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.

 

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.

Body Recomposition – Part 6

The Chart of Hopes and Dreams

Here’s the chart of theoretical progress.

Day Weight LBM lbs Fat Cals Needed Cals from Body Fat Calories from Food Wt loss Fat(g) Carb(g) Protein(g) Cal(Fat) Cal(carb) Cal(Prot) Exercise Met Rate
0 202.8 156.0 46.8 2230.8 1450.8 780.0 0.4 22.3 20.0 124.8 200.8 80.0 499.2 N 11
1 202.4 156.0 46.4 2428.6 1438.0 990.7 0.4 45.7 20.0 124.8 411.5 80.0 499.2 Y 12
2 202.0 156.0 46.0 2423.7 1425.2 998.5 0.4 46.6 20.0 124.8 419.3 80.0 499.2 Y 12
3 201.6 156.0 45.6 2217.2 1412.6 804.7 0.4 25.1 20.0 124.8 225.5 80.0 499.2 N 11
4 201.2 156.0 45.2 2414.0 1400.1 1013.9 0.4 48.3 20.0 124.8 434.7 80.0 499.2 Y 12
5 200.8 156.0 44.8 2409.2 1387.7 1021.5 0.4 49.1 20.0 124.8 442.3 80.0 499.2 Y 12
6 200.4 156.0 44.4 2404.4 1375.4 1029.0 0.4 50.0 20.0 124.8 449.8 80.0 499.2 Y 12
7 200.0 156.0 44.0 2199.7 1363.2 836.5 0.4 28.6 20.0 124.8 257.3 80.0 499.2 N 11
8 199.6 156.0 43.6 2395.0 1351.1 1043.9 0.4 51.6 20.0 124.8 464.7 80.0 499.2 Y 12
9 199.2 156.0 43.2 2390.4 1339.2 1051.2 0.4 52.4 20.0 124.8 472.0 80.0 499.2 Y 12
10 198.8 156.0 42.8 2187.0 1327.3 859.7 0.4 31.2 20.0 124.8 280.5 80.0 499.2 N 11
11 198.4 156.0 42.4 2381.2 1315.5 1065.7 0.4 54.1 20.0 124.8 486.5 80.0 499.2 Y 12
12 198.1 156.0 42.1 2376.7 1303.9 1072.8 0.4 54.8 20.0 124.8 493.6 80.0 499.2 Y 12
13 197.7 156.0 41.7 2372.3 1292.3 1079.9 0.4 55.6 20.0 124.8 500.7 80.0 499.2 Y 12
14 197.3 156.0 41.3 2170.5 1280.9 889.6 0.4 34.5 20.0 124.8 310.4 80.0 499.2 N 11
15 197.0 156.0 41.0 2363.4 1269.6 1093.9 0.4 57.2 20.0 124.8 514.7 80.0 499.2 Y 12
16 196.6 156.0 40.6 2359.1 1258.3 1100.8 0.4 58.0 20.0 124.8 521.6 80.0 499.2 Y 12
17 196.2 156.0 40.2 2158.5 1247.2 911.4 0.4 36.9 20.0 124.8 332.2 80.0 499.2 N 11
18 195.9 156.0 39.9 2350.5 1236.1 1114.4 0.4 59.5 20.0 124.8 535.2 80.0 499.2 Y 12
19 195.5 156.0 39.5 2346.3 1225.2 1121.1 0.4 60.2 20.0 124.8 541.9 80.0 499.2 Y 12
20 195.2 156.0 39.2 2342.1 1214.3 1127.7 0.3 60.9 20.0 124.8 548.5 80.0 499.2 Y 12
21 194.8 156.0 38.8 2143.1 1203.6 939.5 0.3 40.0 20.0 124.8 360.3 80.0 499.2 N 11
22 194.5 156.0 38.5 2333.8 1192.9 1140.9 0.3 62.4 20.0 124.8 561.7 80.0 499.2 Y 12
23 194.1 156.0 38.1 2329.7 1182.3 1147.3 0.3 63.1 20.0 124.8 568.1 80.0 499.2 Y 12
24 193.8 156.0 37.8 2131.8 1171.9 960.0 0.3 42.3 20.0 124.8 380.8 80.0 499.2 N 11
