Intermittent Fasting For A Sustainable Timeframe
- How to use intermittent fasting effectively in your lifestyle.
- Don’t eat breakfast? What should we do if we aren’t eating carbs?
Significant differences in processed food versus unprocessed food▼
Before we get started I would just like to mention that the National we’ll be live-streaming recording this from astronaut social media our staff are trained in patient safety and privacy and will not be disappearing with the presentation also I handed everyone a note card at the beginning if you do not feel comfortable asking your question out loud just write it down please and to grab it so today we have dr. Angela venture she is the associate director of the center as well as we’re excited to be here and we have a lovely day here in Massachusetts so a little in the warm for this time of year spring is coming so that’s exciting for new health ventures right as we get into health and wellness so we’re going to talk about the potential health benefits of intermittent fasting because I’m going to tell you guys what interment intermittent fasting is we’re going to talk about that why it might be beneficial to human health and how to use it effectively in your lifestyle this is something that you think you would like to implement in your lifestyle how you might go about doing that I’m going to have a Mista slide there I must’ve missed a slide but I had a good slide that talks about disclaimers and we’ll see if it comes up a little later but let’s start with fasting isn’t new okay so people been fasting for centuries and so this is Plato he said I fast for greater physical and mental efficiency so Plato you know was around in about 300 400 BC and this is Hippocrates Hippocrates is considered to be the father of medicine he was around about the same time as Plato he said everyone has a doctor in him or her we just have to help it work the natural healing force within each one of us is the greatest force in getting well our food should be our medicine our medicine should be our food but to eat when you’re sick is to feed your sickness so again he was advocating for a mantra of when you’re sick maybe you don’t quite eat as much so that your body can heal itself better when it’s not working on on digesting calories right digested calories takes work there’s work effort after we eat we have to do some work in our body and if we’re if we’re trying to heal from something that touch thing you should try to have times in which we’re not working to do the work of eating and digesting Paris Celsius it’s a physician around about 1400 now they talk as well he was considered to be the father toxicology was one of the first physicians modern physicians to think about chemistry and medicine and he advocated in Switzerland that physicians should learn about chemistry and learn about how the human body interacts with the chemicals and the things in the world around us and he also said that fasting is the greatest remedy the physician within he called it and then Ben Franklin is notable because Ben Franklin was also a person who who advocated for fasting and he said the best of all medicines is resting and fasting so he added one more component which we’ll talk about a little bit later which is sleep right the benefits of sleep and the benefits of rest and then the benefits of not eating for a period of time typically during the same time as rest right and interestingly Ben Franklin lived into his 80s he died he was 84 in the 1700s does anything know with the life expectancy of a of a normal man in a the 1700s was 38 years old a life expectancy at least according to Google and at the same time as Ben Franklin so he outlived his peers by almost 40 years right by practicing some of this sort of idea of mindfulness if you will or spending time you know honing down and let your body heal itself so here’s my disclaimer slide I put a little bit later so here’s what we’re gonna say at the beginning of this is nutrition research is really hard you’ll hear all the time eat breakfast don’t eat breakfast what should we do right eat carbohydrates don’t eat carbohydrates what should we do eat plants don’t eat plants or eat me don’t eat me what should we do right so there’s a lot of back and forth because nutrition research I know some of the dietitians in there right now can confess that it’s really hard to do right unless you lock people up an award right if you want to live an award right so Kevin Hall did this recently at the NIH he’s one of the preeminent research on her research also on how our body metabolizes calories okay what do we do with calories right and Kevin Hall is a wonderful person who does this type of research and he does have a ward at the NIH where people can live for about 40 you know right because who wants to stay longer than that in this metabolic Ward that measures everything you eat and everything you do and all the energy you consume and all the energy you burn and maybe you fidget a little or maybe you are little hotter than everybody else or maybe you look older than videos so again this room will measure all that and that’s almost what it takes to tell right what’s going on and that’s very hard to do in the world around us most of the studies on fasting in humans are very small sample size we are in the very very beginning of looking at how how fasting and the effects of fasting relate to human health so all of these we’re going to talk about right now are potential benefits right because again we don’t have big studies to say this is exactly what you should do now on the other hand I would say in the terms of fasting at least for relatively sustainable periods of time it’s not necessarily bad for a hurt you probably right so at least we know it might be good for you and it might be you might be able to do it and if you’re able to do it and you like it and it works for your lifestyle why not do it right because again if it’s not gonna hurt you then it might help you that might not do that most of the data on the health benefits have been event in fasting today of these some of the stuff we’re gonna talk about comes from animal models for now so we do have a lot of the Audion emotes that if you feed an animal less or if you fast them for a certain period of time that these are the metabolic benefits that happen so there are things that happen to you or to these animals for example that we’ll talk about a little later that it’s beneficial to human health and that’s what we get most of our data are from the animals and we don’t in medicine in general we don’t know all the answers right everything that we do is is with it what we call shared decision-making as a physician when I meet with you and I try to decide you know how are we going to help you with your disease or how we’re gonna help you with your wellness you know we’re focusing on what you can do and what you can accomplish right and what we know in the science that might be able to help you what works for one person this is the other key might not work for another okay so this is a pound of fat that I have in my hand and if you think about a pound of fat like a pound of butter right a pound of butter is a pound of that most people know how to do that at the store this is a pound of fat in the lab if I put this if I put this pound of fat in a calorimeter which is something that burns it up in the lab it takes 3500 calories to burn up this pound of fat that’s how much energy it takes to burn it up well we are not in a lab in a little box right so I don’t know how much it takes Angela Fitch to burn this pound of fat but let’s assume it takes for thousands it takes a little bit more for me maybe I’m good at storing energy maybe I like to store energy maybe I don’t move very much maybe I don’t sleep very well and it tell me that a little bigger maybe I eat a lot of processed food right and so maybe it takes me a little more maybe 4,000 right well this morning I got my pellets on bike and I rode for 30 minutes and I was drenched in sweat and I thought I was gonna die okay and after that you to workout with Dennis Martin you know I the Machine told me I’ve burned a hundred hundred calories I would have to ride that bike about 20 times all right in order to burn off this top of that I got 19 more to go right so again that’s the issue is that that we’re trying to get rid of this right this is what we have too much of today stored on our bodies in quite a few of us and in fact by 2030 the year 2030 it’s estimated and 50% of people would have the disease of obesity which the disease obesity is defined as excess fat that is then interacting with your life and causing other diseases to happen or causing you know other problems in the functioning of your human body right so this is the issue and the most important thing is do what works for you we never want anybody to do anything that makes them miserable I had a patient tell me one time well I’m going to just do this because because I know it gets better results and I’m going to pretend like it’s chemotherapy and that’s coming that again thing when you don’t want your doing something in your life it has to be that that that much of a struggle right because obviously going through chemotherapy is something that’s very challenging for the human body and you know what challenging for people to do and we don’t necessarily want life to feel like that 365 days a year for the next you know 60 years or whatever it might be so the first thing we talked about real quickly is who should not fast okay I wanna I wanna highlight that the beginning in case people don’t get to stay around as long if you’re underweight if you’re severely underweight what do you have an eating disorder like anorexia you really shouldn’t undertake something like this