast. The difference is that he kept going, and as he depleted his glycogen
storage, hunger started melting away. In day 5 he did some walking and also
began doing some intellectual work. To his surprise, "I read and wrote more
than I had dared to do for years before" [42]. His sleep was not affected.
However, each day around noon he would feel weak (possibly due to
decreasing cortisol levels). He mitigated this phenomenon with a massage
and a refreshing cold shower.
These practices may sound obscure, but these folks were not crazy.
Later research shows how coffee enemas can increase the activity of
glutathione S-transferase in the liver by 700%. This enzyme is responsible for
fighting free-radical damage [43].
Upton lost a total of 17 pounds during his 12-day fast. Most of the
pounds were lost during the first 4 days - that is 15 pounds. I suspect this has
a lot to do with glycogen depletion and water loss, and much less with fat
loss. During the next 8 days he claims to have lost only two pounds (that is
~900g). I suspect that much of this subsequent loss would be from fat mass.
Upton broke the fast with some orange juice. This is a very common
practice among experienced fasters (people who fast a lot). But it is not the
main protocol of breaking the fast and reintroducing food that I describe later
when I talk about prolonged fasting. Upton kept on juicing for the first two
days (the juice of ~12 oranges), then he switched to the milk diet (a glass of
milk every hour, or so, for 3 days). He describes an extraordinary sense of
inner peace on the milk diet, "as if every weary nerve in the body were
purring like a cat" [42].
During the first 24 days after his first fasting experience, Upton
gained a total of 32 pounds. It is also intriguing to observe this trend of post-
fast huge gains in the letters people were sending him. Most of them saw this
as a successfully completed process and this is totally different from what
many modern practitioners would say.
"Now, after the cleaning-out of the fast, I would go into a gymnasium and do
work which would literally have broken my back before, and I did it with
intense enjoyment, and with amazing results. The muscles fairly leaped out
upon my body; I suddenly discovered the possibility of becoming an athlete."
Not only that, but he also discovered that most of his allergies went
away. He was now able to consume acid fruits, bananas, and peanut butter
with no trouble. It would be engaging to research the changes in the
microbiota in people who fast for 5 days or more.
"I know one man who reduced his weight from 365 pounds to 235. I know one
little girl whose spine was bent in the shape of a letter U lying sideways, and
who, by means of fasting and a diet of fruits exclusively, has come four inches
nearer to straightness in a few months. She has the complexion of perfect
health, and is rapidly recovering the use of arms and legs, which were
paralyzed years ago."
Another letter is from an anemic school teacher who had a big goiter
and was constantly the victim of colds and headaches. She fasted for 8 days
and she cured herself from all her ailments. She modified her lifestyle and
started consuming ~1,200 kcals a day mostly from fresh fruit.
"Holy Writ says that Moses fasted 40 days, and to prove to his congregation
that one did not have to be superstitious to believe some of these Old
Testament tales, Rev. J. E. Fitch, at the age of 80, fasted fifty days; and
instead of losing flesh towards the last part of his fast actually gained in
weight. He is as vigorous to-day as he was at 21."
A particular letter from the end of the book caught my attention [42]:
"Tarbox, whose letter I enclose, on the thirty-seventh day of her fast, her
tongue was perfectly clean and she had natural hunger, and she was well on
the way to recovery from the terrible cancerous growth and condition in
which I found her. Since Mrs. Tarbox' cure, I have had several other cases of
cancer cured through fasting."
Even so, in his opinion, longer fasts would mostly seem fitted to
those suffering from chronic diseases (rheumatism, Bright's Disease,
Cirrhosis, and cancer, to name a few). I believe that by "longer" he refers to
fasts that last for more than 10-15 days. Hence, I would cautiously regard 6-
10 day fasts as fairly safe.
Unlike Luigi Cornaro, Upton did not advocate for calorie restriction
or fasts lasting 2 or 3 days because he regarded them hard to attain to. One of
his motives was that in prolonged fasting, the first two days are the hardest
because hunger may be persistent, same as it may happen in calorie
restriction under a certain nutrition protocol.
He did not consider that people should regard pigs and chickens as
their brothers, hence not kill them. He experimented with meat-only diets
same as he did with the milk-only diet from the re-feeding period of some of
his fasts. However, he was not a big meat eater and he consumed it every
now and then.
If it were for me, I would quote the entire book that Upton wrote in
the early 1900s. But that may not be considered fair use. What I can do is to
highlight its importance as a sound reference guide for the uninitiated faster
(person who fasts) written in a simple and easily understandable language.
Now that you are regarded with some decent knowledge on the
practices of fasting and caloric restriction, I will start elaborating on the
science and focus on the studies conducted in the 1900s, especially on those
lead by George Cahill in the '50s and '60s, one of the brightest minds in the
field.
Chapter 3
But on the other side of the spectrum there were also these lean
individuals who decided to try total fasting for healing, detoxification and
rejuvenation purposes. As I previously mentioned, I can easily relate to the
Christian-Orthodox monks from my country whom most often do caloric
restriction and fasting altogether.
- Dr. Tanner who reportedly fasted for 40 days in 1880 [45, 46].
- Alexander Jacques did a 30 day and a 40 day fast in 1887 and another 30
day fast in 1888 [46].
- Signor Succi completed at least 32 fasts of 20 days or more [47]; he also
completed longer fasts during 1890 (40 and 45 days) [48].
- F. Penny, M.D. completed a 30 day fast in 1905 [49].
And, on fasting for weight loss in obese subjects [44]:
Drenick and colleagues [50] had obese subjects undergo fasts lasting
for up 117 days, while Thomson et al. (1966) [51] supervised fasts of 139,
236 and one lasting 249 days. The longest recorded fast was that of a 27 year
old obese man and it lasted 382 days, resulting in the loss of 125 kg. I have
discussed about this medically supervised world record in the introduction of
the book [52]. They also mention fasting for the treatment of convulsions,
referencing two studies, one dating back to 1910 and found in a 1963 paper
[53] and another one from 1921 [54].
It is beyond the scope of the book to go into the details of all these
medical experiments and individual stories, which is why I provided clear
references to them. And many can be accessed for free online. I wanted to
mention them and detail some of them so that the practice of prolonged
fasting is not further seen as some controversial, unachievable and religious
endeavor, but on the contrary, if well conducted, it can be a powerful tool to
repair and rejuvenate the body from DNA level and above. I will go into
more details for the very recent research on prolonged and intermittent
fasting.
And now, to stay in line with the chronologic flow of the book, I
want to get into the specifics of the n=1 (includes one research subject) study
from the 1980s (which provided the plethora of historical medical reference
from above).
He initially lost 0.9 kg/day (~1.98 pounds) during the first 5 days,
but then it gradually decreased to 0.3 kg/day (0.66 pounds) after the third
week. I suspect the initial increase in weight loss during the first 5 days was
from glycogen and water mostly, as the body gradually adapted to using fatty
acids and ketones predominantly.
