Intermittent fasting activates many beneficial effects in the human body that could be just what many patients need to reverse diabetes and overcome obesity...and forward-thinking doctors have taken note.
One such doctor is Dr. Jason Fung, who is a pioneer of intermittent fasting in the clinical setting.
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Hey listeners welcome to this week's episode of the H.V.M.N. Podcast and I'm really excited to bring back one of our most popular guests, ever, on this program, Dr. Jason Fung. It's been about, almost a two years now, and for those that are new listeners, or want a reminder, Dr. Jason Fung is a doctor, obviously, but specializing in nephrology, a section of internal medicine. But I think what he's really become a world leading expert on is intermittent fasting, low carb high fat diets, especially in the clinical use case. He's the founder of Intensive Dietary Management, which has treated thousands of patients in managing their metabolic syndromes through fasting and low carb high fat diets. And also co-author of two best selling books "Obesity Code" and "The Complete Guide to Fasting". Welcome back to the program.
Oh, thanks for having me here. Yeah, it's been great. I was just saying that it doesn't seem like two years. It's just been flowing right by. (laughs) Great to be here.
Yeah, and I think that just thinking about the momentum. I think two years ago we were just starting to get into fasting as a community with Wefast. I think we had maybe a couple thousand people at most, and now we're over 20 thousand people plus in that group now. I think that was around the time "The Complete Guide to Fasting" and "Obesity Code" were published around 2016. I think we chatted in 2016, so it was just when your books just started coming out. But even at that time you had huge following as these books were being released. What's it like from your experience. I mean, I can share a little bit of it's like over the last two years from my experience and you've seen the community grow, but I'm sure it's in the center as one of the key thought leader on a lot of these topics. What has it been like for you?
Yeah, it's been very interesting because we're seeing it sort of move into areas that you would never have thought. So, for example, I come at it from a very medical sort of stand point. So I deal with kidney disease. I deal with a lot of Type 2 diabetes. So that's been my focus. I treat a lot of Type 2 diabetics, and I'm all about weight loss, getting people off their medications, reversing their Type 2 diabetes. And that was my sort of initial interest in it, but there's so many different reasons that fasting can be beneficial for somebody that we're seeing it in elite athletes, for example. We're seeing it in people doing martial arts and ultimate fighting sort of things. We see all these people who are talking about training in the fasted state. So it's really... We see about cancer. We see about Alzheimer's disease. So all these different areas that can benefit, but are really people starting to really think about why they're so beneficial from a medical stand point.
When I started doing this about five years ago, boy everybody thought I was crazy. 100% of people thought I was crazy. Except for you, maybe.
But from a medical standpoint it's changed, because now you're seeing it discussed on the 'Today' show. It's been discussed on the 'Doctors'. You see it discussed on different shows, so it's actually getting out there. Now there's still a lot of skepticism about it, but at least people are talking about it. For example, I'm coming down to San Diego, for the conference, the spring conference, which is the Obesity Medicine Association. Which is the largest association of obesity specialists, and I'm doing the keynote. So it's like, okay, well we went from 'boy this guy's a real quack' to 'hey, what can we actually learn about fasting that may give us an option'. And that's sort of the way I had always positioned it, is like nobody has to do it, but it's an option for you. Don't eliminate your options because it may work very well for people. In some people it's a great option. In some people it's not a very good option. But the bottom line is that you need to keep your options open. So why not do it.
There's been a very large change, that even amongst the medical community, which is one that I obviously spend a lot of time in. I speak at medical conferences, and I speak at local talks to doctors. And you see that there's this real growing acceptance, that hey, we should really think about this, because it makes a lot of sense. And then from your standpoint, you see this sort of huge interest, huge wave of interest you see intermittent fasting on all kinds of mass media, social media. The interest is really getting to fever pitch. You know, it's great.
Yeah, I mean, I think part of it is one, people are trying it and seeing the results. But two, I think that published data is becoming more and more compelling. Like Mark Mattson at the NIH is publishing good work. There's a bunch of researchers in the broad fasting, ketogenic diet, ketosis space, that are I think doing good work on the RCT side. Just publishing good, good work. And I think... It seems interesting, I think other companies, or groups around ketogenic diets, like Virta Health are publishing interesting results for the ketogenic diet reversing a lot of endpoints of Type 2 diabetes. I think it's one, a perfect storm of data out of peer reviewed journals. Two, clinicians like yourself, seeing the results of the patients, and persons. And subjects saying, hey, I'm actually off my insulin meds. I'm off my diabetes meds. I feel way better. I've never been this healthy. Something is working, right?
Yeah, absolutely. I think that the thing is that ketogenic diets and intermittent fasting are sort of related approaches, because in the end the they're trying to do is really lower insulin. Sort of the acknowledgement that too much insulin is really the underlying cause of obesity, and Type 2 diabetes. They're both soft of diseases of hyperinsulinemia, which is a word that means too much insulin in the blood. So if hyperinsulinemia is the cause of all this. We used to say that, oh these are diseases of insulin resistance, but that doesn't help you. Because then it's like, okay then what causes insulin resistance. You could say that meat causes it, then you should eat less meat. That didn't really work. But if you understand the cause of these diseases is hyperinsulinemia, then it leads you to say, okay, well if you have too much insulin, how are you gonna lower insulin. Because a lot of drugs are not going to do that for you.
And one way to do that is cut the carbs to, sort of, very low level, which is a ketogenic diet. Another way to do it is intermittent fasting. Because again, if you don't eat anything your insulin levels are going to drop, and that's sort of what I talk about. I have a book coming out, another book called "The Diabetes Code" which is sort of the follow on to "The Obesity Code." Which explains what Type 2 diabetes is, and how that lowering insulin is really the key to treating the diabetes, rather than taking a bunch of medications that are just gonna make things worse.
So the ketogenic diet and fasting are sort of related in that way. And you see that where one does well, the other also does well. Virta House is very interesting because they came out that data in Type 2 diabetes showing that a ketogenic diet could do very well for Type 2 diabetes. But interestingly they don't endorse fasting at all. They actually hate the stuff.