25 193.5 156.0 37.5 2321.6 1161.5 1160.1 0.3 64.5 20.0 124.8 580.9 80.0 499.2 Y 12
26 193.1 156.0 37.1 2317.6 1151.2 1166.4 0.3 65.2 20.0 124.8 587.2 80.0 499.2 Y 12
27 192.8 156.0 36.8 2313.7 1141.0 1172.7 0.3 65.9 20.0 124.8 593.5 80.0 499.2 Y 12
28 192.5 156.0 36.5 2117.3 1130.9 986.4 0.3 45.2 20.0 124.8 407.2 80.0 499.2 N 11
29 192.2 156.0 36.2 2305.9 1120.9 1185.0 0.3 67.3 20.0 124.8 605.8 80.0 499.2 Y 12
30 191.8 156.0 35.8 2302.0 1111.0 1191.1 0.3 68.0 20.0 124.8 611.9 80.0 499.2 Y 12
31 191.5 156.0 35.5 2106.7 1101.1 1005.6 0.3 47.4 20.0 124.8 426.4 80.0 499.2 N 11
32 191.2 156.0 35.2 2294.5 1091.4 1203.1 0.3 69.3 20.0 124.8 623.9 80.0 499.2 Y 12
33 190.9 156.0 34.9 2290.7 1081.7 1209.0 0.3 70.0 20.0 124.8 629.8 80.0 499.2 Y 12
34 190.6 156.0 34.6 2287.0 1072.1 1214.9 0.3 70.6 20.0 124.8 635.7 80.0 499.2 Y 12
35 190.3 156.0 34.3 2093.1 1062.6 1030.4 0.3 50.1 20.0 124.8 451.2 80.0 499.2 N 11
36 190.0 156.0 34.0 2279.7 1053.2 1226.5 0.3 71.9 20.0 124.8 647.3 80.0 499.2 Y 12
37 189.7 156.0 33.7 2276.1 1043.9 1232.2 0.3 72.6 20.0 124.8 653.0 80.0 499.2 Y 12
38 189.4 156.0 33.4 2083.1 1034.6 1048.5 0.3 52.1 20.0 124.8 469.3 80.0 499.2 N 11
39 189.1 156.0 33.1 2269.0 1025.5 1243.5 0.3 73.8 20.0 124.8 664.3 80.0 499.2 Y 12
40 188.8 156.0 32.8 2265.4 1016.4 1249.1 0.3 74.4 20.0 124.8 669.9 80.0 499.2 Y 12
41 188.5 156.0 32.5 2262.0 1007.4 1254.6 0.3 75.0 20.0 124.8 675.4 80.0 499.2 Y 12
42 188.2 156.0 32.2 2070.3 998.5 1071.8 0.3 54.7 20.0 124.8 492.6 80.0 499.2 N 11
43 187.9 156.0 31.9 2255.1 989.6 1265.5 0.3 76.3 20.0 124.8 686.3 80.0 499.2 Y 12
44 187.6 156.0 31.6 2251.7 980.9 1270.8 0.3 76.8 20.0 124.8 691.6 80.0 499.2 Y 12
45 187.4 156.0 31.4 2061.0 972.2 1088.8 0.3 56.6 20.0 124.8 509.6 80.0 499.2 N 11
46 187.1 156.0 31.1 2245.0 963.6 1281.4 0.3 78.0 20.0 124.8 702.2 80.0 499.2 Y 12
47 186.8 156.0 30.8 2241.7 955.0 1286.7 0.3 78.6 20.0 124.8 707.5 80.0 499.2 Y 12
48 186.5 156.0 30.5 2238.4 946.6 1291.9 0.3 79.2 20.0 124.8 712.7 80.0 499.2 Y 12
49 186.3 156.0 30.3 2048.9 938.2 1110.7 0.3 59.1 20.0 124.8 531.5 80.0 499.2 N 11
50 186.0 156.0 30.0 2231.9 929.9 1302.1 0.3 80.3 20.0 124.8 722.9 80.0 499.2 Y 12
51 185.7 156.0 29.7 2228.8 921.6 1307.1 0.3 80.9 20.0 124.8 727.9 80.0 499.2 Y 12
52 185.5 156.0 29.5 2040.1 913.5 1126.7 0.3 60.8 20.0 124.8 547.5 80.0 499.2 N 11
53 185.2 156.0 29.2 2222.5 905.4 1317.1 0.3 82.0 20.0 124.8 737.9 80.0 499.2 Y 12
