Karim, you might want to listen to the Rhonda Patrick interview with Walter Longo. Longo’s not particularly keto-friendly but his research on fasting is really interesting, and one of the things that he’s found is that there’s a certain amount of organ-shrinking during fasting, but the organs pop back up to normal in the refeeding stage( and likely with healthier cells). I think that there’s probably a corollary with muscle growth as well: that fasting is great, and refeeding is also great, and that cycling those states will give you nice results as you re-shape after your weight loss (congrats, by the way!).
Loose Skin autophagy vs muscle loss
Don_Q
(Windmill Tilter)
#42
Dr. Fung’s exact claim is that “he has never had to refer any of his patients for surgery to remove excess skin”, which is different than that none of his clients has ever had loose skin. It’s a matter of degree. Canada also has universal healthcare which would not cover the procedure, and the skin removal surgery itself can run north of $20,000. So the claim may actually be “I’ve never had a patient who had $20,000 in cash to correct their excessively loose skin”. Personally, I trust and respect Dr. Fung and I believe that he meant that autophagy greatly reduces excess skin when weightloss occurs via >24hr fasting, but he never said that none of his clients had loose skin.
Another thing that’s interesting is that Dr. Fung’s protein suggestions are much lower than many people actually do in practice. I think he suggest .6g/kg of lean body mass (somebody correct me if I’m wrong). Personally, I usually get 1g/lb of lean body mass, which is more than double his recommendation. I’m starting to rethink that. It may be that by intentionally limiting protein even during feasting, we’re priming the autophagy pump. That may play an important roll in reducing excess skin, as the body is forced to scavenge to meet requirements?
I’m a member over at IDM; I’ll ask this question over there.
Don_Q
(Windmill Tilter)
#45
Thanks for that reference. Dr. Fung does explicitly say that if you’re trying to lose weight, you should eat less than .6g/kg bodyweight per day so that you catabolize unnecessary skin, connective tissue, etc.
That is, if you are trying to achieve negative energy balance (lose weight) then you need LESS protein. Why? Because there is all sorts of protein loss associated with fat loss. There is less skin, connective tissue, capillaries, blood, dermis etc associated with weight loss – all of which needs to be catabolized (burned up and not replaced). Think about those bariatric surgery shows on TLC where surgeons remove 20-30 pounds of excess skin after weight loss. Yes, that’s all protein that should have been catabolized. As an aside, in my clinic where we do a lot of intermittent fasting, I have not yet sent a single patient to the plastic surgeon for removal of excess skin, even though weight loss sometime is over 100 pounds.
In the IDM weightloss course though, Megan Ramos says that there is not definitive answer to the question. She says .6g/kg bodyweight is a decent target generally speaking, but that it’s not the right amount for everyone, and it’s affected by physical activity weight training, HIIT, etc. The recommendation is a bit of trial and error. If 2 hours after a meal, you’re kicked out of ketosis by a lot of protein, well, that was too much. Drop it down a bit and see how that goes. If you start feeling lethargic and your hairbrush has more in it than expected, well then add some more protein and see how your glucose responds and how you feel. Seems pretty sensible. Basically, as little protein as it takes to keep you feeling good I guess.
Karim_Wassef
(Karim Wassef)
#46
I’m not trying to lose weight. I’ve lost it and have loose skin.
I’m in maintenance and I want to be in ketosis for mental clarity. But I also want to build muscle and protein is key to hypertrophy.
So… I’m looking to lose skin (protein-), build muscle (protein+), and stay clear minded (low carb or fasting ketosis).
I guess some people carb cycle, others protein cycle and others fat cycle too (fasting). I’m looking for the right cycle (time and macros) to tighten skin and build muscle as efficiently as possible.
Seems wasteful to lose protein in skin just to eat more protein to build muscle. I’m a fan of recycling but don’t know the hormonal triggers to do that yet.
Don_Q
(Windmill Tilter)
#47
Tough to square that circle and lord knows I’m no expert. One solution, and you probably won’t like this one, would be to just do a traditional bulk. You’ll gain muscle faster, and some fat as well. You can use that bodyfat to fuel some more extended fasts for autophagy purposes. Your metabolism will also probably be happy for the break after an extended period of calorie restriction and significant weight loss (amazing job BTW, congrats!) For your cutting cycle, try to keep protein low (.6g/kg) to prime the pump for autophagy, do some 3-4 day fasts, and keep lifting. Take before and after pictures and measure excess skin folds with calipers. After a few months and a cycle or two, you’ll know if it’s working.
I’m not saying it’ll work, I’m just brainstorming here. Hopefully somebody will chime in with a success story and a proven strategy. Just my 2 cents.
Don_Q
(Windmill Tilter)
#49
During the cut, lifting while in the middle of a 2-4 day fast is something worth considering too. During last month’s Zorn Fast, I was inspired by @Brenda to do some heavy lifting at hour 40 of an 85 hour fast. It really surprised me. Not only did I feel totally fine the next 2 days, but for the first time in 1 year of doing the Body by Science routine, I didn’t have any DOMS whatsoever. If I recall, she said that she lifts mid-fast often, and she’s continued to gain lean mass, has the DEXA’s to prove it, and her lifts have been steadily increasing.