Yeah, let's tease into that. I think... what you said aligns with my understanding of the space and the research in the space. That there are different forms of lowering, or approaching the hyperinsulinemia problem. Can you talk about the pros and cons, and also your clinical experience with IF, and low carb or ketogenic diet. How do you actually see this in practice versus being on the dogmatic side of one versus the other. Do you see... I think what you just said, it sounds like they're more hand in hand, both tools to be utilized. Do you think there's conflict there, to use then together? What have you seen in your practice?
I use them together, and this is the way we approach it, is that it's a toolbox. So, that if one person really hates fasting, then it's like okay, well then don't do it, because you hate it and you're never going to do it. So therefore, use more on the diet side, but then you gotta be a little bit stricter on the diet. Maybe go more, sort of ketogenic, which is sort of less than 20 grams of carbs as opposed to say just low carb, which is maybe 50, even 100 grams of carbohydrates. Because if you combine a low carb approach with fasting, then you sort of get the same idea. If you don't like the fasting then you go to ketogenic diets. That's sort of the clinical approach, because everybody's different so we work with people individually. We have a program called, the intensive dietary management program, so that you can get counseling, or you can just join the membership and get updates regularly. And the point is that there isn't a one size fits all. It's not like everybody should be doing the same thing, because we're all individuals. So maybe you need this, and maybe you need that, but there's always gonna be workarounds that we can get you to the place that you wanna go. If you can't do the fasting, maybe it's because you don't have the proper support. Maybe you don't have something that helps you through with the hunger and all that sort of stuff. And that's what we're working on developing as well. You know, getting something to help people with it.
In medicine the thing is that, it's strange, because we know that weight loss is difficult. And if you don't eat you're going to lose weight. Well there's not much brain power involved in understanding that, so if you don't eat, you;ll lose weight, then well, that's great. That's one way of losing weight, that's not particularly unhealthy for you. The pushback that we always get, is that nobody's ever going to be able to do it. It's like, one, that's not true, because we've done...
What's up with that? Yeah.
..thousands of people, right. And you have in your group, you said 20 thousand people.
So, there you go. 20 thousand people, but you also know that billions and billions of people around the world do it as part of their religion. So if you do Ramadan, if you do fasting during Lent, if you do...
Yeah, exactly. There's so many different fasting regimes, Buddhism, Hinduism, all this stuff. So literally, billions of people around the world do it. But yet the pushback is always, well you'll never do it. But in medicine, if we say something's really hard, but you need to do it, you don't say ah well, forget about it. Like for chemotherapy....
You want the happy socks right.
Exactly. Yeah, it sucks so you're just gonna die, okay. That's no way to be a doctor.
Okay, here's something hard, but you need to do it. So we're going to help you. We're gonna create these medicines that are gonna help with the pain. We're gonna create these nausea medications. We're gonna put you in a hospital, if you need to, to get through the chemotherapy. That's what we do. We say how can we help. Yet with fasting we say, well, you know, fasting will take away your Type 2 diabetes, but you'll never do it, so forget it. Just take your insulin shot. I'm like, what are you talking about, that's no way to be a doctor. It's hard, so let me help you. How can we help you? Can you create support groups, like what you've done with your We Fast group. Can we create tea, and stuff, that may help with the fasting. Can we do other things, like give people information, give them books, so that they understand what they're getting into. What to expect when fasting sort of thing. I mean, we have this book that's been on the best seller list for 50 years, 'What to Expect When Expecting', because again, we know pregnancy is hard.
Let's tell you what's coming up. So that you can prepare for it. We don't have a what to expect when fasting, which is what.... the reason I had to write that book, 'The Complete Guide to Fasting'.
Yeah, I know. Let's talk about those three aspects. Let's talk about 'The Complete Guide to Fasting', and then the new book. I'm actually curious to hear. I think to me, 'The Obesity Code', one of the core arguments was that the calories, the calories are out argument, in terms of weight management was sort of outdated, and we should think about obesity as a hormone, or insulin, problem. So I'm curious to see how 'The Diabetes Code' expands upon that. Two, you mentioned teas or other interventions to assist with fasting. I know you recently announce a partnership with Pique Tea, so let's talk about that second. And then third, I'm actually curious to just zoom out, and for folks that are just getting into fasting, or just learning about it. We talked about individual, personalized, programs, but if you could just sort of summarize. Again, this is to say that everyone's an individualized, but if you were to say hey, what does a protocol typically look like. Can we first start with a typical protocol and then go into the book, and other topics.
Yeah, so the protocols. We use a couple of different core protocols. For older people, obviously we're gonna go more towards a shorter fast. So you might do something like, time restricted eating. A 16-8 sort of protocol, so that they fast...
Yeah, this is for, we're talking like 75, 80 year olds, right. We're not talking a little older, like 45, like me, right. (laughs)
You just got a bit more careful. These people are a bit more frail. We treat very serious disease, and we treat a lot of older people, because that's my core sort of population group, that I see. So for older people, yeah 70 years old, above, we're going to be a lot more cautious for you. If you're on a lot of medications, again, we're gonna be a lot more cautious for you. And we're gonna make sure you have a physician that is going to adjust your medications ahead of time, so that you're not getting into problems. If you're not on medication then you don't have to be quite as careful about that.
The next step would be like a 24 hour protocol, which is also sometimes called one meal a day.
So if you go from breakfast to breakfast, or lunch to lunch, or dinner to dinner, that's about 24 hours where you're not eating. And that's a pretty good regimen again, not particularly severe, but enough to kind of get people into it and also create some good weight loss. Which can be sustained fairly easily. It's especially good, and this is what I do a lot of myself, is the 24 hour fast. Because, honestly, it slides right into your working day. So I'm 44, turning 45, I have kids, so it's really easy for me to skip breakfast and lunch, because nobody knows if you miss breakfast. A lot of people just drink coffee anyway.