54 184.9 156.0 28.9 2219.4 897.4 1322.0 0.3 82.5 20.0 124.8 742.8 80.0 499.2 Y 12
55 184.7 156.0 28.7 2216.3 889.4 1326.9 0.3 83.1 20.0 124.8 747.7 80.0 499.2 Y 12
56 184.4 156.0 28.4 2028.8 881.5 1147.3 0.3 63.1 20.0 124.8 568.1 80.0 499.2 N 11
57 184.2 156.0 28.2 2210.2 873.7 1336.5 0.2 84.1 20.0 124.8 757.3 80.0 499.2 Y 12
58 183.9 156.0 27.9 2207.2 866.0 1341.2 0.2 84.7 20.0 124.8 762.0 80.0 499.2 Y 12
59 183.7 156.0 27.7 2020.6 858.3 1162.2 0.2 64.8 20.0 124.8 583.0 80.0 499.2 N 11
60 183.4 156.0 27.4 2201.3 850.7 1350.6 0.2 85.7 20.0 124.8 771.4 80.0 499.2 Y 12
61 183.2 156.0 27.2 2198.4 843.2 1355.2 0.2 86.2 20.0 124.8 776.0 80.0 499.2 Y 12
62 183.0 156.0 27.0 2195.5 835.7 1359.8 0.2 86.7 20.0 124.8 780.6 80.0 499.2 Y 12
63 182.7 156.0 26.7 2009.9 828.3 1181.6 0.2 66.9 20.0 124.8 602.4 80.0 499.2 N 11
64 182.5 156.0 26.5 2189.8 821.0 1368.8 0.2 87.7 20.0 124.8 789.6 80.0 499.2 Y 12
65 182.2 156.0 26.2 2187.0 813.7 1373.3 0.2 88.2 20.0 124.8 794.1 80.0 499.2 Y 12
66 182.0 156.0 26.0 2002.2 806.5 1195.7 0.2 68.5 20.0 124.8 616.5 80.0 499.2 N 11
67 181.8 156.0 25.8 2181.4 799.3 1382.1 0.2 89.2 20.0 124.8 802.9 80.0 499.2 Y 12
68 181.6 156.0 25.6 2178.7 792.3 1386.4 0.2 89.7 20.0 124.8 807.2 80.0 499.2 Y 12
69 181.3 156.0 25.3 2176.0 785.3 1390.7 0.2 90.2 20.0 124.8 811.5 80.0 499.2 Y 12
70 181.1 156.0 25.1 1992.2 778.3 1213.9 0.2 70.5 20.0 124.8 634.7 80.0 499.2 N 11
71 180.9 156.0 24.9 2170.6 771.4 1399.2 0.2 91.1 20.0 124.8 820.0 80.0 499.2 Y 12
72 180.7 156.0 24.7 2168.0 764.6 1403.4 0.2 91.6 20.0 124.8 824.2 80.0 499.2 Y 12
73 180.4 156.0 24.4 1984.9 757.8 1227.1 0.2 72.0 20.0 124.8 647.9 80.0 499.2 N 11
74 180.2 156.0 24.2 2162.7 751.1 1411.7 0.2 92.5 20.0 124.8 832.5 80.0 499.2 Y 12
75 180.0 156.0 24.0 2160.2 744.4 1415.7 0.2 92.9 20.0 124.8 836.5 80.0 499.2 Y 12
76 179.8 156.0 23.8 2157.6 737.8 1419.8 0.2 93.4 20.0 124.8 840.6 80.0 499.2 Y 12
77 179.6 156.0 23.6 1975.5 731.3 1244.2 0.2 73.9 20.0 124.8 665.0 80.0 499.2 N 11
78 179.4 156.0 23.4 2152.6 724.8 1427.8 0.2 94.3 20.0 124.8 848.6 80.0 499.2 Y 12
79 179.2 156.0 23.2 2150.1 718.4 1431.7 0.2 94.7 20.0 124.8 852.5 80.0 499.2 Y 12
80 179.0 156.0 23.0 1968.7 712.0 1256.6 0.2 75.3 20.0 124.8 677.4 80.0 499.2 N 11
81 178.8 156.0 22.8 2145.2 705.7 1439.5 0.2 95.6 20.0 124.8 860.3 80.0 499.2 Y 12
82 178.6 156.0 22.6 2142.8 699.5 1443.3 0.2 96.0 20.0 124.8 864.1 80.0 499.2 Y 12
83 178.4 156.0 22.4 2140.4 693.3 1447.1 0.2 96.4 20.0 124.8 867.9 80.0 499.2 Y 12

