Yang – Part 1 – What is Lost During a Diet or Fast?

There was an interesting study done back in the mid 1970’s. The study may not be possible today since there may now be ethical issues about starving people. We seem to have a fear of fasting that fails to take into account our human history of long fasts and famines.

This study is (Yang, Composition of Weight Lost during Short-Term Weight Reduction: METABOLIC RESPONSES OF OBESE SUBJECTS TO STARVATION AND LOW-CALORIE KETOGENIC AND NONKETOGENIC DIETS)

The six subjects in the study were each given one of three different diets for ten days each. Over the course of the thirty days they ate either a ketogenic diet, a mix fat/carbohydrate diet, or they were fasted.
This is a pretty unique study since it provides the opportunity to see what effects fasting has vs other means of weight loss. Perhaps most interestingly is that they looked at what was lost during each of the three diets. Here’s the results of the losses from each in table form (with percentage of the total weight loss):
Diet/Intervention Weight Loss Water Loss Fat Loss Protein Loss
Ketogenic Diet 466 g/day 61.20% 35.00% 3.80%
Mixed diet 278 g/day 37.10% 59.50% 3.40%
Fasting 751 g/day 60.90% 32.40% 6.70%
Here is the same data in grams per day:
Diet/
Intervention
Weight Loss Water Loss Fat Loss Protein Loss
Ketogenic Diet 466.6 g/day 285.6 163.3 17.7
Mixed diet 277.9 g/day 103.1 165.4 9.4
Fasting 750.7 g/day 457.2 243.2 50.3

Ketogenic vs Mixed Diet

Once again the Ketogenic diet is shown to be more effective at weight loss than a mixed diet. However, the different is almost entirely made up of a much larger water loss on the keto diet than on the mixed diet. Looking at the grams per day of fat loss (the only thing that really matters in weight loss) the keto diet and the mixed diet are almost identical. Protein losses were equivalent on both the Keto and Mixed diets so there’s not much of an advantage to either. In the case of Keto vs Mixed it might just come down to which diet is easier to comply with and Keto wins that hands down for most people.

Fasting vs Ketogenic Diet

The results here show that a person can lose more weight fasting than they can even with either a ketogenic or a mixed diet. After all, they are eating nothing while fasting. Fasting produced almost three times the weight loss of the mixed diet. And when it comes to fat loss, fasting also wins hands down with a 1/3 greater amount of fat lost.

However, protein losses while fasting are almost twice those of the ketogenic diet on a percentage basis. The loss of 50g of Protein a day is almost two ounces of protein per day. That could be a significant amount for someone and is not a great preservation of Lean Body Mass.

The answer here may be found in the subjects themselves. They were six grossly obese males. The mean weight was 140 kg (308 lbs). They were great subjects for fasting since they had more than enough fat mass to support a ten day fast.

Fasting was slightly better about not having as much water loss as the Keto diet but Fasting was not as effective for weight loss as a percentage of weight lost.

What Does This Study Say About Fasting?

  1. Fasting produces the quickest weight loss of any of these three methods.
  2. Over 60% of the weight lost during a fast was water weight. This was the same for the Ketogenic diet. A mixed diet with carbohydrates is better at holding onto water. Much, it not all, of water weight is quickly regained after leaving the any diet.
  3. Fasting does not spare Protein as well as the Ketogenic diet. In fact, it is about twice as bad at preserving Protein.

 

Another Bone to Pick with Dr Fung

Another point I disagree with Dr. Fung is on the subject of Electrolytes. Dr Fung’s book, The Complete Guide to Fasting, leads many people to think that they don’t need electrolytes while doing Extended Fasting. They reach that conclusion from soundbites like the chapter heading:

Electrolytes Remain Stable (TCGtF, p 49)

And

Prolonged studies of fasting have shown no evidence of electrolyte imbalances…

This is led many to conclude that they don’t need to be concerned about electrolytes during extended fasting.

This is further exacerbated by Dr Fung being a clinician, IE, Dr Fung runs a weight loss clinic. He has thousands of patients and if he says that electrolytes are not needed then they are not needed… Or so the logic goes.

However, there are many others in the keto community who will tell you that they got into serious trouble by ignoring electrolytes. In particular, they had to end fasts due to electrolyte levels being way too low and some have ended up in the ER getting electrolytes via IV bags.

