Phinney thinks Long term fasting no benefits

[OldDoug]

I should clarify one subject, which is speed of fat loss. IMO, during the initial phase of Keto, especially when severe metabolic derangement is present, the one to two lbs. per week often doesn’t apply. I myself often exceeded it as my body was reducing my detrimental lipogenic adaptations. It was only after two years of adaptation and essentially one year of maintenance that I had to make changes in order to lose additional fat. At that time, with a normal insulin-glucagon, as well as a leptin-ghrelin balance, I found that I had to consciously reduce calories in order to lose additional fat. If I reduced to more than a 1000 Cal per day deficient, I experienced a starvation response. I was training at the time, so this may have made my body more sensitive. I found that a 500 Cal per day deficient worked, as long as I had some dextrose around workouts (three day split, with just cardio and swimming on the fourth day, but seldom a real day off) and did a 36hr full glycogen recompensation on the weekends. I lost an additional 60 lbs. of fat that way, in two six month periods about a year apart. I never regained any fat, nor have I for some 17 years now.

Ken, kudos to you for being so attentive to the feedback your body was giving you all this time, and for your admirable recounting of it.

Maybe it’s flogging the dead equine, but I always think CICO is relevant - the problems arise when we don’t fully take into account all the ways in which calories are disposed of. I also feel there is often a temptation to discard it, and say that “CICO does not matter,” a temptation partially rooted in some people’s desire for an excuse to eat more. That may sound harsh, and I’m not trying to be critical or start trouble - just thinking in the same realms from which come our tendency to have “guru worship” or take certain things on faith and stake out a ‘religious’ position with respect to diet.

It’s really interesting to me how the 500 calorie per day deficit worked for you. You had a patient and cerebral approach to it. It’s largely the reverse of what Dr. Fung describes - that the starvation response will occur with some calorie restriction but doesn’t kick in if we go low enough, like 800 calories or less per day (same with Dr. Taylor’s Newcastle experiment - remarkable results on 800 per day), or totally fast.

Personally, a little restriction is the worst of all worlds for me, but I have not tried it all that much, and I’m pretty new to all this in the first place. Great discussion.

[Marty_Kendall]

So eat by your blood sugar reading. @Marty_Kendall brilliant advice IMHO what think you Marty?

This opens another can of worms. Most people don’t see their blood sugars rise after a high protein meal unless they are not producing eneought insulin (e.g. Type 1, not IR or type 2).

My wife Monica has to make sure she doses with enough insulin for a high protein meal to ensure the protein is used as well as keeping he blood sugars stable. But I’m not sure how most people would use their blood glucose to guide their protein intake.

why do my blood sugars rise after a high protein meal?

Do your blood glucose and ketone readings improve or stay the same?

I’m also not sure what ‘improved ketone’ levels means either. I’m find this optimal ketones levels chart confusing.

Most people eating low carb or keto tend to have moderate amounts of BHB ketones (not really high) when their blood sugar control is excellent. Most people need to fast or actively avoid protein to get really high ketones.

Based on this analysis of about 3000 data points of people taking glucose and ketones at the same time I think a healthy ketone range for people following a ketogenic diet would be 0.3 to 1.1mmol/L unless you’re in a long term fast.

optimal ketone and blood sugar levels for ketosis

Interesting to note Virta’s study where they defined nutritional keto as 0.5 to 3.0mmol/L ketones they only averaged 0.6mmol/L. Perhaps their definition of ‘optimal ketosis’ needs to change?

[Victoria_McCoy]

@richard and @carl - can we have another podcast or two to go deeper into the biochemistry of fasting and hormonal shifts, and the relationship between GKI and lipolysis/weight loss? Curious and striving to understand more, but as an English teacher, I’m straining at the limits of my decoding and inference skills here. Out of my depths, but earnest.

So I persevere, motivated by the desire to examine my N=1 experience to regain my health from the grips of (presumably) decades of insulin resistance liberally mixed with intermittent periods of various diet strategies, yo-yo results, and lapses into the SAD mode that is so seductive and destructive for those of us who have had hormonally deranged hunger signals for so long. Understanding obesity as a hormonal illness, not a character flaw, is such a revelation for me - as a person who has battled it and failed so many times. Tired of the shame. Believing that with this new knowledge maybe health is in reach for me again.

Your podcast (also love the OC podcast) has been manna from heaven as I have been earnestly pursuing a ketogenic WOE since January 1 on the heels of a borderline T2D diagnosis. I’ve been consuming seminal literature on the subject, watching Dr Fung’s videos, and bingeing 2KD podcasts from episode 1 (almost up to date - at #96 now) but I still find my head swimming sometimes (like in this fascinating, but science-dense thread!). I could really use some of the translation and application treatment that you two do SO well in the podcast.