Source of elements

There is only one thing that changes throughout this methodology – the amount of fat eaten per day. And it goes up dramatically over the time of the diet.

  • Day: Incrementing count of days starting at 0
  • Weight: Starting from the scale but this is the calculated weight based on best case drops
  • LBM: Lean Body Mass. Original Source of Data was the Navy LBM Calculator
  • Lbs Fat: Weight minus LBM
  • Calories Needed: BMR times the current Weight
  • Calories from Body Fat: 31 times the Lbs Fat
  • Calories from Food: Calories needed minus Calories from Body Fat
  • Wt Loss: Calories from Body Fat divided by 3500 (number of calories in a lb of fat)
  • Fat(g): Come back to this at the end, it’s the only variable left
  • Carb(g): Fixed at 20 (Max per day)
  • Protein(g): 0.8 times LBM – This could be higher or lower depending on LBM preservation/gainz goals
  • Cal(Fat): Come back to this at the end.
  • Cal(Carb): 4 times Carb(g) = 80 (Max)
  • Cal(Protein): 4 times Protein(g)
  • Exercise: Select between two different metabolic rates
  • Met Rate: Higher rate on exercise day, lower on recovery day

Calculating the fat per day

All that is left to do is calculate the fat consumption per day.

  • Calories from Fat = Total Calories from food minus (Calories from Fat plus Calories from Protein).
  • Fat(g) is Calories from Fat divided by 9

 

Chia Seeds

I referred to Chia Seeds in another BLOG post as part of my refeeding strategy for ending extended fasts.

Chia Seeds are one of those SuperFoods which should be a part of our diet. They provide a lot of fiber and very few calories. One ounce (about 2 tablespoons) contains 139 calories, 4 grams of protein, 9 grams fat, 12 grams carbohydrates and 11 grams of fiber, plus vitamins and minerals.

For Low Carb folks the 12 grams of carbohydrates are before subtracting fiber so the net carbs are 1-2.

To use them I soak the seeds in water (1/4 cup seeds to 1 cup liquid) until they take on a chewy texture reminiscent of tapioca pudding, about 20 minutes. Soaked chia seeds can be refrigerated for up to 5 days, so you can make a big batch at the start of the week.

I eat them one day before ending a longer (more than 7 day) fast. I also eat them three hours before refeeding. I usually eat them with a dill pickle which acts as a Sodium bomb.

 

Electrolytes are not Optional During a Fast (KetoGains)

One things I have struggled with on extended fasts is getting the formula right for electrolytes. There’s a variety of advice on what to do about electrolytes during a long fast varying from next to nothing (the “tough it out” mentality) to very specific minimums.

KetoGains has the following recommendations for electrolytes:

That is probably the best listing I have found in one place of what to take and how much to take.