because it might be too challenging for you to alter your lifestyle such that it sticks with that if you’re pregnant or breastfeeding or you’re under the age of 18 probably shouldn’t do this type of thing now I’m gonna caveat that my pain then we’re going to talk about a little bit towards the end is in the middle then all of us should probably be fasting for about 10 to 12 hours right that’s what we did I mean this is what we you know you’ve probably heard people tell you don’t eat after 8 o’clock ok or don’t need after seven o’clock in order to manage your weight or in order to manage your baby better be healthy you’re right or not have her at night or whatever it is don’t need after that time right well that was really something that we kind of made up right he said don’t eat up to this time because of fasting now because it’s bad to eat necessarily after aid but because most people eat again at 8 o’clock in the morning and then or even earlier right and then you’re fasting for 12 hours right if you don’t eat after 8 and you need to get at 8 in the morning you’re automatically fasting because half the most that time you tonight cleaning right and so again the issue is that even in kids and people are pregnant resting it’s ok to be sort of fasting in the night right when we’re sleeping you probably can fast that you may need special medical supervision if you have diabetes especially have type 1 diabetes which is the tiniest we see mostly in childhood but type 2 days as well if you’re on medicines and lower your blood sugar that could be a problem if you’re gonna go into the periods of time when you’re not eating so please you know work with a physician to help you do that I say whether you take prescription medications for blood pressure and Tiger medic medicine for your heart failure or if you have gallagher high uric acid or a serious medical condition that might affect your liver heart or kidneys again make sure you’re working with a registered dietician or our position that knows you know what you’re doing so you can make adjustments in those medications now nutritional research as I said is really hard to do for the longest time we focused on the thing at the bottom which is quantity right we’ve always talked about calories and calories in and calories out but the focus today is more on that two at the top which is at the top is is timing and eating which is now a specialty called chrono nutrition right this one we talked about today when are we eating when are we not eating it probably makes the difference right related tour circadian rhythm which is the rhythm we’re supposed to have when we’re up in the day and we’re sleeping in the night this also brings up the topic of people who work night shift we know people with work night shift store extra energy as fat just because the night shift we have a lot of people that have to work night shift you have to have a nurse at your bedside in the middle of the night somebody in the hospital to take care of you right they have to work that night shift and so again looking at that trying to help those people it’s going to be a future of some of this research but Colonel attrition is the timing of meeting the quality its what Kevin home he’s going to the research arm and his love at the NIH which showed significant difference in processed food versus unprocessed food so if you take nothing else away from today as well as intermittent fasting the big thing in people ask me what should I eat if you’re eating unprocessed food you’re doing a good job right so the more focus we can have on Whole Foods right these are foods that come out of the ground that or you know that may be you know a chicken or something you know or whatever it is the church you’re eating that’s something that a factory-made right i mean a lot of things today we’ll see a little bit later that are made by a factory and with Kevin Halsted people the same guy it’s the same calories of process versus unprocessed so chicken and broccoli versus chicken nuggets and french fries or something that the same amount of calories the process through people gained more body fat despite the fact that they were eating the same you know the same amounts of food it was just that they were eating processed foods versus unprocessed so there’s something about that processing that isn’t good friends so what is intermittent fasting it’s really just the time you spend during a 24-hour period and you’re not eating right when am I going to eat what am I not going to eat you just take some planning you have to decide I’m not going to eat during this time window I find it helps me because I can say to myself I don’t trouble eating at night because I you know get home and I’m stressed and I’m like decompressing and I’m like you know I’m getting late dinner doesn’t start to set in and then dinners done you know dessert comes around at 10:00 right and so then it’s like you know I’m so I try to make it a pact to myself at least to try to go for 12 hours okay and it can be kind of hard write it again don’t each have to solve it like 8:30 or 8 o’clock or you have to go later in the morning until you eat so you get it but you can try that in it need it make it a positive thing instead of a negative so and I’m going to reach the ice cream I’m like oh wait it’s not that I can’t have ice cream it’s that I’m trying too fast right it’s like a step backwards thing right the other thing that you should talk about a couple definitions is again fasting in the times that not consuming any calories and so you really have to not consume any calories during that time which means you probably can’t have cream in your coffee in the morning and make it count right there’s a debate about that out there but again we don’t really know it’s probably different for different people right the fact that I got a might tell us I’m like this morning the fact that I’m not influenced distance which we’ll talk about in a second I probably could have a little splash of cream in my coffee at least that’s what I justify and still be fasting but again that’s probably not the same for different people right and you have to kind of know what your biology is about but the other thing we talk about is something called time restricted feeding if you hear that in the literature that’s again focusing more on a time window and Witney me so the idea is I don’t eat during these 12 hours but I’m eating during this 12 hours right so that’s the time let’s directortv I’m only going to eat from 8:30 until 8:30 at night and I’ve cut myself off any other time with it so again what we have to work with is carbohydrates fat and protein everything we eat has those things in them in some sort of proportion right they go into our body we either use that energy to run around to build new like my son who was 12 and he’s growing like you know 2 inches I feel like every week you know I mean he’s putting energy into growing right I’m not doing that sadly you know and so that means I have a little different you know a little different to eating routines I’m gonna have to follow on the other side of the coin you know how do we get how do we get rid of excess weight if we have this excess fat that we’re trying to get rid of is we have three components pretty much we have our nasal bit of ala great which is how many calories we burn when we’re laying down in bed and everybody’s is different ok so that’s the other challenge we have our physical activity the amount of exercise that we’re actually expending by walking around the hospital or by walking at work or by doing you know actual sighs and then we have this little piece at the bottom that shouldn’t go unrecognized which is Dietary thermogenesis almost 10% of your daily energy expenditure so if a person has energy excited about 2,000 calories that might be someone like myself 200 to those calories come from the fact that I have to digest my food okay now if I eat a frozen waffle for breakfast or if I eat nuts with Opie help right or nuts with quinoa that’s a for a little more fiber entirely quinoa right it’s gonna take me more energy to digest that nuts and quinoa it is the frozen waffle right so if I get a hundred calories frozen waffle I’m getting all those hundred calories they’re going right here right if I don’t use them up but if I have a hundred calories over here of quinoa and nuts I might only see 70 of those calories right in my body cuz the other calorie other 30 calories went to digesting that food that do have more fiber and so I had to spend more time and energy digesting those nuts not and that quinoa right so that’s about the quality of our food the quality of our food helps us to maximize that 10% of our dietary neurogenesis and this just sort of shows you that same thing that we are showing on that side where most of our resting energy expenditure is are sleeping metabolic rate you see that in red right if you don’t sleep enough this is my point here if you don’t sleep enough for whatever reason that might be right you miss out on a lot of that sleeping metabolic rate and if you lose out on that sleeping metabolic rate that’s like a 30-minute ride on my palate on this morning about 150 calories that you can lose in the night if you’re not sleeping well if you’re not using your CPAP and you have sleep apnea that’s 150 calories that’s where the half-hour and the gym just the way your CPAP okay so that’s what I tell patients when they come in and don’t want to wear their CPAP I get it I wouldn’t want to wear it either but you know if you can do that you can get extra calories out of it why not then we have that very compact insulin did I talk about there and then we have all the energy that we might extend and this is what we have to deal with to try to work on this energy balance