Fasting Rediscovered The Science Of Not Eating

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Fasting Rediscovered The Science of not eatingMark Jabro, MD

Metabolic definition of FastingThe beginning of ketogenesis andthe depletion of glycogen is thebeginning of fasting.

Fasting is Ancient Humans evolved with fasting and feasting Famine was a regular occurrence in ancienttimes Religious observances

Fasting/Intermittent CalorieRestriction Time restricted feeding (TRF) 16:8 24 Restrictive eating time window Modified fasting 5/2 2 consecutive days of calorie restriction(low calorie intake) Extended/Periodic Fasting 3-5 days or longer to deplete glycogenstores and begin ketogenesis Alternate Day Fasting Full day fast followed by normal eatingnext day

Meal Frequency Has increased overtime, from 3 meals to 6 meals per day. Continuous eating during waking hours 1960s study-showed frequent smaller meals better Epidemiological Study- 1.5 times more likely to beoverweight/obese with meal frequency of 5 or more per day vs3 or fewer.

What to “eat” during a fast Classic water fasting Conventional advice is more “comfortable” Coffee, tea, broth/electrolytes

No proven best way to fast Multiple variables Percent calorie reduction 50-75-100% (pure water fast) How long? hours to days How often to cycle Alternate day, weekly, monthly, quarterly Which is best?

Why Fast Survival Gene Activation Brain-Body increase efficiency and selfprotective Fasting is stress on the body. Gene expressionis altered to protect from this stress. Decreased insulin resistance/improvedbiomarkers Saves Time and Money

Misconceptions of fasting Fasting Starvation Fasting is volitional Body enters starvation mode Metabolism shuts down and prevents fat burning Muscle Loss 2016 study 8 wks 16/8 TRF resistance trainingpreserved muscle mass Breakfast is the most important meal of the day. Breakfast is not essential for weight control Controlled trials do not show weight difference

Challenges of Fasting Not appropriate with active eating disorders Anorexia, binge eating, bulimia Uncomfortable Exercise requires more planning Social Factors Impromptu happy hour, dinner with friends

Weakness of Observational StudiesBecause of their passive nature and lack ofconstants, observational longitudinal studieshave less ability to detect causal relationshipsthan do controlled trials.When evidence from multiple observationalstudies is consistent the association is morelikely to be real.

What is the important for weight loss? Dated Concepts Calorie counting and exercise. What should I eat? Low fat How much should I eat? calories New Concepts Diet composition, timing and good genes. When should I eat? Should I eat at all?

Circadian Rhythm

Asynchrony leads to disease Multiple body clocks Brain, gut, kidney, and liver Master clock is Suprachiasmatic Nucleus (SCN) Dysregulation of circadian rhythm is linked toobesity Eating before bedtime is not a good idea Sleep deprivation and timing of eating areimportant Diet is a key extrinsic cue interacting withintrinsic clocks

TRF and Circadian Rhythmsbased on Dr. Panda’s research TRF limiting calorie intake. 8-12 hours Focus on when to eat and not just what andhow much to eat. Digestive clock Activates with food consumption Stand by mode when processing is complete Repairs occur when system is not processing

Time Restricted Feeding is a Preventative and TherapeuticIntervention against Diverse Nutritional Challenges(Dr. Panda, 2014) Mice restricted to different feeding intervals 8, 9, 12, 15 hours eating window One group had access to 24 hours Calorie intake comparable in all cohorts Mice with the most restricted eating window performed best on fitnesstests. Mice restricted to 12 hours or less were protected from obesity, metabolicdisease and inflammation vs control.Take away:TRF is a behavioral interventionDe-emphasizes calorie intakeResults:Attractive and easily adoptable lifestyle modification.protects against weight gain and metabolic diseases

Eating during consistent time periods eachday is helpful for keeping biologicalrhythms in sync which can help withpreventing metabolic disease and chronicdiseases related to obesity

Intermittent calorie restriction 5:2 or 2 day diet aka intermittent energyrestriction (IER) Calorie restricted, low carb diet 2 consecutive days each week More practical than total fasting Short term human studies (Dr. Michelle Harvie) Benefits include weight loss and improvement inmetabolic disease markersNegative: does not allow cells to enter a fasting state

Periodic Fasting/Extended FastingLimiting calories between 3-5 days or longerValter Longo, PHD, USC Longevity Institute Deplete glycogen stores and begin ketogenesis Destruction and removal of damaged cells during fasting Replacement of functional cells during refeedingCreated Fasting Mimicking diet (FMD) to limit calories between770 and 1,110 a day.Longo’s Human study, February 2017, results: Improvement in body weight, waist circumference andBMI Improvement in absolute total body and trunk fat Improvement in risk factors for aging and disease

Guides to Fasting Jason Fung, MD – Intensive DietaryManagement program in Toronto. TheComplete Guide to Fasting. Excellent Resource for what is fasting, why it isimportant, and how to fast in a way that improvesyour health.

Guiding a Patient through Fasting Success is dependent uponpersistence, reproducibility andcomfort. 100% compliance is notrequired Adjust TRF to the daily socialschedule Focus on time interval first andthen once mastered thenoptimize diet composition Calorie counting only importantfor breaking through plateaus Fasting is safe for anyonewithout preexisting medicalconditions and good health Physician supervision shouldbe considered for patientswith metabolic disease anddiabetes Waves of hunger are transientand will pass Proper hydration is importantalso supplement withelectrolytes If uncontrollable hungry orsevere weakness then eat.

“They should moreover, eat onlyonce a day”-Hippocrates

Obesity Fact-BMI Body Mass Index: kg/m2 Introduced by a Belgian Mathematician Early 19th century Designed as a quick and easy way to measure obesity inthe general population to assist gov in resourceallocation. Obesity is defined as fat excess not weightexcess BMI does not measure fat and does notdifferentiate between visceral andsubcutaneous. It is accurate in assessing disease risk and easyto measure

Obesity Fact: Cancer Risk55% of all cancer in Women and 24% in men areassociated with overweight and obesity.Breast, colon, endometriosis, esophageal,prostate, thyroid, kidney , pancreas, gallbladderTake away: Body fat reduction is anti cancer.

Mark Jabro, MD. Metabolic definition of Fasting The beginning of ketogenesis and the depletion of glycogen is the beginning of fasting. Fasting is Ancient Humans evolved with fasting and feasting Famine was a reg

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