Questions for Jason Fung and Megan Ramos

(carl) #1

OK, forum hoppers! Here’s your chance to be FAMOUS!

As you may know, @richard and I are producing a new podcast for @drjasonfung and @meganjramos centered around patients at IDM and their stories. In the podcast, they would like to answer questions, kind of like the MAAIIIL segment of 2KD (but more civilized - they’re Canadian, after all). So, let’s hear your questions!

(Sjur Gjøstein Karevoll) #2

As far as I’ve understood things, measuring lean body mass and fat mass can be confounded by variables such as hydration, visceral fat and fat content in non-adipose tissues as well as gut content and this makes it hard to say exactly how much protein is lost during an extended fast and how much of a boost, if any, protein synthesis gets during the refeeding period. Do we have any data either from studies or even just from well documented anecdotes that have measured body composition before and after an extended fast as well as after a week or two after the fast ended?

(Mark Rhodes) #3

Along with this during autophagy there is a loss of cellular material with the damaged material being disposed and the recyclable being shuttled to be reused. After fasting regularly for some time would a person expect less autophagy and thereby less LBM loss?

(Mark Rhodes) #4

My question revolves around the fast feed cycle on extended fasts. Currently I will fast for three days taking in only water and black coffee. My eating cycle begins and I am ravenous for days! At first I considered it normal but now I am not so sure as the hunger cues seem to be non-stop. Could you explain the optimal feasting cycle for fat loss and the optimal feasting cycle for autophagy? Perhaps I am misconstruing what it means to feast?

Other details: 200 lb male, 53 last Dexa 20.4BF. EF 3 days weight 192. 2 weeks later 199-200. Weight lifter and active. Avg BS 81 mmol, fasting 60mmol. Ketones range .4-1.0 normally, will climb to 2.7 at end of fast. I do feel better fasting and the fluctuations do not really bother me but I am trying to rid myself of spare tire around my abdomen, like a bicycle fat tire inner tube. Keto since April 1 but a slightly higher carb intake with produce coming from my gardens ( good stuff like kale, cabbage, zucchini, cucumbers, tomatoes and brussels).

(Brian ) #5

I am an Internal Medicine Doc in San Diego, CA. Thank you so much for your podcast and your honest (and scientific) approach to health. I think it would help the community greatly if we had primary care providers share accounts from their patients. I was inspired by Dr. Fung greatly and changed my approach to diet and treatment of illness as a result. Just yesterday I received A1C results on a patient who has been on a Ketogenic Diet since 5/5/17—upon starting the diet his AIC had spiked to 12.3 but now is 6.2 (DM is diagnosed at 6.5) without meds (he has hep C so we decided not to start Metformin). He was only on insulin for a few days until we determined that he was making insulin still. The crazy part is that his starting weight was 151 lbs…not obese at all! He feels great and is thrilled with his progress. I have at least 20 diabetics who are killing it with intermittent fasting and ketogenic diet and coming off of meds. I love my job more than ever now! Thank you and keep up the great work!

(carl) #6

Thanks for sharing, @BrianL. We need more docs like you to share their experiences!


(Elaine Funk) #7

So exciting to hear that this dynamic duo is returning to podcast land. I have been waiting! My question is; I see a lot of T2D in remission, but is Insulin resistance a forever ‘till death do us part’ problem?


My understanding is that Dr. Fung has successfully used fasting to reduce insulin resistance in people who are not able to sustain ketogenic diets. Is this correct?


Yeah, there are murmurings out there about being able to heal and gradually go back to higher percentages of carbs–in a healthy way, of course, not just hopping back on the ol’ SAD bandwagon. I find the notion of being able to utterly reset one’s system compelling but I’m hesitantly hopeful.

—Can individual organs like the liver, pancreas, colon, fat cells, heal completely on a keto diet? (Healing = performance indistinguishable from an organ that never endured the impacts of insulin resistance)

—Once healed, is the body more susceptible to insulin resistance after having gone through it?

—Does the length of time a person was insulin resistant impact how susceptible they are to becoming insulin resistant again?

—Is it more in the organs or in the brain that the susceptibility is encoded?

—How does epigenetics play into it? Are successive generations being born more and more susceptible to insulin resistance or is it simply that the food environment is becoming increasingly hostile to our systems?

(KCKO, KCFO) #10

I would like them to address some of the side effects of extended fasting. Things like skin elasticity, will it improve, hair loss from losing weight, will it grow back, does your insulin resistance keep increasing or will it level out or even taper off at some point?

So glad you will be working with them. Can’t thank you two enough for all you are doing.

(Scott Cavendish) #11

Here’s a question…

I’ve been keto going on 11 months, fat adapted (I’m sure). I have a USB (newer 2017) ketonix breath analyzer and typically can blow between 2 and 6 ppm, so I know how it works. I’ve done extended fasts of 3, 7, and 10 days. Last month I did a 16 day fast and I could never get it to blow about 2 ppm, most tries blowing a zero! Once I started eating again, I started back with a 5 day egg fast, and the meter started going back up. Is there something about fasting that would cause my acetone levels to plummet? Tech support ran some tests, said the meter was working fine, and told me I must be blowing into it wrong. Another poster on the forums had the same issue. Wish I would’ve gone with a blood meter instead.