every day and this just exemplifies that thermic effect of food we have carbohydrates our body only burns pretty much two sources three sources technically so it burns carbohydrates it burns fat and it burns something called ketones which are the byproducts of the fat so when the fat gets burned that ketones develop and then the ketones are used in energy consumption okay so but it really only burns carbohydrates and fats in order to produce energy carbohydrates are broken down into simple carbohydrates that would be like my processed waffle or like my Cheerios for breakfast right those are simple carbohydrates whereas complex carbohydrates are more things like like the quinoa I talked about or oatmeal or things like that where they have more complexity to that it takes them more energy to break down they break down into polysaccharides and then into starches fibers and hydrogen those starches fire is a glycogen are harder for your body to do things with the glucose to fructose they go right into energy storage so if you don’t use them because you’re good you’re giving a talk and you’re moving your hands a lot right you don’t use them right then you’re gonna store them somewhere in your body and you’re either gonna store them in your fat storage okay which a lot of times ends up in our bellies or you’re gonna store it in your liver which causes studied liver disease okay so that’s one of the things that we’re going to talk about a second so our goal is humans is to really sort of maximize our fat burning right it’s if 50% of us are probably more like 80 percent of us to be active to be truthful because 50% of people in 2030 are going to have obesity there’s going to be another 20% of people that are going to be overweight or over fat if you will having excess body fat right the idea is we want to burn this at maximum potential right and if we want to do that you’ll see in this diagram the red on the but this is time after eating so time after your last meal is on the bottom so two hours four hours up to 24 hours after your meal and the red is when you’re storing energy so immediately after your you’re storing that that food and energy and you look at that inflection point there at about about 12 hours is when you start to burn the energy from fat that you’ve stored or that you have excess storage of if you have excess like me so again the thing is is that you want to maximize that fat burning time and that’s where if you get out into 16 or 24 hours after your meal you see all that green that’s all the time you’re going to be spending burning energy and from a fat store so if you’re fasting for 24 hours 12 of those hours if you’re willing you’re burning your fat that your sports you’re maximizing the fact that you might not have to ride 20 times right am i right 15 times because you’ve been burning some extra fat you know during that fast or during your sleep right so in Florida is the form that we have in our body that lets energy in the cell that controls our blood sugar mind if you have a diet Edythe take one baby this and children start to childhood usually I mean obviously don’t have type 1 negative but they don’t make any more insulin they have to have a new flow pump or have to take it for because everybody doesn’t make any more and that’s life-threatening if you don’t make insulin insulin is the hormone that lets our energy into cells so insulin works like a key so the the black balls here in the blue balls here are glucose so we get sugar and right you saw those carbohydrates breaking down into glucose and fructose right so we get that sugar in our body right and then the insulin has to interact with yourself and open it so that the sugar can go into the cell and the cell can use it for energy right the cells all of our cells we get lots of them right have to use this for energy and so if you have insulin resistance which we’re going to talk about next which is a big chunk of people people diabetes technical resistance type 2 diabetes a lot of us have insulin resistance in the country what happens is the keys don’t work anymore okay so our body becomes resistant to insulin we have to make more and more insulin more and more keys start to be made because the sounds like where’s my key in the keys like I can’t go in okay go ahead make another key okay well that one doesn’t do anything okay they get other key if that one doesn’t go in either there’s a processing that’s broken all right and persistence that broken process causes the excess insulin when we have excess insulin around in our bodies we store more energy as fat so insulin resistance was a chosen genetic thing across centuries because we wanted to store fat one point time but we needed to be good fat stores to strive winter so those of us that survived the winter because we were good fat stores because our genes told us we were right we survived the winter and what did we do after we survived the winter we had more babies right because we were surviving and we replicated if we replicated those people that are good fat stores right so the other people that work at that stores so sorry for you in the room that are insulin resistant or that are a little bit leaner by nature right in the day you know they have these genes that make them eat right but I tell a lot of time if I wasn’t here you guys went through so energetic glucose right the energy of glucose that we get in our carbohydrates that we eat mostly right or in the if we’re using energy from fat waste or it’s like traffic right there’s all these cars right not only of those on the road but they need to find a place to park so envision is this road here we gotta find a place to park all those cars right where we going to park the cars some of them we’re going to burn up right and we’re just going to explode them all right otherwise we’re gonna need to park somewhere put somewhere in case we need up in the winter we need it when we’re riding our bike so I took this from dr. Burnett and sin had his book on South Asian Health Solutions I thought it was a nice dragon he looks at those cars those carbohydrates as cars right and where we gonna park them so we can park them in our muscle tissue as glycogen and the path parking pass is accepted there and you know the cars want to go there and they go up into the muscle they get stored as energy muscle energy and then when I do my workout then I burn that muscle energy right I need that to walk across the parking lot I need that to just energy on the other hand they go to the energy of just the human body over there on the left-hand side so you know my organs need energy my heart needs energy etc they they don’t go parked in the in the liver usually right and people’s are insulin sensitive because there’s no parking there okay so the liver says oh there’s a parking here your son’s into insulin I need you to go other places okay the problem is when your insulin resistant you’re resistant to storing energy in those cells and those muscles it goes or get your assistant to that right so instead that the cells say there’s no parking here sorry your past is not accepted it’s like when I go to the garage no you can’t break your classifier you know so there’s no demand maybe there’s no if you’re inactive if you’re sitting a lot there’s no demand and so then you you’re not you know there’s no parking there because you don’t need me and then if you’re in taking a lot of pot right at 20 cars depart right then there’s no parking because there’s too many cars right we can’t put them anywhere then instead the storage goes into our belly fat or the story explicit or our liver and cause a static liver disease so they have to be stored somewhere is the point right and if your insulin resistance you tend to store things in your liver and you tend to store things in your belly or in your fat storage so another way to picture that is you have the insulin which is little guy you know this sugar which is the sugar cubes and you want to get that into the cells so that we can burn it it’s energy right so if you’re sensitive you’ve got this blue guys push the sugar over into the cell the cells are running in when you’re resistant you have to recruit more guys to push this up sugar right so you have ten times the amount of guys some pages let’s see in the office have fasting insulin levels in the 60s and the normal is less than twelve so if you’re fasting insulin now even that fasting even when you’re getting up in the morning is already starting six times higher than the average person or the normal person if you will right you’re already starting six times higher that’s a problem right because you’ve got six times the amount of people out there insulin insulin tells your body to store energy as fat if anybody’s known anybody they had to go on insulin for type 2 diabetes and that you need to take influence you control your blood sugar because they can’t have that sugar around either that sugar is toxic to ourselves so be extra sugar around it hurts our kidneys hurts our heart causes blockages in our hearts causes buildup of lipids in our heart et cetera so we can’t object your sugar around if you have to take insulin for diabetes most people gain weight they gain 1020 pounds after that because in salute tells your body store energy as fat and not I’m not gonna put it in my cells right mr. resistor glycogen or glucagon sorry glucagon is the key that opens the door to let that energy out right so we want more glycogen around who’s willing to burn that energy and we want less insulin so that we can prevent it from being pushed in right so we want less than split around and we want more look at God and that’s what we’re trying to manage when we’re internet fasting so we’re trying to manage this insulin resistance essentially our insulin