Phinney thinks Long term fasting no benefits

[devhammer]

Look at the Cortisol spiking pattern?

Without context, the chart is difficult to apply to this discussion. Is this data for a single person, or for multiple people? Are the subject(s) fat-adapted prior to fasting, or simply fasting from a carb-burning state? Are the subjects overweight and have sufficient body fat to sustain their daily metabolic needs, if insulin is driven low? Or lean people who likely have insufficient body fat to fully fuel their metabolism when fasting?

I would not be at all surprised to find that cortisol rises during extended fasting, for the reasons you cite. But at the same time, my n=1 experience is that I see a dramatic rise in ketone production (as measured by breath acetone) when on an extended fast. And I know from prior fasts that during an extended fast, my glucose drops dramatically as well. Given that one issue with cortisol is that it can stimulate gluconeogenesis, that suggests that in my case, cortisol did not rise sufficiently to stimulate gng to an extent that would push up blood glucose level. All of which suggests that during an extended fast, I am burning fat and not seeing a large cortisol spike.

To be clear, I’m not suggesting that cortisol isn’t a factor, but absent the context behind the chart, it’s not clear that it’s applicable to fat-adapted ketonauts doing extended fasts.

[devhammer]

It (EF) will also cause fat to more specifically populate around internal organs also.

On what are you basing this? Is there a citation you can share for the science backing this statement?

[devhammer]

it was research, not clinical practice, that brought out the dangers of that treatment.

Sadly, that research was based on treatment with hormones derived from horse urine, not bioidentical hormone replacement therapy, which is very different. So now, in many cases, women are being warned against HRT based on research that may not actually be telling the full story. Science is hard. Especially when there’s lots of money involved.

(that sounded really cynical, didn’t it?)

[infromsea]

The jury is out. At this point, we’re all running the experiment on ourselves.

That’s all we can do right? experiment on ourselves and see what works.

When I fast (either IF or EF) or eat keto on a regular basis, and feel great with good markers (body weight/blood work etc) then that’s the data I use.

One thing we have to remember about science is that it isnt’ perfect and the “results” of studies focus on the average, there will be many data points outside of that average. My point is this, a study can come out tomorrow stating XXXXX or YYYYY, that doesn’t make it true for everyone and does not apply in all cases. That’s the beauty of the “soft sciences”, the hypothesis put forward can never be truly “proven” so we’ll have endless things to debate on internet chatboards!

[devhammer]

Women with a history of bulimia nervosa

Sorry, I’m not sure of the applicability of a study of bulimics to the general population.

It’s certainly possible that the effect you cite is generalizable to the population as a whole, but given that bulimics in all likelihood have potentially serious derangements in their digestive and hormonal regulation, I’d be hesitant to assume that the effect is generalizable without additional studies to that effect.

[4dml]

I respect Dr Phinney, I’ve listened to many of his lectures on YouTube and learned a lot from reading his book, Low Carb Performance. He’s a smart dude and knows his stuff. But he’s not an expert on fasting.

Unlike Phinney, Dr Fung isn’t a researcher. He probably doesn’t have as much intellectual curiosity as Phinney. I think he’s more driven to have a direct impact on people’s (patients) lives.

Questioning and curiosity are good traits. I’m not anti-science, I’m just more focused on what works in the complicated real world, not the (necessarily) reduced constraints of studies. My number one question is always the same: how does this apply to me?

EF has risks, but the results are measurable. Whether it’s weight, BP, lipid panel, A1c, fasting insulin. Unlike diets, there is no long term EF, even in its longest application, it is a short term tool. So safety and efficacy are measured in the short term. EF must eventually be combined with a long term tool, which is responsible for long term success or failure.

There is no one best solution that fits all. That’s what makes science so complicated and solutions so elusive. Fasting isn’t for everyone. Neither is a HFLC diet. Or a Mediterranean diet. Or a vegan diet. Some people thrive on one diet, while another diet makes them ill. What works for you isn’t applicable for everyone.

[atomicspacebunny]

There can be no significant or profound difference between anorexia nervosa, bulimic or a self-induced hypoglycemic like state (extended fasting, intermittent fasting) to compare a general populous too?

Not unless your one of those rare creatures that does have adrenal glands above your kidneys?

Fortunately there is a fix for that visceral fat issue!

[circesdad]

If you just rely upon Science, you end up missing the important piece … THE PATIENT. I’d go to Dr. Fung to lose weight and if I needed a Keto experiment done, I’d ask Phinney to run it.

The wisdom density of your comment is profound. At the end of the day a patient wants help. The healer informed by experience, insight and research can be that help.

[atomicspacebunny]

No significant difference between a ketonaut (love that term) and a sugar burner. Cortisol levels will go on the incline when you fast extensively within the same cycle!

[richard]

Forty years ago, everyone’s anecdotal, N=1 experience told us that you cured peptic ulcers with careful diet, but then Robin Warren’s and Barry Marshall’s research showed that peptic ulcers are caused by a bacterium and are cured by administering an antibiotic. And, God help us, there are still doctors in practice who didn’t learn that in medical school, who aren’t yet sure they believe it, and whose clinical practice seems to bear them out.