It stands to reason that weightlifting in the absence of dietary protein would be a very strong autophagy trigger, and since growth hormone will be elevated, you might be able to build do some “skin-to-muscle recycling”. That’s complete speculation and barely rises to even the level of bro-science, but it seems plausible enough to experiment with at any rate.
While you’re breaking new scientific ground in the field of excess skin reduction, consider pioneering a new excess skin measurement methodology with the humble bodyfat caliper. Generally, skinfold measurments are simply measuring the thickness of skinfolds at various points of the body to estimate body fat %. In your case, I think you could modify the standard protocol to measure not only the thickness of the skinfold, but the length as well. The length is obviously the more measurement of the two. That way, you can track whether different approaches are effective, and if you find something that works, you can quantify how efficient a particular protocol is for posterity. There are thousands of people who would love to know what to do with excess skin as an alternative to a $20,000 bill for highly risky plastic surgery that’s not covered by insurance. 
Iced
(The amazing autoimmune 🦄)
#51
I have recently been reading a lot of science journal articles on autophagy. One of the outcomes in one of the papers(sorry not sure which one) stressed that autophagy could be advanced by stressing the body during a fast i.e. lifting. I believe the sample size was all male and under 30 test subjects. Nonetheless I figured that when I am concentrating on loose skin I will be adding in lifting. Which is in the distant future, got lots to lose.
Ruina
(Hyperbole- best thing in the universe!)
#52
The two goals, losing weight and reducing loose skin are not mutually exclusive. If you can’t worry about skin now, that’s fine. Focus your energy on your number one goal. But, if you keep a side-eye on preventing loose skin now, then maybe it will be easier to deal with when the time comes.
These things are hard to know, because there are so many aspects that are little understood. So maybe you work hard and don’t have bad loose skin, but you wouldn’t have anyway because of genetics. Who knows? But if making sure you get plenty of collagen and doing things we believe induce autophagy now will make life easier down the road, then worth it, yeah?
Iced
(The amazing autoimmune 🦄)
#53
I agree and autophagy is why I do EF. I feel that by integrating IF and EF into this WOE I will have less loose skin. But I am sure that at the end I will still have loose skin given how fat I am. It is already showing up and then disappearing. Two weeks ago I had some really wrinkly loose skin on my upper arms now it is less so.
The OP was asking a question about lifting and loose skin as a combination. My best guess is that the lifting will complement the EF and subsequent autophagy if done at the right time and aid in getting rid of the loose skin.
Karim_Wassef
(Karim Wassef)
#55
Yes. I lift during IF carni+ and EF. Those are basically my only two modes. The only variable is whether the IF is OMAD or 20/4.
I’m not looking at bodyfat at all. I know how to increase and decrease it on demand now. I’ve even managed to gain fat in ketosis. So fat and carbs (energy foods) are not really in focus for me right now. It’s all about proteins and their hormonal, catabolic autophagic (loose skin) and anabolic hypertrophic (muscle gain) effects. Lifting while fasted should recycle the protein and even drive an aggressive demand - any papers or research on lifting fasted to reduce pre-existing loose skin?
I don’t know if the body is able to have both hormonal triggers simultaneously- the literature seems to point to one state or the other. I can’t find one that shows evidence of canabolic and anabolic hormone triggers simultaneously except fasting & ketones to “spare” muscle wasting (hgh and testosterone) - not grow it.
I’m hoping the body is smart enough to handle demand side pull with lifting and supply side push with autophagy. Can’t see it though.
Measuring loose skin is tricky. It depends on how I stand, lean over or lay down. Will need to experiment to find a repeatable metric.
PaulL
(Bacon is a many-splendoured thing)
#56
Some of that muscle can be built from recycled amino acids from skin, no?
Madeleine
#57
This is an area where it would be hard to do a direct N=1 cause and effect kind of experiment if you want to play with different variables, but I would take pics from from different angles and tuck them away for a few months, then do another set. My guess is that you’ll start to notice a difference.
Do you know about skin brushing?
Karim_Wassef
(Karim Wassef)
#58
I did find it during my research, yes. The needle rollers, stiff brushing and some kind of acid.
It seems that they’re more support elements to stimulate blood flow to that area of the skin and get more focus there. More supply side - making sure the body is aware and has access to the loose skin there.
I’m trying to create demand side dynamics first. Cutting and then bulking works but it’s slow and inefficient. Sometime, nature is slow and inefficient but I’m on the hunt for the hormones or enzymes that will turn it around faster.
Madeleine
#59
To me the needles and skin peels (for the body) and seem really extreme, but I love skin brushing as a normal practice. I think of it as stimulating the skin and moving the lymph, and my intention is to do a bit extra on my belly when I’m fasting (I don’t always do it, but that’s my goal!).
This is a very interesting thread Good luck to you, and I hope you keep posting what you find!
Janie
(Jane)
#60
Thanks for this thread. I don’t have a huge amount of loose skin and it is definitely tightening and toning up over time. My husband notices it more than me. 
He said it started above my knees and has worked it way up to the tops of my thighs and the wrinkles are gone and skin much more toned. The only exercise I do is walking.
I don’t know if it is from the fasting/autophagy or collagen peptides I started adding to my morning coffee and few months ago, but some of this loose skin has been there long before keto and only now toning up so it is one or the other or both.