levels optimize insulin levels so that we’re not storing fetch that we’re burning fat okay so when insulin is around at high levels during a fat storage mode like after your meals right you’re in the fat storage moon because you have more insulin around insulin resistance the other issue with it is you eat food let’s say let’s say you did some resistance we’re starting to leftover that you eat food you produce insulin yourself that’s where she resists the insulin right I said oh we’re gonna make more and more more more MORE what happens with that is it tells your body to store more fat and then the next time around you make more insulin again to store more fat alright so it keeps increasing and then what happens is you get lower blood sugar too and you get tired and you eat more food again because you’re like a home tired now because I can say that so the classic you say buns people say you know after a big sort of dinner at the Chinese restaurant for example you might go there get a big meal with lots of carbohydrates or lots of rice at least in our country right you can lots of rice and then chores later you want to eat again you look for myself where I’m a hungry get right because you ate a bunch of rice and not a lot of the other stuff that you that was there the cause live in close distance as I talked about our genetics prolonged sitting longer than 20 minutes at a time so you guys have been sitting for minutes so unfortunately here becoming in solar system so if anybody I know it’s a big room if you want to get up those in the back good for you right understanding you’re not influenced together each time you sit that’s the problem with work environments down we sit for long periods of time the longer you sit that’s why it’s good to get up every twenty minutes lack of sleep less than seven and a half hours a night for whatever reason or sleep that’s not good right the cat’s jumping on you the kids are yelling at you you have hot pleasures from menopause whatever the reason for you’re sleeping or if you’re not sleeping well you’re becoming insulin resistant and then PCOS which is a syndrome of positive variance around and then increased stress daily increased stress increases insulin resistance so the more we’re stressed out that’s why practicing mindfulness doing meditation doing some other sort of relaxation activity going for a walk in the woods can reduce stress reduce cortisol reduce insulin resistance the picture at the right hand bottom corner shows a picture but back to the person’s neck which is called a can ptosis which if you can’t see it from the from the on line it’s a thickening of the back of the neck and darkening of the skin so if you have darker skin on the back of your neck and it’s thicker back there that they met marker of insulin resistance so we see that in patients where it’s gotten like that and that is tailed us gives us a clue that people have been flitter sister so again as we said after we eat zero to three hours we consume the food it’s broken down our body decreases our ghrelin ghrelin is the hormone that tells us that we’re hungry okay and we decrease it growling who’s we’ve eaten so we don’t have as much around we said okay I’m not – hungry anymore then the blood level of glucose and amino acids and fatty acids Rises the pancreas releases insulin and then the insulin number five shuttles nutrients into the cells to be stored as glycogen fat muscle or uses energy hopefully not as much into fat storage right and more into the other things if your insulin resistant that’s where you make too much insulin and then what happens is you store more of that energy as fat instead of to yourselves right maybe show that because you can’t get that energy in the cells that you’re resistant at 4 to 24 hours is where you start to experience your blood glucose drops a bit you with the release of insulin slows down so at that four hour mark you’re not as making as much insulin your liver begins to pump out some glycogen and you begin to burn some fat storage okay so that’s what we want to do is maximize that time then with that burning and so what we’re trying to do again is keep those infants low you can see here breakfast lunch dinner those insulin levels are spiking the insulin levels are the black line and shown by the black humps because so each hump right has the more you eat and the more carbohydrates you eat in particular are processed carbohydrates right without the fiber right so the more you eat that sugar the higher those levels the higher those levels are going to be the more resistant you are right so I said if you’re starting if your baseline is already at six times normal and you’re eating you know something that’s her grade for breakfast so don’t add our bagel you’re gonna be even higher right so it’s about trying to keep those humps low and trying to maximize the glucagon and decrease the insulin levels and this is an example of what we call 16-hour fasting and in our eating window this is time restricted feeding in an eight-hour window probably the most popular form of intermittent fasting that people are doing today so they’ll fast for 16 hours and then eat in an eight-hour window and you get to pick that you know we know that you eat it especially if you’re like you know working nights etc again it’s probably better from the science we have today to pick the morning window okay but that’s hard to pick right because you have dinners out and you know dinner with your family and you know socially we tend to eat at night right I mean our major meal is at night time not during the day so biologically it’s probably better than too fast you know to not eat after 3 o’clock in the afternoon in the morning ok and then not eat sort of later you know in the evening but if you’re not able to do that it’s it’s also helpful to eat in a shorter window time in eight hour window versus a 12-hour window into eight right or eight to ten we’re sorry midnight snack ready so again you know picking a time window to eat in is it’s the ability what you’re trying to do here you can see now you only have a spike at lunch and dinner you have these periods of time when you’re getting more green and you’re burning more fat right so the amount of green versus red is what you’re trying to maximize what are the potential health benefits of this intermittent fasting so intermittent fasting or fasting for a period of time right not eating for 12 hours or 14 hours or 16 hours whatever you can accomplish decreases inflammation so things like inflammatory diseases like rheumatoid arthritis or other inflammatory conditions get better after decreasing inflammation we see some weight loss or more importantly fat loss sometimes as long as people during the eight hour window aren’t eating excess calories so it doesn’t it breaks down if you’re doing it for weight loss you have to make sure during the eight hour window you’re not you know eating bags of donuts or something right like so in other words again we don’t advises for people that struggle with binge eating disorder because they tend people with ingénue to sort of tend to have trouble controlling the volume they eat and if that’s a trouble for you we don’t want you overeating during the eight hour window like restricting and then overeating right so you can overheat a little bit but you can’t overheat a lot is the part you can’t you know go just one into the other there’s a possible decrease in cancer risk or better effective cancer treatment with fasting so cancer cells all cells we showed need glucose to survive if you put cancer cells in a petri dish and you don’t give them glucose you don’t give them sugar water they die okay so if you start them on glucose they they don’t survive and so the thought process here is that if people who are undergoing cancer treatment do some fasting that they can optimize the benefits of their chemotherapy so again this is very early there’s not a lot of good human data but there’s data in animals to support that longevity a big reason for intermittent fasting has been longevity living longer okay and living healthier like been drinking quietly lived twice as long as the average guy because he was this behavior improve cell growth so the longer you fast the more you grow new cells good cells cells that are are needed for you to improve your heart function or cell to improve your pancreas function cells to improve your your gut function you resist stress better you have improved heart health and also importantly two can be improved cognition many people they do this note they have better mental functioning they can function better during the day they can focus better their ADHD might not be as bad and that the the piece on the side there shows normal cognition mild cognitive impairment and Alzheimer’s disease and as you increase that go down to Alzheimer’s disease they’re finding in Alzheimer’s now that these patients with Alzheimer’s have significant influence systems so Alzheimer’s disease is now being sort of quoted out there as type 3 diabetes because it’s again related to this insulin resistance pathway and the more that insulin you have around more you kind of store these these broken particles in your mind right these these April beef things in your mind and that caused it up and then you get dementia and other types of mental dysfunction so why do we care the prevalence of chronic disease in the United States is increasing dramatically and by 2030 it’s estimated 171 million Americans are going to have a chronic disease and this is why we’re trying to work on these things right to limit these chronic diseases in ourselves so we feel better so we live better so we don’t live you know sort of in a state that isn’t quite as healthy this graph is showing the obesity rates