And half the time nobody knows if you missed lunch either, and I work right through. So that gives me a lot of extra time, and I'll say that I typically do more fasting when I'm really busy. Because then I gain time. So today I'm fasting because I had to take some time and do this podcast. That's great, because it's like now I can fit it in, and it's no big deal for me. It doesn't really matter to me, because I know that my body will provide the energy that it needs. But then I get an extra hour and I can fit in all this extra stuff. You multiply that by weeks and years, and it's like, whoa, you got all this extra stuff done. Yeah, because I'm not spending all day figuring out where to eat. The 24 hour schedule fits in very nicely into the working day, and then that leaves you your evening to have dinner with your family, and to go out to dinner with your friends. It doesn't disrupt you in any big way. You're not doing it every single day, I'm not doing it every single day, but three times a week, maybe twice a week depending on what your goals are.
And that's one of our core soft of messages in the IDM program is that you gotta realize that the fasting is not particularly fun. Some people like it, but if your goal is to lose weight, then change your regiment to do that. If it's Type 2 diabetes, which is a more severe condition that can have health consequences, then you've gotta be a bit more severe. I remember, I was doing it fairly religiously for a while, and then I realized I'm doing it not for any particularly good reason. As in my weight was around where I've always been. My waist size was fairly ideal. I don't have Type 2 diabetes, so I was doing it just for the heck of doing it because I was talking about. So then I was like, I don't really need to do it that often. And now it's more of a time management, with me, than anything else. But that's my goal now. So if my goal is to be able to write my books, and to do various podcasts, and do the blogs and stuff, that's as good a reason as any.
Then I'm going to do more. But I know where my goal is. It's not simply just a matter of this. And some people have these different goals, or autophagy, which we sometimes.... I don't know if you talked about before, but their goal is autophagy. You're gonna do it different. You're get more into the loss that you log class...
Water fast, yeah.
And you're gonna do a water only fast. That bone broth, you're not gonna do it. You gotta stick to the water only. So if your goal is for autophagy, and the benefits should be huge, but they're mostly theoretical right now. Then keep that in mind when you're choosing your regiment. As we go into Type 2 diabetes, we typically go into the longer ones, and the more medically supervised ones. So 36 hours, is sort of a standard regiment. Three times a week. If they're on medications, particularly insulin, we have to adjust that before they go on. And then for severe diabetes, and this is where you have to be very careful, is we start going into a sort of extended fast. The reason we do this, is we see a lot of people with severe diabetes and are on the verge of developing organ damage. That is eye damage, kidney damage, nerve damage, and so on. If you don't get that controlled right away, once they develop it you can't reverse it. It's like the oil in your car. If you never change the oil in your car, and then it breaks down, then you say now I'm going to change the oil in my car...
It doesn't work.
Same thing. If you've shot your kidneys out, it's too late. I can get your diabetes reversed, but I can't....
Your kidney's gone... your arm... your leg is chopped off, right?
Exactly, so for those people we'll go into longer fasts, but again we know why we're doing it. We've got a goal in mind to reverse their diabetes very quickly so that they will have the best chance possible of reversing their disease. Type 2 diabetes is really the sort of, one of the areas I'm really focused on because it causes so much disease.
It's not simply a weight thing...it's dialysis, it's blindness, it's amputations, it's heart attacks, it's strokes, it's cancer. It's a lot of human suffering, all related to diabetes.
And as a physician that's sort of my goal area. But I acknowledge that there's tons of other areas. So when people come to me for cancer, for example, I'll switch the regiment. There are people who want to do training, like sort of elite athletes, and I'll adjust the regiment based on that.
Yeah. Are there endpoints beyond just the time? Are you measuring glucose, ketones? Are you doing blood panels for lipids, inflammation markers, or...
We often check the baseline blood test for everybody, and that's more of a cover your ass, sort of move. Because you don't want to get blamed afterwards. So I will check a fairly detailed panel on everybody, although I rarely find any problems. One problem I do find sometimes, in Type 2 diabetes, is a low vitamin B12 level. Because that Formin, which is a very common medication can actually cause B12 deficiency. So the last thing I want to do, is find out after they've been fasting that their B12 is low, and somebody say, hey, that's because they're not eating. I'm like, no. I pick them up all the time. So I pick them up way before. And I always check the iron, for example, because I don't want somebody to come back to me and say, oh, they've been fasting and now they're iron deficient.
Because I picked that iron deficiency up at the beginning, and then everything kind of...
How often are you using checkpoints, before and after a program, or are you doing weekly, or daily checks?
Again, it depends on the situation. So if your...
I guess if your more serious then more....
Okay, makes sense.
For Type 2 diabetes, for example, there's a fairly standard marker, called the A1C, which is a three month average. So I'll often do blood work every three months to check up on that. If it's just weight loss, and not diabetes, there's no reason to do it more than once or twice a year. Assuming that everything is going well.
If it's not going well, of course, then you have to adjust and kind of go from there.
Yeah. I think it's an interesting segue into adjustments. So I think a lot of people in our groups always ask, should I drink... You know, one of the recommendations is bone broth, MCT oils, coconut oils, green tea, coffee. What are your thoughts? I think, your point around bone broth, perhaps not being ideal for treating autophagy because it has amino acids and amino acid triggers mTOR, which is what is hypothesized to control or mediate cytophagy. You probably don't want bone broth for an autophagy crutch.
Exactly, but for diabetes it'd be perfectly acceptable.
Because that little bit of amino acid is not going to do anything to you. It's not gonna... it's going to have so little effect. The same for, a lot of people ask about bulletproof coffee, and MCT oils, again you've got calories but you've got very little insulin effects. Again, if your point is to try and lower insulin effect, for weight loss, for diabetes, hey that's great, then you are going to be able to take the bulletproof coffee or MCT oil, and still get the lowering of insulin that you want. So keeping your goals in mind, you'd say, okay well that'd be perfectly fine for Type 2 diabetes. Typically we'll use bone broth for more longer fast, 36 hours plus. Something like the bulletproof coffee is acceptable from an insulin standpoint, but again it's understanding what your goal is. Green tea is a very interesting substance, and I've been talking a bit more about that lately.
If you look at traditional Chinese medicine, green tea is actually one of the substances that has been always purportedly helpful for weight loss.
If you look at the studies, what's interesting is a couple of things. One, is that green tea, when you give it in a study, typically has much higher levels of the catechins. The catechins are the antioxidants and the flavonol, the compound that thought to be responsible for the benefits, but they're at much higher doses. They are like, 10 cups a day sort of...