Looking at What Fung Actually Says

Fung’s book has different messages on electrolytes depending upon the fasting length.

p.48-49 During short-term fasts, salt depletion is not a concern.

p. 49 During prolonged fasting (more than a week) the kidneys are able to reabsorb and retain most of the salt needed by the body. However, some salt supplementation may be required.

People seem to miss the second part (on Extended Fasting).

There very little guidance on supplementation in the book, but several examples are found in the book (p. 240):

Dizziness
If you experience dizziness during your fast, most likely, you’re becoming dehydrated. Preventing this requires both salt [ed: Sodium and Chloride are two electrolytes] and water.

The same advice is given for headaches on the same page.

Also (p 241):

Muscle Cramps
Low magnesium, which is particularly common in diabetics, can cause muscle cramps. You may take over-the-counter magnesium supplement.

Facts Keep Getting in the Way

I have a serious concern with Dr. Fung’s method when it comes to Extended Fasts and the evidence against needing electrolytes. On p 50, Dr. Fung has Figure 1.4 which states in the legend:

Figure 1.4 Electrolytes remain stable during extended fasting

The book shows charts for Chloride, Potassium and Sodium.

But what is missing from these charts? What is in the charts themselves? And, who is the subject of the charts?

The charts are from the Guiness Book record holder for longest extended fast, Angus Barbieri. I have written about Angus’ fast. His fast was medically covered in this study (Stewart, Features of a successful therapeutic fast of 382 days’ duration).

Angus was a big man

There are some significant things of note. Angus was 456 lbs at the start of his fast. To use his extreme situation as evidence that electrolyte supplements are not needed during an extended fast is sketchy at best since he had so much available substrate to draw from during his fast.

Missing Data?

Further, Dr Fung omits in his book Angus’ Magnesium (Mg) levels which were published in the study and did show him with low Mg levels for much of the fast. The Normal range is clearly marked and the points are below that line. This is the figure from the study itself.

As you can see Angus’ Magnesium levels did drop during his fast very quickly and were on the low range of normal for almost the entire fast.

Fung doubles down with the statement (p 228):

While monitoring the world-record-breaking 382 day fast, researchers measured the magnesium content within the cells, which remained firmly in the normal range.

Dr Fung does go on to note (p 229) something ignored by many:

Nevertheless, we often supplement patients with magnesium to be on the safe side.

Did Angus Get Supplements?

The study also clearly notes that Angus was given supplements for the entire duration of his fast:

During the 382 days of his fast, vitamin supplements were given daily as ‘Multivite’ (BDH), vitamin C and yeast for the first 10 months and as ‘Paladac’ (Parke Davis), for the last 3 months.

I am not sure if the formula for Multivite has changed between the mid 1960’s and today, but the current formula is:

As you can see, Angus was actually given Magnesium, Potassium, Calcium and Phosphorus during his fast in the form of a supplement. Not in high dosage but not ZERO either.

Did Angus Receive Other Electrolytes?

The most serious issue with respect to Dr Fung’s claims about Angus’ fast however, is the study indicates that Angus actually did receive additional electrolytes during the fast.

From Day 93 to Day 162 only, he [sic: Angus] was given potassium supplements (two effervescent potassium tablets BPC supplying 13 mEq daily) and from Day 345 to Day 355 only he was given sodium supplements (2.5 g sodium chloride daily).

Here’s the chart from Dr Fung’s book which clearly shows Angus’ Potassium levels dropping below normal to the point where he was given potassium supplements (day 93 in the study). They went up to normal after Angus was given the Mg supplements and even after he discontinued the supplements.

Conclusions

Angus Barbieri is an example where electrolyte supplementation was required which is the exact opposite of what Dr Fung says in his book. Angus Barbieri was not only given Potassium when his levels fell, he was also given Sodium Chloride for another portion of his fast. He also had a daily vitamin which contained these elements.

Angus Barbieri was medically monitored and tested during his extended fasts. The doctors could tell when to supplement and when it was unnecessary.

It is a serious mistake to use Angus Barbieri as evidence that electrolyte supplementation doesn’t need to be done in Extended Fasting. Fung’s book on this subject is sloppy and ignores the evidence in the study. It sends a mixed message in the practical advice section later in the book from what it sent in the earlier part of the book.