Apologies if what I’m asking for m is waiting for me already and I just haven’t found it yet. So grateful for what you two do and HOW you do it. Serious, honest, agenda-free, accessible information and abundant affable support from two virtual “friends” who are on the journey with me, full of joie de vivre and practical advice. I’m a fan for life. Thanks for considering this newcomer’s request

[farmgirl]

So I persevere, motivated by the desire to examine my N=1 experience to regain my health from the grips of (presumably) decades of insulin resistance liberally mixed with intermittent periods of various diet strategies, yo-yo results, and lapses into the SAD mode that is so seductive and destructive for those of us who have had hormonally deranged hunger signals for so long.

Victoria, you must be an excellent English teacher. You have beautifully stated the plight of many of us. I hope you find the answers you are seeking here. Self experimentation is seemingly an endless and unpredictable process, at least in my experience. Best of luck to you.

[atomicspacebunny]

I know these are older posts but for me this IF chart solves (explains everything) the entire riddle (the be all that ends all) and is the answer to autophagy and weight loss using a glucose meter as a fuel gauge and it also explains why EF is not needed to get the exact same results[1]! During an IF (3 days {median point} then again over a period of time when done consistently) blood glucose also fluctuates but hepatic insulin clearance happens more rapidly at great speeds as you become a more efficient sugar burner[2] (fully keto adapted, not just fat adapted) and perhaps you choose to burn glucose rather than ketones for energy at certain times whether it be straight sugars, gluconeogenesis or ketones from the liver to the brain. I get those low ketone readings the deeper I go into the fast which is my goal, NOT high acidic ketone readings[1]!

[1] As Thomas DeLauer points out: In this study, a man voluntarily fasted for 50 days. His ketones were high (14 mmol/l) and he was injected with insulin (around 0.1 IU/kg, so around 7-8 IU). For 30 min, his ketones and blood sugar dropped and there was a massive uptake of ketones by the brain and ketone production was halted. However, within 30 min his ketones started shooting back up. In short, an insulin spike can kick you out of ketosis, albeit temporarily, as insulin clearance is seemingly fast …More

[2] Recent research* on endurance athletes (T-Low/C-High) in KETOSIS demonstrates that they BURN 23x SUGAR (glucose) and 2x FAT, but that’s only AFTER 3 MONTHS of being in KETOSIS and not completely KETO ADAPTED (ketosis adaptation takes 6 MONTHS) in contrast to Dr. Otto Warburg’s research in 1931 that demonstrates cancer cells need 18x more sugar (glucose) to thrive and prosper.

*RESEARCH:

Metabolic characteristics of keto-adapted ultra-endurance runners - Jeff S. Volek - Nov 2, 2015

The Effects of a Ketogenic Diet on Exercise Metabolism and Physical Performance in Off-Road Cyclists - Adam Zajac, Stanisław Poprzecki, […], and Grzegorz Zydek

Ketogenic diets and physical performance -Stephen D Phinney

Endurance athletes who ‘go against the grain’ become incredible fat-burners Elite performance on a diet with minimal carbs represents a paradigm shift in sports nutrition - November 17, 2015 Source: Ohio State University

[Oksandrat]

@atomicspacebunny @brownfat I’m a bit late to the party, but found this really interesting. I was curious and looked up normal morning cortisol levels. According to the Cushing Support and Research Foundation 10-20 ug/dl is in normal range in the morning. Mayo Clinic reference ranges are from 7-25 if/dl in the morning.

I found a cortisol conversion calculator on ENDMEMO:
10 µg/dL = | 275.9 nmol/L
20 µg/dL = | 551.8 nmol/L

These normal morning cortisol ranges appear match up to the morning cortisol levels as reported on the chart. It doesn’t appear that fasting is elevating cortisol levels, but normal circadian rhythm.

“When assessed with a typical radioimmunoassay (the most commonly used method), cortisol levels range from about 10 to 20 micrograms per deciliter (ug/dl) in the early morning (within one hour of the usual time of awakening), from 3 to 10 ug/dl at 4 PM, and are usually less than 5 ug/dl after the usual bedtime”

https://csrf.net/doctors-answers/diagnosis-qa/normal-values-of-cortisol-and-acth/

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8545

http://www.endmemo.com/medical/unitconvert/Cortisol.php

[atomicspacebunny]

Mostly when cortisol comes into question we are talking about basic human hormonal physioendocrinology 101 and psychosocial stressors, we know that this does that e.g. blocks fat burning etc… but under what conditions besides circadian hooks etc? My theory is that HGH overrides (when in Ketosis) all other mones in the absence of excessive glucose and rate of insulin clearing including the increase in DHEA; adrenaline, cortisol, estrogen, progesterone, androgen and testosterone in amylase conversion variation variables!

