Loose Skin autophagy vs muscle loss


(Karim Wassef) #1

After losing 90lbs, I have to deal with the issue of loose skin. My Dr’s solution is surgery… no.

My personal solution has been fasting and it is working … slowly.

I’m also building muscle and trying to build up 15lbs by increasing my amino acid intake and lifting. It also seems to be working … slowly

Ketones have a muscle sparing effect as long as the muscle is being triggered & that’s why I can lift as much as I did when I weighed 255…

The question - am I basically fighting on two fronts by trying to fast to reduce my loose skin while trying to clean bulk with protein and lifting simultaneously???

The action here may be to choose one path or the other until I’m satisfied with the outcome and then switch to the other path.

My bias right now is to continue to clean-bulk for another month and then start a very EF for 24 days to trigger hard autophagy and get rid of the loose skin.

What’s holding me back… without evidence, I have the instinct that the current slow path is potentially working by efficiently recycling my skin protein to build muscle protein while I fast… no evidence of that though, just seems logical. It’s mostly all collagen and hormones that drive the redistribution so maybe it’ll be slow whether I do them in parallel or sequentially…?

Thoughts? Resources? Opinions?

(Doug) #2

Fasting for losing loose skin works better for some people than others, Karim. Our skin is about 1/6 of our weight, so there’s a good bit there to work on.

One generalization is that people tend to end up with less excess skin if they fast, then don’t fast, rather than just reduce eating over a long period of time. Dr. Fung has noticed this among thousands of patients - it was either him or another doctor that said, in effect, “I’ve never had a patient need surgery when they lost their weight by fasting.”

I don’t believe that is totally true, i.e. I can’t believe there was not at least one person that ended up with excess skin. However, as a generalization I agree - fasting is better than just eating less, regularly - and this goes beyond ‘CICO’ - it applies to ketogenic eating as well.

The younger we are (the more elastic our skin is) and the less weight we’ve lost also matter.

It sounds like you are quite lean now - a 24 day fast would probably be hard, I’m guessing, or perhaps intolerable. This is an interesting question - one that doesn’t come up often, rather than fasting for weight loss, just for skin loss when we’re at or close to our goal weight.

(Karim Wassef) #3

I’m 45 and while I’m hydrated now, my poor skin hasn’t always been treated well … guy “lotion-use is girly” issues…

I also lost it very fast on keto, and the IF/EF came later. I’ve done the math and I can do the 24-28 day fast and still stay above 10% bf. I enjoyed my last 12 day EF so it’s not a big risk.

I do a combo IF EF now - I fast EF from Tuesday evening to Saturday afternoon. And I IF on normal eating days Saturday to Tuesday.

But going all EF for weeks is a different feeling than the 4 days EF. Much more productive in my view.

It’s vasically a question of maintaining my short cycle or going to a longer cycle to achieve better results faster - lose loose skin and gain muscle.


I suggest you read the series on autophagy on Dr. Fung’s blog, here is a link to part one but read all part of it he discusses the good and bad effects that autophagy causes. And growth hormones play a bigger part in extended fasting. Just read this to get grounded in autophagy before just fasting for days on end. Also if you do go for that EX have some medical supervision.


(Karim Wassef) #5

Thank you. I have read it and it’s one of the reasons I started EF in the first place. I’ve been doing 4,5,7 and 12 day fasts for the past year.

(Doug) #6

:slightly_smiling_face: I have not ever used anything. 60 next month :open_mouth:

I hope you give us the story, Karim - whatever you decide to do. I have a bias toward the “more is better” philosophy but also think for most of us there really is value in at least occasionally doing longer fasts.

(Jenny) #7

I’m kinda doing the same, but I’m not at maintenance yet. Partly because I dont know what my goal is. I’ve picked a number mid- healthy bmi my doc has signed off on. everyone says it’s too low except my husband lol! so we’ll see how I look and feel along the way.