 

I Keep Running into Fung-damentalists

I am a huge fan of Dr. Jason Fung. You can see throughout this BLOG how Dr Fung’s video on Diabetes and Intermittent Fasting turned my life around. But I also keep running into people who misunderstand Dr Fung’s words in his book and lectures.

An Extended Fast is not Short Fast

One of the ways that people frequently misunderstand Dr Fung is to take what Fung said about Short Term Fasts (3-4 days) and make it apply to longer (Extended) fasts (5+ days).

The study Dr Fung quotes on this point was (Zauner, Resting energy expenditure in short-term starvation is increased as a result of an increase in serum norepinephrine).

With any study it is important to know at least a few things:

  • Who were the participants? Are they like me?
  • How long was the study for?
  • What type of study was it?
  • What special conditions were there for the study?

In the case of this study the participants were:

Eleven healthy, lean volunteers (7 women and 4 men) participated in the study.

The study only lasted four days.

The first measurement was made after an overnight fast [started at 2100 the previous day (day 1)]. Further measurements were undertaken 36 h (day 2), 60 h (day 3), and 84 h (day 4) after the beginning of starvation. All volunteers entered the metabolic unit at 0700.
So, quoting the study to say that it is applicable to an Extended Fast it not justified based on the study. And that is not what Dr Fung has said. And if someone specifically asked Fung if the study warrants drawing conclusions about metabolism on longer fasts I seriously doubt he would say it does.
The study was done on an outpatient basis to mimic real life except the the study did limit sporting activity. Also, if you were told to limit yourself to only “necessary activities” would you do less? I’d skip doing the laundry for four days, etc.
The study was performed on an outpatient basis to keep subjects under normal living conditions. However, the subjects were instructed to perform only necessary physical activities (ie, to avoid sports).

What Did Fung Actually Write?

On several pages of Dr Fung’s book, he writes that Fasting does not lower metabolism. For instance:

In fact, metabolism revs up, not down, during fasting (The Complete Guide to Fasting, p 73).

And here:

And, studies show that after a four day fast, resting Energy Expenditure increased by 12-percent. Rather than slowing the metabolism, fasting revs it up. (TCGTF, p 49).

 As I have showed above the context of what Fung is writing is about a fast which lasted only four days. Further, Fung includes the data from the study in the chart (TCGTF, p 74).

Conclusions

Dr. Fung is talking about a short (four day fast). It is a mistake to extrapolate from a four day fast to a much longer fast.

The chart actually shows a decline in metabolism (the red line in the figure above) from day three to day 4 (45.3 to 44.3).

The reason that the body gets that energy burst at the start of any fast is explained in the study:

Our results indicate that an increase in serum norepinephrine concentration rather than a decrease in serum insulin concentration initiated by the decline in blood glucose concentration may be the primary initial signal of metabolic changes during early starvation.
This is a short term effect until ketone levels rise a few days into the fast and are able to provide energy at that point.
And to be fair to those who misunderstand him, Dr. Fung has not made this any easier due to the expansive language he uses. When he says “metabolism ramps up during fasting” in this context he means intermittent and short fasts. To take what Dr Fung says specifically about short term fasts and extrapolate it to Extended Fasts is not warranted either from the evidence from the study nor from Dr Fung’s own words.

Protein Sparing Modified Fast Calculator

I put together the previous formulas into one single webpage, the Protein Sparing Modified Fast Calculator. I’ve put my own current numbers into the calculator. Just hit the “Calculate” button to see my numbers. Feel free to try it out with your own numbers and see if it helps you figure out any of this. I don’t see the numbers you enter nor are they stored in any database. All of the calculations are done on your phone web browser or Internet browser (Firefox and Chrome works but Internet Explorer doesn’t).

If you find any errors, please let me know. I tried it with my own numbers and they make sense but I didn’t have a woman’s secret numbers to check.

Here’s a decent introduction to the Protein Sparing Modified Fast (PSMF). I only take exception to one point which is the question of how long you can do a PSMF. They say you can’t do it for an extended period of time. If you continually re-calculate your numbers you should be able to fine tune for maintenance levels. This calculator makes that re-calculation relatively easy. Here’s the results I got for my numbers.

