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  • Is Fasting an Effective Treatment for Diabetes? | NutritionFacts.org

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    By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

    Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

    More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

    Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

    “Poor diabetic people’s medicine
    He should live like a saint (Munni);
    He should walk for 800–900 miles.
    Or he shall dig a pond;
    Or he shall live only on cow dung and cow urine.”

    That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

    Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

    Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

    As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

    When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

    The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

    With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

    Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

    To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

    Doctor’s Note

    Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

    For more on fasting for disease reversal, see:

    Fasting is not the best way to lose weight. To learn more, see related posts below.

    What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.

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    Michael Greger M.D. FACLM

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  • The Effects of Fasting on Cancer | NutritionFacts.org

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    Ever since the days of Hippocrates, 2,400 years ago, fasting has been offered as a treatment for acute and chronic diseases, based on the observation that when people get sick they frequently lose their appetite.

    Along with fever, decreased food consumption is one of the most common signs of infection. Often regarded as an undesirable manifestation of sickness, it’s actually an active, beneficial defense mechanism. As I discuss in my video Fasting for Cancer: What about Cachexia, chronic under-nutrition can impair our defenses, but data suggest that, in the short-term, immune function can be enhanced by lowering food intake.

    Researchers have shown that the blood from starved mice was nearly eight times better at killing off the invading bacteria in a petri dish, dramatically boosting the capacity of their white blood cells to kill off the pathogens. What about people? And what about cancer?

     

    Does Fasting Help Our Natural Killer Cells Fight Cancer Cells?

    When study participants fasted for two weeks on an 80-calorie-a-day diet, not only did their white blood cells show the same kind of boost in bacteria-killing ability and antibody production, but their natural killer cell activity increased by an average of 24%. This is especially interesting because our natural killer cells don’t just help clear infections, but they also kill cancer cells. In fact, that’s how the researchers measured natural killer cell activity; they pitted them against K562 cells, which are human leukemia cells.

    Fasting is said to improve anticancer immunosurveillance, or, more poetically, by “stimulating the appetite of the immune system for cancer.” So, why isn’t fasting used more to treat cancer? Because so much about cancer care revolves around keeping people’s weight up to try to counteract the cancer-wasting syndrome.

     

    What Causes Cancer Cachexia?

    Until recently, fasting therapy was not considered to be a treatment option in cancer, related to the fact that a common therapeutic goal in palliative cancer treatment is to avoid weight loss and counteract the wasting syndrome known as cachexia, which is the ultimate cause of death in many cancer cases.

    Tumors are voracious, rapidly expanding and in need of a lot of energy and protein, so cancer metabolically reprograms the body to start breaking down to feed its tumors. It does this by triggering inflammation throughout the body. It’s not just that people lose their appetite. “The fundamental difference between the weight loss observed in CC [cancer cachexia] and that seen in simple starvation is the lack of reversibility with feeding alone.”

    Therapeutic nutritional interventions to correct or reverse cachexia frequently fail. The best treatment for cancer cachexia, therefore, is to treat the cause and cure the cancer. In fact, maybe forcing extra nutrition on cancer patients could be playing right into the tumor’s hands. Like in pregnancy when the fetus gets first dibs on nutrients even at the mother’s expense, the tumor may be first in the feeding line. Maybe our loss of appetite when we get cancer is even a protective response.

     

    Is Chemotherapy Enough?

    As I discuss in my video Fasting Before and After Chemotherapy and Radiation, for the past 50 years, chemotherapy has been a major medical treatment for a wide range of cancers. Its main strategy has been largely based on targeting cancer cells, by means of DNA damage caused in part by the production of free radicals. Although these drugs were first believed to be very selective for tumor cells, we eventually learned that normal cells also experience severe chemotherapy-dependent damage, which can lead to dose-limiting side effects, including bone marrow and immune system suppression, fatigue, vomiting, diarrhea, and in some cases, even death.

    If you do survive chemotherapy, the DNA damage to normal cells can even lead to new cancers down the road. There are cell-protecting drugs that have been tried to reduce the side effects so you can pump in higher chemo doses, but these drugs have not been shown to increase survival––in part because they may also be protecting the cancer cells. What about instead fasting for cellular protection during cancer treatment?

