That’s the title of this video, which came up in Lisa’s YouTube related videos feed about a year ago.
It’s a gripping TEDMED talk from 2013 by Dr. Peter Attia, who confesses the judgmental attitude he had harbored six years earlier toward an obese patient who had come into the emergency department with foot ulcerations.
She obviously must have let herself go, he thought, consuming too many calories and not moving enough.
But then three years later he found himself 40 lbs. overweight and with metabolic syndrome, and he knew that physical inactivity was not the cause in his case: he had been “exercising three to four hours every day, and following the food pyramid to the letter.”
It led him to wonder whether, in the case of obesity, insulin resistance and type 2 diabetes, the medical community might have the chain of causation backwards.
Watch this video. It’s totally worth the 16 minutes.
I have found Dr. Attia one of the most thoughtful online voices when it comes to evaluating and making sense of dietary and lifestyle research related to both longevity and healthspan.
As he says in this video, perhaps he’s been humbled by what the thought he knew that turned out to be mistaken.
I expect I will have several more posts in this series that feature (or at least mention) Dr. Attia. His website is an amazing resource, and his podcast, The Drive, is the only one for which I pay for premium access.
Like Tim Ferriss, Dr. Attia also has introduced me to many other leading researchers and thoughtful analysts. Follow him on Twitter.
As I mentioned in this post, when I heard Art De Vany say he eats “two meals a day, sometimes one, sometimes none” I thought that was unfathomable.
But after reading The Obesity Code and The Complete Guide to Fasting, in which Dr. Jason Fung described his experience with his Intensive Dietary Management clinic and how he would get many patients with type 2 diabetes off insulin and diabetes medications within just a few weeks through extended fasting, Lisa and I were ready to give it a try.
Neither of us had even been diagnosed as prediabetic, but Lisa’s fasting blood sugar had been 102 in October 2016, which is what got us started on this dietary and lifestyle journey.
In The Obesity Code, Dr. Fung cited a study of 70 days of alternate daily fasting in which body weight was decreased by an average of 6%, while fat mass decreased by 11.4%, with no loss of lean mass. He also said
Studies of eating a single meal per day found significantly more fat loss, compared to eating three meals per day, despite the same caloric intake. Significantly, no evidence of muscle loss was found.
The Obesity Code, p. 243, Jason Fung, M.D.
It’s important to note that with alternate daily fasting, you’re still eating every day. Typically you eat dinner every evening, and skip breakfast and lunch every other day.
So on Sunday you would eat all three meals, but then on Monday skip breakfast and lunch, limiting yourself to water, black coffee or tea. Then repeat the cycle.
Two Three important additional points:
If you are taking insulin or medications for diabetes, you absolutely need to have medical supervision while fasting to prevent dangerous low blood sugar episodes.
If you’re eating lots of carbohydrates, you will be miserable on an all-day fast. It’s best to get at least somewhat converted to fat metabolism before starting fasting. Eggs, meat, avocados, nuts and other foods relatively high in fats and with moderate protein, combined with limiting carbs to 25-40g per day, will help convert your body to burning fat.
I’m not a doctor. I’m not giving medical advice. Check this out for yourself and make your own decision in consultation with medical professionals you trust.
One more tip: a good way to start is with time-restricted feeding, just skipping breakfast every day and eating lunch and dinner during a 6-8 hour window. This still gives you an extended period of lowered insulin levels, and isn’t quite as extreme as going 24 hours without food.
With all of those caveats, here are my weekly bluetooth scale readings from our 10 weeks of alternate daily fasting. I weighed every day, but for simplicity am just sharing the Wednesday morning readings.
With the caveat that the body fat and muscle percentages seem to be calculated by some voodoo electrical signals running through the soles of my feet, at least all of those readings were coming from the same scale.
So the bottom line is that I lost about a pound of fat per week while essentially preserving muscle mass. (The other 4 lbs. lost, according to the scale, were water weight .)
Note also that when we started the 10-week experiment I was already down 37 lbs. from Peak Lee, as demonstrated in my “before” pictures. So presumably I had already lost the “easy” weight.
And in keeping with the study cited by Dr. Fung, my body weight was reduced by 6.2%, while my body fat was reduced by 18.1%, during the 10-week period.
Have you tried intermittent fasting or time-restricted feeding?
The Obesity Code by Dr. Jason Fung came up among my recommended titles on Audible in May of 2018.
The name didn’t put me off, because the subtitle was compelling: “Unlocking the secrets of weight loss.”
And while by that time I had lost about 25 lbs. through the Trim Healthy Mama Plan and the Slow-Carb Diet, I figured this highly rated and recommended book would add to my knowledge.
Little did I know it would be among the most important books in my health journey.
Dr. Jason Fung is a nephrologist who became increasingly dissatisfied with his practice because he felt helpless to deal with the progressive kidney damage his patients were experiencing.
Many if not most of them had diabetes resulting from obesity, which led them to need increasing amounts of insulin, which led them to gain more weight, and the cycle would continue. Eventually, they would end up on dialysis or would have foot ulcers that required amputation.