across since 2011 2017 and you notice as the grass progresses that it gets more proportionally red right so as it goes closer to 2017 most of the country is getting redder redder is greater than the dark red is greater than 35% so you see there Mississippi and down south really the 35% of people in that region already in 2017 have obesity which is a disease of excess fat storage it’s not people’s fault that’s the biggest thing we want to talk about anybody’s fault that they’re storing extra fat in people all the times for you at the weight center and say it’s just my fault that I can’t stop eating or I’m not eating the right foods right it’s not a side of your fault you can be completely completely needing the quote-unquote right thing right but then having some dysfunction in the way your body stores it is the way your body utilizes it medical complications of storing excess fat so the word of Easy’s up here but even if you have excess fat storage you can get things like non-alcoholic fatty liver disease you can get things like cornea heart disease cancer increased cancer risk by 30 to 50 percent by excess fat storage even if you have a normal weight I the 10% weight loss or fat loss more importantly decreases your mortality by 20 to 30 percent decreases your risk of diabetes by 58 percent just lose 5 percent 5 percent for a 200-pound person is only 10 pounds right so most people aren’t happy with 10 pounds of weight loss they come in they’re like I want to lose 50 pounds or I think I want to be like what I was in high school but losing that 10 pounds of keeping it off for the rest of your life if you can do that with intermittent fasting you can do that with some other type of work with a dietician or work with us the weight center our medication or whatever it is you’re doing for that you know it’s good for you is the point and then it decreases your LDL and triglycerides these are the things that we associate with heart disease and so there’s a great benefit to doing that so I have this little mnemonic that I share which is by ip’s for healthy lifestyle and healthy weight unfortunate did that fasting in there cuz I can’t find a P for fasting if anybody could to give up P for fasting I was trying to google it like what’s a good P for fasting but I have pillow which is get a good night’s sleep so hopefully during your sleep is when you’re going to be fasting right for at least that 10 maybe 12 hours at least planned portions we need to eat planned meals and snacks so even if we’re eating in a 12-hour window the more we can plan what we’re eating the better off we do if we just free live in the environment again 50% of people by 2030 you’re gonna have excess weight or excess fat storage so that means the the default in our world is to have excess right so you can’t just live free building in the world and let the world take care of you like the rats in the cage I mean they people the researchers just feed them right they don’t have any choices and so we we can’t we have to make specific choices we have to play Neels and plan our snacks and consider planning those in a specific time window he bought plans and protein we were eating so what we’re eating in our time window make sure we eat enough protein the last thing you want to do is go into a period of only eating eight hours and then not get enough protein because you’ll become protein malnourished so you need that protein to build muscle and to increase your metabolic rate and so you have to get that protein and so don’t forget about that you might need a protein shake or a protein bar because you’re trying to optimize how much protein you get per unit of heating that you’re eating in that time period right power doing some physical activity especially so interestingly intermittent fasting those benefits we talked about the inflammation and the other benefits one of the things that resemble the cancer risk reduction etc it’s exercise so if you look at what exercise done for us and what intermittent fasting does it’s about the same thing in the lab okay so intermittent fasting is kind of like exercising you know without exercising and if you add exercise to what I’ve been fasting the hope is you can get even better results so there are some things you can do with exercise like high intensity interval training that have been shown to increase mitochondrial production the mitochondria are tiny little engines we have it all ourselves they’re what produces energy or what we use energy – there was earned energy that we had as our mitochondria when we fast we actually make more mitochondria throughout our body when we exercise we make more mitochondria this is a good thing because now we have more energy burning little sources and then we’re doing a better job eat food mostly plants and not too much that’s what Michael Pollan says in his in his his motto and again during our eating window we want to do that this again just highlights the fact that 63% of our current environment is processed food okay in the United States 12% is plant food but interesting li half of that if you have this little note at the top that little note how did that 12% is plants considered apples and apple pie [Music] you know our Tomatoes in frozen pizza and then 25% is the animal food so this is one of our struggles and this just shows you to the bars along the the along the along the bottom those bars are the obesity rates in our country so the prevalence of obesity is on the right-hand side in those bars are the markers you can see in the 80s our prevalence of obesity was pretty flat you know from 1960 to 1980 and then the eighties are when you get to 1990 our obesity rates have jumped and then jumped again and jumped again if we have more data okay and the line graph is actually our process carbohydrate consumption so frozen waffles Cheerios I’m not picking on those people by the way I’m crackers you know whatever it might be right those sorts of foods those processed carbohydrates have increased dramatically during that time right and they overlay and they match up with our obesity rates interestingly that’s not causation right but it’s interesting that they match up right in the 1980s we did something in particular in the United States anybody knows what happened in the eighties I grew up in Iowa that gives you any hints yes so we subsidized corn we had this big corn with foreign aid in the unites in Iowa Willie Nelson came to Iowa and played for us it was so exciting here’s Muno you know and so they were ok thing to raise money for the farmers because the farmers were going bankrupt and so the US government says we’re going to subsidize corn we want you to find out what to do with it and then the government said great we’re gonna make all these things corn syrup we’re gonna feed the animals corn animals don’t eat corn normally and so we’re gonna feed them corn why do we feed them corn because it gets them to market faster and makes them fatter faster go figure and so again you know that process is continued and so who knows what that’s doing here at Harvard we have the healthy eating plate which is mostly made up of vegetables and and a little bit of fruit some healthy protein and a very small amount of what’s called whole grains so again this is whole grains these things like quinoa like farro like oatmeal you know these are not things like necessarily like bread right that’s not a whole grain or or you know things are made with whole grains right it’s better for you that white bread so weak breads better than like bread at the same time you know if you’re trying to lose weight you’re trying to get rid of fat and you’re not Michael thumps and burning thousands of calories you know in the pool you might not need those extra process carbohydrates because they’re going to be digested much easier so methods of fasting are like we said timers are good feeding that’s you fast for 10 to 16 hours and then you eat for eight to fourteen hours so sometime you know you got to equal 24 right so you pick I like to recommend people start with at least 10 hours of fasting for you know for a week see if they can do that then increase that to 11 increase that to 12 you know again the more you get into that 1416 the more you’re getting more benefit but even at 1012 you’re getting some benefit so there’s been some human studies looking at that and showing that that that could be beneficial even for that 10 hour fast by – fasting is where two days a week you eat only 500 calories on those days okay so this was I’m highlighted in the book by a gentleman in the UK alternate day fasting is where you instead of instead of two days a week you’re going too fast for 24 hours and you do that every other day so you leave dinner one day right then you don’t even get until dinner the next day usually that’s how people do it because we keep dinner it tends to be something we do and so you fast and out for 24 hours and you do that every other day and you get all you can do it two days a week so like the five – you’re doing the same thing almost but you’re just picking two days a week to do that 24 hour thing you know where one day I’m going to eat and then I’m not going to eat again then the last thing is the fasting mimicking diet they will cover quickly so this is that 16/8 method so the idea is here that the person picking that sort of bed time that you know that last meal 8:00 p.m. fasting again the next day for that 15 hours and then eating in that that eight hour time window okay then there’s the five – like we said we’re again in the bun – technically you would have 500 calories for women and six these four men on those alternate days and you can eat them throughout the day so some of our patients will do that and they’ll do just 500 calories and they might use