     

    Fasting and Chemotherapy

    Many may not recognize the role fasting can play in cancer prevention and treatment. Short-term fasting before and immediately after chemotherapy may minimize side effects, while, at the same time, it may actually make cancer cells more sensitive to treatment. That’s exciting! 

    During deprivation, healthy cells switch from growth to maintenance and repair, but tumor cells are unable to slow down their unbridled growth, due to growth-promoting mutations that led them to become cancer cells in the first place. This inability to adapt to starvation may represent an important Achilles’ heel for many types of cancer cells.

    As a consequence of these differential responses of healthy cells versus cancer cells to short-term fasting, chemotherapy causes more DNA damage and cell suicide in tumor cells, while potentially leaving healthy cells unharmed. Thus, short-term fasting may protect healthy cells against the toxic assault of chemotherapy and cause tumor cells to be more sensitive––or at least that’s the theory.

    Researchers found that, in rodents, fasting alone appears to work as well as chemotherapy. What’s more, unbridled tumor growth was also knocked down by radiation therapy—and even more so after the combination of radiation and alternate-day fasting. However, alternate-day fasting alone seemed to do as well as radiation. These data are exciting, but for mice with breast cancer. What about people?

     

    Fasting Put to the Test Against Cancers

    As I discuss in my video Fasting Before and After Chemotherapy Put to the Test, several patients diagnosed with a wide variety of cancers elected to undertake fasting prior to chemotherapy and share their experiences. They reported a reduction in fatigue, weakness, and gastrointestinal side effects while fasting and felt better across the board, with zero vomiting. The weight lost during the few days of fasting was quickly recovered by most of the patients and did not lead to any discernable harm. So, overall, fasting under care seems safe and potentially able to ameliorate side effects.

    chart showing reduced chemotherapy side effects with fasting

    In a randomized clinical study, breast and ovarian cancer patients fasted from 36 hours before chemotherapy until 24 hours after, and fasting did appear to improve quality of life and fatigue. However, another study found no such beneficial effects. There did appear to perhaps be less bone marrow toxicity, given the higher counts of red blood cells and platelet-making cells. But no benefit when it came to saving white blood cells—the immune system cells—so that was a disappointment. Perhaps they didn’t fast long enough?

    A systematic review of 22 studies found that, overall, fasting may not only reduce chemotherapy side effects (like organ damage, immune suppression, and chemotherapy-induced death), but it may also suppress tumor progression, including tumor growth and metastasis, resulting in improved survival. But, nearly all the studies were on mice and dogs. The studies on humans were limited to evaluating safety and side effects. The tumor-suppression effects of fasting––for example, its influence on tumor growth, metastasis and prognosis––sadly, were not evaluated.

     

    Does Fasting Make Chemo More Effective?

    As I discuss in my video Fasting-Mimicking Diet Before and After Chemotherapy, short-term food withdrawal during chemotherapy may begin to solve the long-standing problem with most cancer treatments: how to kill the tumor without killing the patient. Short-term fasting––for example, for 48 hours before chemo and 24 hours afterwards––may reduce side effects, so-called “chemotherapy-induced toxicity.” However, the potential tumor-suppressing effects of fasting have still not been thoroughly evaluated.

    Some argue that reducing chemo’s side effects alone could improve efficacy, since patients could withstand higher doses. For example, the heart and kidney damage associated with the widely prescribed anti-cancer drugs limit their full therapeutic potential. It’s not clear, though, that maximizing the tolerated chemo dose would achieve longer survival or better quality of life. For now, I think we should just be satisfied with the fewer side effects for fewer side effects’ sake.

     

    How Does Fasting Work?

    Fasting can reduce the levels of insulin-like growth factor-1 (IGF-1), a cancer-promoting growth hormone. The reduced levels of IGF-1 mediate the differential protection of normal cells and cancer cells in response to fasting and improve chemo’s ability to kill cancer but spare normal cells.

    So, reducing IGF-1 signaling may provide dual benefits by protecting normal tissues while reducing tumor progression. It may even help prevent the cancer in the first place. But fasting isn’t the only way to drop IGF-1 levels: A few days of fasting can cut levels in half, but that’s largely because protein intake is being cut. Protein is a key determinant of circulating IGF-1 levels in humans––suggesting that “reduced protein intake may become an important component of anticancer and antiaging dietary interventions,” particularly a reduction in animal protein.