...level. Which most people don't get to. But that's what the studies are at. And is shows that you can lose about an extra kilogram of weight with that. What the catechins do, is they block an enzyme called COMT, and COMT is responsible for breaking down noradrenaline. So if you block the COMT, noradrenaline goes up. What happens is that you get this activation of the sympathetic nervous system, and your energy expenditure can go up by about 4%. So not a huge increase, but significant. Essentially, when you're losing weight a lot of the problems come from when your metabolic rate is going down. So if you can take the green tea catechins, and increase your metabolic rate that's huge. The other thing that they showed in this study from just 2016, is a randomized control trial, is that when you compare it to placebo, you get a reduction in ghrelin. Ghrelin is a hunger hormone. If you lower ghrelin, you have less hunger, which is exactly what people tell us.
Green tea catechins, interesting.
Green tea catechins. Yeah, absolutely, and it's very interesting. That's great, because that's the main problem with weight loss, is that you have too much hunger and your metabolic rate is slowing. That's why people fail with weight loss. Now you have an all natural substance that people have been using for thousands of years, that increases your metabolic rate and lowers your hunger. That's what people tell us all the time, they drink green tea and then their hunger sort of goes away. That's fantastic, but you have to get, to be up on the studies... Oh, the other interesting thing is that Asians all take different...
I was going to ask, caffeine also known to be an appetite suppressant, so were they controlling for that, or was it an additive effect, okay.
It's an additive effect. In fact when you compare catechins and caffeine, or caffeine alone, you get better effect with the catechins plus caffeine.
There you go.
So it seems like that they actually have a better effect. So what caffeine does is it blocks this other enzyme called phosphodiesterase, which also raises the noradrenaline. So they actually work through different pathways, and of course normal green tea has both catechins and caffeine. You can decaffeinate it, but I don't recommend it.
Because if you want the benefit, you gotta have both of them, to get twice the benefit. I was just saying it's interesting, because in some of the studies they show that Asians actually get a better weight loss effect than Caucasians.
Because (laughs)... You get an average weight loss of 1.5 kilos for Asians verses 0.8 kilos for Caucasians, and the reason is that Asians have a higher incidence of this high activity COMT. So that's the enzyme that's being blocked by green tea. So if you're Asian, and you have a lot of activity of the COMT, blocking it is going to give you a better effect. That's really fascinating, but never the less 0.8 kilos is still a pretty good effect, even for Caucasians. But it may even be better for Asians, which is huge because you look at the obesity epidemic in China and stuff. It's like massive, because the numbers are huge over there. But in any case it fascinating. The problem was... So I recommend this for people, the problem is that the dose of catechins you have to have is very high. You have to have up to 10 cups a day. Which isn't feasible for most people. And that's where we worked with Pique Tea.
What's interesting about Pique Tea, first, their tea is really great. I love the stuff. What they do is different. It's an organic green tea, and they get it from a single plantation, but they do this cold brew crystallization, where they actually steep it. You could probably do it yourself. You take green tea, and you put water, sort of like cold brew coffee. You can make it yourself.
You put it overnight in the fridge and you let it sit for eight hours, and then because you're extracting the catechins at lower temperature you get more of it out. So you get two, three times the amount-
At the steeping process, it doesn't break... it breaks down some of these complex molecules. Where if you're cold brewing it...
Yeah, exactly. The hot brew will not get as much, because you don't have the time in contact with it. So just like cold brew coffee, you go to Starbucks, you pay like twice the price for this cold brew, because it's actually hard to make. This is the same thing.
But what they've done is they cold brew it, and then they sort of dehydrate it, so it's basically crystals of concentrated tea. That's all it is, it's a whole food. It's not like what they do in the studies, which is industrially extract the catechins and then add it to the green tea. This is sort of a, just concentrated cold brew tea. That's all it is. But it's in a single serve packet, and then you mix it up and you drink it, and it's terrific. It's a little bit more, obviously, just like cold brew coffee. It's a little bit more, but if you want to get that benefit. So that then, what we did with... is sort of created a blend for fasting specifically. So we've made two flavors, one is with matcha, which gives it a bit more body and helps with the appetite suppressant, the hunger. And then, we did this ginger citrus because some people have this gurgling stomach, and some issues with that, and we found that ginger, and also citrus is helpful for that. Personally, I drink green tea plain, so I don't like the flavors myself, but those are supposed to help. That's what a lot of our patients tell us.
So that's what we've done and created a line, sort of specifically for tea. Which is not something that's really been readily available, because we have people to help with all kinds of stuff, but then when you're fasting it's like, oh yeah, you're like out of luck. Just do man, just man up.
You don't do that for anybody else. We create stuff to help them.
So because nothing was available, we created this. I mean, bulletproof coffee is sort of a similar idea, but it's different. That people use as a fasting aid as well. They don't always say that, but that's essentially what they do.
It's basically what they're doing, but I think the thing kind of funny with bulletproof coffee is that you're eating like 500 calories of fat. So, it's just like, you're getting a lot of calories, but I think the thing is, you see some people on a ketogenic diet, at a certain point you're still eating a lot of calories, and it's hard to lose weight if you're eating like three thousand calories of butter. I like the tea. Again, it's very acaloric, if there's any calories, probably close to nominal.
Close to zero.
Sounds like there's, what, a three, four X amount of catechins. So instead of having to drink 10 cups, you can drink 2 cups.
Yeah, two, three cups and you're good. It's still a whole food, it's really just cold brewed tea. It may help you with the fasting, and then you get all the benefits and it makes it a little bit easier for you. And that's the whole point is to really try to make something that will help people. Obviously, if it doesn't help you, then don't take it, right. That there's no point, but if it helps you then hey, you're going to get a lot of benefit from the fasting. And if it helps you fasting, hey great that's terrific.
So P-I-Q-U-E Tea, if folks are interested. I've had it before. I remembered seeing some of their product, I think, out in San Francisco. Yeah, it's good tea. Give it a spin fellow listeners out there. I think with the interest of adjuncts to fasting, one thing that we saw that's interesting from a ketone ester perspective, one of our products, was the paper published kind of near your backyard, UBC, University of British Columbia.