References:

1. How to Fast Before Test for Cortisol Levels “…Normal morning cortisol levels range from 6 to 23 mcg/dL according to “Mosby’s Manual of Diagnostic and Laboratory Tests.” …” …More

2. Intermittent fasting, cortisol and blood sugar on NOVEMBER 17, 2010 by Dr. CHRIS KRESSER. MD “…So, while I agree that IF is part of our heritage, and that it can be helpful in certain situations, I don’t believe it’s an appropriate strategy for everyone. Why? Because fasting can elevate cortisol levels. One of cortisol’s effects is that it raises blood sugar. So, in someone with blood sugar regulation issues, fasting can actually make them worse. I’ve seen this time and time again with my patients. Almost all of my patients have blood sugar imbalances. And it’s usually not as simple as “high blood sugar” or “low blood sugar”. They often have a combination of both (reactive hypoglycemia), or strange blood sugar patterns that, on the surface, don’t make much sense. These folks aren’t eating a Standard American Diet. Most of them are already on a paleo-type or low-carb diet. Yet they still have blood sugar issues. In these cases, cortisol dysregulation* is almost always the culprit. When these patients try intermittent fasting, their blood sugar control gets worse. I will see fasting blood sugar readings in the 90s and even low 100s, in spite of the fact that they are eating a low-carb, paleo-type diet. That’s why I don’t recommend intermittent fasting for people with blood sugar regulation problems. Instead, I suggest that they eat every 2-3 hours. (PROTEIN FOR GLUCAGON rather than glucose/sugar…emphasis added by me) This helps to maintain stable blood sugar throughout the day and prevents cortisol and other stress hormones like epinephrine and norepinephrine from getting involved. When my patients that have been fasting and experiencing high blood sugar readings switch to eating this way, their blood sugar numbers almost always normalize. I don’t think eating every 2-3 hours is “normal” from an evolutionary perspective. But neither is driving in traffic, worrying about your 401k, or staying up until 2:00am on Facebook. The paleo template is there to guide us, but it’s not a set of rules to be followed blindly. This should also be a reminder that there’s no “one size fits all” approach when it comes to healthcare. Successful treatment depends on identifying the underlying mechanisms for each individual and addressing them accordingly. …More

3. Effects of fasting and glucose load on free cortisol responses to stress and nicotine. “…Although glucose load per se did not affect free cortisol levels, psychosocial stress induced a large cortisol response in glucose-treated subjects. …” “…Low glucose levels appear to inhibit adrenocortical responsiveness in healthy subjects. In agreement with results from animal studies, the present results suggest that ready access to energy is a prerequisite for hypothalamus-pituitary-adrenal stress responses. …”

4. Intermittent Fasting and Cortisol “…Transient increases during a short time of fasting or exercise or fasted exercise or a stressful situation, are not too much for our body to handle. If such a minor stressor (fasted exercise) was so detrimental, we would not have evolved to where we are today. As a matter of fact, one of the main benefits of intermittent fasting is its ability to boost the resiliency of cells in response to “stress.” Cortisol and fasting are often pitted against each other in certain fitness circles. Those who preach, “Beware of cortisol increases in fasting,” are typically using cherry picked studies that don’t accurately depict the discussion at hand or simply ignore the entire picture. For example, some of the common studies for those in this camp include one where the participants fasted for 5 straight days and cortisol increased. Well of course, why wouldn’t it? Your body is trying to spare glucose. This leads to clickbait-esque thinking…fasting = more cortisol and cortisol = bad therefore fasting = bad. …More

5. Lehigh scientists believe they have found link between DHEA and central nervous system

6. Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate: Anabolic, Neuroprotective, and Neuroexcitatory Properties in Military Men Marcus K. Taylor, PhD

[N1coleS]

I think you bring up a good point, but it just seems like I am missing something or doesn’t match my N=1. Or maybe I just misinterpreting something. When I read the Obesity code and Dr. Fung/Megan Ramos stated your blood glucose would go up with fasting because the body was finally dumping all that extra stored sugars in the liver and fat cells. But they also stated that in time they would drop and normalize. I ate keto/low carb for 2 years prior to starting fasting. I ate 2 - 3 hours a days as stated by Chris Kresser and the weight did not come off. Granted, I think there was some internal healing going on so I won’t dismiss the good it did but I did not see any stabilized blood glucose levels. I finally got fed up and started fasting and began doing 3 - 5 day fasting per week. Like stated, my blood glucose shot up and stayed up! But the weight finally began dropping. After 2 months, my blood glucose levels dropped back down and stabilized! I had more energy, got better sleep and everything fell into place. That was 10 months ago and not once did my body feel “stressed”.
The last few months, I can rarely go more than 24 hours for fasting now that I am my goal weight, and now I see those levels creeping up a little more. Is it cortisol levels causing havoc from so much fasting? Who knows? Is it maybe because its time to build up muscles and my insulin sensitivity? That’s what I am betting on.