     

    Lowering Protein Intake to Lower IGF-1

    If you compare those who eat strictly plant-based diets and get about the recommended daily intake of protein (0.8 grams per kg of body weight) to individuals who are just as slender but consume the higher amount of protein more typical to Americans, going on a calorie-restricted diet may lower IGF-1 a little, but eating a plant-based diet can lower it even more than going low calorie. 

    Chart showing bigger restriction of IGF-1 concentration compared to a low calorie or western diet

    So, not only may a diet centered around whole plant foods down-regulate IGF-1 activity, potentially slowing the aging process, but it may be a way of turning anti-aging genes against cancer.

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    Michael Greger M.D. FACLM

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  • Fasting and Plant-Based Diets for Migraines and Traumatic Brain Injuries  | NutritionFacts.org

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    What effects do fasting and a plant-based diet have on TBI and migraines?

    An uncontrolled and unpublished study purported to show a beneficial effect of fasting on migraine headaches, but fasting may be more likely to trigger a migraine than help it. In fact, “skipped meals are among the most consistently identified dietary triggers” of headaches in general. In a review of hundreds of fasts at the TrueNorth Health Center in California, the incidence of headache was nearly one in three, but TrueNorth also published a remarkable case report on post-traumatic headache.

    The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than a million Americans sustain traumatic brain injuries (TBIs) every year. Chronic pain is a common complication, affecting perhaps three-quarters of those who suffer such an injury. There are drugs, of course, to treat post-traumatic headache. There are always drugs. And if drugs don’t work, there is surgery, cutting the nerves to the head to stop the pain.

    What about fasting and plants? A 52-year-old woman presented with a highly debilitating, difficult-to-manage, unremitting, chronic post-traumatic headache. And when I say chronic, I mean chronic; she experienced pain for 16 years. She then achieved long-term relief after fasting, followed by an exclusively plant-foods diet, free of added sugar, oil, or salt.

    Before then, she had tried drug after drug after drug after drug after drug—with no relief, suffering in constant pain for years. Before the fast, she started out in constant pain. Then, after the fast, the intensity of the pain was cut in half, and though she was still having daily headaches, at least there were some pain-free periods. Six months later, she tried again, and eventually her headaches became mild, lasting less than ten minutes, and infrequent. She continued that way for months and even years, as you can see below and at 1:45 in my video Fasting for Post-Traumatic Brain Injury Headache. 

    Now, of course, it’s hard to disentangle the effects of the fasting from the effects of the whole food, plant-based diet she remained on for those ensuing years. You’ve heard of analgesics (painkillers). Well, there are some foods that may be pro-algesic (pain-promoting), such as foods high in arachidonic acid, including meats, dairy, and eggs. So, the lowering of arachidonic acid—from which our body makes a range of pro-inflammatory compounds—may be accomplished by eating a more plant-based diet. So, maybe that contributed to the benefit in the fasting case, since many plant foods are high in anti-inflammatory components. In terms of migraine headaches, more plant foods and less animal foods may help, but you don’t know until you put it to the test.

    Researchers figured a plant-based diet may offer the best of both worlds, so they designed a randomized, controlled, crossover study where those with recurrent migraines were randomized to eat a strictly plant-based diet or take a placebo pill. Then, the groups switched. During the placebo phase, half of the participants said their pain improved, and the other half said their pain remained the same or got worse. But, during the dietary phase, they almost all got better, as you can see here and at 3:11 in my video.

    During that first phase, the diet group experienced significant improvements in the number of headaches, pain intensity, and days with headaches, as well as a reduction in the amount of painkillers they needed to take. In fact, it worked a little too well. Many individuals were unwilling to return to their previous diets after they completed the diet phase of the trial, thereby refusing to complete the study. Remember, the participants were supposed to go back to their regular diets and take a placebo pill, but they felt so much better on the plant-based diet that they refused. We’ve seen this with other trials, where those trying plant-based diets felt so good, they often refused to abandon them, harming the study. So, plant-based diets can sometimes work a little too well.

    All my videos on fasting are available in a digital download here.  