Showing that acute use of ketone ester actually reduces glycemic response. What that means is that a ketone ester versus placebo, before a sugar test, or oral glucose tolerance test, which is a standard test to test for insulin resistance or sensitivity, reduced the glycemic response. I'm curious to get your thoughts on that, if you've had a chance to review the paper.
And your thoughts on, like, exogenous ketones, broadly.
I think exogenous ketones have a role to play. And this is kind of goes along with the fasting aids and sort of thing, because it's not quite a whole food, obviously, but again it's something that may help along the way. So there's a couple of things. One, is that the properties of ketones have not been well appreciated for a long time. I don't think anybody really looks at it every. But lately, with this interest in the ketogenic diet, you're getting these really really interesting things popping up. Like, hey, you can treat seizures with it. Oh, hey, you can enhance athletic performance with it. Oh, hey, if you got fat adapted endurance athletics maybe particularly beneficial if you're running your body off of ketones.
The point is, that if you take a ketone supplement you would get your ketone levels much higher, much faster. The natural way to do it is fasting, but if you take a ketone ester you're gonna get way higher.
Like right away, almost. So is there some benefit to that, and increasingly a lot of evidence says yes there could be some potential benefit to it. Because some cells, perhaps, run a lot better. And of course, the brain is one of these areas, that has been studied a lot, and I think a lot of doctors stick to the prescribed script sort of thing. It's very interesting because the ketogenic diet was originally described like 100 years ago, as a treatment for seizures.
And then it got lost, with the development of medications, and it took, not a doctor, but a film producer... This is the story of the Charlie Foundation. The son of a famous Hollywood producer had intractable seizures, nothing worked, none of the meds worked, had all the best doctors, and it took him researching the archives to find out this ketogenic diet would reduce seizures. So he tried it on his son and boom! All his seizures went away, and it's like okay that's a great story, why were the doctors not the ones to do it. It's because they knew about it 100 years ago, and then they totally forgot about. It takes a Hollywood producer to tell you how to do your job? Are you kidding me!
And I always think that it's very instructive because a lot of these things get met with skepticism by the doctors, the mainstream medicine professionals, but when it work, it works. Then your job is to understand why it works. And ketones falls into that range, where maybe there's some benefits to doing it, but if it works don't just say, oh that's quackery. Because that's what everybody says. I got my fair share of that. Oh fasting, that's just quackery. Now it's like, oh yeah, of course it works.
It's all over the planet now.
They're like, or course it works. You're not eating so your blood sugars will go down. It's like, that's not what you said four years ago, five years ago. You said, that'll never work, you're a quack. But I'm like, if you don't eat, you'll lose weight. They're like, no you won't. I'm like, how are you not going to lose weight.
This is the same thing with ketones that we see in that study is that there's a benefit to the ketones, in terms of reducing the blood glucose. And of course, this is one of the areas that I'm very passionate about, which is Type 2 diabetes and is there a benefit there. It's very preliminary, obviously, but maybe you can use it as an adjunct in some way. Maybe you can use it in conjunction with the ketogenic diet, or conjunction with fasting, or some of these dietary mechanisms, or even with your regular medications, and maybe you can lower the blood glucose. And is there a benefit? Maybe the answer is yes, we don't know. All we can say is that it's worthwhile studying.
The other thing I think is very interesting about exogenous ketones, in Type 2 diabetics anyway, is that you can measure this ketone to glucose index. So as your blood glucose falls, your ketones should rise, because your body is essentially switching over from burning glucose to burning ketones and burning fat. Well, this doesn't always happen in Type 2 diabetics, so if your glucose falls, your ketones don't rise...
Then you feel like shit.
Yeah, exactly (laughs)
So you got no glucose, you got no ketones, you're just feeling like crap. Now if you stick it out long enough, your body will eventually produce ketones, because it's no gonna die. But in the mean time it's not as easy as it could be. We've studied this. We know that this glucose-ketone index exists, and that there are different slopes for different people. So normal people, glucose down, ketones up. Type 2 diabetics, a lot of them, glucose down, ketones not up, so what do you do. Well, that's where exogenous ketones could have a benefit. Maybe if you define the proper place to use it, you could say okay, we'll give them ketones until they get into that ketotic state themselves and then they're gonna derive...
Endogenously produce it, yep.
Exactly, because they can't endogenously produce it, because it's great if you do endogenous ketones, that's the whole point. But what if you can't, then exogenous ketones is a great solution. And again, more research is going to have to be done to define the best sort of solution to this thing, but here's something that would be very very interesting to look at, and potentially consider. And you could definitely mix it up. If you're trying to get into that ketotic state, but you're falling into this low energy state, where you have no glucose, no ketones, you can bridge it with exogenous ketones until that fasting kicks in and you produce endogenous ketones. That's like, hey, that would be a great solution. Then you can start getting better from the diabetes and stuff.
Yeah, so many possibilities here. And I think that that paper was just a first...
First step, yeah. I agree. We gotta send you a couple cases so you can, you know, start experimenting. If there's a way to publish some of the results, I think that's just how progress is done. I appreciate your perspective there, as someone who's looked at it clinically across all types of interventions. So the last topic I want to talk about was "The Diabetes Code". So, "The Obesity Code", awesome book. It was one of the key books that I read to get really ramped up into this space. What are the new grounds that you're planning to cover. So the book comes out in April, right? In about a month.
In April, yes. In about a month. So "The Diabetes Code" is very specific towards Type 2 diabetes, and it's important for a lot of people because if you look up the population of the United States, the adult population, it's about 14-15% Type 2 diabetes, and about 38% pre-diabetics.
Almost, actually a little bit over 50% pre-diabetic or diabetic. So that actually effects a huge number of people.
100 million plus people. Yeah, it's like one of these numbers that people don't understand.
It's crazy. And one of the things, the main thing we talk about is that this is a reversible disease. So everybody tries to convince you that it's a chronic and progressive disease, that you've got it, you're going to have it for the rest of your life. But it's actually not true. You can actually reverse it, and we see that with studies of say, bariatric surgery, weight loss surgery. When you lose the weight, the diabetes just goes away. What I do in the book is really present a sort of paradigm of diabetes, of thinking about Type 2 diabetes.