protein shakes or meal replacements and do five of those right you can do five of those to make sure you get your protein nutrition and you can just do that two days a week so sometimes people do choose to do that if that fits in with their schedule you know if they’re busy and they they maybe don’t eat dinner with their family or whatever they do on a couple days a week so that sometimes fits with people’s lifestyle and again this is the Lipscombe eat stop eat which is for 24 hours so one day you pick you’re gonna have dinner and then you don’t eat dinner till the next day very important that you drink enough fluids you know during the time when you’re fasting right so non-caloric fluid too near fastings you’re not getting dizzy and again make sure you’re not a blood pressure medicine other things are working at your doctor if that’s the case the last thing quick is the fasting mimicking diet and this was developed by dr. vulture long ago at USC University of Southern California the idea here is that in the first 12 to 16 hours or the first 24 hours is where we get mostly weight management and metabolic health benefits so we’re burning the fat we’re getting the fat out of our livers right we’re clearing our livers out that’s happening in the first 12 to 16 hours or 24 hours when you get to 2 to 3 days or 4 to 5 days at two to three days the purple there is called Auto staging so after 2 to 3 days of fasting this is if you’re you know really fasting for 5 days in a row after two to three days yourself eat themselves up the bad ones right so the cancer set up can eaten up by the the immune function cells that are eating up those cancer cells and getting rid of them that’s what happened to all of us we get a bad cell and then our body eats it up our immune system eats it up and then we don’t get cancer hopefully that’s kind of how that’s supposed to work that all the things it’s increased after 2 to 3 days of fasting at 4 to 5 days of fasting at the bottom and the green is when you get stem cell rejuvenation so animals that fast for longer than 4 days their body makes stem cells stem cells are the cells that can produce anything in our body so give a stem cell transplant many patients will have them instead of a bone marrow transplant we’ll get a stem cell transplant because those stem cells can turn into any cell so if you take those love your body you put them back in after you have chemotherapy it grows a new cell right it grows new bone marrow grows new cells so that happens at the 45 days now it’s very challenging for people to pass that long Gandhi and other people do this for religious reasons etc up too fast for long periods of time so dr. Valter Longo has come up with what’s called the fasting mimicking diet which he’s figured out at least and animals that if you eat just only certain very small amounts of things during the five days you can actually mimic five days of fasting and you would do that once a month for example or once every quarter depending on what you’re trying to accomplish so you might pick five days in which you follow this eating plan and that eating plan is outlined in his book the longevity diet or you can buy actually a bunch of sort of ready-made supplements there’s all in it there’s there they’re healthy sort of foods they’re soups and olives they’re mostly sort of healthy fats that you need your body needs and essential amino acids that you’re getting from these drinks and teas and stuff anyway you can do that for five days and just eat that right instead of having to try to make it up yourself but you can’t make it up yourself so that’s just another way of creating some of the health benefits of fasting you know there’s these different methods and it depends on what works for you so this just came out in the New England Journal in December by dr. Madison dr. Kable and this sort of suggests how you might do that like I said for the first month you might have a ten hour feeding period five days a week right so you might do that and then in the next month you focus on an eight hour feeding period and the next month or six-hour etc so that you can get you know work yourself into this so you don’t have to go quite so cold turkey make sure you’re eating the rainbow of phytonutrients other times of the day right because you want to get all these good things all these good things are what happens this is from the Cancer Society and it shows all these good effects of orange foods beta carotene supports immune system and is a powerful antioxidant so we need beta carotene we need all these colors in our diet which is why we say eat the rainbow and fiber is your friend our goal is to get 30 grams of fiber a day especially three biotic fibers such as inulin so any of it is what our good bacteria eat prebiotic fiber is found in chicory root asparagus leeks and onions so if you eat those things that prebiotic fiber your good bacteria eat that fiber and then they are populated in your gut and there’s a lot of connection between our gut health and our mental health and everything else right so the healthier the duck we have the more fiber we have in there the more we’re going to have a better gut health and better outcomes so quickly before we get to questions the NGH weight sensor is a place you can call if you struggle with your weight and struggle with obesity unfortunately we don’t do just intermittent fasting consults so if you’re looking for advice on intermittent fasting and you don’t start with your weight we don’t have that option for you at the weight center but certainly work with your doctor ask your doctor this is becoming more knowledge people become more knowledge about this but if it makes us wait you can’t come to the weight center and intermittent fasting might be something that we can help you with if that’s something that you choose we have the team approach dieticians psychologists obesity minutes and positions parity surgeons I’m gonna be see medicine physician here’s all of our beastie medicine physicians here’s all of our surgeons are amazing dietitians that might help somebody with with this type of thing that’s the other thing too you can look to a dietician in the community you know they you can meet with and work on intermittent fasting as obesity isn’t the reason why here you’re working on it and our psychologists again psychologists are important in this behavior change and how do we stick with this behavior right if it’s hard just stick with behavior and it’s hard thing to do and then we also do pediatrics at the at the weight center as well the issue with weight is that the more health risks you have the higher your BMI is the higher your treatment intensity has to be to get that weight off because weights very hard to get off is the problem right so for people with a BMI greater than 27 or BMI greater than 30 we tend to use a medical approaches such as prescriptive nutritional interventions the purple there that’s where intamin fancy might come in the prescriptive nutritional intervention that you’re following on purpose because you want it achieve some health out of pollen right and so whatever that helps come out in the is can service reduction or anti-inflammatory or weight loss right you’re trying to do something to your nutrition we have medications for obesity we have prestigious for obesity and for our patients that have BMI is greater than 40 or greater than 35 especially with diabetes surgery is the most effective tool that we have for treatment so in summary I suggest everybody work on fasting for at least ten hours you know if you can especially if you can go for 12 that’s even I think a bonus right so if we can just work on that as humans and then work on making the best choices the best bright rainbow that we can eat during the day that’s going to be essential and again this idea of you eat breakfast well breakfast just comes from the word break fast okay so what it really means is breaking your fast so you’re gonna eat breakfast and you that might be like for me today at 11 o’clock they’re doing my fasting right so I still have breakfast right but but it just wasn’t that eight it doesn’t have to be at six is the point right focus on unprocessed food choices prioritize your sleep especially the sleep of your children because they have to learn how to do that they don’t just naturally sleep I have to learn how to sleep you have to prioritizing to tell myself I’m going to bed I’m turned off at phone etc the active sit less strength train if you can and talk to your doctor in your care team thank you so much explain this phenomenon the obesity curve introduced the phone always hungry educator Ludwig he’s here at Buster Buster children Delano Kenai is about book about intermittent fasting longevity diet doctor Valter Longo the diet doctor taught me and I have no affiliation with any of these books or any of these things so I don’t have any you know any disclosure in there the tanyaconnor comm is a great website that talks a lot about intermittent fasting how to do it what kinds of foods things like that so that’s a great resource for people try to accomplish this as well question the bass have been a public read so the question was how do you calculate the basement of a great so in the weight Center we actually measure it so you can actually measure it and I think they’ll be devices in the next you know here or two that you can actually probably hook to your iPhone and you’ll actually be able to breathe into it and actually measure your basement of a great so that’s coming because it actually isn’t quite that challenging but we have a little machine you read in so we can actually measure it for you that’s the best way because that is what you’re burning what I’m burning etc right because we know it’s all different