I have some lose areas but I believe truly theres fat underneath and its not skin. I also believe getting super lean is the way to combat loose skin. but I’m not there yet.

I lift, but I switch off w cardio because I an still trying to lose fat. I’ve lost 103 pounds so far.

I also fast and I do believe once fat is gone under that skin I will see a big difference.

I eat more protein than a lot of ketoers with at least equal protein to fat being my goal. so I feel like I’m fighting in the same 2 fronts and slowly seeing progress as well.

perhaps take stats now and again after the clean bulk. pics, measurements, I know the scale is not a great indicator for body fat percentage but it would show a trend. then try a fast and see how each of the results stack up.

I dont think slow is really a bad thing (although annoying) and I think your theory is right on. I heard dr. Fung say this but I listen to so many of his things I’ll never track it down. he was answering why you dont lose muscle while fasting or get loose skin. he said skin is protein and you’re using that along with other protein to build muscle… basically autophogy.

just to throw in an n=1, when I fast, then eat, I build toning/definition at a crazy level. The body is amazing!

I also am curious what he means by loose skin…these old folks he treats probably donr have a six pack but maybe he means…loose skin bad enough to get in the way of “life”.


YUP! But from what you’ve said, that’s the correct course. I put on muscle while dumping most of my fat and you can absolutely do it, just takes longer. But as long as you’re not afraid of protein and lifting for gains you’ll put on muscle. Creatine’s a great supplement and I’m personally a fan of using pre and post workouts for not only the energy to really kill your workout but for all the nutrients you get from them to put the edge on muscle building. The purists like to say that all the supplements are a scam, but the reality is that we ARE at a slight disadvantage for muscle building on keto, even when it goes great, it’s considerably slower than our carb eating counterparts. I like to stack the deck in my favor. If you’re half as stupid as I am, I wound up buying a red therapy light for many reasons, crap skin was one of them. I’ve got seborrheic dermatitis as well as scalp psoriasis, plus crap complexion, stretch marks from when I was real big, knees that get ashy as hell without urea cream to basically melt the skin off… you get the point. So far, it’s been helping everything. I rarely have to use my steroid cream to make rashes go away and it’s helping with some small wrinkles. No cheap, but seems to work.

(Karim Wassef) #9

I did have skin issues but IF/EF cleared that up. Are you saying you used red light therapy for loose skin?

(Doug) #10

:clap: Wow, Jenny. :slightly_smiling_face:

I think the evidence has tilted in favor of “thinner is better” to some extent, lately, i.e. there has been downward revision in ideal weight charts, etc.

Dr. Roy Taylor, Newcastle University, etc., says that a BMI of 25 - the high end of Normal range - has four times as much chance of developing diabetes versus a BMI of 20. Significant, but still a relative deal, I am sure - 25 must bring vastly less chance than being much more obese.

(Karim Wassef) #11

I’m not a big fan of BMI since it doesn’t really account for muscle properly. I prefer the waist to height ratio and I’ve gone from 44 to 32 belt size.

Ok. To help steer this to an outcome:

Do you think I should alternate long EF to IF to focus on loose skin and muscle building separately (option 1)… or do you think I should fast alternate the way I’m doing now and try to balance both (option 2)… and why?


For me it was more of the complexion and scar/stretch marks, my skin has definitely tightened up, but that wasn’t what I was going for directly. The light is supposed to increase blood flow to the skin (which shows after 10 minutes on the face) increased ATP, increased collagen so everything our skin needs magnified. There’s a lot of general info on red light therapy for loose skin, only thing I’d recomend after doing a ton of research is if you consider it, but a full powered light and not one of those random red bulbs you put in a normal light. I think those are fine for your face but for medicinal like benefits you need a lot of light power. I bought mine from here https://platinumtherapylights.com/ the other big one many people are buying is Joovv, but those things are VERY expensive and seem to not be as powerful as the ones Platinum makes.