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    Michael Greger M.D. FACLM

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  • Should We Fast for IBS? | NutritionFacts.org

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    More than half of irritable bowel syndrome (IBS) sufferers appear to have a form of atypical food allergy.

    A chronic gastrointestinal disorder, irritable bowel syndrome affects about one in ten people. You may have heard about low-FODMAP diets, but they don’t appear to work any better than the standard advice to avoid things like coffee or spicy and fatty foods. In fact, you can hardly tell which is which, as shown below and at 0:27 in my video Friday Favorites: Fasting for Irritable Bowel Syndrome.

    Most IBS patients, however, do seem to react to specific foods, such as eggs, wheat, dairy, or soy sauce, but when they’re tested with skin prick tests for typical food allergies, they may come up negative. We want to know what happens inside their gut when they eat those things, though, not what happens on their skin. Enter confocal laser endomicroscopy.

    You can snake a microscope down the throat, into the gut, and watch in real-time as the gut wall becomes inflamed and leaky after foods are dripped in. Isn’t that fascinating? You can actually see cracks forming within minutes, as shown below and at 1:03 in my video. This had never been tested on a large group of IBS patients, though, until now.

    Using this new technology, researchers found that more than half of IBS sufferers have this kind of reaction to various foods—“an atypical food allergy” that flies under the radar of traditional allergy tests. As you can see below and at 1:28 in my video, when you exclude those foods from the diet, there is a significant alleviation of symptoms.

    However, outside a research setting, there’s no way to know which foods are the culprit without trying an exclusion diet, and there’s no greater exclusion diet than excluding everything. A 25-year-old woman had complained of abdominal pain, bloating, and diarrhea for a year, and drugs didn’t seem to help. But, after fasting for ten days, her symptoms improved considerably and appeared to stay that way at least 18 months later. It wasn’t just subjective improvement either. Biopsies were taken that showed the inflammation had gone down, her bowel irritability was measured directly, and expanding balloons and electrodes were inserted in her rectum to measure changes in her sensitivity to pressure and electrical stimulation. Fasting seemed to reboot her gut in a way, but just because it worked for her doesn’t mean it works for others. Case reports are most useful when they inspire researchers to put them to the test.

    “Despite research efforts to develop a cure for IBS, medical treatment for this condition is still unsatisfactory.” We can try to suppress the symptoms with drugs, but what do we do when even that doesn’t work? In a study of 84 IBS patients, 58 of whom failed basic treatment (consisting of pharmacotherapy and brief psychotherapy), 36 of the 58 who were still suffering underwent ten days of fasting, whereas the other 22 stuck with the basic treatment. The findings? Those in the fasting group experienced significant improvements in abdominal pain, bloating, diarrhea, loss of appetite, nausea, anxiety, and interference with life in general, which were significantly better than those of the control group. The researchers concluded that fasting therapy “could be useful for treating moderate to severe patients with IBS.”

    Unfortunately, patient allocation was neither blinded nor randomized in the study, so the comparison to the control group doesn’t mean much. They were also given vitamins B1 and C via IV, which seems typical of Japanese fasting trials, even though one would not expect vitamin-deficiency syndromes—beriberi or scurvy—to present within just ten days of fasting. The study participants were also isolated; might that make the psychotherapy work better? It’s hard to tease out just the fasting effects.

    Psychotherapy alone can provide lasting benefits. Researchers randomized 101 outpatients with irritable bowel syndrome to medical treatment or medical treatment with three months of psychotherapy. After three months, the psychotherapy group did better, and the difference was even more pronounced a year later, a year after the psychotherapy ended. Better at three months, and even better at 15 months, as you can see here and at 3:58 in my video.

    Psychological approaches appear to work about as well as antidepressant drugs for IBS, but the placebo response for IBS is on the order of 40%, whether psychological interventions, drugs, or alternative medicine approaches. So, doing essentially nothing—taking a sugar pill—improves symptoms 40% of the time. In that case, I figure one might as well choose a therapy that’s cheap, safe, simple, and free of side effects, which extended fasting is most certainly not. But, if all else fails, it may be worth exploring fasting under close physician supervision.

    All my fasting videos are available in a digital download here.

    Check the videos on the topic that are already on the site here. 

    For more on IBS, see related posts below. 