The easy way to think about Type 2 diabetes is like, think of your body as a sugar bowl. Your body actually just has too much sugar. That's the whole disease.
If you have too much sugar, your bowl is full, and then when you eat, all that sugar spills out into the blood. Insulin, which is the sort of standard medication for Type 2 diabetes, does not get rid of that sugar. What it does is it takes the sugar that's in the blood and rams it back into your body. Well, your body takes is, because it's forced to, but then it's just getting more and more stuffed with sugar. So then eventually, that insulin that you're using is not enough to cram the sugar into the body.
And you need more and more insulin.
That's what you do. So what we've done is give more and more insulin. And then, because the medical treatment doesn't work, because you never treated the underlying cause, we say it's chronic and progressive. And why do doctors say it's chronic and progressive, it's actually because doctors simply cannot admit to themselves that the treatment is so spectacularly wrong. Think about it this way. You're an endocrinologist, you spent 20 years in the field treating Type 2 diabetes, and under your watch 98% of Type 2 diabetics have gotten worse. You know they're getting worse because you're increasing the medication. So you can either say, one, this is reversible disease. Therefore, if you put two facts together, one it's a reversible disease, we know it for a fact, because when people lose weight the diabetes goes away. Two, almost all my patients are getting worse. The only conclusion you can draw from that fact is that you're a bad doctor.
You don't know what the hell you're doing.
Because it's reversible, but your patients are getting worse. You're not doing a good job. As a doctor you can't face that. You can't face that you have no idea what the hell you're doing.
So then, therefore you have to change the fact that it's not reversible. It's chronic and progressive, and now I'm doing the best that I can. It's like aging. You might want to get young, but there's no way. You always get older. Type 2 diabetes you say is the same thing, but it's not true. And that's the problem is, that it's not true and it's a reversible disease. And it comes down to this. What we did was took a disease, that's essentially a dietary disease, and we gave a lot of drugs. And then we wonder why isn't your diabetes getting better. Because we're giving you drugs to treat the blood glucose, but here's the thing, we're giving all these... we're so focused on treating the blood glucose that we forgot to treat the diabetes. You give insulin, are they gonna lose weight? No, the answer is they're gonna gain weight. So how is that going to make their diabetes better? It's not, it's gonna make it worse.
It's a bandaid.
It's a bandaid. Because you;ve put a bandaid over a bullet hole.
Then you can't see it, and you pretend that you're better.
So these drugs are essentially placebos for doctors. They make the doctor feel good about himself...
...but they don't do anything for the patients, and that's the problem. But it's such a simple thing, if it's a dietary problem, you gotta use your diet to fix it. And here we have a solution, intermittent fasting, or extended fasting, where it's completely free, it's available to everybody, like tomorrow, and anybody in the world can do it at any time.
And you're gonna save money. You're gonna make your diabetes better. And think about it, if you don't eat, your blood sugars will drop. Well hey, if your blood sugars drop, you don't need that insulin anymore.
But what you're doing, of course, if you think about that sugar bowl, is you're letting your body burn down all that sugar in the sugar bowl. Now when the sugar comes in, it just doesn't spill out anymore. But it's 100% natural solution. Is it fun? No, it's not fun. We beg...
We beg people to do it. We club them over the head with it. We threaten them. We yell at them. We do what it needs to do, but in the end what we're doing is we're trying to take advantage of the body's own ability to heal itself, instead of giving pills.
And that's where it's really powerful, and that's where we created this sort of intensive dietary management program. The website is idmprogram.com. Where you can get somebody to help you with your fasting.
We put them in group situations, where you can get support. We do have this membership site which you can join for a lower monthly fee, which is not personalized, but you can get things like group fast, which is just like what you do with the WeFast, where you have somebody. And we'll say, okay everybody we're gonna fast these days.
And who's in, sort of thing. And we'll have tips on fasting, and recipes for when you're not fasting, and all this kind of stuff. But at the same time, it is all dietary stuff. We're not trying to give people medications, we're trying take that medication away. Here we're like, we can save people all this money. Like, even if you don't care about your health, if you don't have to buy that insulin, you're gonna save a lot of money. And to insurance companies, hey, your patients are gonna get better, and you're not gonna have spend all that money on health. Everybody wins.
Except for the insulin producers.
(laughs) Yeah, we won't worry about that.
No, I mean, I agree 100% with you. I think just seeing the stories in WeFast and just people literally getting off of insulin through fasting and diet. It's like, you know Dr Manny Lam, that we work closely with. I know that he works with you as well. He's taking people through fasting and diet protocols, and taking people off their Formin and insulin. It's just like, okay, something is working here. What I think about it is, you talk about it being hard, it's like, oh, exercise is hard too. Like, if you've never worked out in your life, it sucks. But we all know it's healthful for us to do some workouts. I think the same thing will change with the culture of the fasting. Yeah, the first time you fast, it's gonna suck, because it's like working out your liver, and whatever, it's working out your body to go into the fasted state, but you get used to it.
And it's healthy long term.
Yeah, it's what you need to do to get better. And that's what I always say, like I get this push back a lot from people that are like, yeah we understand why it's good, but people will never do it. I'm a doctor, my job is not to tell you what you can, and cannot do.
My job is to tell you what you need to do to get healthy, and if fasting is what you need to get healthy, then I will do whatever I can to support you through it.
And we'll create the fasting tea. And we'll create the IDM program to help you. And we'll create these support groups like WeFast. We'll create these ketones that maybe help you get through the tough areas. But that's the point, it's like, we're helping you. We're on the same team here, we're not trying... we're not at cross purposes.
We'll help you do what we can. We'll do what we can, and you do what you can, and maybe together we can get you healthy. I'm not going to tell you, you can't fast because I don't think you have the willpower. That's like, such a defeatist attitude. It's terrible, and you see it all the time. And again, it's just like your group, when you tell people that it's great, hey all of the sudden you get 20 thousand people. And when you start showing it online, I was talking to Sumaya yesterday, and it's like all of the sudden you're on the 'Today' show, and people are like wow this is really interesting. It's like, well, these are not new ideas.
These are ideas that have come...(laughs)...sort of from the mists of time.