After all, the duration of the fast (other factors considered optimal)
may be tightly dependent on the volume of bodyfat. One thing to note is that
initial water intake was 2 liters/day (~68 oz) for the first 3 weeks, which then
decreased to 1 liter/day (~34 oz) throughout the rest of the experiment.
In the next table you can observe the fluctuation of different
biomarkers before, during, and after the fast [44]:
Thyroxine (T4) levels in this subject were 5.9 µg/dL before fasting,
decreased to reach 4.9 µg/dL in the 36th day of the fast, while they measured
4.4 µg/dL 12 days after the fast ended. Normal values are between 4.5 - 12.5
µg/dL. Measuring T3 (triiodothyronine - active thyroid hormone) levels
would have been more accurate, but as researchers point out: during
prolonged fasting T3 levels fall but clinical hypothyroidism does not develop,
as TSH levels remain mostly unchanged.
In this study [44], the lean subject did not develop any of these
symptoms throughout the fast. However, he had to interrupt his 40 day fast in
day 36 due to the signals (low pulse, low blood pressure, etc) given by his
body that "It should be over".
"Others [51] have reported euphoria without total anorexia. Ketosis, which
develops rapidly during fasting, was commonly believed to be responsible for
the anorexia [60];
The hard part of the experiment was the semi-starvation phase that
lasted for 6 months, between February and July 1945. The subjects consumed
~1,570 kcals of foods similar to the ones in Europe at that time, such as
potatoes, bread, jam, sugar, cabbage salad, jello, oatmeal and macaroni and
seldom some token amounts of dairy and meat products [72]. They mostly ate
breakfast and lunch.
I think there are many reasons that prolonged fasting has become an
active (yet, silent) area of research. Some of them could be: the discovery of
insulin, the investigation of the mechanisms of diabetes, especially Type 1
Diabetes (ketosis vs. ketoacidosis), a possible treatment for obesity, as well
as other disturbing conditions such as epilepsy.
During his early studies, George Cahill figured out that "the fuel
substrate for brain could not continue to be glucose since gluconeogenesis
from protein would consume so much muscle that long-term viability would
be dramatically decreased." [66].
In some other studies, total fasting was not quite total as it included
small amounts and sometimes moderate amounts of protein so that
proteolysis would be minimized [78, 79]. Even though there was substantial
weight loss, the subjects may not have fully adapted to the efficient
prolonged-fasting metabolism described and observed by George Cahill and
other researchers. Hunger may have not been minimized, as it is in prolonged
fasting experiments. I would personally say these studies are in-between
starvation and much closer to the experiments of Ancel Keys, with regards to
the gravity and emotional distress of food deprivation.
Blood glucose levels were constant in both states, but more glucose
was produce and utilized in PA (post-absorption) compared to fasting. The
Respiratory Quotient (R.Q.) increased in PA but did not change in the fasted
state; "pyruvate and alanine increased less in PA than in fasting; lactate
increased similarly in PA and fasting; FFA did not change in PA but
increased in fasting; and 3-hydroxybutyrate did not change in PA but
decreased in fasting. Insulin decreased in each subject with exercise in PA
and fasting, whereas little change occurred in glucagon." [83].
In the end of this chapter, I'd like to remind you of some n=1
medically supervised prolonged fasting experiments in healthy non-obese,
that would provide helpful insight on the topic:
Have you ever considered why this type of protocol (fasting) may
not get the buzz and popularity that conventional diets do? Who's got
something to win from telling you not to eat? Supplement companies could
go bankrupt if they stop selling you "hunger suppression pills" or "fat
burners" or whatever "what not product" you can think of.
Imagine that! One would die for not eating every 3-4 hours. The
metabolism would crash. The thyroid will start to malfunction. Please excuse
my sarcasm.
One reason I know it was false hunger is that I had enough bodyfat
that I could do prolonged water-only fasting for more than 2 months (other
factors considered optimal). In those situations I could understand why Ancel
Keys' semi-starvation subjects felt so miserable on a daily 1,570 kcals diet.
In phase I (first couple of hours after the last meal), the body fuel is
glucose, largely from exogenous sources. Glucose is burned at ~40g/h. From
4-16 hours (phase II), glucose is burned at ~7-8g/h and most of it comes from
hepatic glycogen. At this point the body has already started to increase the
production of glucose in the liver through the process of gluconeogenesis.
During the first three phases is when the average person would find
their most difficult time to cope with. As the body's sugar levels drop and as
the metabolism switches to the fat burning mode, the panicking brain screams
for the fuel it's been widely used to (especially in the first 0-16 hours).
Since this is the most crucial time, I'd rather recommend one to start
a prolonged fasting experiment consuming the last meal sometime in the
evening, 3-4 hours before going to bed. Assuming an 8 hour sleep, the
subject will be ~12 hours into fasting by wake-up time. There still remains a
few more painful hours with respect to hunger.
Serving some black coffee, tea, and a ton of water will definitely
help. After 24-30 hours most of the (false) hunger symptoms are gone,
glycogen is depleted, GNG is still undergoing but at a lower pace, insulin
secretion is low and the body can tap into using fats and ketones efficiently.
Occupying oneself with work around the house or other errands can serve as
means of distraction from hunger.
Much of them may not be present if the faster comes from a very-
low-carb or ketogenic nutritional background. I, for example, have not felt
any hunger and/or the rest of the symptoms when I did my 5-day water-only
fast. Though I had a headache by the end of the second day, it was gone when
I woke up the third day.
Daily cold showers and/or alternate hot/cold showers can also help
tremendously. Cold showers could last for 5-10 minutes, depending on the
level of cold adaptation of the experimenter, while hot/cold showers may last
for up to 15 minutes. In hot/cold showers, one can alternate hot/cold water in
a ratio of 2:1 (20 seconds cold, 10 seconds hot) or they can use hot water for
the first 5 minutes and cold water for the remaining 5-10 minutes. Anyway
you do it, please make sure your body can tolerate such stress. Consult your
personal health care practitioner first.
If you have to stay indoor for some reason, make sure you get some
fresh air and direct exposure to sun light (predominantly in the morning) by
opening the windows. It will not help if you stay by the window and the
window is closed because beneficial UVB (Ultraviolet B) radiation does not
seem to efficiently penetrate glass [95]. Sunlight is critical for many
metabolic processes as it allows the production of vitamin D3 (which is
considered a hormone); this does not mean it should be abused.
"The one danger in the fasting treatment is that when you break the fast,
hunger is apt to come back with a rush, while, on the other hand, the stomach
is weak, and the utmost caution is needed."
When one feels that their digestive tract is able to tolerate more
solid, nutritious-rich-and-energy-rich foods, they could introduce olive oil to
the green mix, coconut oil, coconut meat, nuts and seeds, and eventually the
rest of the foods allowed on their dietary protocol.