Your Scale and Metabolism Numbers

Current Weight: 199.8 lbs
Goal Weight: 171.3 lbs
Lbs from Goal Weight at start: 28.5 lbs
Body Fat at start: 25.4%, 50.8 lbs
Lean Body Mass (LBM): 149.0 lbs
Basal Metabolic Rate (BMR): 1818.0 cal/day
Initial Total Daily Energy Expenditure (TDEE): 2500 cal/day
Initial Maximum Fat Loss on Protein Sparing Modified Fast: 0.45 lbs of body fat per day

Notes

Protein Sparing Modified Fast (PSMF) Dietary Macros (per day)

It is very important on the PSMF that you eat at least the macros listed here. If you go below these numbers you risk lowering your metabolism and you actually can’t lose body fat any faster. Attempting to be just above the numbers is OK.

Protein: 119.2 g (476.8 cals)
Carbs: 20 g (80 cals)
Fat: 40.9 g (367.7 cals)
Your total Dietary Calories are 924.4 cals for maximum fat loss.

If you consume 216 g (1943 calories) of fat you will stay at your current weight.At your goal weight you will be able to consume 119.2 grams of Protein, 20 grams of Carbs, and 176.3 grams of Fat.

Notes

Can You Fast?

One important question to ask when considering extended fasting is whether or not you have sufficient body fat to fast.

You currently use 2500 cal/day. You have 1575 calories per day available from your body fat for maintenance. You have less calories available from body fat than your daily requirements and may not be able to fast. If you fast, your body may drop your base metabolism, energy expenditures or may consume protein stores. You will be -924 calories short per day

The thermic effect of food contributes somewhere from 5-20% of your current TDEE number so if you are fasting that can reduce your TDEE. Reducing your TDEE by 10% would result in you using 2250 calories per day. Calculating in a 10% Thermic Effect of food still leaves you in a caloric deficit during fasting. The Protein Sparing Modified fast solves this issue by providing the calories needed for the deficit.

How Much Muscle Can You Gain?

The Maximum Lean Body Mass that you can carry on your frame is 186.5 lbs at your goal of: 15.0% Body Fat. That would be a weight of 214.5 lbs.

Disclaimer

Use this information at your own risk and with the advice of your medical professional. We are not doctors nor do we pretend to be one on the Internet. We do not take responsibility for errors in these calculations. We do not guarantee that these numbers will work for people at the extremes of the ranges. If you discover an error in calculation, please let us know through email: keto at land-boards dot com.

Body Recomposition – Part 2

Goals

Proposing to do a test on myself with the following goals:

  1. Improve HbA1C number (HbA1C is a lab test which shows the Blood Sugar over the previous three months)
    July 2017: 5.8 (Low end of Pre-Diabetic level)
    Goal: < 5.6 (Below bottom of Pre-Diabetic levels)
  2. Lose weight to reach 15% Body Fat (Visualize Body Fat percentages)
  3. Barring any injury, be able to do exercise throughout entire test (CrossFit)
    Submaximally is OK (<85% of max level)
  4. Conserve current LBM (Lose Weight but not muscle)
    Possibly add LBM?
  5. Maintain current metabolic levels.
    The same thing as saying not to eat at a net calorie deficit.

Methodology

The means to this end is a form of the Protein Sparing Modified Fast:

A protein-sparing modified fast (PSMF) is a very low calorie diet with some protein, fluids, and vitamin and mineral supplementation.

I don’t plan on doing this using very-low-calories but with an adequate level of calories to not lower my metabolism. The source of calories will come from both body fat and from macro-nutrients consumed.

See also Very-low-carbohydrate diets and preservation of muscle mass.

The Math

Some math is required. Some of this is constants (values which don’t change) and some of it is variables (numbers which you can play with). Part of the variables relate to weights and measurements. Some of the variables change day to day.