People have been doing this for thousands of years. The three most influential people in the history of the world. The prophet Muhammad, Jesus Christ, and Buddha, all told their parishioners to fast. Not because they wanted to kill them, because they knew there was something, sort of, intrinsically healthy about once in a while, letting your body clean itself out of all this extra junk that accumulating. And that goes, not just for the glucose, but also the excess protein that's accumulating. And that's what autophagy is, you're breaking down these sub-cellular components, this old junky protein, and trying to replace it with something new and better. Can it prevent cancer, potentially. You know that the World Health Organization now labels 40% of cancers as obesity related.
It's like here, we pretend that cancer is genetic disease. It's like, it can't be genetic, because obesity accounts for 40% of the cancer. So breast cancer, for example, is very highly related to obesity. So therefore, it's not genetic, it's related to the obesity.
The Warburg theory of cancer.
Yeah, the Warburg theory. There's so much interesting things about that, this whole thing. And we think about cancer in this way, but say you turn down, and this gets into the nutrient sensors. Which is another sort of fascinating topic, because...
mTOR all these pathways
mTOR, AMPK, and insulin. So there's... Your body, actually, is very very interested in knowing if you have access to food. Because if you don't have access to food, your body does not want to grow. So nutrient sensors, and growth pathways are very very tightly linked. And you see this in the ovary as well. For polycystic ovary syndrome, for example, you can treat it very easily by lowering insulin. But the ovary has insulin receptors. Why? Because the ovary wants to know that there is lots of nutrients available before it ovulates. Produces an egg that can potentially become a fetus, and a baby. You do not want to be in the middle of a famine and producing eggs that can become a baby. You're gonna kill the mother, which is gonna kill the baby.
Because you have to divert resources into growing this fetus. So the ovary is very interested in knowing if there's available nutrients. So one of the things that the body has is several nutrient sensors. So there's insulin. So when you eat insulin goes up, so that's a nutrient sensor. mTOR is the one for protein, and there's one called AMPK, which is sort of this fuel gauge of the body. So it's a reverse fuel gauge. So when it's high, it means your energy stores, cellular energy stores are low. So it's a fuel gauge, but reverse. If your AMPK is low, it means your energy stores are high.
And this is why a lot of people take metformin. Because it activates AMPK, and it tells your body that it's in a low energy state which is actually healthful for you. Which actually may help prevent cancer.
There's a few studies that say, well metformin can help protect against cancer. Why? Because it lowers AMPK.
It's a very interesting sort of idea, because again, if you turn down... if the body is not sensing any nutrients it is going to turn down the growth pathways, and the things that are growing the fastest are those cancer cells, but also for things like polycystic kidney disease. I has this lady once who was very interesting, had a hemangioma. And what those are, hemangiomas are these little benign tumors of the kidney. They're blood vessels and they bleed a lot. So she actually had to get one whole kidney resected, because it was bleeding so much, she would have bled out. And they had to embolize two other hemangiomas, which just means they clotted off...
Like burning it.
Yeah, it's like burning. So anyway, a few years ago she decided that she's going to intermittent fasting instead. So what's fascinating is that if you do this fasting, she had her ultrasound measured a few times, and on each one they say well it looks like the hemangioma's getting smaller, but we know that never happens, so it might just be a fluke. (laughs)
Yeah, she's had like four that have shown it's shrinking in size. Like, fantastic, because we understand what's happening. You're eating zero, so you're turning down all your nutrient sensors. You're turning down your insulin. You're turning down your mTOR, and you're raising your AMPK.
Ketogenic diets are not going to do that. They're only going to turn down your insulin, but they're not going to affect AMPK, and they're not going to affect mTOR. Therefore, fasting is a much more powerful way to turn down your nutrient sensors. The body senses there's no nutrients, turns down the growth pathways, which effects the hemangioma much more than it effects other cells.
So then, all of the sudden, you get this shrinking of this, it's a benign tumor, but this hemangioma, this benign tumor. And all of the sudden she hasn't bled for, you know, the last year and a half. It's fantastic, and it's like wow, the power of that is simply amazing.
Because it's free, and it's available, and hey, you might lose some pounds, and you might reverse your diabetes on the same breathe and you may prevent the Alzheimer's disease. Again Alzheimer's disease is this clogging up of your brain with all this excess protein.
Amyloid protein, exactly. So, what if you could activate your body to break down all this protein. Intermittent fasting. It's like, whoa, this is amazing.
mTOR goes down. All of the sudden you stimulate autophagy, and you're breaking down protein.
One of the interesting theories around that as well, is something that we're looking at, is that perhaps Alzheimer's has a nickname of Type 3 diabetes. It's a glucose uptake disfunction in neurons. If you can feed it through ketones can you rescue some function and help clear out some of the tau and amyloid. Which is related to, some of the similar pathways you're talking about. But I think, you know, mTOR, AMPK, insulin, are some of the most targeted targets for drug and foods. I think it is very cool that we can activate them in the right ways, and the right levels, with fasting. I mean, yeah, in Silicone Valley people are looking at Metformin, rapamycin, which is a target for mTOR. Potentially, longevity hacks. Those might have additive or adjunct effects on top of fasting, but it's all within that related ecosystem.
Yeah, it's all in that wellness state. Yeah, exactly, how are we going to increase longevity, and I think AMPK actually plays a big role in that.
But what's interesting, of course, is that you can target it with Metformin, you can target it, but you're not gonna turn down your insulin. If you eat enough formin, you're gonna target the AMPK. If you eat rapamycin, you're gonna target mTOR, you're not gonna effect the other pathways.
So, fasting actually simultaneously effects all three pathways.
It's like, wow, that's way more powerful, and it's natural, and then you go back and say, hey, let's look at these wellness practices for the two, three thousand years.
What do people say, oh hey, you should fast once in a while. You go back to Hippocrates, you go back to Benjamin Franklin, you know, Mark Twain, they're like, the best of all medicine is resting and fasting. That was his quote. And that's like, whoa, people understood this thousands of years ago, that yes, if you want to be well, you should fast once in a while. And it's like, oh, they were totally right.
