Dr. Adam Nally rants against long fasting, Dr. Fung

(What The Fast?!) #21

If I’m going to do a single meal refeed and jump back into a long fast, then I will have some non-keto foods like fruit, because I find that I have a higher tolerance since I’m so deep in keto. I usually don’t drop out at all, but if I do, I fall right back in because of the new fast. However, if I’m going to eat for several meals or a couple days, then I stay strictly keto to maintain ketosis.

(betsy.rome) #22

Adding IF up to 48 hrs at a pop has upped my progress a lot, compared to straight keto.
The up side: Weight loss, energy, empowerment, lower blood sugar readings.
The down side: Now it’s possible to feel guilty about eating ANYTHING, just by eating.
Welcome to the dark side!

(What The Fast?!) #23

Saaaame. I’m trying to kick that feeling. We shouldn’t feel guilty for eating.

(Brian) #24

I did listen to most of his talk and I got the impression that when he was talking about a fast, he may have been suggesting some might define a true fast as abstaining from ALL food and ALL water, too, as in zero intake of any kind. I can see how that could be views as dangerous to continue even out as far as 24 hours for some people.

What I got from his talk is that there are are a lot of different definitions of fasting and that people tend to get themselves into trouble when they get their electrolytes out of balance and combine their fasting with certain medications and end up in the doctor’s office or the ER because they’ve messed themselves up.

He is appears to be a big advocate of listening to your body and eating when you’re hungry, not eating when you’re not hungry. I don’t know how long a person could go with not being hungry before he’d be concerned.

Overall, I appreciate his perspective. It’s a little different than some but I still appreciate his perspective.

#25

Yes, that is the gist of his concern, I agree. I got the end to play finally, and he mentioned something about 60 or 72 hour fasts, which is longer than most would consider to be intermittent.

I play Dr. Fung vs. Dr. Nally in my mind quite often, it is great to have these different perspectives, backgrounds and experiences offered up for our benefit. I really appreciate these men and what they do. I know they have a business angle too, but I’m fine with that, they are up front with what they offer and what they do for a living. “The laborer is worth his wage.”

#26

I don’t have time to listen to the podcast right now, but does he cite any science or studies to support his objections about people ignoring hunger signals? I get the electrolytes issue and think a lot of people in this forum are well aware of their importance.

#27

This is it, in a nutshell. Fasting, like anything you choose to do for or to your body, should be considered carefully. Educate yourself, make an informed decision and pay attention to what your body and your self-talk/common sense tell you about the chosen route you’re trying. Being honest with yourself and your reasons for fasting or keto, etc. is what is most important I suppose.

#28

I’ve been wondering how you were progressing with this functional medicine program. I love reading about your experiences and thoughtful musings on the different processes and how they may or may not affect your own health.
Interesting topic, so many of us have jumped right in, but I know that I have read and listened to a LOT in order to be safe with my fasting choice.

#29

His evidence is drawn from his clinical experience. He’s had people in the hospital with electrolyte issues, it sounds like. I don’t recall any evidence given for the hunger signals concern. I would argue that fasting helps restore satiety signaling (leptin signaling) - and my functional medicine doctor says the same.

#30

Hi Helewisa, so nice to see you here, and I know I’m past due for an update on my adventures in functional medicine and with Symlin. I have been very busy with my kids’ school (all 4 at home, online public school) plus I myself have signed up to go back to school… I realized I am very interested in helping people like myself, and that sometimes people like myself want someone with a degree or official documentation to help… long and short, I am starting a 3 year road to become a registered dietitian. “God willing and the creek don’t rise.” I will try to put together an update soon though! Summary: it’s going ok but nothing definitive yet, and I am really missing being able to jump on a fast when my sugar gets too high. :slight_smile:

(CharleyD) #31

Disclaimer: I haven’t heard the podcast in question so I’m writing this judging from context clues :innocent:

When I’m trying to suss out motivations for seemingly contrary positions from docs who you’d think would be friendly to the cause, I try to put myself in their shoes.

Like what if I had an MD, a practice, and knew everything we discuss here was factually true, but had to give interviews to a greater audience with a demographic breakdown much like the whole U.S. and not like the demos of the ketogenicforums.

From a liability perspective I may publicly say that IF or EF is not a great idea, knowing many people are on medication that works best or is safest while taken with food.

I will also assume that the people that end up in the ER for electrolyte imbalances are dismissing their specific electrolyte hunger signals, (not reliably taking salt, definitely not taking a broth or bullion) during the fast and I might make a judgment that a low-information type being swayed by reports that IF will cure this, that and the other, will jump in without doing due diligence.

And then in private, when confronted by a well-read patient wearing a ‘Show me the science’ t-shirt and a ream of studies, I would acquiesce and challenge them to pay close attention to their bodies and that IF isn’t a magic bullet and to end the fast as it can be started back whenever.

It was the doctor from north of the Artic Circle that wrote in on the 2KD podcast in defense of your GP that dampened my ire against my own. That email did so much to remind me to practice more empathy, and from there I’ve tried to see their positions from more angles.