After 3-5 days of water-only fasting, it is easier, but still not without
any risk, to break the fast more abruptly. Caution is necessary. It may be
better to have the first 2-3 meals spread apart for at least 7-8 hours and use
low-calorie keto-friendly foods like the ones mentioned above.
When I broke my 5-day fast I ate a small avocado mixed with some
lemon juice from a freshly squeezed lemon. Then, after a couple of hours, I
consumed some nuts (2-3 oz, 60-90g). That was it for the first day. The next
day I resumed my keto-friendly nutrition protocol.
I suggest (not only when breaking the fast, but as a general
guideline) not consuming water at least 30 minutes prior, post, or during
meals as this may burden the digestion process. This may be even more
important as one starts refeeding after water-only fasting. You should
consume water at your own disposal, but try not doing it around or during
your meals.
Green vegetables would also come in hand into the mix. For longer
fasts (7, 10, 20 days or even longer) one may juice for the first 2-3 days and
then gradually and carefully add other foods (which do not require long
digestion) to the strategy.
One should observe how the body responds to food, and keep
experimenting and adapting the tactic. Of course, it would not be wise to
break a 10-day water-only fast with a copious meal of beef, sweet potatoes,
bread and some red wine. While some folks could thrive doing that, many
may experience negative consequences such as digestive system
disturbances. And we have seen what can happen if a person suffers from a
certain disease and are not careful in the realimentation phase (even death can
occur - see the examples from the mid 1900s [44]).
Moreover, recent studies (2014) show how IF/IER can boost brain
health by increasing the production of BDNF (Brain Derived Neurotrophic
Factor) leading to new neuron formation (neurogenesis), better survival of
existing neurons, and strengthening of synapses [97].
Even if I am not a huge fan of the 5:2 diet (5 days eating normally, 2
days restricting food to 500-600 kcals/day), its adopters experience better
insulin sensitivity, lower insulin and leptin levels, better usage of fatty acids,
higher ketone levels, as well as reduced IGF-1 levels. IGF-1 is the short for
insulin-like growth factor which works together with insulin and often with
mTOR (mammalian target of rapamycin) to regulate hypertrophy (cell/tissue
proliferation) [98, 99, 100, 101].
Recall the prior studies where I showed you how growth hormone
levels can increase 10-20 fold (or even greater) in prolonged fasting, as well
as in intermittent fasting (more than 18-20 hours). I will try to fine tune these
mechanisms in further chapters, as well as in my n=1 prolonged intermittent
fasting protocol.
For folks who want to increase muscle mass using insulin, IGF-1,
mTOR and their related pathways, it is a good way to approach it. Others
have 6, 8, 10 or even 12 hour feeding windows, allowing for more moderate
insulin secretion, more convenience, compliance, and satiety. Of course, the
benefits differ from one protocol to another.
I, for example, have been doing intermittent fasting for 1 year and 3
months (at the current date and time) almost everyday. I usually fast for 16-
18 hours and eat ketogenic-friendly foods in my feeding windows of 6-8
hours.
Often times, I fast for more than 24 hours, usually when I travel or
when I combine intermittent fasting with religious fasting. I consume 1,500-
1,700 kcals/day on average; sometimes more, sometimes less. So, I
calorically restrict, eat ketogenic foods, and do intermittent fasting at the
same time. And I've never been more satisfied or compliant with any other
dietary protocol so far.
What happens when your body is adapted to irregular feeding cycles and you
significantly do the opposite?
What happens when your body expects sleep to emerge as natural light (the
sun) goes down and that never occurs?
What happens when you think and feel that 4-6 hours of sleep per night is
enough for you, when in the long-term it will lead to an accelerated
degradation of your health?
These are few of the critical questions that we raise when we talk
about the circadian clock and the deep mismatch (circadian desynchrony)
most of us live in today. As Mattson et al. (2014) point out [6]:
"The modern lifestyle perturbed the human circadian system in three primary
ways: shift work, exposure to prolonged hours of artificial light, and erratic
eating patterns."
Add to that agriculture and the food processing industry and you
have a good recipe for disaster. Nobody denies the benefits of technology and
modern day life. But I think we've taken things to the extreme.
Even though we are able to cure many diseases that 100 years ago
would have killed many, and even though we have tremendously increased
our lifespan over the last two centuries, what would have happened if we
mitigated most of the costs (health-related) associated with modern life from
the very beginning?
At this point you may be a bit confused. Please bear with me. Things
will eventually clear up.
The human body mostly never experiences the dose of daily light
exposure with which it was accustomed to for so many generations. Living in
big cities where sun light may be partially blocked by buildings, staying
indoors many hours during the day, and staying late at night being exposed to
artificial light from TVs, light bulbs, tablets, smartphones and other devices
prevents sound circadian rhythmicity.
And when you desynchronize your internal clock, when you are
exposed to too much artificial light, when you are not exposed to stress
coming from the environment (living in constant conditions 365 days a year),
and when you sleep poorly, no wonder you are so vulnerable to many
ailments.
When you consume food regularly everyday and when you do not
sleep enough, your body mostly never goes into repair and maintenance
mode, mainly because it has to focus on food digestion; hence the higher
exposure to diseases; hence accelerated aging. I strongly think that eating
frequently every day is not an optimal strategy.
As I get deeper into research, as I analyze more data from good and
bad research studies, and as I experiment with different strategies myself, I
come to realize that an optimal human condition has much more to do than
the regular advice to focus on diet and exercise that most experts promote.
In this context, I would safely assume it matters little what you eat as
long as you eat naturally, irregularly, and use these strategies along the way
(including fasting). Of course, optimizing nutrition would provide increased
benefits.
In plants and animals there are two genes coding for the
cryptochrome proteins CRY1 and CRY2. These proteins are sensitive to blue
light and are components of the vast repository of the circadian clock.
But on the other hand, it may provide one with powerful tools of
keeping the clock synchronized as much as possible when traveling, when
working in shifts or in other disturbing circumstances. For example, when I
traveled across continents, from Romania to Thailand (5 hours difference) or
from Romania to America (7 hours difference), I suffered minimal jet-lag,
possibly because I fasted mostly throughout these trips.
Conventional wisdom says that full recovery from jet-lag takes 1 day
per every hour of time-zone difference. So it would have actually taken 5
days, respectively 7 days for me to fully recover from my travels. Yet, I was
able to mitigate this pitfall with fasting. And of course, it's much more
convenient and cheaper because food is expensive in airports; and it would be
impractical to carry packaged-food with me all the time.
For folks not familiar with leptin and its action in the human body,
you should know that leptin is a hormone secreted by your fat cells -
affecting hunger and satiety. Its mechanism is similar to insulin and it is often
mentioned in contexts regarding insulin resistance. Here's how it is supposed
to work:
Normal-weight subjects secrete leptin as a response to feeding.