I agree with @Victoria_McCoy - I think us lay persons need someone to further digest all this technical data because it all seems contradicting at times and I am having hard time to figure out what might work for me.

[atomicspacebunny]

The last few months, I can rarely go more than 24 hours for fasting now that I am my goal weight, and now I see those levels creeping up a little more.

Things change once you become more metabolically fit (24 hour fasting becomes more difficult i.e. no fat to burn? weight? muscle mass? fat? ratios) so you have to change or discard previous protocols for different stages (body composition & chemistry?) of the game and adopt new ones?

E.g. I go back to the way I was eating before; adding more carbs (potatos & freshly milled bread too) and try to avoid refined and processed sugars!

Note: takes a lot of carbs to knock me out of Ketosis (or what is detectable by a blood meter?) now!

This is what I do now:

I slowly pull myself back out of Ketosis for a month and then slowly back in the next month (4 to 5 week intervals), because I am now a more efficient sugar burner! In this way you are giving your body a break from both modalities!

[ironhead341]

I respect Dr. Phinney and will certainly consider what he says about fasting and autophagy but I just finished a 60 hour fast and I lost no muscle mass or strength. I’m a weight lifter and I decided to try to do a normal workout before eating and my strength was through the roof. I performed extremely well and felt unbelievable. I didn’t gave the stamina to do as many sets as I normally would but I expected that. It’s hard to argue with Dr. Fung’s assertion that we, as hunter gatherers, adapted to periods of fasting and our bodies have safeguards in place to protect against lean tissue degradation. I like to trust my instincts too with regards to fasting and having been a competitive wrestler I went through periods of hard work and water fasting (even dry fasting in order to make weight) and my performance was unaffected. I can also attest to the seemingly physical and mental feeling of a rebooting of my entire being that feels phenomenal. Obviously a fast of 3 days or more there will be some loss of lean tissue but I do think that HGH slows that down and that autophagy is a positive and healthy benefit that makes it worthwhile. Not to mention the mental and spiritual side of fasting but I’ll reserve those comments for a different forum.

[KetoJimFL]

Enjoying the dialog guys.

I wish we had more hard science data to resolve the tension between LBM loss from fasting claimed by credible men like Phinney (who cites 5 studies albeit ancient 50 year old ones) and those advanced by Dr. Fung by reference to an “editor”'s book by Marshall D. McCue’s (ref. chart of Protein/LBM loss as a result of sustained fasting) “Comparative Physiology of Fasting, Starvation, and Food Limitation”. I can’t afford the $200 book by McCue to examine his footnote references. Anyone seen them or can vouch for his pedigree?

But from common sense alone it would be the most glorious of Divine Comedy for Nature to bestow on humanity this extremely complex system to store body fat for survival then reduce the body to a limp noodle by cannibalizing muscle to shed “excess horsepower capacity” before tapping into the huge caloric stores in body fat (months of fuel in most cases). I refuse to believe that Nature or Nature’s Creator is as incompetent as that notion implies. It would also mean that we are endowed with defective reasoning skills to believe this nonsense in the first place. Lack of symmetry in that systemic design defect implies fallacy (if my reasoning is not degraded or being gamed for entertainment by a higher order being).

[PaulL]

Well, as Gary Taubes points out, the same endocrinologists who can explain in detail the mechanism by which high insulin levels signal fat cells to store fat also believe that human weight gain can be explained solely by an imbalance between caloric intake and energy expenditure (i.e., we’re either gluttons or lazy slobs). So nature or nature’s Creator seems to have given us a high capacity to endure cognitive dissonance. . . .

(Personally, I subscribe to the theory that God has an extremely well-developed sense of humor. Otherwise, why create the human race in the first place? )

[OldDoug]

Jim, if there are “higher beings” out there, then I figure they are laughing their asses off.