but as far as calculations there’s calculations you can google it via monarchism about recalculation you plug in your height your weight your age your gender and it just gives you a number know BMR same thing yes the dietitians I’m using equation there’s different equations there’s Mifflin st. John there’s different equations out there but essentially they calculate it for you and you can do both as you can inside basal metabolic rate calculator and you’ll come up and you plug in you know your like I said your age your height your weight and your gender and it roughly calculates what you should be based on that weight okay one being how strict should you be eating unprocessed foods well again I don’t I mean I need the word strict right because the thing is is that we have to do something eighty percent of time and save a little bit in fasting if you break your fast because you at a party don’t feel that about it right like the next day just get back John what you’re doing it’s so often we create a lot of guilt and a lot of shame around our eating and that shouldn’t be the case right so the idea is that eighty percent of time we should be doing something right and so if you can work on I mean I you process dude I just had three Oreo cookies last night [Music] in the house you know so anything but you can’t live a pure essential you know completely unprocessed life very easily in a 60% processed world but it’s like a salmon swimming upstream you know somebody’s when you’re when you’re like that you have to and you have to enjoy things always gonna be enjoyment but the hope is that the internet could be 20% of time and not like you know more than that right that’s the idea and then how would you characterize in a minute fasting as a complement to other dietary programs such as low fat low carb diets yes the question was how do you characterize it emitted fasting or how does that complement other types of dietary lifestyles so again we don’t like to talk about the word diet because no one should be on a diet they should be having a lifestyle right so if you’re on a diet you’re doing something that you’re trying to stick with that’s like hard for you you know verses like this is my lifestyle right and so again it have been fasting sizes you can go with any lifestyle really I mean it’s you’re a vegetarian or you’re vegan or you’re doing something that’s a little lower carbohydrates then your insulin resistance so like me I try to manage my carbohydrates and try not to consume them extra if I can avoid it and so again it goes along with a lot of things the other thing about it too is it doesn’t cost anything right intermittent fast so I think it’s a great resource for our patients who might struggle or if you online or in the room are struggling with finances you know because you’re just focusing on the time period in which sure you’re eating or not eating right and so again it can it can be done by my almost anybody as long as you’re healthy enough to do it and doing it under the right decision how can we know what type of food is good for our type of body so the question was how do we know what type of food is good for our type of body so that’s going to be the future of precision medicine so we don’t have precision medicine yeah it’s for nutrition and I know there’s a lot of controversy on that out there meaning there’s a lot of sites that will say they have precision nutrition for your body it may be true maybe not like in other words I don’t say that that’s that that’s bad for you but at the same time you know we we just don’t have the the data and the science today to necessarily predict what Angela fish should be eating what you should be eating what you should be eating right and so that’s why it’s so hard because we know we all react to different foods different ways so it’s kind of a trial and error process at this point in time but the one thing that comes back to is right unprocessed food right so every back to the Mediterranean diet which is super good for us which is full of a bunch of unprocessed food right there’s not a lot of pasta there’s not a lot of Pizza you know and again that’s good I love pizza it’s my favorite food but you know the thing is is that you know they do it a shorter period of time right you don’t do it every night and then lastly to have any recommended patient information resources about an R in fasting so patient information resources I gave them that that last slide which is some of those books that were there on the delay jodean I book longevity diet diet dr. tom has a lot of great resources I’ve been fasting we’ve had on a handout today that we’ve heated the weeks I turn in a min fasting and I think that’ll be available potentially online to be able to access that too through the Blum Center website so again I think it’s certainly dieticians in your community again as more and more physicians are becoming trained in this I think you can talk to your doctor about it it certainly doesn’t hurt the more you talk to them about it hopefully the more they’ll they’ll go home and read up on it so they can do this kind of want to I think it was up to me in a PDF sort of format yes uh-huh yes the woman there is she had a question earlier so you could do that it’s not that you can’t if that I said that you should do that under supervision of step one so it just because when you fast or when you when you when you lose weight especially if you’re if you’re also losing weight at the same time which many people do it can raise your uric acid level the weight loss so we see that in our surgery patients or our patients that are going through you know losing 50 pounds with us at the weight center they can have flares of gout during that weight loss attempt and so again we just have to try to manage that and and when you’re doing gout of course you want to make sure you’re eating a count healthy diet you know during the times that you’re eating right and then drinking plenty of water to you right is always a good thing you know during these fasting times like I said over and over non-caloric beverages so there’s again there’s a bunch of myth out there whether you can have cream in your coffee and still be fasting and and you know people have said you can have 50 calories and it won’t jack your insulin levels right I think that’s not true for everybody right because again some people are starting out fasting with levels are six times normal so if you’re one of those people you probably can’t have anything in your coffee if you you know if you’re a different person maybe you can’t have a little it’s about practicing and just seeing what happens right I think people all the time we are trying to change your lifestyle you’re trying to practice something different because again the standard is the 60% processed world out there right and the standard is what we have in our in our in our standard American diet which the acronym for standard American diet by the way is sad it’s kind of sad but the thing is is that when we’re practicing something we have to have help usually to practice right you hire a coach to get better you know at whatever it is you’re training for right you hire a piano teacher to learn to play the piano you don’t usually just kind of do it by yourself so work with your care team and work with people who can help you do it yes you mentioned [Music] the best thing you can write so the question was non-nutritive sweeteners no artificial sweeteners or other types of sweeteners they may not even be artificial but also may have you know a sweetening effect um the best thing to do is if you’re truly trying to do it you know purely by the book is to just drink water or tea or black coffee right so nothing in there at all because you’re right the non-nutritive sweeteners the Splenda and other types of things can actually increase your insulin levels I mean we have some data to show that so that’s the the problem is that you know you’re trying to manage those insulin level trying to keep them intentionally low so as to be more in a fat-burning mode instead of a bad storage mode yes any comparison between the different fasting methods like it’s one superior to the other so no one has really compared that Cup again we’re really in our infancy so really it’s about the different methods the question was any superiority of any of the different methods of fasting and we don’t really have any data on that so other than the fact that I suppose the differential there would be the fasting mimicking diet which is sort of mimicking the 5-day fats which may have that autophagy and that stem cell production effect so if you’re doing it for like inflammation or you’re doing it for cancer risk reduction that’s where the longevity diet after long most research comes into play is in those sorts of arenas right not for weight loss but for other reasons you may want to do that method right you’re going to get more of that autophagy and more of that cellular regeneration from that fasting mimicking lifestyle but again in general there hasn’t been any you know that’s what works for you I mean the reason I use several different methods is because you have to figure out what works for you because what works for me might you know might work for me to do the two days a week you know because I like to just get her done and be done it might work for somebody else to do the same thing every day because then they they’re gonna have it and they’re doing it better well so again if you’re running into I mean hopefully you’re not struggling with hypertension you know most people can control their blood pressure if you’re on medicines you might have to adjust those medicines or diuretics that’s why same work with your doctor because on the days that you’re fasting you might have