Leptin communicates with the hypothalamus telling your brain that it had
enough food and that you should stop eating. In obese subjects, the adipose
tissue releases more leptin and there is an inefficient communication between
leptin and your brain, marking reduced leptin sensitivity (increased leptin
resistance). Feeding cessation often occurs much later in obese subjects
compared to lean subject, a mechanism that further promotes obesity.
In one study, healthy subjects had to move their last meal from 19-
20 P.M. to 23-24 P.M. (midnight). After a period of 3 weeks, the overall
daily glucose levels and insulin secretion increased significantly, marking a
correlation between feeding cycles, circadian rhythms, and glucose and
insulin secretion [134]. Subsequently, sleeping less than 6 hours or more than
9 hours per night has been associated with increased risk of developing poor
glucose tolerance and T2D [135].
These studies suggest that we should not interfere with our circadian
adapted metabolism, which has been polished and perfected over the
thousands of generations of hominids on Earth. Constant exposure to
artificial light, reduced sleep, and feeding at night may disrupt the processes
involved in homeostasis and may actively participate in the development of
diseased conditions.
AMPk is like an energy sensor inside the cells and one of its main
purposes is to restore energy balance, whenever energy levels follow
descending trends, such as in fasting regimens [136, 137]. AMPk partially
works by modulating SIRT1 activity and NAD+ levels [114]. It is present in
many tissues, including the brain, the liver, and the muscles.
As pointed out by Froy and Miskin (2010), SIRT1 may also link the
metabolism with the circadian clock due to their observed transcriptional
silencing potential and genome stability seen in yeast [114]. The authors
consider that:
“Sir2 or its ortholog enzymes are involved in life span extension and the
response to caloric restriction in yeast, Caenorhabditis elegans, Drosophila
and mice.”
“Thus, the levels of NAD+ together with the cycling of SIRT1 can determine
the activity and robustness of clock gene transcription at least in cultured
cells."
To support the claim that Sir2 has anti-aging effects, some studies
found that using resveratrol (which activates SIRT1) leads to increased
SIRT1 activity and may extend lifespan in various species, same as caloric
restriction does [162, 142].
Resveratrol is found in red wine. Think about increasing your lifespan
using both strategies, consuming some red wine and doing caloric restriction
through a high-fat diet (without ever feeling restricted). One may increase the
activity of these potentially powerful factors AMPk, SIRT1, and others while
reducing the number of mutations that may come from an increased mTOR
activity.
Increasing Healthy Life Span – From Animal Models to Humans
One of the papers that I want to delve into was published in 2010
and has been written by two of the contemporary researchers that I appreciate
tremendously with regards to healthy aging and increasing life-span.
We all know and hear in the media about the amazing pills and
products made to magically increase your longevity. Sadly, it is not as easy as
that. Any reasonable human being should be smart enough to know that there
is not one single thing (i.e. drug, herb, etc) to have a holistic effect on the
entire human metabolism. As we’ve seen so far, everything is amazingly
complex; adopting multiple interventions would be a safer and sane
approach.
Getting back to the paper of Longo and his colleagues from 2010, let
us see the life-span increase and the potential health benefits through dietary
restriction and through mutations/drugs observed in model organisms [163].
When analyzing the beneficial health effects that come along with
dietary restriction in monkeys, researchers observed increased prevention of
obesity and protection against diabetes, cardiovascular disease and cancer
[163].
Now let me get into the more specific molecular details of these
adaptations/changes seen in model organisms and humans when it comes to
increasing healthy life span through dietary restriction and/or
mutations/drugs.
In the last part of their review, Longo et al. (2010) specify that [164]:
Plus, the researcher acknowledges that his animal models were more
corpulent (overweight) when following the high-carbohydrate protocol and
from my research, I find compelling evidence correlating adiposity with
inflammation (the starting point for many chronic and age related disease).
In light of these findings, from now on, I would pay a cautionary eye
when extrapolating findings from studies across species. To generate a better
understanding of the processes dictated at molecular levels in fasting, energy
restriction and similar situations, I would like to observe how AMPk and
SIRT1 work together in metabolic tissues.
Even though there are similar factors activating both AMPk and
SIRT1 and even though they display convergent regulatory functions, they
also exhibit divergent regulatory processes. In the muscles, both of them
seem to upregulate fatty acid oxidation, glucose uptake and mitochondrial
biogenesis.
"Resveratrol is not the cure all. In mice it had some good results and some
bad results. It works better if the body is out of whack so if you try to treat
disease such as heart attack...or obesity in mice it works very well but I think
we can do better than that..."
"You know, I'm taking it not because I think it's gonna make me live to 200
but maybe because I know what's gonna happen if I don't take it. I don't want
to make the impression of anybody to think it's the best thing we have
(resveratrol). In fact that's 10-year old technology. We have better things
now...I think that the NAD+ approach that I mentioned is going to be
superior..."
Chapter 6
The sample size of the study goes well beyond 100 subjects (obese
adult men and women). Researchers tabulated their age, height, initial weight
and initial BMI:
In a lunch lecture (you can hear the noise of forks and spoons on the
dishes in the background) on Type 2 Diabetes and Insulin Toxicity presented
in 2013, Dr. Jason Fung [197] talks about how alternate-day fasting may
preserve lean mass by pointing out to a paper from 2010 [198]. From my
perspective, the lecture is excellently presented, but the context is somewhat
weird due to the ironic nature of talking about fasting to people who are
currently gorging their meals.
The subjects on this study were obese, and the protein loss would not
matter for them as much as it does for leaner subjects, especially considering
the great amount of fat they lost over the entire experiment.
"The relatively high fluid intake per day corresponded not only to the general
recommendations for the stabilization of the metabolic and cardiovascular
systems during fasting, but from today's perspective it is also favorable and
supportive for weight loss by inducing thermogenesis."
Moreover:
The mean age was 49±8.1 years old, BMI was 30.4±6.7. The
metabolic syndrome group included 12 patients, while the non-metabolic
syndrome group included 18 patients. Markers of the metabolic syndrome
that had to be satisfied were:
The full results of this study are finely categorized and explained and
they can be accessed by following the link at [197] in the references section.
What I'm intrigued of is that even though the study does not meet my
personal standards of a well formulated prolonged fasting experiment, it is an
overall well conducted and highly-detailed study which has been cited only 3
times in the literature.
One of the possible reasons for the unpopularity may be that it does
not benefit from the exposure of studies published in highly trafficked
journals, while another possible reason is that most subjects do not want to
put themselves on a long-term fasting experiment because of their fear of
hunger (which is a very understandable fear, but which can be reduced to
minimum or eliminated completely).
Reducing Protein Consumption
"Mouse studies confirmed the effect of high protein intake and GHR-IGF-1
signaling on the incidence and progression of breast and melanoma tumors,
but also the detrimental effects of a low protein diet in the very old."