What I find scary is that it took 10 years after Warren and Marshall proved the link between H.Pylori and ulcers … for the NIH to recommend the standard of care to be antibiotics instead of heroic surgery to treat ulcers. Imagine being that last patient who was operated on, when everyone had known for over a decade that a pill would have been a more effective treatment.

I swear, this forum is like taking 3 or 4 college courses at the same time - and the weird thing is that every course holds your attention.

I totally agree. I’m just an biochem undergrad this year … probably going to fail everything not about diabetic metabolisms

Dr. Phinney certainly deserves his due. I don’t see that excusing scoffing at the existence of autophagy, or acting like fasting will have people in effect “giving up their organs.” The science is not on his side, there.

Agreed. Dr Phinney is a legend and deservedly so. But I don’t agree with how other people characterize his views … and that may be the case here. For example you can find plenty of lipophobic caloric reduction facebook groups who repeat his every word except when he says “eat fat to satiety”, or “Satiety is the key, don’t leave the table hungry”.

I disagree with some of his views on protein and fasting - colored as they were by being a ketogenic research in an era when the liquid protein diet was killing people and ruining the career prospects of ketogenic researchers. I accept that, and respect him anyway.

I’ve seen Dr. Fung overgeneralize incorrectly, etc., too. Not at all taking sides among these docs.

Also agreed, but as I have been working these past months on back filling Jason’s content with citations (in the Obesity Code Podcast which Carl and I produce for him) he knows the literature. Most claims he makes have studies supporting them. So in that process I have come to respect what he does more - which is distilling complex topics to actionable strategies for the “every man”. That kind of thing probably requires a little overgeneralization - his clinical results are outstanding tho so I respect his results.

[OldDoug]

patients with Cushing’s Syndrome have elevated visceral fat as well as chronically elevated cortisol levels

Well. Elevated visceral fat is fat buildup there. I don’t think we’re very far apart on this, Bunny - I’m not disagreeing about the effects or possible effects of cortisol; I’m just saying if it does not apply - and I think it does not apply to a great many people - then it’s no knock against fasting.

I realize it’s anecdotal, but I’ve seen relatively few people with cortisol issues, period. Yes, there are some stalls in weight loss, and of those a significant portion may be due to cortisol. Yet among those with a good bit of fat to lose, the number for whom fasting works well dwarfs those for whom it does not.

They will only reveal bits and peices to make a profit so they can leave you stumped in mystery and bewilderment so you will buy their next new book to only give you a fraction of what they know!

Yeah, sometimes.

[devhammer]

No significant difference between a ketonaut (love that term) and a sugar burner. Cortisol levels will go on the incline when you fast extensively within the same cycle!

This is an assertion, one whose origin it would be nice to understand. There are many, many ways that sugar burners and ketonauts differ that are demonstrably true from existing research (lower insulin being just one) and many of them directly affect hormonal response. If you’re aware of research that compares cortisol responses in fat-adapted individuals vs. those who rely primarily on carbohydrates, I’d be very interested in seeing that research.

[OldDoug]

Also agreed, but as I have been working these past months on back filling Jason’s content with citations (in the Obesity Code Podcast which Carl and I produce for him) he knows the literature. Most claims he makes have studies supporting them. So in that process I have come to respect what he does more - which is distilling complex topics to actionable strategies for the “every man”. That kind of thing probably requires a little overgeneralization - his clinical results are outstanding tho so I respect his results.

No question about it. I didn’t mean to sound critical of Dr. Fung, rather only that he hasn’t been perfect in his blog statements/I wasn’t taking issue with Dr. Phinney and Dr. Volek’s statement out of hero-worship, etc., of Dr. Fung.

@richard - the bolded part of what you said above - you are so right. This past April I read every blog post Dr. Fung had then written, and wow - he was talking about me. Keto, fasting, and that was all it took to make a huge change for the better. 98.5% of my life was ‘Pre-Fung,’ so certainly still new to me, but cannot imagine going back.

[atomicspacebunny]

So let’s take the “assumed assertion” down to basic science

Flight or fight responsiveness?

Ketonauts responsiveness differs from that of a non-ketonaut?

Yes it does and this is why; the tolerance to adrenal stress is increased with the improved health benefits of low glucose intake; over all homeostasis and switch in fuel for energy!

However that is not true when it comes to extensive fasting and the observed incline of Cortisol in the existing research which is a component of adrenaline; that is clearly experienced by the euphoric (endorphins, dopamine) feeling of well-being.

No matter what kind of fuel wether it be ketones or glucose that is being utilized by the body; that does not distinguish any kind of difference between Cortisol incline when fasting extensively!

e.g. If you take a ketonaut and a glucose burner and test the cortisol level incline your not going to see any change in the responsiveness (survival mode mechanism or, flight or fight responsiveness) to the adrenal reflex to starvation. If the human body senses it is starving, it reacts to this as a threat to its survival; thus releasing more cortisol to block all fat burning hormones contrary to its survival, so I fail to see how any research would be needed to make any kind of useful distinguishment in my assumed assertionism.