In listening to this book, I felt an increasing sense of the despair he must have felt in his practice, because in the first several chapters he laid out the scope of the problem, describing both the epidemic of obesity and why so many diets fail.
Essentially our weight control mechanisms behave like a ratchet, at least in our current food environment. Once we gain weight and our bodies adapt to a new normal, they in effect establish a new “set point.”
If we then follow the “eat less, move more” advice as exemplified by The Biggest Loser, we may achieve some short-term success, but at a long-term price. With chronic caloric reduction, our metabolisms slow because our bodies sense starvation and the need to conserve energy.
Instead of a basal metabolic rate of, for example, 2,000 calories per day it may be reduced to 1,500.
Our body temperature is reduced, as is the stroke volume of our hearts. We end up cold, tired and hungry.
Then when we resume normal eating, we gain it all back (and more) because we still have the lowered metabolism.
Fung describes obesity as primarily a hormonal issue, and highlights those hormones that play the largest roles: leptin, grellin, cortisol and, above all, insulin.
He describes how the Atkins diet showed some success, but that it too tends to have problems with long-term compliance.
This dreary story continues for 18 chapters, until he summarizes as follows:
There are two primary findings from all of the dietary studies done over the years. First: All diets work. Second: All diets fail.
Dr. Fung then gives some helpful advice on the importance of eating whole foods and avoiding sugar and refined carbohydrates. But it isn’t until the final chapter, after nine hours of describing the futility of other approaches, that he provides the solution.
As I said, the title of this book is really unfortunate. I would love to have all of my friends read it, but the title makes it kind of awkward to recommend.
Tim Ferris introduced me to several interesting thinkers through his podcast, “The Tim Ferriss Show.” I’ve learned a lot from them, and they in turn have introduced me to others who have affected my approach to diet, exercise and wellness.
Art De Vany is one of the pioneers of the Paleo movement. He’s an economist, not a physician. And as Tim said, “he’s nearly 80 years old and ripped.”
Now he’s 82, and one of the things I appreciate about him is that he’s approaching the study of aging as a layman. “I only started studying it a few years ago. I figured I’m an expert because I’m experienced… When you’re coming up on 80, you start thinking about – when you approach middle age, you start thinking about these things.”
Beyond his characterization of 80 as approaching middle age, here are a few more snippets from Art in that conversation that caused me to stop and think.
I never have three meals a day. I sometimes have one. Sometimes none. Most times two. But you don’t have to cut calories. It’s just the timing.
I eat only twice a day. So I want long intervals between meals. I want low insulin signaling so that I bring on the defensive and repair pathways. I want to be conscious of maintaining my stem cells.
The leanest are the ones who engage in the most intense bursts. Little children don’t steady state exercise.
I work out almost every day. Maybe 10, 15 minutes.
Yeah, you can jog if you want to. If you want to kill some of your stem cells.
Having been one of those guys who jog, thinking it was good for my health and longevity, that last point was jarring. But given that Art has something like 8% body fat, and that he says his blood test results are at levels typical of men 30-40 years younger, I thought it was worth exploring further.
Somewhere else I recall him comparing the overall physical appearance of sprinters vs. marathoners and asking: “Which looks better to you?” The sprinters are bright-eyed, muscular and vigorous, while the marathoners look like they’re about to die.
So this interview was part of my journey toward high-intensity interval training (HIIT) as well as more weightlifting.
Having been on a regular three (or more) meals per day cadence, the first bullet point above about eating two meals most days, sometimes one, and sometimes none was unfathomable to me. It seemed crazy.
But on further reflection, it increasingly made sense. Our ancestors didn’t have constant access to food. When they succeeded in a hunt, they ate, and with no refrigeration available it meant they loaded up while they had access to food. And then they were hungry for a while.
While I didn’t realize it at the time, this was my introduction to the concept of intermittent fasting or time-restricted feeding.
This podcast episode is well worth your time. Art discusses some fascinating concepts from his work as an economics professor, and the importance of major events in our personal lives and in economics as opposed to incremental developments. By far the most impact – for good or bad – comes from a handful of events, and he says it’s essential to recognize and remain poised in those situations.
My post yesterday on why A Calorie is NOT a Calorie — and why “eat less, move more” is a simplistic and harmful slogan masquerading as scientific weight-loss advice — led to a delightful reconnection with someone I first met more than a decade ago.
My good friend Dave deBronkart’s comment on my LinkedIn post drew Dr. Ted Eytan into the discussion, and it was a great pleasure to renew our acquaintance.
I first met Dr. Eytan in 2009 when we were on a panel together at a conference in Baltimore (which was also the day I met Ed Bennett for the first time after having interacted for several months on Twitter).
I had heard Nina Teicholz on a podcast talking about the Dietary Guidelines Advisory Commission and her work with The Nutrition Coalition, so it was cool to find out that Dr. Eytan is working so closely with her. As described earlier in this series, her book — The Big Fat Surprise — started me on this journey of dietary discovery.
The Nutrition Coalition is urging public comment as the U.S. Dietary Guidelines Advisory Commission is developing its 2020 Guidelines. This process happens every five years, and it has a huge impact. It affects everything from hospital meals to school lunches to what physicians and dietitians recommend to patients.