Their conclusion is that low protein intake during middle age and
moderate-to-high protein intake in older age may lead to increased longevity
and healthy aging. In a similar finding by Fontana and colleagues (2013),
researchers conclude that reducing dietary protein is highly effective in the
inhibition of tumor growth. The study was done on human xenografts (grafts
of tissue) of prostate and breast cancer models and the researchers think that
the possible mechanism by which reduced protein intake inhibits tumor
growth is by lowering the activity of IGF/AKT/mTOR pathways [205].
In mice and in human studies, it was shown that fasting for 48 to 120
hours increases cellular resistance to toxins, as in the case of heavy dose
chemotherapy. I'll get back to this concept farther in the book, but the basic
idea of fasting for more than 24 hours leads to enhanced results is because of
"the requirement to fully switch to a fat and ketone bodies based catabolism
after glycogen reserves are depleted during prolonged fasting" [200].
"In a cohort of female C57Bl6 mice, bi-monthly 4 day FMD feeding cycles
followed by normal food intake, significantly improved survival in mice
without causing excessive weight loss. Mice in the FMD cohort had a
significantly reduced lifelong cancer incidence rate."
When comparing subjects from the FMD group with subjects fed ad
libitum (how much they wanted and whenever they wanted), they noted that
lymphoma (cancer of the immune system) affected ~67% of the subjects in
the ad libitum (control) and ~40% of the subjects in the FMD group [204].
These are significant findings, especially because the fasting mimicking diet
is supposed to elicit similar metabolic adaptations as prolonged water-only
fasting does.
Brandhorst et al. (2014) also found that the FMD intervention lead to
a switch from higher metastasis (tumors in ≥3 organs) to tumors being
present in 2 or less organs or not being present at all [204]:
"In summary, the periodic FMD cycles had a significant impact on the
development of cancer while allowing the preservation of lean body mass and
animal weight until old age and extending longevity."
- using cold showers or cold therapy to boost the immune system (among
others), while prolonged exposure to extreme cold may induce hypothermia
and be lethal.
- ingesting small doses of toxic chemicals, from food or water.
- reducing energy availability (food scarcity)
- increasing short-term energy expenditure (fighting, sprinting)
- increasing cognitive challenges.
- etc [206].
The plethora of ill conditions associated with modern life may also
point to the importance of using hormesis as a strategy of intervention. When
one never challenges their body and their brain, complacency may be
established, paving a neat, straight-forward, route to increased risks of injury
and disease. Mattson and Calabrese (2009) affirm [206]:
"Studies have shown that neurons respond to mental and physical activity by
increasing their production of “neurotrophic factors” that may help them to
resist disorders such as Alzheimer’s disease and Parkinson’s disease."
"To wake up in the morning and have something to look forward to."
I know you may say that such statement is already overused, and you
may be right. Given that it's widely overused, we tend to have forgotten its
importance. To test that, try to recollect how many times you woke up
recently with big enthusiasm and fired up for the day. Extra-credit goes for
Monday mornings.
Even though Irving recently passed away (Feb. 24, 2015) [210]:
"...he, his sisters, and his brother were, collectively, the world's oldest living
quartet of siblings. Kahn himself lived to 109. His sister, Helen Reichert
(1901–2011), nicknamed "Happy", died seven weeks before her 110th
birthday. The youngest sibling, Peter Keane (1910–2014), died at the age of
103. Kahn's other sister, Lee (1903–2005), died at the age of 101."
This may give you some clue about the genetic factors of longevity
in this family of centenarians. Kahn himself smoked a lot during his lifetime,
while his sister smoked for !!! 80 years. They also did notconsume a
specific diet over the long term. These remarks would point out to the
important factors regulating cellular detoxification and increased expression
of repair and rejuvenation pathways. If you follow the links in the references
section, you may find many other examples related to Khan's. Don't forget to
always maintain a critical perspective!
In another paper from 2014, Mattson [211] discusses how
intermittent fasting improves one's health and wellbeing through various
mechanisms. One is to induce the expression of chaperones (glucose-
regulated protein and heat-shock protein) and increase autophagy inside the
cells. Through autophagy, cells are able to dispose damage organelles and
proteins, and, I suspect, they become better equipped to use smaller amounts
of protein provided through food.
"IF can also increase neurotrophic factor signaling in brain cells, which may
contribute to its abilities to enhance hippocampal neurogenesis (Lee et al.,
2002) and protect neurons against oxidative and metabolic stress in animal
models of Parkinson’s disease (Duan and Mattson, 1999), Huntington’s
disease (Duan et al., 2003), Alzheimer’s disease (Halagappa et al., 2007)
and stroke."
"Fasting prior to cancer treatment has been recently trialed and there is
evidence for a single episode of fasting (48–140 hours) to reduce side effects
of chemotherapy."
"IF also resulted in reduced levels of mRNAs encoding the LPS receptor
TLR4 and inducible nitric oxide synthase (iNOS) in the hippocampus.
Moreover, IF prevented LPS-induced elevation of IL-1α, IL-1β and TNF-α
levels, and prevented the LPS-induced reduction of BDNF levels in the
hippocampus. IF also significantly attenuated LPS-induced elevations of
serum IL-1β, IFN-γ, RANTES, TNF-α and IL-6 level."
From what I see, this means that IF lead to fewer genes being
expressed to result in the creation of LPS receptors, needed for LPS to
appropriately trigger damaging effects at cellular levels. Through an
associated mechanism, IF prevented the increase of pro-inflammatory
cytokines as well as the reduction of BDNF (factor responsible for neuronal
growth). While this may not translate exactly in humans, it hints to a possible
protective, anti-inflammatory effect that IF invariably has inside organisms.
This study has to be read carefully so that the reader may clearly
understand how the diets were formulated and how the subjects were able to
achieve the overall 25% daily energy restriction.
This study could have been optimized in terms of the results if the
researchers had randomised subjects into a couple of more groups: such as
one that would do daily intermittent fasting, another that would do daily IF +
calorie restriction, another one that would do daily IF + carb restriction, and
many others. However, that may not be easily attainable as they would have
had to measure for significantly more variables and pay closer attention to a
much wider pool of results. Sadly, I have to be realistic and digest from the
studies we have available :).
I have to, once again, remind you that I empathize with calorie
restriction especially when it comes in the same package with daily
intermittent fasting and a well formulated ketogenic nutritional protocol. In
this context, calorie restriction would reveal a much different meaning to
what's out there, especially because of the powerful anti-hunger effect elicited
by the long-term well formulated ketogenic protocol.