I have no doubt that we can lose muscle if things get extreme enough, i.e. if the body thinks it needs to burn it to sustain life. I contrast that with the experience of most people who fast - especially those of us with a good amount of fat to burn. There’s also the mistaking of lean body mass like skin and cellular components - the stuff that autophagy handles - for muscle.

I really would like to know when it is, on average, that we start to lose muscle when fasting.

[KetoJimFL]

Exactly OldDoug.

I believe that Phinney to some degree plays into the hysteria for drama effect (more page views and following) by purposely conflating protein loss with Muscle Loss. There’s tons of excess protein sources internal to the body that are NOT muscle - connective tissue, loose flabby skin (from losing all the weight under chin etc), tumors, skin tags, dead or defective/mutated organ and intestinal tissue cellular matter etc.

I only lost muscle as a heavy faster lifter when I did intense cardio HIIT/Sprints (600 cals daily) on top of that fasted gym workout (OMAD) and when doing extended 4 day fasts. Had record body fat losses (skin fold calipers and looser than ever skinny leg jeans [5th wardrobe reduction]) but did lose visual mass in chest and strength too. I cut the cardio down to low level 200-300 traditional aerobic and cut the anerobic and now back up to near max strength again (6x lifting per week 3 muscle group rotation).

I want to know the real science on the matter so I can talk intelligently to others and give rational debate/dialog to make the sales. The visual impacts to my transformation make the case for those who know me (down 85 lbs to 10.5% BF) but those who don’t know me prior to “new Jim” need the science to back up the sales pitch - even when I get excited talking about it. Most of my compadres are science oriented like me.

[KetoJimFL]

Any deep medical science guys here who know the biomechanics of how amino acids are generated by the body? Is it possible that in a fasted state that the body in addition to normal autophagy regeneration might amp up its internal amino conversion process in “anticipation” of a tardy anabolic refeed growth phase to have it at the ready for muscle?

What is it sourced from - just recycled body tissue and cellular matter or can the body synthesize amino’s from residual glucose/glycogen, fats and hormonal interaction? I suspect that Phinney’s presumption that the presence of “N” (nitrogen) is mostly due to protein breadkdown - but could it not also be present in the formation of new amino acid generation ratios as a leading indicator of a new phase of preparatory tissue restoration?

[PaulL]

The body can synthesize most of the amino acids it needs from proteins in the diet. There are a number of “essential” amino acids, however, which must be supplied in the diet, because the body cannot make them. But amino acid synthesis would not free up nitrogen; quite the reverse. Fats and carbohydrates are made exclusively of carbon, hydrogen, and oxygen. They do not contain nitrogen, so the presence of nitrogen (or ammonia) in the bloodstream is a sign that protein is being broken down to synthesize either fat or glucose, depending on whether you’re lipolytic or glycolytic.

[Jennifer_Kleiman]

Anecdotally, I’m a huge fan of the show Naked & Afraid, where participants go on near-fasts for 21 days as they’re forced to forage and hunt for their food. Only of few of them are able to obtain substantial source of nutrition so most of them basically fast the whole time. Some of the participants intentionally pack on 20-30 pounds of fat prior to their stint on the show and they universally do well, losing the fat but not becoming gaunt or weak. The participants who go on the show looking lean almost inevitably tap out within a few days due to their immune system being weakened so they succumb to disease, or spend the time lying around and complaining about feeling weak and cold.

Any study on long-term fasting MUST distinguish between people with ample bodyfat vs already lean. I believe the studies Phinney is looking at were all on fairly lean individuals, right? Whereas Fung is looking at people with way more than an extra 20-30 lbs?

[devhammer]

So nature or nature’s Creator seems to have given us a high capacity to endure cognitive dissonance. . . .

Ain’t THAT the truth! And not solely about nutrition…

[devhammer]

Any study on long-term fasting MUST distinguish between people with ample bodyfat vs already lean. I believe the studies Phinney is looking at were all on fairly lean individuals, right? Whereas Fung is looking at people with way more than an extra 20-30 lbs?

Spot-on. That’s consistent with what I recall reading regarding Phinney vs. Fung. Also consistent with the study/formula that @richard has posted discussing the max amount of fat oxidation that’s possible daily given a certain level of body fat.

[richard]

I’m a huge fan of the show Naked & Afraid, where participants go on near-fasts for 21 days as they’re forced to forage and hunt for their food.

I would so rock that competition. I’m not particularly fazed by being naked, I’m fat adapted, I have adequate body fat to fast, and I learned how to make basic shelters in the boy scouts. I do have high fasting insulin, although after I fast for more than 3-5 days my BP drops and my normally low Ketones rise - so I can infer that my insulin has dropped.

I think my special item would be a kindle so I could catch up on my reading.