Franky I think I failed to go past 25 days in my last extended fast due to not keeping control of my electrolytes so I’ve got a particular interest in getting this right. I really haven’t paid much attention to electrolytes in the past. All I have done has been to add Morton Lite Salt to my coffee (a couple of shakes). Mortons Lite Salt is half Sodium Chloride and half Potassium Chloride.

The Nutrition Facts Label for Morton Lite Salt shows:

The problem with Morton Lite Salt is that it is intended to be used to replace regular table salt and the manufacturer adds Iodine. Each 1/4 tsp has 40% of the RDA for Iodine. Too much Iodine can be a bad thing. 3/4 tsp would exceed the daily RDA for Iodine and only provide 36% of the Sodium and 30% of the Potassium.  My conclusion is that the Morton Lite Salt is a good thing to add as a shake or two into coffee since it gets both Sodium and Potassium over a few hours or a day, but is insufficient for daily needs during extended fasting. So what to do for electrolytes during fasting?

Sodium

For Sodium, this can easily be solved by using either Sea Salt or Pink Himalayan Salt. These salts do not contain Iodine. Morton Fine Sea Salt costs $2.24 for a 17.6 oz (500g) container.

Here is the nutrition label for the Morton Sea Salt.

To meet the 5000 mg minimum listed on the Ketogains electrolyte slide would be 10 servings of 1/4 tsp. The cost per day is ($2.24 for 36 servings or 6c per day).

Sodium: Use 2-1/2 tsp of Morton Sea Salt

Potassium

Where should Potassium come from? The KetoGains Electrolyte slide shows Potassium from either Nu-Salt® or NoSalt.

Nu-Salt® contains 0.530 grams or 530 milligrams of Potassium per 1/6 tsp. (1 g) serving. So a tsp of Nu-Salt® would have 3180 mg of Potassium. A half tsp of Nu-Salt® would have 1590 mg of Potassium.

NoSalt is a similar product. It is available at WalMart for $5 for 11 ozs.

Here is the nutrition facts for NoSalt.

Presumably the .25 Serving size is 1/4 tsp? One tsp would be 2560 mg of potassium which is in the Ketogains range. That means that the container has about 60 days worth of NoSalt ($5.00/60 days is less than 10c per day).

Potassium: Use 1 tsp of NoSalt or NuSalt

Warning for Taking Dietary Postassium

Note some medications, such as ACE inhibitors for blood pressure interfere with Potassium. Read this warning. Consult your physician for specific information.

Magnesium

This is probably best done with a supplement.The Ketogains suggestion is to avoid Magnesium Oxide and use Magnesium Citrate instead. The Magnesium Citrate is available in smaller doses of 70 or 100 mg so more tablets are needed).

These are available from Walmart for $6 for a bottle of 100. Three capsules would get to the minimum 300 mg of the Ketogains numbers. That would be 18c per day.

Magnesium: Take 3 of 100 mg Magnesium Citrate tablets

Conclusions

  • Sodium: Use 2-1/2 tsp of Morton Sea Salt
  • Potassium: Use 1 tsp of NoSalt or NuSalt
  • Magnesium: Take 3 of 100 mg Magnesium Citrate tablets

These are numbers for fasting only. Less are required when eating since some of these come from food.

 

Biochemical Stages of Short and Long Fasts

Here’s a great paper on what happens during a short and a long fast.

The paper covers the daily feast/fast cycle of the regular American diet. It also covers what happens over a longer fast. One of the interesting charts relates to a longer fast:

The chart on the left is the Glucose level over a longer fast and the chart on the right is the Ketone Bodies chart. Per the charts the Blood Glucose falls faster than the Ketone Bodies can kick in. That could the reason that the third day of an extended fast is considered to be the toughest. This also explains why it is much easier to enter a fast being already in Ketosis because your Ketone levels are higher.

 

The Cori Cycle – Not a new kind of bicycle

I had an interesting response to intense exercise the other day. I was many days fasted and went to an introductory CrossFit class. I measured my blood sugar after I got home from the class and my blood sugar was around 80 points higher. Did some digging to try and find out why.