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    Michael Greger M.D. FACLM

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  • Boosting BDNF Levels in Our Brain to Treat Depression  | NutritionFacts.org

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    We can raise BDNF levels in our brain by fasting and exercising, as well as by eating and avoiding certain foods.

    There is accumulating evidence that brain-derived neurotrophic factor (BDNF) may be playing a role in human depression. BDNF controls the growth of new nerve cells. “So, low levels of this peptide could lead to an atrophy of specific brain areas such as the amygdala and the hippocampus, as it has been observed among depressed patients.” That may be one of the reasons that exercise is so good for our brains. Start an hour-a-day exercise regimen, and, within three months, there can be a quadrupling of BDNF release from our brain, as seen below and at 0:35 in my video How to Boost Brain BDNF Levels for Depression Treatment.

    This makes sense. Any time we were desperate to catch prey (or desperate not to become prey ourselves), we needed to be cognitively sharp. So, when we’re fasting, exercising, or in a negative calorie balance, our brain starts churning out BDNF to make sure we’re firing on all cylinders. Of course, Big Pharma is eager to create drugs to mimic this effect, but is there any way to boost BDNF naturally? Yes, I just said it: fasting and exercising. Is there anything we can add to our diet to boost BDNF?

    Higher intakes of dietary flavonoids appear to be protectively associated with symptoms of depression. The Harvard Nurses’ Health Study followed tens of thousands of women for years and found that those who were consuming the most flavonoids appeared to reduce their risk of becoming depressed. Flavonoids occur naturally in plants, so there’s a substantial amount in a variety of healthy foods. But how do we know the benefits are from the flavonoids and not just from eating more healthfully in general? We put it to the test.

    Some fruits and vegetables have more flavonoids than others. As shown below and at 1:51 in my video, apples have more than apricots, plums more than peaches, red cabbage more than white, and kale more than cucumbers. Researchers randomized people into one of three groups: more high-flavonoid fruits and vegetables, more low-flavonoid fruits and vegetables, or no extra fruits and vegetables at all. After 18 weeks, only the high-flavonoid group got a significant boost in BDNF levels, which corresponded with an improvement in cognitive performance. The BDNF boost may help explain why each additional daily serving of fruits or vegetables is associated with a 3 percent decrease in the risk of depression. 

    What’s more, as seen here and at 2:27 in my video, a teaspoon a day of the spice turmeric may boost BNDF levels by more than 50 percent within a month. This is consistent with the other randomized controlled trials that have so far been done. 

    Nuts may help, too. In the PREDIMED study, where people were randomized to receive weekly batches of nuts or extra-virgin olive oil, the nut group lowered their risk of having low BDNF levels by 78 percent, as shown below and at 2:46.

    And BDNF is not implicated only in depression, but schizophrenia. When individuals with schizophrenia underwent a 12-week exercise program, they got a significant boost in their BDNF levels, which led the researchers to “suggest that exercise-induced modulation of BDNF may play an important role in developing non-pharmacological treatment for chronic schizophrenic patients.”

    What about schizophrenia symptoms? Thirty individuals with schizophrenia were randomized to ramp up to 40 minutes of aerobic exercise three times a week or not, and there did appear to be an improvement in psychiatric symptoms, such as hallucinations, as well as an increase in their quality of life, with exercise. In fact, researchers could actually visualize what happened in their brains. Loss of brain volume in a certain region appears to be a feature of schizophrenia, but 30 minutes of exercise, three times a week, resulted in an increase of up to 20 percent in the size of that region within three months, as seen here and at 3:46 in my video. 

    Caloric restriction may also increase BDNF levels in people with schizophrenia. So, researchers didn’t just have study participants eat less, but more healthfully, too—less saturated fat and sugar, and more fruits and veggies. The study was like the Soviet fasting trials for schizophrenia that reported truly unbelievable results, supposedly restoring people to function, and described fasting as “an unparalleled achievement in the treatment of schizophrenia”—but part of the problem is that the diagnostic system the Soviets used is completely different than ours, making any results hard to interpret. There was a subgroup that seemed to correspond to the Western definition, but they still reported 40 to 60 percent improvement rates from fasting, but fasting wasn’t all they did. After the participants fasted for up to a month, they were put on a meat- and egg-free diet. So, when the researchers reported these remarkable effects even years later, they were for those individuals who stuck with the meat- and egg-free diet. Evidently, the closer the diet was followed, the better the effect, and those who broke the diet relapsed. The researchers noted: “Not all patients can remain vegetarian, but they must not take meat for at least six months, and then in very small portions.” We know from randomized controlled trials that simply eschewing meat and eggs can improve mental states within just two weeks, so it’s hard to know what role fasting itself played in the reported improvements.