#32

This news of becoming a registered dietician is great news! I have pondered the same, just not so sure that I want any more hefty school bills for higher learning. I agree that most would like someone with a degree, a certain level of professional accountability. Having more pros who are on board with Keto, fasting and etc would be a real plus. What a great choice! God bless, and best with all of the children, school and etc.

#33

I think they have a different patient base. Dr Fung (especially before his international popularity), was seeing patients whose diabetes was advanced enough to cause sufficient damage to their kidneys that it warranted referral to a Nephrologist. In addition to being sicker, they were older, less sophisticated, and more set in their ways than the middle age tech and nutrition savvy folks hanging out on internet forums from which Dr Nally probably draws his base from.

My 85 year old grandma couldn’t understand, let alone implement a HFLC diet. She could understand a fasting regime.

Fasting is simple, cheap, flexible, and works with any diet. Most importantly, it’s the most effective intervention that can be undertaken. But like any intervention, it’s not without risk.

(Bacon is a many-splendoured thing) #34

This is very similar to concerns about fasting for religious reasons. It’s one thing to fast on Good Friday and other Fridays of the year, and traditional Christian fasting has evolved into more of a caloric restriction than a true fast in any case. But if you’re the spiritual director of someone who wants to do the whole forty-days-in-imitation-of-Christ thing, you really need to help them get clear about their motives before attempting it. The possibility of obsession is too real, otherwise.

Of course these concerns were first raised centuries ago, by people for whom anorexia wasn’t even a concept, but your post shows that the issue is real, no matter the terms in which we conceptualize it. Thanks for sharing your experience and concerns. Whatever people eventually decide is right for themselves, we would all benefit from thinking things through first.

I returned to church at a much deeper spiritual level shortly after I got sober, and I was really eager to get into fasting and other forms of self-discipline. I found, however, that I simply could not fast. Because of the metabolic damage from drinking, I would get hypoglycemic and start to go nuts. I wonder what my experience would have been if I’d known about nutritional ketosis back then. Hmmmm . . . .

(Erin Macfarland ) #35

@PaulL you have a really interesting history. It is amazing to hear everyone’s experience and perspectives here.

#36

That’s true. It’s interesting that Dr. Fung started out promoting keto, but it was too complicated for his patients, so then they went to simply fasting, and now they are back to promoting keto eating between fasts.

(Doug) #37

I think that if something is dangerous for a given person, then… it’s dangerous for them. Okay, so, that profound statement laid down - well yes, not everything will work for everybody. The electrolyte deal - sure, taken to an extreme, there will be problems. However, seems to me, non-doctor that I am, that this is rarely an issue, as people will start feeling bad because of any real problem with electrolytic imbalance, often manifesting as hunger/cravings.

I have not fasted longer than 6 days, but in reading accounts, anecdotal, one-by-one, to be sure, of others’ fasts, I have never seen anybody get into trouble because they were fasting. Not saying it does not happen - I’m sure it does, and I believe Dr. Nally when he says he knows of such-and-such cases. I still think that for the vast majority of us, ain’t no thing.

#38

I was trying to remember if I had heard any fasting horror stories, but couldn’t think of any. I can believe it would happen though, especially if someone was taking insulin for blood sugar control, and wasn’t careful to check and adjust their dose during a fast. [edit to add: the same is true of someone taking insulin who starts keto] The warning symptoms usually are a red flag to tell someone something isn’t right - bad headache, dizziness, leg cramps, etc. That seems to spur people into asking a question in these forums or searching for more information, where they find out about the importance of electrolytes and hydration. Another thought, Dr. Nally is in Arizona where hydration is even more important than other areas might be, due to the extremely dry climate. Maybe he sees more problems with that than docs in other areas would (Toronto, for instance).

(Doug) #39

Agreed, Darcy - lots of things can happen. If anything, I think the doc’s rant is aimed a tad askew, as if people in general are not paying attention to their bodies and how they feel. Not trying at all to demean any present dangers, but hey - if people aren’t going to be on top of the situation, then they could well be in a world of hurt from many directions. To rather generalize things and criticize fasting seems a bit overly alarmist - again, judging from everybody I know and the many people whose accounts I’ve read.

Good example of the insulin-injector who does not adjust their dose. Even with oral diabetes medication, really bad things can happen when somebody isn’t aware of what could happen with big dietary changes. No question that there could be problems with fasting. Doc Nally just seems a bit too generally against it, to me.

(Chris) #40

If you go on the fasting Reddit there’s plenty of horror. One girl had a seizure because her blood pressure dropped during the night. She’s okay and got checked out but she wasn’t taking any BP meds, only had a slight family history of hypotension. There’s a lot of people there who just go drink water and fuck up their electrolytes and then post threads asking why, when it’s covered in the FAQ. There’s others who juice fast with sugar and other crap…and think that it’s perfectly okay. Well, sure do what you want…

Frankly, while I agree with many of docmuscles’ points, he comes off kinda childish here, perhaps he’s upset that some of his loyal followers are looking up to another mentor? I don’t know. I’m a ranter myself, so maybe I’m not one to talk.