Questions for Jason Fung and Megan Ramos

(sue) #21

I’d like to know if they’ve experienced their patients suffer from acne after fasts that exceed 80 hours or so.

This year I’ve done three 100 hour fasts (water, black coffee and salt only) and each time it resulted in a really nasty breakout. It would start at about 80 hours into the fast with one on my chin, one on my nose bridge, one on my upper lip, and then they’d spread like wildfire.

I’ve read anecdotes and theories online that losing body fat “releases” estrogen into the blood stream and wreaks havoc. Is there any science to support this? Over the course of the past 6 months I’ve lost ~30 pounds through a combination of low carb, keto, intermittent fasting, and 3 extended fasts.

I personally loved the long fasting experience but won’t do it again for fear of the acne. I’ve had acne most of my teenage and adult life and it cleared up 95% on keto so I hate that it comes back when I fast, and it doesn’t respond to my usual acne fighting routines. So frustrating!

So for now I’ve decided to keep my fasts between 16 hours and 60 hours at most. Just wondering if you have come across patients in your clinic that have gone through the same thing!

Other stats: Asian 27 year old female, was diagnosed pre-diabetic 5 years ago, 5’4", currently 153 lbs. Current hbA1c is 5.0 and fasted insulin is 6.2 (down from 10+) thanks to what I’ve learned via this community! :slight_smile:

(Richard Morris) #22

Both. We will have a pilot for the podcast in a special 2KD episode just like we did with the KetoWoman, KetoFamilies and KetoKiddos pilots. And all 4 new podcasts will have their own independent syndication so you’ll be able to subscribe to any of them on your podcast catching device.

(Amy Fischer) #23

I am a 51 y.o female, not overweight(5’ 5", 135 lbs) and with no health problems BUT struggling severely with menopause symptoms. Most recently with anxiety, depression, memory, brain fog, and sweating a little again. The anxiety is especially extremely debilitating. I started keto Feb 2017 and it cured the insomnia and hot flashes and I was able to IF naturally (18/6 or longer sometimes 20/4 and I felt great!) Now I no longer can. I am hungry all the time and have cravings again. I just started ex ketones and MCT oil powder hoping that will help. Any insights into menopause? I think fasting is my ticket but can’t do it anymore for some reason…I am desperate! P.S. I lift heavy weights twice a week and have an active job. Thank you so much for your books. I have read them both.

(David Cumming) #24

I would like to understand Dr. Fung’s / Megan’s experience related to whether there is a maximum amount of fat one can burn per day based on the amount of body fat a person has (Richard has explained this limit in detail on this site) and how this should alter your fasting strategies (fat fasting versus shorter fasts versus longer fasts). Also, should you be exercising while you are fasting if your body fat is only providing 50% of your BMR? I know Dr. Fung and Megan largely deal with very obese patients who have no shortage of body fat but surely some of them are getting leaner now and are finding fasting more difficult.

(Dan VanDeRiet) #25

Here’s my question. I’m 56 and having been doing a ketogenic diet for about two years. I’ve done some fasting, with the longest being a water-only fast the week before Easter last spring (just for the experience and to try to knock off the last 5 lbs. to get to my goal weight.) I’m now at about the weight that I want to be at; are there still benefits to doing some fasting and if so, what duration?



(Jack Brien) #26

Does the question have to be about fasting? I have a salt related question. How much is too much? Currently taking 2 tsp each of low salt and sea salt and 2400mg of Mg a day and still getting calf cramp in the morning

(Karen Parrott) #27

I second Dr. Brian’s request for primary care providers sharing positive patient outcomes.

Glad to see Dr. Fung and Megan back on the Podcast rotation and I heartily support them and kudos to the 2 Keto Dudes.

(Richard Morris) #28

Nice work. I would keep pushing to get it below an average of 110 mg/dl (HbA1c 5.5%) which is the point where we apparently kill of more beta cells from glycotoxicity than we can make new ones - that’s pretty much the point where a progressive disease becomes a reversible one.

I did it. 11.2% to 5.2% so it can be done :slight_smile:

(VLC.MD) #29

Hi Dr. Fung,

Q: Why do you love Vinegar so much ? :+1:

Vinegar references

(1) screenshot from The Aetiology of Obesity Part 4 of 6: The Fast Solution

(2) ingredient in Essential Bone Broth recipe (page 266, Complete Guide to Fasting)

BTW, Loved both your books (The Obesity Code, The Complete Guide to Fasting) and your video series The Aetiology of Obesity: The Fast Solution.