to make an adjustment or you might adjust the time window in which you’re taking those things so that’s the important thing I mean we say 80 ounces of fluid a day just as a standard and most of us but even you have 220 ounces a day is certainly potentially needed during fasting you know if you’re really focusing on fasting so really just carrying around stuff with you you know a water bottle our manager over in our clinic our senior ministry ministry client one because these markings on it like it’s a little like this big his gold streak to them he’s really good you know so I mean again the voyeur can chicks better yeah so what the diets you have noticed into the storage so so the great questions a couple questions which is great so the question is that weight loss and plateauing so everybody plateaus all weight loss stops eventually like other words that’s we were engineered we’re not engineered to continue to lose weight so even if you’re them in fasting or doing some sort of intervention usually you’re gonna reach a plateau and whether that plateau is where you want it to be is the question right just I mean a lot of times that’s what so is hopefully what you wanted to be other times it’s not what you want it to be is that ten pounds right and you want to leave off more than that so everybody plateaus because the body fights back against weight loss and as the more weight you lose the more the body fights back and that setpoint we speak you spoke of so the idea is the more weight you lose the harder becomes to keep it all so you just have to keep working at it so that’s a good point to make is that whatever you’re doing you have to keep doing it which is why it has to stay with your lifestyle if that thing for sixteen hours is like chemotherapy to you then you shouldn’t do it you know cuz I don’t think anybody should do chemotherapy three and sixty five days here right so I mean again you should do it if you need to do it so you get better but you know you know there’s a finite into it so with any of these things you want to do them forever there’s no data to suggest that the different types of whether again like like the question was earlier like if you’re doing it two days a week if that’s sort of you know invigorates your metabolism and such we don’t have any data to support that we don’t know unfortunately this was just a discussion on one of our Facebook groups then you know how do we know as dietitians or as physicians you know how do we recommend to people to break through that Plateau and we really don’t have good answers to that yet today you know we don’t we tell people things like quantum to big sit up a little bit Australian fasting you just the point is whatever you’re doing once you get to a plateau you decide to do something dippings right so whatever that different is it might be and I’ve been fasting it might be you’re gonna you know increase your exercise time increase your exercise intensity you know so there’s lots of different things that you can kind of mix up in their sleep letter is a huge one d stress you know that’s another one and they have trouble working on those things you can only sleep as well as your sleep right I mean but maybe have to go and get your hot pushes treated because maybe that’s something that if you treated those and you were sleeping better you wouldn’t be struggling as much that’s excellent question was it’s important to time your example so there’s some theory that if you work out when you’re intimate like when you’re in a fast that you may that may be better for you so like in other words you should work out fasting as you can okay not everybody can do that though right I mean I do it because I mean that’s what I like to work out in the morning but I’m not fasting first you know I mean I’m not I’m working out like you know not at my 16 hours when I’m working out right I mean I’m working on it 12 hours before that 10 hours straight cuz I mean I’m I’m eating up until 8 o’clock and I’m working on at 5:30 right so I mean it’s not but there is some data to suggest at least now again it’s not we don’t have all the answers we don’t know you know so we don’t know any but there are people that do that intentionally to try to improve their metabolic performance as it relates to that you know but again I mean that’s not recommended and certainly for athletes assuming you know it’s a Michael Phelps’s of the world right because I mean again you know because you’re an elite athlete you’re probably trained yourself such that you need to be sort of eating you know when you’re working out in order to work out and the deaths of doubt that when you’re fasting you also don’t have as many calories right so you’re a little bit calorie depleted by tired yes so you have to balance that with how you feel certainly I mean so you know you spend how hard you’re working out how look what level of training you’re training at right you know so and how did you are right because again if you’re if you’re relatively lean are ready you might need not need to be timing your workout to when you passed right if you’re mean trying to burn more fat then you might want to time your workout to win your battery so it’s a good question the question was you should do time your meals out three main street ransacks well most the time again the advantage of it and fasting is you’re only eighty two meals so there is some thought process that the less it probably depends off of your insulin resistance in turn insulin resistance probably better to eat potentially a little at discrete times because you really increase your info and you eat right so if you can limit those times it might be better than kind of doing it constantly right so that you’re having these cosmic jumps but the same time you also a lot of you don’t have big volume swings either right because you’re gonna also so they’re really you know isn’t a lot of data in this day which is better it’s really whatever it works for you and whatever you like to do right I mean for the most part but again it’s picking that window to eat in most people can’t eat three meals and two snacks in eight hours and it’s a little bit hard but but if you can that would be fine you know there’s nothing wrong with that if you wanted to eat but like they may be smaller you never get to be eating so every hour or whatever you know to get that in every two hours to get that in yes the benefit to the 24-hour passed over the five – no yeah no we don’t again the question was benefit of one method over the other we don’t have any data its whatever works for you again it just allows you to have the it allows you to have more calories you know it just allows you to put them in different places and do it a different time that’s probably better – right so the point is that even I mean probably doing 24 hours one day a week is better than not doing anything at all so whatever keep work for you is the key yes back then I’ll get you this well especially it depends on your fitness your level of fitness and your own personal a lot of people can exercise even at a 24-hour fast so it just depends on you know you’re not able to you know go like like you know hard do a marathon you know something like that but but if you can go for a walk or if you can spend 20 minutes on your peloton bike and be able to do it you know I I would probably pick here I wouldn’t pick a 60 minute powered zone max ride which is one of the party rides on the bike she know after I defensive in 24 hours I might pick a beginner on 20 minute clearly sort of intense yes sir yes the question was how do you lose belly fat if you’re kind of an overweight well that’s the thing is a lot of us as I showed that picture store that extra energy in our bellies we know that as we get older that happens in fact menopausal women well gain belly fat they’ve done ten years studies of CT scans and than a puzzle women and they will show going through menopause and just show the fat accumulating over and over again right so many getting bigger and bigger so it’s a natural process so when you’re trying to fight the natural process it’s hard to do right but again some of these strategies that’s what it’s designed for is to burn the fat because if you have excess fat the Nexus 5 even if your weights is kind of normal so it’s really about our body fat percentage and not about our actual weight so we’ve made it into our weight problem but it really did the body that problem so me I’ll take myself for example who I’ve lost 30 pounds in the past few years intentionally into trying to be healthier and when I was not as healthy you know my body fat percentage was was was some you know 38 39 40 % body fat normal is to be less than 34 percent and now I’m at about 32% okay but I still have all the weights but I’m normal like my body temperature is normal you know right so the thing is is that you know that’s the it’s really about our fat percentage and it really it’s you storing it in your belly it’s actually kind of worse for us than people who store it naturally you know in your hips yeah so technically speaking when you’re passing you shouldn’t decrease your basal metabolic rate you’ll decrease your total energy expenditure the base metabolic rate stays the same no matter what it’s your basal metabolic rate it’s dependent more on your sleep through stress and other types of factors than actually whether you’re eating or not the thermic effect of food you don’t get and then the the the so that’s really what you’re missing right when you’re not eating from a total energy expenditure the total so again yes the shortage of question is that the the metabolic effects of fasting and fat burning are what’s good for you right independent of the amount of energy that you’re burning okay I think we’re probably.