Constants and Variables

  • Current Weight (CW) = what the scale told you that you weigh this morning (using lbs for this discussion). My Current Body Weight at the start of this exercise is 205 lbs. This number should decrease over the course of this test or something is really wrong.
  • Lean Body Mass (LBM) = The amount of non-fat in your body. This includes muscle, connective tissues, and everything that is not fat in your body. Without any other value, the US Navy Calculator gives a good estimation of your current LBM. Better values can be found by BodPod or DEXA scans. My LBM is 156 lbs.
  • Pounds of fat is your current weight minus your LBM.  For me, I have 49 lbs of fat left. I can’t lose all of that, but that’s what I have left.
  • Basal Metabolic Rate – The number of calories you burn (per hour) doing nothing. Here’s one on-line calculator for your basal metabolic rate. I am using 11 calories/lb/day for my exercise rest days and 12 calories/lb/day for my exercise days. Better values of your Resting Metabolic Rate can be found by BodPod or DEXA scans.
  • Percent Body Fat – A goal. Use Visualize Body Fat percentages to select your goal number. My own goal is 15% body fat. No point in going any lower.
  • Fat oxidation rate – 31 cal/lb/day (SS, Alpert.A limit on the energy transfer rate from the human fat store in hypophagia. J Theor Biol. 233 (1): 1–13). You can only lose 31 calories worth of fat per lb of your body fat weigh in one day. Since I currently have 49 lbs of fat, I can lose 49 times 31 calories of fat per day or 1519 calories from body fat the first day. This number decreases as you lose weight. (Checking the numbers/units, the article states 290 kJ/kg-day, which is 69.26 kCal/kg-day. With 1 lb = 2.2 kg, that’s 31.5 kCal/lb per day).
  • Calories per pound of fat is 3500 calories/lb.

MacroNutrients to Achieve Goals

There are only three macronutrients in this world (other than alcohol). They are fat, protein, and carbohydrates. Selecting the right mix and amount of each of these three macronutrients is what any diet is about.

Low Carbohydrates

Of the three macronutrients, carbohydrates have the most effect on blood sugar and are the lest important macronutrient for function. It is necessary to stay at a low carbohydrate level to maintain a low blood sugar level.

I plan on sticking with the 20 grams of carbs per day limit. This number will not change over the course of this experiment. The source will continue to be green vegetables.

Protein for LBM preservation and Gainz

The Protein Sparing Modified Fast provides enough protein to maintain LBM and a little extra protein to cover muscle building. Dr Fung has a lower value for this number than most of the other sources (0.61 g/kg/day). KetoGains has a number of 0.8 g/lb/day of LBM.

For my LBM of 156 lbs, that’s 124.8 grams of protein per day. This number will not change over the course of this experiment since I want to maintain my LBM. I don’t want this number to be higher because it will lead to GNG or lower because it will lead to LBM loss.

Fat Level

When I have done long fasts, the lack of fat during the fast put me at a metabolic deficit. I could see this was true from my body temperature which was cold. I had enough energy to walk and function but was quickly tired by any exercise.

What gets left over after carbs and fat are determined is the amount of fat. Rather than High Fat or Moderate Fat of the typical LCHF/Keto diet, dietary fat is only used to make up the difference between the fat oxidation rate and the number of calories needed to not drop the base metabolic rate.

On day 1, that is only 17 grams of fat – about 1/2T of butter a day. That is quite a bit lower than I am currently doing but that’s probably why I am not losing weight. If I go over this number it will decrease my daily deficit and I will lose weight slower.

Intermittent Fasting

In the short term, I plan to do this experiment by continuing to feed one time per day. This is convenient and helps me keep my Insulin levels as long as possible. I may experiment with the timing of this one meal or may split it into a pre and post workout meal.

Testing the Results

Any good experiment requires some evaluation criteria against the goals. For this experiment I will:

Proposing to do a test on myself with the following goals:

Goal: Improve HbA1C number

Measurement: Get test done of HbA1C on Jan 1 for  < 5.6. Surrogate will be 90-day average blood sugar of 110 or less.

Goal: Reach 15% Body Fat

Measurement:  Use Visualize Body Fat percentages to check body fat percentage. Get third party to check from the pictures. Alternately use BodPod or DEXA scan test.

Goal: Be able to do exercise throughout transition

Measurement: Stick with current CrossFit with minimum average attendance record of 3 days per week. Stretch goal of 4 days per week (only open 5 days per week). Submaximal performance is OK although I would like to be able to complete at least 50% of timed WODs in the allowed times.

Goal: Maintain current LBM

Measurement: Same as Body Fat % Goal.

Goal: Maintain current metabolic levels.

Will know if this works if end weight is maintainable.

Best thing is this all could be done by Christmas!

Tapped Out at 25 Days

I made it 25 days on my Water Only Fast. Ended yesterday. I miss fasting already. Felt better while fasting than I do on food. Ended with Chia Seeds and a pickle. The Chia Seeds act like a slowly moving cork through the system which is good after a long fast.