Steak is good for you?! Who knew?
(Richard Morris) #30

I tell you why I like it. well why I am fascinated by it.

Vinegar … well it’s active component Acetic acid is actually the only purely saturated fat in our diet. Even lard is mostly monounsaturated fat. It’s also one of the few fats that is not a lipid, as it’s miscible with water (along with butyric, propionic, and formic acids).

Of course I am likely fascinated because I am a trivia junkie. :slight_smile:

(VLC.MD) #31

Is there a deadline for question submissions ?

(Brian ) #32


That is amazing. Thank you for being my companion to and from work daily! I truly appreciate your podcast and refer patients to you for education. Keep up the great work! Congrats on getting that AIC under control…I will let you know when my patient gets to 5.1!

(carl) #33

No deadline. Not really sure when we’ll get to them either. Just keep asking them.

Also, we just published the first episode of The Obesity Code Podcast:



Hi all, Here’s my question

I’m a type II diabetic and I’ve been Keto for the last two months. I’ve been keeping my daily carbohydrate intake to 20 mgs or less and on average my glucose levels have dropped to an average of 130’s without any medication besides Metformin. I know I have high insulin resistance, but my question for Dr. Fung and Megan centers around high glucose spikes during extended (coffee/broth only) fasts. It could be day four of a fast and sometimes I will register glucose levels in the 160s-180s range. The only explanation I’ve ever come across has been sugar pockets trapped in fat cells and then released as you burn fat. Is this the only explanation?



I still do not completely understand why fasting when fat adapted is perfectly safe in terms of not losing LBM as opposed to the Minnesota starvation experiment.

Is fasting when not fat adapted even safe for perserving LBM and BMR? Such as if someone is doing a 36 hour to 5 day fast while also on a Mediterranean or moderately low carb (75 - 150 carbs) whole food diet? This was me back in March before I went on Keto in April. Interestingly, the fasts were so easy initially even though I was eating moderate carb. I had a lot of celebrations in March and literally would fast from one celebration to the next and not really limit myself at the celebration, usually eating in a short window (4 hours or less). In one case I allowed myself to have dessert which was delicious but I forgot to get more before it was gone!

The first few fasts on Keto were much harder, I was much hungrier. I am still not sure why that is. Any ideas? Especially as to why the pre keto fasts were so easy

I solved the problem with feasting

Another question, what stops autophagy during a fast, bone broth, HWC in coffee, small amounts of high fats or none of the above?

Related question, is there autophagy in a traditional Atkins style fat fast where you eat about 800 calories of macadamias or avocados?

Finally when is maximum autophagy achieved, how many hours or days. Does it continue?

(Jason Thomas) #36

Sue, it’s an interesting question. After my last 120 hour water fast (yay), days later I developed massive zits (2) on my legs and one on my back. I almost never struggle with acne, so it was odd. The one on my leg was so big, my wife thought I had some sort of wasting disease. It looked ghastly. I’d be curious of the answer. I mean fasting does release toxins…

Thanks for asking the question.

(Ken Early) #37

I’m looking at the GKI importance when battling cancer and how to maintain the 1:1 ratio? I started radiation and chemo 9/25/17.
Currently keto for 5 weeks (8/21/17)
Blood ketone average: 1.75 mmol/L.
Blood glucose average: 4 mmol/L
GKI average: 2.8
I’ve hit the therapeutic GKI ratio of 1:1 twice since testing. I have a spread sheet with all this information I would share if it’s wanted. I track macros daily.
I know fasting is another great way to get them up there. I use 24 hour and 18:6 hour fasts weekly. I eat only 2 meals per day totaling 2500+kcal. 85%fat, 10% protein and 5% net carb.
I workout 5-6 times per week and do cardio 4-5 days.
Any words of wisdom, or advise would be great.

(VLC.MD) #38

This GKI ?


Does eating bulletproof coffee break intermittent fasting?

(VLC.MD) #40

Dr. Fung makes fun of Bulletproof coffee frequently … so I’ll answer for him. YES.