My question pertains to fasting for autophagy vs. fasting for weight loss (i.e. lowering insulin sensitivity by keeping levels very low for extended periods). I’ve heard Dr. Fung say that any protein will shut down autophagy (i.e. drinking bone broth while fasting). But drinking bone broth helps make extended fasts much easier for some people. So my question is where do you draw the line on fasting for autophagy vs. weight loss? Would you suggest regular fasts of say 36-48 hours with the inclusion of bone broth and perhaps small amounts of fat and then do a 7-day water only fast once a year for the autophagy/anti-cancer effects as Thomas Seyfried has suggested? For me, despite doing IF regularly for the last 6-8 months and doing a couple extended fasts of around 1-week I always struggle at around the 20-30 hour mark. I guess I feel like using bone broth while fasting is cheating so I’d like to know if it’s worth really trying to stick to water only or if the occasional inclusion of broth while fasting is almost as effective?

(Michelle) #13

echo @rian’s question.


My question also centers around autophagy. If during an extended fast (say a minimum of 3 days) one consumes only water and coffee and fat (absolutely NO protein or carbs), will autophagy still happen? If so, is there a limit to the amount of fat one can consume before autophagy is inhibited? (I’m thinking of the calculator posted by @richard which I find intriguing.)

(Mike Glasbrener) #15

My question pertains to “switching it up”. I have done several 60 hr fasts and many 36hr fasts. I switched from an occasional 60hr fast to a Mon/Fri 36hr fast after not seeing weight results from my last 60hr fast. I do not monitor fasting blood glucose nor HBa1c. My weight and the way I feel has been a very good guide for me so far as I’ve lost over 70lbs. However, I’m getting to about 20-30lbs from my ideal weight and I’m working through a several week slow down/stall in weight dropping. How do you decide in your clinic when to switch things up and what is the physiological changes induced by changing things up? At this time I have done two 36hr fasts per week for several weeks and could likely switch to one longer fast per week as my hunger pangs seem to once again be more psychological rather than physical.

Follow up (actually paraphrased I suppose):
When you switch things up what are the components/variables of diet and fasting that you adjust, especially for someone who consumes a keto diet/lifestyle? How do you decide when to change?


Another question (I hope that’s okay) is: if my hunger spontaneously drops so that I’m eating significantly (ie 300-400) less calories a day than usual, will my metabolism slow down?


I would like to hear Dr. Fung discuss the amount of energy that can be obtained from bodyfat in a given time period. In his 2KD podcast he said that he did not agree with the limit suggested by the macro calculator (and referenced by Richard). I know that I do lack energy (“bonk”) on runs when fasted. Sure, if the “run” is sufficiently slow and short there is no problem; however, there is certainly a range of fat ingestion where at the lower end I simply can not run as fast for the same distance as I can at the higher end. Carbs factor in too. Is that something that I can train? Basically, I am talking about fat adaptation for intense levels and durations of exercise. More specifically, is there a limit on the energy that can come from bodyfat such that exogenous fat (or carb) is necessary beyond a certain energy requirement? Even if a person were to burn 1.9g of fat per minute during exercise, as did the one person referenced in Drs. Volek and Phinney’s “…Performance”, how much of that can come from bodyfat?

(Mandi) #18

This is the first I’ve heard that the 2ketodudes are bringing Megan and Jason back to podcasting and I am thrilled! It’s a match made in heaven!

(Central Florida Bob ) #19

May I ask for details on the podcast? Is it going to be a new podcast or hosted during the 2KD?

In short, how do we find it?


So grateful for the chance to ask this of Dr. Fung and Megan Ramos!

I am T2D, 45 year old female, not taking any medications. I lost 20 pounds or so since starting keto in April, but have been pretty much stalled for the past couple of months (lose a little fasting, gain it back between fasts). I could still stand to lose 100 pounds. Through a recent glucose/insulin challenge test, my doctor confirmed I do have Type 2, not Type 1 diabetes. My fasting insulin at the start of the test was 20.4, rising only to 24.4 at 1 hour and 27.4 at the two hour mark. My fasting bg was 259, going to 323 at the 1/2 hour, 410 at the 1 hour, and 420 at the 2 hour. My c-peptide was 4.56 ng/mL.

Eating keto alone, without incorporating fasting, leads to my having blood glucose numbers in the 300s. Fasting knocks my bg readings down quickly, sometimes 100-point drops (or more) over the course of a day (I typically have my highest bg when I wake up, and lowest by late afternoon).

It takes about 5-7 days of fasting (water, pink salt, two servings a day of a sugar-free b-vitamin/caffeine drink called Berocca) to get into the low 100s or a little lower than 100. After breaking the fast, I have about one day of those lower bg readings but inevitably they start climbing back up over the keto eating days, even though I am trying to follow Megan’s advice to eat during only one or two 90-minute eating windows within an 8 hour period. If I eat on 5 days in a row or more, I typically hit the 300 bg mark. There is some improvement overall (low 300s rather than high 300s before I started doing a lot of fasting), but it is discouraging seeing the blood glucose keep going back up.

How long and/or how often should I fast to get to a point where my blood glucose stays in a normal range on eating days? I have done several 2- and 3-day fasts, a few 4- or 5-day fasts, and one 7-day fast over the last couple of months. (During August I had more fasting days than eating days.) Should I look into a much longer (medically supervised) fast in order to get lasting results?

Thank you for helping so many people heal.