(Jenny) #13

I want to tell you to try both and analyze the data to see how to continue.

re: option 1, did you effectively EF before? did you like the results? how did you feel? if you are a low bf % you may not feel great. you could supplement with fat also ala the calculator floating around here somewhere. Did you see any loose skin improvement?

re: option 2 … this is what you’re doing now so, how Is it? sustainable? are you hungry/crabby, are your results consistent? is your complaint just that it’s going slowly?

I, personally, dont do extended fasts cuz I suck at them. my PR is only 96 hours. but short fasts are good, fat fasts are good, and I even do liquid fasts sometimes.

so I feel like I can’t answer this for you.

(Doug) #14

Human autophagy needs some serious study. My gut feeling is that trying longer fasts is good, here. As autophagy is up-regulated, the autophagosomes begin increasing in number, and start encircling damaged cellular parts, the first step in their destruction. This is not the same as entire skin cells going away.

As we gain weight, the body realizes it needs more skin cells. In the absence of whatever signalling is going on there, it does not reduce the number of cells nearly so fast. It doesn’t get negative feedback enough, or the extra skin is seen as a resource against starvation - hey, I’m just guessing.

There is some “low hanging fruit” for autophagy - badly aged/damaged cellular parts. This gets going comparatively fast. To lose skin, we need the body to really be in protein-scavenging mode, and it’s a relatively slow thing, i.e. after 5 days of fasting I can feel a real difference, mostly water loss. After another 5 days, I can definitely feel things getting “looser” due to fat loss. Skin loss does not keep up with that, even though I think I’m fairly lucky in not accumulating loose skin.

It’s a great question - how long do we have to go? I’d say long enough for the body to really be eating skin.

(Karim Wassef) #15

Thank you all.

I do feel good on EF and my current blend of IF/EF is sustainable.

I tend to want to optimize and not waste time so if there’s a better way to do something, I want to know. If it must be slow, so be it… but I need to know that that’s the best way.

My bf% is not certain because my smart scale isn’t very smart. Gym meter calls me out at 17.5% so I got plenty of reserves left.

The idea of a fat fast is interesting… I haven’t considered this before. I need to research it more.

I’m open to more feedback but I’ll keep my short cycle IF/EF for now and then start the long EF in March. Will update as I learn more

(⚕ lowcarb.skrinak.com ⚕) #16

Well, I only lost 70 pounds, but that was over a year ago. I had a lot of loose skin but it’s tightened up over time and is no longer a concern for me. I skip meals, but I don’t fast. I don’t consider fasting necessary to remove loose skin, but I do consider patience as necessary. No other diet removed my loose skin, no other diet let me luxuriate at this reduced weight for such a sustained period of time, either.

I wrote something up about my then loose skin, but it’s on the lighter side of low-carb:


My understanding is that autophagy starts around 16-18 hours fasted. However, many supplements can break a fast and therefore prevent you from getting to autophagy. On another thread in here recently, I asked about BCAA because I had been taking them in my pre and post workout. The consensus was that they will break a fast and inhibit autophagy, especially leucine. This makes sense to me since leucine seems to play the biggest role in protein synthesis. I have lost a little over 50# and probably have about another 20-25# to go. I have some loose skin already but not a ton. I do not know enough of the science to know if autophagy is an all or nothing kind of thing. I have seen some say that BCAA are ok to have while fasting if combined with training, as they have such a transient effect on insulin, but hard to know for sure. I would say that it is likely that you are trying to cut and bulk at the same time essentially, and would probably have better success with one or the other. I personally plan to stop taking my supplements, and see how it goes, then maybe restart them once I hit maintenance.

(Karim Wassef) #18

I do take leucine to keep my muscle gains going. It’s very effective but it may be interrupting my autophagy too much.

(Karim Wassef) #19

Great results!

I’m pushing to see my abs again - I’ve missed them :slight_smile: so I still have more fat and skin to lose. At 45, it’s an ambitious goal. I’m patient but hate inefficiency if there’s a better smarter way.

(Karen) #20

Jason Fung’s clients fast and no loose skin… so they say.