Thinking about doing Chia Seeds once a day on my next fast. Won’t technically be a water fast, but I like the idea of keeping some fiber moving through my system. I am just a few lbs over my goal weight so I am not in all that much of a hurry.

Weight loss was 24 lbs. Should hang onto a lot of it since I really kept up on salt.

Can’t wait to do my next Extended Fast. Maybe after the Keto meetup this weekend.

Tomorrow is my third intro class to CrossFit then I can join the regular people in torturing myself. I know that this will be much harder than Keto and Intermittent Fasting. And I will definitely keep up the Intermittent Fasting and Keto. Never going to give up the gains I have made with Keto + IF.

Preliminary Thoughts on Exercise

My Original Goal

At the start of this experience my goal was to Hack My Type Two Diabetes. Per my MD, I am no longer a diabetic and am just at the bottom end of the Pre-Diabetes range. So mission accomplished???

Are We There Yet?

My initial observation was that Diabetes is just a symptom of the underlying condition which is Insulin Resistance. Eating Low Carb. Moderate Protein and High Healthy Fats reduces the need for the body to produce Insulin but does it cure Insulin Resistance itself?

What is Insulin Resistance?

Insulin Resistance is the inability of the body’s cells to take in glucose in the presence of Insulin. From Skeletal Muscle Insulin Resistance Is the Primary Defect in Type 2 Diabetes.

Under euglycemic hyperinsulinemic conditions, ∼80% of glucose uptake occurs in skeletal muscle

If your muscles are not able to efficiently take up glucose then you have Insulin Resistance. It may be that exercise is the only way to improve glucose uptake in the muscles.

Types of Exercise

When it comes to improving Insulin Resistance, I think there may be a difference between the sorts of exercise, ie, aerobic and anaerobic exercise. Repeatedly dumping all of the glucose out of the cells is part of what is needed to increase insulin sensitivity. That seems like where High Intensity exercise comes into play. Things like rapid reps of high weights vs walking on a treadmill.

My Experience with Exercise

This would bear out with my own experience of the quick dump of glucose that I experienced in the high intensity workout. My glucose went up at least 80 points which I now think is due to Insulin Resistance. Not only is the liver dumping in that case but the muscles are dumping too. And that’s a good thing.

So perhaps if I got this right it’s more about the type of exercise when attempting to improve the underlying Insulin Resistance than it is about the exercise itself. Is it true to say the reason my blood sugar rises so high with high intensity exercise is that my muscle cells are still Insulin Resistant and that with more exercise they will get better at responding to the Insulin they are given and then I will not see high blood sugar spikes during and immediately after exercise?

If I have this right I should easy be able to measure and observe progress by checking my blood sugars after exercise to exhaustion and the levels should drop.

Here’s a pretty good article on the subject.

So why LCHF and Fasting?

Using LCHF + Fasting has helped me get to a weight where my pulse rate is lower, the stress on my joints is lower, my BP is lower and I am now at the point where I can safely exercise. Surely my Insulin Resistance is somewhat better but the only real way to attack it that is left is with high intensity exercise.

Thought about Longer Extended Fasting

I’ve put together some thoughts on Extended Fasting. In particular, I am interested in the subject related to Angus Barbieri. Here are my thoughts:

  1. Support helps. Angus’ doctors originally intended for his fast to be a relatively short one but when Angus decided he wanted to fast longer they agreed to monitor his fast. Since few modern doctors would support such a fast there are other supports such as Facebook groups on Fasting.
  2. Fasting until you reach your goal weight was a much more accepted practice back then. They didn’t feel that shorter fasts had as much long term effectivity as fasting until goal weight. That mindset allowed the doctors to support Angus’ fast.
  3. Fasting is easier than even LCHF. No obsessing about macros, too much protein, etc. It is absolutely free. It requires no meal preparation or planning. There is no shopping time.
  4. Sometimes we self limit in Extended Fasting. We could go longer but we set our minds to fasting for a particular time length.
  5. Having a realistic goal weight is important. Angus stopped at 180 lbs which is the chart value for the upper end of normal weight range. This can guard against judging by the mirror and the charge of anorexia (although that is a totally different issue of body image dysphoria).
  6. It helps a lot if you are already fat adapted. The transition to fasted state can be tough but it’s easier the more times you have fasted. Day three seems to be the hardest day for many people.
  7. Social engagements are a major reason for ending fasts early. We often have an event to go to with friends or family which gets in the way of an Extended Fast. A helpful white lie is “No, thanks. I already ate.” It is true though. If you are fasting you are consuming your own body fat so you are actually eating really well. Saying no to children, parents and friends only invites questions so be prepared ahead of time for what you are going to say. Or cancel the engagement altogether.
  8. Fear of refeeding syndrome can derail a longer fast. Picture the German concentration camps after WW II. The American soldiers came in and fed the starving people and many died from overeating. But there are many significant differences between us and those poor souls. They had no body fat left. They were truly starving. Their organs were in very bad shape. One of the prisoners who was liberated by the Russian troops said that they were better off being freed by the Russians than by the Allied troops since the Russians didn’t feed them.
  9. Another thing which derails us is we feel ill at some point and the standard fasting advise is to stop when your body tells you to stop. But how do we differentiate our body telling us to stop and dehydration? Eating a lot of salt can help with that. I put Morton’s Lite Salt in my coffee because it is half Sodium and half Potassium. Angus was given Potassium and Sodium supplements at different times in his medically supervised fast.
  10. Another common reason is the advise that people give to cover their own backsides of “Make sure you do this fast under medical supervision.” Judge for yourself the soundness of this advice. I followed their advice and ended up on 100 units of Insulin a day. Medical doctors know very little about this subject. Research for yourself by visiting scholar.google.com. You can search for anything there. Angus’ own story is up there in a scientific paper.
  11. Daily life, cooking for others can derail. TV has constant commercials for food. People eat food at work at their desks and you are assaulted by the smells. I have a friend who is on keto and his food really bothers me because it is so attractive. They buy a cake at work to celebrate a good goal being met. You can’t have that reward. I especially feel sympathy for moms and dads who cook for their kids all the time.
  12. High expectations of rapid losses. You hear stories of how people lose 25 lbs with 10 days of fasting. How long have they been at this? Angus lost 3/4 of a lb on average a day and he started at over 450 lbs so much of his weight was when he was heavier. Expect to lose anywhere between a quarter pound a day and a half lb a day. The longer you fast the less the drop will be. There might be days that the scale doesn’t show any loss or maybe even a gain. I put on 6 lbs after I drank a half jar of leftover juice from olives.
  13. Looking at the Blood Glucose meter can instill fear. I saw a blood sugar number in the 50’s. Angus had blood sugar as low as 17 at least one day with no symptoms of hypoglycemia. The brain switches over to be fueled by ketones. Angus was mostly in the 30’s. That would put any diabetic in the hospital. If you are ketone fired this is no issue but if your regular blood sugar is high then going low may make you feel ill. That makes me think that many people who try fasting are not yet fat adapted and the blood sugar drop is a problem for them. If you don’t have one, blood sugar meters are cheap. This is probably one of the things that surprised Angus’ doctors the most. They had not experienced patients with such low Blood Sugar numbers before who were functioning fine.
  14. Stopping because of the clock. Having an open ended fast may produce a longer fast. I knew that because when I got to ten days the last four fasts I didn’t want to stop but I only wanted to fast to ten days.
  15. You will get acidosis. That is what my own MD told me. Yes, your body becomes more acidic when fueled by ketones. Dr Berg says that’s the problem – we are too alkaline. That’s why Apple Cider Vinegar is effective it lowers your pH value. Ti answer the object, Ketoacidosis is when your ketones are high and your blood sugar is high. That is not the problem during long fasts where your blood sugar is very low. If you are concerned monitor your blood sugar. Ketoacidosis can be an issue when refeeding after fasting if you eat a lot of carbs.
  16. I will be fuzzy headed. I don’t have that experience in general. There are moments where I feel that. The research also indicates that ketones don’t mess up mental functioning.
  17. But, Angus was only 52 when he died. Well he died 24 years after the fast so it’s pretty unlikely that the fast killed him. We don’t yet have a death certificate for Angus and we don’t know what his diet was like after the fast. We also don’t know what damage was done to his body for the years he was heavy. His whole family was heavy per his friend. Angus did marry and had two children so obviously he had a quality of life.
  18. Competition can be a motivator. Fasting with someone else can be great but expect them to wash out early if they are not experienced fasters. Or they may go much longer if they are more experienced.
  19. The first rule of fasting is don’t tell anyone about your fast. Same as Fight Club. Others will discourage you and try to scare you. I had a VP come and talk to me after one of his people told him I was fasting. I don’t tell too many people what I am doing.