My first assumption was that the liver was dumping glycogen and that’s partly true. Turns out that the muscles store around 80% of our glycogen stores and the liver contains the rest. The muscles use the glycogen locally and they don’t dump glucose into the blood stream. All of the glucose does come from the liver which takes it out of stored glycogen. That would account for some of the rise. I usually see a ten point pop with some exercise like bike riding but not like that time. The CrossFit exercise was very hard compared to normal exercise.

Here’s where the the Cori Cycle comes into play. I was fasted during the exercise for more than 20 days. From the Wikipedia article:

The Cori cycle is a much more important source of substrate for gluconeogenesis than food. The contribution of Cori cycle lactate to overall glucose production increases with fasting duration. Specifically, after 12, 20, and 40 hours of fasting by human volunteers, the contribution of Cori cycle lactate to gluconeogenesis is 41%, 71%, and 92%, respectively.

This was a piece of data which I didn’t have before. This makes sense of the experience that I had with intense exercise. The muscles released a lot of lactate which at the end of the exercise gets converted in the liver through gluconeogenesis into glucose. Hence, the large pop in blood sugars.

Here is a great discussion of exercise and the Type 2 Diabetic with Dr Finney.

 

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.

Phases of an Extended Fast

From a Facebook group:

What happens to your body when you fast for 30 days.‬

‪Detoxification Stage 1 (Day 1 To Day 2)‬

‪On the first day of fasting, the blood sugar level drops. The heart slows and blood pressure is reduced. Glycogen is pulled from the muscle causing some weakness. The first wave of cleansing is usually the worst. Headaches, dizzinessnausea, bad breath, and a heavily coated tongue are signs of the first stage of cleansing. Hunger can be the most intense in this period.‬

‪Detoxification Stage 2 (Day 3 To Day 7)‬

‪Fats, composed of transformed fatty acids, are broken down to release glycerol from the glyceride molecules and are converted to glucose. The skin may become oily as rancid oils are purged from the body. People with problem-free skin may have a few days of pimples or even a boil. The body embraces the fast and the digestive system is able to take a much-needed rest, focusing all of its energies on cleansing and healing. White blood cell and immune system activity increases. You may feel pain in your lungs. The cleansing organs and the lungs are in the process of being repaired. The breath is still foul and the tongue coated. Within the intestine, the colon is being repaired and impacted feces on the intestinal wall start to loosen.‬

‪Detoxification Stage 3 (Day 8 to Day 15)‬

‪You will experience enhanced energy, clear-mindedness and feel better. On the downside, old injuries may become irritated and painful. This is a result of the body’s increased ability to heal during fasting. If you had broken your arm 10 years before, there is scar tissue around the break. At the time of the break, the body’s ability to heal was directly related to lifestyle. If you lived on a junk-food diet, the body’s natural healing ability was compromised. During fasting, the body’s healing process is at optimum efficiency.‬

‪As the body scours for dead or damaged tissue, the lymphocytes enter the older, damaged tissue secreting substances to dissolve the damaged cells. These substances irritate the nerves in the surrounding region and cause a reoccurrence of aches from previously injured areas that may have disappeared years earlier. The pain is good as the body is completing the healing process. The muscles may become tight and sore due to toxin irritation. The legs can be the worst affected, as toxins accumulate in the legs. Cankers are common in this stage due to the excessive bacteria in the mouth. Daily gargling with salt and water will prevent or heal cankers.‬

‪Detoxification Stage 4 (Day 16 to Day 30)‬

‪The body is completely adapted to the fasting process. There is more energy and clarity of mind. Cleansing periods can be short with many days of feeling good in between. There are days when the tongue is pink and the breath is fresh. The healing work of the organs is being completed. After the detoxification mechanisms have removed the causative agent or render it harmless, the body works at maximum capacity in tissue proliferation to replace damaged tissue. After day 20, the mind is affected. Heightened clarity and emotional balance are felt at this time. Memory and concentration improve.‬

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.