When examining obesity and diabetes, Dr. Jason Fung (2014) has
some interesting, well formulated, and logic theories (which in practice have
lead to amazing results of disease reversal) [221]. He takes into consideration
the two large myths that have widely been accepted and promoted by the
medical communities all over the world, and (sadly) have been further
promoted by most health care practitioners:
Folks put too much trust into their healthcare practitioners, who
unfortunately do not stay current with research and who still promote the
same old dogma that was derived from manipulated research studies. The
dogma was pushed mainstream by Ancel Keys (a very influent person) and
lead to the adoption of the widely cited dietary guidelines, which frightened
nations of fat consumption. Dr. Peter Attia (2015) beautifully explains the
history of this message in a recent lecture [222].
In such a scenario (ketosis), blood sugar levels are mostly low and
insulin secretion follows the same pattern, given that the diet is well
formulated and that nutrition consists of whole foods (avoiding the use of
low-carb bars, breads, and all the related packaged products). If the strategy
of keeping low insulin levels is persistent over a certain period of time and if
it is efficiently combined with fasting and/or energy restriction, it can restore
the ability of the body to process higher amounts of carbohydrates, should
that come into discussion. From this perspective, diabetes is a treatable and
reversible condition and it does not imply the burdens that come with the
current medical treatment protocol.
To support this theory, Dr. Jason Fung (2014) mentions the diabetes-
cure approach of Dr. Taylor and colleagues (2011) who consider that T2D is
partially a dysfunction of beta cells in the pancreas [221, 224]. They showed
that beta cell function and insulin sensitivity can be restored by acute energy
restriction [224].
"It's not that the beta cells were 'dead', but their function was impaired."
Given that patient 4's improvements were only seen during fasting
days, this could suggest a combined effect of the two protocols (IF+KD).
This may be supported by patient 3's improvement in seizure control, as a
possible result of the modified 24 h once a month fast. While this may not be
the most appropriate design for an IF protocol, I would have to be realistic
and understand that it may not be easy to adhere children to IF protocols
easily. But since these kids have shown improvement through the
combination of these protocols, it would be reasonable to keep using them
until other interventions/drugs are developed for improved results.
Sadly, this article has also failed to catch the public's eye because as
of March 2015, it has only been cited 5 times in the literature. Even though
the concept of intermittent fasting has been receiving a lot of popularity
recently, it needs to be crafted in such a way in which it's not perceived as a
burden but as something extremely enjoyable, something to which I attribute
my long-term strict adherence.
Slightly shifting from pathologic conditions to enhancing human
performance, Hayward et al. (2014) wanted to determine the effects of IF and
resistance training on body composition, resting energy expenditure and
mood state [227]. They recruited 24 participants (8 males and 16 females).
They assigned them into 3 groups:
While the researchers are shy to give us the very details of the results
(or they will be published sometime in the future), they conclude that [227]:
"An 8-hour eating and 16-hour fasting day resulted in a decrease in fat mass
as well as weight for the Intermittent Fasting plus Resistance Training group
when compared to the Resistance Training only group.
On the other hand no differences were found between the Resistance Training
only group and Intermittent Fasting group, hinting to that intermittent fasting
alone may not be affective in decreasing body fat percent. However, when
paired with resistance training, lean mass can be retained and/or enhanced
while decreasing body fat, thus enhancing body composition."
I agree that IMFRT may retain or enhance lean mass while lowering
% body fat at the same time, and, contrary to what the researchers suggest, I
also think that IF alone can be effective in decreasing body fat percentage. It
would be rational to say that restricting feeding to an 8 hour window would
allow for a greater mobilization of fatty acids from the adipose tissue,
regardless of the dietary pattern. However, since I do not know the specifics
of their protocol, as well as the exact results, it would be unsafe to further
derive conclusions about this.
"We have demonstrated for the first time that IF, started when HF is already
established, ameliorates cardiac function and inotropic reserve in an
experimental model of HF. At the molecular level, IF diet significantly
improves βAR signaling in HF."
There are many more studies out there left to be analyzed. Dozens of
experiments can be found for each small molecule in different given contexts.
Even if I try to keep things simple, I may have already went into too much
detail on some topics. This may bother the non-technical reader who only
wants to know what to eat, when to eat, or when not to eat to increase his/her
health status.
Chapter 7
If the title is not explicit enough, in the next few pages my focus is
going to be on cancer and some of the fasting strategies that can help with
this major (mostly) metabolic disorder, as Thomas Seyfried sees it [3]. I will
build upon lectures made by two brilliant researchers: Professor Valter Longo
from University of Southern California and Dr. Colin Champ, who works in
radiation oncology [193, 155].
Reducing calories over the long term may protect from conditions
such as cancer, high inflammation, diabetes, cardiovascular disease and
others, but if the nutrition protocol is not well formulated it can also lead to
reduced immunity, decreased libido, poor mood, irritability, increased
hunger, and many other conditions that may make life miserable.
And one of the answers is, as you may have guessed, through
fasting. Thomas Seyfried (2010) argued that if each one of us were able to do
water-only fasting once a year for 7-10 days we would basically reduce our
risk to develop cancers by 99%. Now, this may have sounded extreme if you
would not have the knowledge you acquired throughout this book.
What happens when your body focuses away from food? It shifts its
attention to repair and maintenance. It rebuilds broken DNA, it gets rid of
cellular waste products, it finally is able to remove most of the stuff inside
your bowels (which never get depleted if you're eating food regularly), it uses
fatty acids and ketone bodies for energy (a second way to kill cancerous
tumors), it enhances neuroprotection, it lowers oxidative stress, and many
other highly complex mechanisms, all very interconnected to each other.
Two of the hypothesis that Longo (2013) started from are [193]:
2. Short-term starvation (STS) does not protect cancer cells because of the
constitutive activity of oncoproteins
Since both IGF-1 and glucose decrease (more than 50%) following
72 hours fasts and since IGFBP-1 was seen to increase 11 fold in fasting
versus normal fed control subjects, fasting would exploit the synergistic
mechanism between these factors. Less glucose and IGF-1 may be secreted
and, at the same time, more IGF-1 will be bound to IGFBP1, rendering it less
activated [193].
The sad part is, as Longo (2013) observes, that many patients
suffering from different forms of cancers do not want to undergo fasting.
Think about it, the fear of not eating for a couple of days is much greater than
fear of a possible increase in the chances for survival.
And this is tricky because this false hunger drastically fades away
once the body efficiently starts using ketones and fatty acids for fuel. But
many people do not go beyond the 48 - 72 hours that are most often a good
limiting step between somewhat glucose based metabolism to fatty acid and
ketone metabolism.
"We don't have any data showing an effect of diet on cancer treatment or
outcomes."
and
"Diet is unlikely to play any part in cancer care, therefore this article is
irrelevant for this journal."
As pointed out by Champ (2014) there are a few dogmas that still
persist in cancer treatment, one of which goes along the lines that weight
should not be lost during therapy but that it should be gained so that patients
are able to tolerate toxic exposure better. I'm not sure if one can view things
from my perspective, but if you focus on gaining weight and keep fueling the
body with a lot of nutrients, it may not build its protection against chemo and
radiotoxicity, as its primary focus would be to process nutrients.