Longest Fast Yet

I am currently on an Extended Fast (EF). An EF is where you only drink non-caloric drinks (coffee, water). I am on day 17 of the EF. This time I am doing it without any coconut oil in my coffee. I was using coconut oil (not a large amount, just a bit) in my coffee but I wanted to see if there was any difference without it. There wasn’t.

I am doing this as an Open Ended Fast with no end date in particular. I am attracted to the story of Angus Barbieri. He lost 382 lbs on an EF and holds the Guiness Book of Records for longest medically supervised fast. I started a Facebook page called the Angus Barbieri Fan Group where you can read is story and find links to the scientific journal which published the account of his fast.

I was honored to be able to speak to a friend of Angus recently. He was a boyhood friend of Angus and knew him at the time of his extended fast. He spoke very highly of Angus’ character and positive attitude. I asked him if Angus ever complained while he was on the long fast and his friend told me that he was the sort of chap who didn’t complain. He was basically a happy man.

How did he do it?

Angus had a whole lot of extra body fat. While you are fasting you basically consume your own body fat and that is what Angus did. He was able to eat [himself] quite well during that extended fast. He lost an average of .75 lbs a day which makes sense. He would have lost a lot more when he was over 400 lbs than when he was near his final weight of 180 lbs. Angus stayed near his end weight and didn’t get over 195 for the rest of his life.

Can Someone Else do it?

Well, unless you weigh 450 lbs or more at the start of your fast, there’s no way you can do that long without really hurting yourself or dying. There is a limit to the end of the body’s stores of fat. Angus, at 185, would have been at the high end of normal weight so he was still not in the danger zone of tearing into his body protein. That’s somewhere less than 10% body fat.

But, yes, I believe anyone who has sufficient body weight should be able to duplicate Angus’ feat of fasting until they reach their goal weight. I have lost 16 lbs in the last 16 days but some of those lbs are an illusion. I have been eating a lot of salt to reduce the water loss because that will all return after the fast ends. It doesn’t matter how much you lose during a fast. It matters how much you keep off.

I have eliminated all but my Blood Pressure meds from my life but when I am fasting I don’t take the BP meds. My doctor advised against that but if I take them I get lightheaded when standing. Keeping up the salt also helps to not get lightheaded. I see so many people who stop EF that will list their symptoms and they are all related to hydration. They probably could have gone on.

We’ll see what comes of this.

 

Navigating the Maze of Facebook Keto Groups

I really want to make some sort of map or list of questions that shows the groups and their “pet peeves”. The sorts of things include:

  1. Is taking Insulin good? Bernstein people say yes because their goal is lowest blood sugars. Keto people say no because they believe that more Insulin is more Insulin Resistance which is the root cause.
  2. Protein macros. Ketogains folks believe in 2-3 times the protein of most other keto groups. Other keto groups focus on the Insulin response of the body to protein. Too much protein although it doesn’t immediately raise the blood sugar does have a significant Insulin response so they keep it low. (Fung vs Finney/Volek).
  3. Exercise or not? Many keto groups say don’t exercise and point to the studies which show that diet plus exercise doesn’t lose any more weight than diet alone. Other groups are all about exercise and point to their physiques as evidence (and some are spectacular). They argue it is more about fitness than weight.
  4. Fasting. Most keto groups are starting to catch onto fasting. Some are not.
  5. What constitutes fasting? One group has a very, very specific list of things that you can consume while fasting and specifically excludes things like dry fasting.
  6. I think for the most part that the keto community agrees with the 20 grams or less of carbs a day but there may be differences with subtracting fiber when calculating. Certainly some have flexibility when it comes to additional vegetables.
  7. Artificial sweetners. Again various opinions on their positive and negative values.
    There are probably a lot more dimensions to this but those are the ones that come to mind.The best piece of advise I can give anyone is to read the pinned post when you join a Keto Facebook group. Most groups will ask you to do that and if you don’t agree with the pinned post don’t make it your personal mission to convert the group to your point of view. Just leave the group.