Like we think, oh yeah, I'm gonna.... if you wanna be well, I'm gonna take some rapamycin and Metformin.
And it's like, okay, well I think you're gonna be better off with the other guy, with Benjamin Franklin, who was fasting. Because you're gonna effect all of the pathways at the same time, and do it naturally, rather than in this sort of artificial way. Because you can turn down sensors and stuff, it's hard inhibit them long term, and it's hard to inhibit them completely, and this sort of thing.
I agree. I don't think it's a magic compound. Because like, human biology is a complex system.
You can't just push one pathway and expect everything else to work magically. I think it's just using interesting levers. And intermittent fasting is one of these things.
It just happens to touch a lot of them in the right way. In the way that's natural. That's part of evolution. Right, like we're designed to go through fasting and famines, or feasting and fasting cycles. And it's been conserved throughout C. elegans, rats, mouse...
So the data's just like, good.
The data is good, because if you look at AMPK and mTOR. So insulin is actually the most recent of the nutrient sensors. mTOR goes way back, and AMPK goes way back, they're conserved from those nematodes, right, the C. elegans, and the Drosophila, the fruit flies, and stuff.
You can find them in every form of life. It's like, wow, these things are essential for life, and thousands of years ago human figured out a way that would actually help extend their lives. So this is like, super fascinating as a topic, from an evolutionary standpoint. How are we going to do it. How are we going to use it to, kind of, hack our life. We all talk about biohacks and stuff, and it's sort of like the ultimate biohack. It's natural, it's free, it's available, we just need the knowledge and the acceptance, and people can tap into all these sort of superpowers, in terms of health and wellness.
Absolutely. Yeah, let's build up the culture here. So, a lot on your plate. You got the fasting tea in June. You got the book, "The Diabetes Code", in April. Anything else in the pipeline, like what's the future? I'm sure we'll have a conversation and have you again on the podcast. Hopefully, not in another two years, but...
Yeah, for sure
What's next as you're looking forward?
Well, I'm working on a couple of things. Obviously, we've done the books and we've also built up the IDM program to actually be a solution for people to actually get some help. So it's an online program, but then people can get help with their fasting, get help with their diet, and so on. That's something that we're working on building up and trying to roll out so that people can benefit. That's idmporgram.com. Then I'm working on a book on PCOS, which is polycystic ovary syndrome.
The reason I'm doing that is one of our IDM partners is Dr. Nadia Pateguana, who is very passionate about this. And the reason she is, is because PCOS is also a disease of hyperinsulinemia. Therefore, as a disease of hyperinsulinemia, fasting and low carb diets work very well. But what we have is PCOS, which effects somewhere around 10% of the target, adult women. And one of the big problems with PCOS is infertility. People are spending like, tens of thousands of dollars, like a lot of money, because they're infertile because of this PCOS. And yet, it's so easy to treat. It's crazy that we could save that... and you know, I have three kids, and I know it's incredible to have kids. Then they become a pain in the ass, but before that, it's incredible.
Just kidding (laughs) But it's incredible to be able to give somebody that sort of gift. Because, you know, it's sort of so intrinsically human to want to have a family, to want to have a big family. If you can't have that, it's like an amputation. It's like having your leg cut off. People want to have family. People want to have kids. And to have to spend ten thousand dollars a shot, for in vitro fertilization is ridiculous, because PCOS is treatable so easily. So that's one of things I'm working on. And in the longer term, I get asked to write a lot of stuff, but what I really want to write is about stuff that can make a difference to people, and where I can bring something new to it. So something like PCOS, there's just not any information. So "The Obesity Code", there's just not a lot of information. Type 2 diabetes reversal, not a lot of information. "Guide to Fasting", not a lot of information, and then PCOS. And then in the longer term, maybe some cookbooks that will help people. Eventually a book on cancer, which is again, really really fascinating from a....
(laughs) Perhaps, I don't know. There's a lot that will go into it. Right now the PCOS is a lot easier, because cancer's not simply about obesity. It's actually a lot more than that. It's about of these...
And there's so many ideologies too. It's like a bunch of micro diseases, under one umbrella term, essentially is the way I kind of think about it.
Yeah, I think cancer comes down to, I think it's about the mitochondrial disease, it's about all those nutrient sensors we talked about. But it's also about apoptosis and autophagy. There's a lot of topics that get in there and it needs to be worked out a little bit better, but there's some super interesting theoook at the progress. Nixon declared war on cancer in 1971. If you look up the rates of cancer now, they're about the same as 1971.
And how many billions of dollars have been spent?
I don't know. How many walks for cancer.
How many pink ribbons. There is so much money going to this, that has done absolutely nothing. It's like you, with your iPhone in 2018, was still using those giant vacuum tube, room sized computers. That's the equivalent. How can you make so little progress in cancer despite the billions of dollars, probably trillions of dollars...
[[Geoff]] And good efforts. Like, people want to do good work there. It's not like people are just wasting money. I think people are honestly trying to solve this problem.
Oh, absolutely, but I think it started off on the wrong foot. Which is that this is a genetic disease. And when you start off, it's like if you're trying to do South, but you start off by going North, it doesn't matter how fast you run, you're never going to get to where you're going.
And that's the thing. We started off looking at it as a genetic problem, and we kept going, and it was a disaster. This whole cancer genome atlas, totally tells us that we went in the wrong direction for 50 years.
And people still want to go in that direction because they've built their careers on it. If you don't recognize your mistake, and start going in the right direction, then you're never gonna get there. And that's the real problem with cancer. It's a much more complicated topic than simply obesity, Type 2 diabetes, PCOS, sort of thing.
It's not simply fasting. Yeah, fasting is going to play a role, but there's all this other stuff that goes into it. So that's maybe the long, long term. But it's a real interest of mine. Getting to the bottom of what causes cancer, what cancer is, and trying to change the paradigm of thinking of what cancer is. Which is not a genetic disease.
100% I like that you're still staying ambitious in pushing forward. I think in the last couple years I think we've seen the community, and interest in the....really the science as well. So I'm just excited to see what yourself, our communities, can continue to do to, I think, really help people live better, healthier lives. So thank you for taking the time Dr. Fung, and we'll talk soon.
Okay, thanks Geoff.
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