[Earthtodan]

Steve Phinney doesn’t scoff at the idea of Autophagy. It’s well established science, has been known for decades, and the 2016 Nobel Prize in medicine was awarded for research into it.

If we’re referring to the same LCDU lecture, Phinney scoffed at the idea that fasting upregulates autophagy somehow (rather he says it’s happening all the time). Personally, in the spirit of “show me the science”, I would like to see the science. (Disclaimer: I haven’t searched for the science yet)

Edit: I was trying to respond to the first subthread but it ended up here instead.

[sks23cu]

Dr. Phinney is a physician as well

I don’t think he practices now … or maybe ever.

He also seems to have either a short memory or he is not able to correlate similar events from his past. In the film Cereal Killers II: Run on Fat he explains that he originally thought Dr Atkins was a fake, but then did a study that he thought would prove Dr Atkins wrong … instead he proved Dr Atkins right. Dr Phinney went on to co-author the modern follow-on book, The New Atkins for a New You, along with Drs. Westman and Volek.

Dr. Atkins was a clinician with hundreds of anecdotal patients that demonstrated the value of his non-standard dietary treatments, but no studies, RCT or otherwise. Just like Dr Fung!

Dr Fung’s book, The Obesity Code, has over 30 source citations in the endnotes to Chapter 20 on fasting. On DietDoctor.com there is a huge library of posts and videos by or about Dr Fung and fasting. On YouTube.com there’s a huge list of videos with Dr. Fung.

So Dr Fung is not reticent about broadcasting his thoughts to the world.

[OldDoug]

Phinney scoffed at the idea that fasting upregulates autophagy somehow (rather he says it’s happening all the time). Personally, in the spirit of “show me the science”, I would like to see the science. (Disclaimer: I haven’t searched for the science yet)

We really do need more studies on humans. In some other animals, like mice, fasting definitely does kick autophagy into gear, or into higher gears, i.e. +300% after 24 hours, with a further, though not so great, increase at 48 hours.

[OldDoug]

No matter what kind of fuel wether it be ketones or glucose that is being utilized by the body; that does not distinguish any kind of difference between Cortisol incline when fasting extensively!

Bunny, what is not adding up here is the “blocking of fat-burning hormones” when fasting. That effect of cortisol may be known, and may be observed, but it must not operate to a large enough degree to mess up most fasting people’s fat-burning, then.

I’ve read a lot of cases of people fasting, and on this forum there have been a large number of accounts. Times where people feel like their metabolisms are really slowing down and where they don’t lose fat like they should are few and far between. For the vast majority of people, it seems to be a non-issue.

Granted that “extended fasting is not for everybody.” That said, the process with cortisol that you mention does not seem to apply to most people. If there are cases where they pretty much don’t lose weight because of that increase in cortisol, they fit easily into the small minority, and the phenomenon in no way is a knock on long-term fasting in general.

[devhammer]

If you take a ketonaut and a glucose burner and test the cortisol level incline your not going to see any change in the responsiveness (survival mode mechanism or, flight or fight responsiveness) to the adrenal reflex to starvation.

Again, absent citation of relevant data, this is an assertion.

If the human body senses it is starving, it reacts to this as a threat to its survival; thus releasing more cortisol to block all fat burning hormones contrary to its survival, so I fail to see how any research would be needed to make any kind of useful distinguishment in my assumed assertionism.

Because you are making the assumption that you fully understand the interactions between all of the hormones involved in the metabolic process, and further assume that there would be no change in them between someone fasting from a fat-adapted state versus someone fasting from a carb-burning state. We already know that the hormonal milieu (in particular insulin), as well as the lipid profile of fat-burners is dramatically different from that of a carb-burner. Why, then, would it be surprising for the adrenal and/or cortisol response in fat burners to be different?

I’m not saying that your assertion is necessarily incorrect. I am saying that you cannot simply reason your way to that conclusion based on assumptions.

[brownfat]

Bunny, what is not adding up here is the “blocking of fat-burning hormones” when fasting.

It doesn’t add up because cortisol promotes fat burning not blocking it. Cortisol releases energy substrates both fatty acids and glycogen and it promotes the breakdown of protein to support gluconeogenesis.

As a fast progresses and glycogen stores deplete more gluconeogenesis is needed to keep blood glucose from falling too low which is driven by increasing amounts of cortisol and GH. Intense resistance training, plenty of sleep, thermal stress such as sauna can all increase GH and thus reduce cortisol and help spare lean mass. Also as the fast progresses most tissues transition from glucose to ketones to fatty acids and the need for glucose drops but doesn’t go to zero as the central nervous system can’t use fatty acids. The amount of glucose consumed falls as ketone levels rise but doesn’t go to zero. As the demand for glucose drops the need for cortisol and GH drops too.