"One third of all NCCN sites (n=7/21) had links to nine external websites.
Four external websites provided nutrition guidelines, and half favored a low
fat, high carbohydrate diet, while half favored high-caloric intake to
maintain weight."
This may not be sufficient to expose the possible benefits that may
come along with a combination of fasting and caloric restriction. Perhaps if
these mice were given limited chow during their feeding days, we would
have seen different results. It may also have lead to decreased bodyweight
(depending of the diet type), but this does not necessarily make reduced
bodyweight a bad thing. When trying to derive conclusions that could be
applied to humans, we also have to consider that mice have a distinctly
different metabolism from ours and that they are night-feeders.
Even if the dietary protocol of lean individuals (utmost left) may not
be the most appropriate, as it is high in fat and only moderate in
carbohydrates, it still shows expression of increased AMPk levels compared
to the high-carb dietary protocol of lean individuals. In such circumstances, I
suspect that we could benefit from increased AMPk activity and reduced
weight loss during cancer treatment (if that's the purpose) as long as a well-
formulated ketogenic diet is followed.
In the next chapter you find out about my n=1 intermittent fasting
protocol that started at the beginning of 2014 and is still going on (March
2015). As an early warning signal, I have to remind you that what seems to
be working for me may not work for you. Even though there may be some
similarities across the population, we are all genetically and epigenetically
different. Hence, I will not provide general recommendations as I do not
believe in such, and I would suggest you to implement your own
interventions, observe, adjust and find out what works for you.
I started eating a keto diet at the end of September 2013 and I started
coping with intermittent fasting in November 2013 when the Christmas
Orthodox religious fast began. I've almost never been out of ketosis since
September 2013, and I'm not likely to be anytime soon. I have never felt
better, been more productive, more energetic, better mentally equipped and
significantly much more satisfied from the type of food I eat. And the beauty
of it is that I never feel deprived.
That was not the case. Waking up on Wednesday morning and not
having to cook food, allowed me to focus on writing and optimizing stuff for
my blog. I was so caught up into what I was doing that hours were passing by
quickly. Hunger was my least concern. I usually had a cup of coffee and
sometimes I sweetened it with a small stevia pill. That was mostly what I
consumed. At ~ 5 P.M. I ate some nuts, some avocado with squeezed lemon
juice, and some dark chocolate (85% cocoa), according to my keto-friendly
and my religious fasting protocol.
During those same weeks of Nov. - Dec. 2013 I decided to try and
complete a fast that would go beyond 24 hours, since I was beginning to get
familiar to fasting for 19 hours twice a week. From what I can recall, I
stopped consuming food at 5-6 P.M. on a Tuesday until Thursday morning.
That translates to 36+ hours of fasting, during which I had a kickboxing
sessions on Wed. evening and a heavy lifting workout on Thursday morning,
after which I consumed food.
Surprise after surprise, I learned how the human body (my body) can
easily go without food and thrive for longer periods of time as long as it
becomes adapted to using fats and ketones for the bulk of energy demand.
And I never actually felt fearful of losing muscle mass because I know that
the likelihood for that to happen is minimal, if existent, when the body gets
keto-adapted, especially if heavy lifting is part of the strategy. Increased
muscle catabolism is more likely to occur for folks on warrior diets who fast
for 16-20 hours or more and force themselves to meet their caloric demands
in the remaining 4-8 hour windows. And on top of that, they gorge on higher-
carbohydrate foods, never actually adapting to efficiently burning fats and
ketones.
For me, there was not 'just one piece of cake' or 'just this once' or
'see how it tastes'. I was so keen to stick to strict ketosis because of the
multitude of benefits it provides to me. Had I been more permissive with my
self, I may have possibly disrupted the adaptation process. And it took a
while for those around me to get used to my protocol, more than just a couple
of months. I never felt the need that I had to explain myself, I just said 'no,
thank you'. This may not be as easy for females.
I believe you can image that I did not consume the wheaty-stuff
from the top-left side of the image, but only the butter. This barely made for a
couple of hundred of calories.
Yes it was for real, and it still is. But this is not something new.
Humans have been doing it for eons. The sad part is that such lifestyle is
currently hidden behind the fear of hunger (false, by the way), behind 24/7
food advertisements, behind unlimited availability of food, and behind the
ingrained habits of regular daily feeding regimens.
While some of you may have already read my first book Ketone
Power, there may be quite a few who didn't. Which is why, I will re-
emphasize some of the experiences that I may have mentioned in that book.
Since I was not feeding regularly, I had the chance to experiment with all
kinds of local (and not so local) foods:
Not so Tempting - Phuket - Jan. 2014
No, I did not eat that, though that thought crossed through my mind
a couple of times. Yet, I only took pictures, like most folks did. You were
only allowed to take one picture. On the other hand, I did ate these:
Of course, I did this most days, but I had exceptions. There were and
still are times when I feed at night, times when I over-consume food (still
ketogenic), though most days I combine a well formulated low-calorie-
ketogenic-diet with intermittent fasting. I deviate from my standard just to
inject randomness into my routine. I do not plan my days of over-consuming
foods. But when they happen, I'm very excited about them and it seems that it
makes me adhere even more strictly to my current protocol.
As you may recall from the beginning of the book, at the end of
March 2014, I decided to do a longer term fasting experiment. Being already
fairly keto-adapted and having some experience with fasting, I initially shot
for 50+ hours, but that turned into 5 days of water-only fasting. I was a lean
individual doing prolonged fasting. Nothing new about that.
This is not the same with most people doing prolonged fasting
experiments. They usually have to deplete glycogen stores, bringing 24-48
hours of possible irritating hunger pangs and cravings for food, light-
headedness, fatigue and other symptoms associated with sugar withdrawal.
Then it becomes easier as they enter ketosis. Then they start realimentation
with orange juices and other sugary drinks. I don't tag that as an inappropriate
protocol. I just want to do it my way.
I will not give you recipes for foods or exact times of the day when I
eat because I do not believe in fixed and rigid strategies. You can find tons of
cookbooks over the internet. The purpose is to give you an idea of what I do,
and sometimes get into the nitty-gritty details.
The mainstream media and bro-science may drive you into the panic
of losing muscle if you don't consume increased amounts of protein every
couple of hours. Similarly, other folks promoting IF protocols may also
suggest forcing consumption of food (especially protein) during feeding
windows, otherwise you will lose muscle.
While that may hold true for many, especially those not adapted to
burning fats and ketones, I personally do not follow such. And besides the
plenty of studies and experiments you have seen throughout this book,
muscle loss is reduced to minimum, if existent, when fasting undergoes.
Please remember that fasting is not starvation. Fasting occurs when your
body uses your own fat to derive the majority of its energy demands and its
main focus encompasses repair, rejuvenation, detoxification and
maintenance.
Starvation occurs when your body fat stores are depleted and energy
is derived from increased muscle catabolism. Starvation is the extreme end of
fasting, and even most lean people have enough body fat to go into prolonged
fasting for weeks before starvation undergoes, maintaining muscle catabolism
at minimum.
Many times I skip gym workouts and often times I do fewer sets
with heavier weights. Some other times I do more sets with lighter weights.
There have been times when I did not go to the gym for more than 10 days
(when I was in Thailand or in The United States). Did I panic of losing
muscle? Of course not. It's not like I was totally inactive. I exercised, but
differently. I focused on calisthenics and I carried a resistance band that I
used for working-out my arms. I describe this in more detail in my second
book called T-(Rx) - The Testosterone Protocol [106].
I'm not sure if you get the picture here. I'm trying to focus not on
rigid routines, but on implementing randomness while maintaining a certainly
flexible protocol. You may understand my protocol much better if you read
Nassim Taleb' Anti-Fragile [207].
I'm sorry if this is not your average: do 6 sets of this and 7 sets of
that and train for 3-5 times every week and eat 3 times a day, using
pre/during/post workout supplements, etc.
I personally believe that for many folks those strategies will lead to
decreased compliance over the long-term. If you read Arnold
Schwarzenegger's autobiography Total Recall you will see that even though
while training for Mr. Olympia and other body-building championships he
mostly followed strict routines, he also used the anti-fragility concepts that I
mentioned earlier [242].
Hopefully you can extract many useful concepts from the studies
presented in the book, from the long-life experiences of the folks I
mentioned, as well as from my personal interventions. I have to, once again,
remind you not to take my words for granted, but to conduct further research
upon the subjects of your interest, adapt and implement them into your own
protocol and see what works for you. In the next and last section (for the sake
of re-emphasizing), I will try to answer some of the questions you folks sent
me, though many of them have already been answered throughout the book.
What are the best foods to eat to break a prolonged fast and still stay in
ketosis?
Are there certain condition which people may have that would make fasting
dangerous?
Yes there are, and many of which I am not very familiar with. Some
of them can include genetic mutations making impossible for fats to be used
as primary metabolic substrates. I would strongly advise for folks to consult
with their health care practitioners before undergoing any type of fasting
protocol.
Yes and no. If you think it increases your safety, besides consuming
copious amounts of water, you may take a multi-vitamin-multi-mineral pill
every day of the fast, as well as consuming a bouillon cube in a hot glass of
water. You may also strategically use coffee and/or tea enemas to boost your
antioxidant activity. However, letting your body figure out it own way
through a fast may be more efficient.
Could any foods be eaten during a prolonged fast that are very low in
nutritional value (such as coffee with 1 tbsp cream, bone broth, jello, etc.)
to help a person stay on their fast?
1. Most if not all of the current extended water fasting literature assumes
that one is burning glucose prior to beginning their fast. I have been
fasting with several other men who were burning glucose prior to
beginning their fast, they had a more difficult time than I did during the
first few days (the beginning of the fast) most likely because the transition
from burning glucose to ketosis was so rough. For me it wasn't too bad
because I was already in ketosis. These gentlemen were given the advice to
begin a very low fat, low calorie diet several days prior to beginning the
fast.
What specific foods or protocol do you recommend prior to beginning a
water fast if you're already in ketosis? Do I have to change my diet at all?
If you plan on being in ketosis before, during, and after your fast, it
does not really matter what you eat before your fast, as long as it follows a
well formulated ketogenic diet. Such diet would be nutritious-rich-energy-
rich and may include lots of vegetables (rich in vitamins, minerals, fibre and
trace nutrients), marine foods (rich in iodine and essential fatty acids),
coconut oil and coconut derived products, olive oil (use for salad dressings,
don't heat it), eggs, organ meats and some fatty meats.
I would say that if your diet is well formulated, you may not have to
change it when you enter prolonged water fasting. But be careful during
realimentation. Please consider the recommendations I make through this
book.
My preference is to break up with bone broth or even egg yolks with a little
bit of grass fed butter, is this recommended? What foods do you
recommend for breaking a fast for the person who would like to remain in
ketosis?
While this may not bring any possible negative effects to your
digestive system, I would personally not break a prolonged fasting with egg
yolks or butter, especially if it is very long (more than 7-10 days) and
especially in the first day of realimentation. I gave my recommendations
above (avocadoes, lemon juice, vegetable broths, coconut derived foods,
various nuts, tomato sauce, etc). You do not have to follow them, but you
may use similar foods to the ones I use.
Some topics that Lawrence thinks would be awesome to see covered are:
The effects on muscle mass for prolonged fasts more than 24 hours
So, straightforward: if you are in ketosis, if you do IF, and if in your feeding
window you do not spike your insulin levels and replete the stores, your
muscle mass may be well protected. It may even be enhanced if you do
resistance training, as considered in a study done on caloric restricted
subjects [247]. A potential argument to promoting muscle mass during
fasting/IF may be the massive spike in growth hormone levels, the sparing
effect of ketones on muscle mass, as well as the increased efficiency of using
protein when energy intake is restricted.
You may not see these protective benefits if you are force-feeding
protein and carbs in your IF experiments, but you may see (in some cases)
growth effects from the infrequent (meal dependent) spikes of insulin (+IGF-
1+mTOR). Though, I would personally not go that route.
Is it really fasting if you do a sort of fat fast where one only eats fat and
little to no protein?
Fasting for weight loss I assume would be covered, but how effective is
long term fasts on weight loss compared to short term fasts.
The results are widely distributed as you have seen in this book. If
you fast for short-term and never go past glycogen-depletion, that may not be
efficient. I would personally suggest IF protocols that include at lest 16 hours
of fasting, if not 18 or 20 (this is when growth hormone starts spiking
significantly).
Why do people feel light headed fasting and what can you do about it?
Finishing this book would have never been possible were it not for
the support of my family, who spared me from many familial obligations and
duties.
I would not have been able to gather data for Periodic Fasting were
it not for the brilliant work of the hundreds of researchers and experimenters
cited throughout. Thank you Luigi Cornaro. Than you Upton Sinclair. Thank
you George Cahill. Thank you Mark Mattson. Thank you Luigi Fontana.
Thank you Valter Longo. Thank you Thomas Seyfried. Thank you Froy
Oren. Thank you David Sinclair. Thank you Jason Fung.
Thank you Professor Richard David Feinman for reviewing the book
and also for increasing my awareness about statistical fallacies and poorly
conducted research studies. You are a great mentor.
About the Author
Other books:
http://cristivlad.com/ketone-power-the-book/
2. T-(Rx) - The Testosterone Protocol - On Achieving True Male Status
http://cristivlad.com/testosterone-protocol/
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