    A single high-fat meal can drop BDNF levels within hours of consumption, and we can prove it’s the fat itself by seeing the same result after injecting fat straight into our veins. Perhaps that helps explain why increased consumption of saturated fats in a high-fat diet may contribute to brain dysfunction—that is, neurodegenerative diseases, long-term memory loss, and cognitive impairment. It may also help explain why the standard American diet has been linked to a higher risk of depression, as dietary factors modulate the levels of brain-derived neurotrophic factor.

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    Michael Greger M.D. FACLM

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  • Does Fasting Help Treat Depression?  | NutritionFacts.org

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    Caloric restriction can boost levels of brain-derived neurotrophic factor (BDNF), which is considered to play a critical role in mood disorders.

    For more than a century, fasting has been espoused as a treatment of supposed “great utility in the preservation of health,” especially rejuvenating the body and, above all, the mind. When people fast for even 18 hours, though, they may get hungry and irritable. After one or two days, positive mood goes down and negative mood goes up, and after three days, fasters can increasingly feel sad, self-blame, and suffer a loss of libido. Then, something strange starts to happen: People experience a “fasting-induced mood enhancement…reflected by decreased anxiety, depression, fatigue, and improved vigor.” Studies tend to show this across the board. Once you get over the hump, fasters frequently experience “an increased level of vigilance and a mood improvement, a subjective feeling of well-being, and sometimes of euphoria.” And, no wonder, as, by then, endorphin levels may rise by nearly 50 percent, as seen here and at 1:06 in my video Friday Favorites: Fasting to Treat Depression. 

    This enhancement of mood, alertness, and calm makes a certain amount of evolutionary sense. Our body wants us to feel poorly initially so we continue to eat, day to day, when food is available, but if we go a couple of days without food, our body realizes we can’t just mope in our cave; we need to get motivated to go out and find some calories.

    So, can fasting be used for mood disorders, like depression? It’s great that people can feel better after a few days of fasting, but the critical question revolves around the “persistence of mood improvement over time” once fasting ends and eating resumes. The little published evidence we have comes out of Japan and the former Soviet Union, and some of it is just ridiculous, like this study that included women with a variety of symptoms, which the researchers blame mostly on marital conflict, as you can see below and at 2:08 in my video. Husband not treating you right? How about some “electroshock therapy”? That didn’t seem to help much, so what about “hunger therapy”? Of course, starving the women made them hungry, but that’s what Thorazine is for. If they keep getting injected with an antipsychotic to calm them down, they can sail right through. So, what happened in the study? What would we even do with those results? 

    Another study, however, skipped the Thorazine. The participants fasted for ten days, but they were also kept in bed all day on “absolute bed rest,” completely isolated and “prohibited from seeing other people except the attending doctor and nurse…also denied access to television, radio, newspapers or any other forms of information.” So, if people got better or worse, it would be impossible to tease out the effects of the fasting component on its own. But researchers found that they apparently did get better, with efficacy reportedly demonstrated in 31 out of 36 patients suffering from depression, as seen here and at 2:56 in my video.

    The researchers concluded that fasting therapy may provide an alternative to the use of antidepressant drugs, “thinking the fasting therapy may be a kind of shock therapy.” People are so relieved to be eating again, to get out of solitary confinement, and to even just get out of bed that they report feeling better. That was at the time of discharge, though. How did they feel the next day, the next week, the next month? Fasting is, by definition, unsustainable, so what we want to ideally see are some kind of longer-lasting effects.

    Researchers did a follow-up with a few hundred patients, not just a few months later, but after a few years. Of the 69 who were evidently suffering from depression, 90 percent reported feeling good or excellent results at the end of the ten-day fast, and, remarkably, years later, 87 percent of the 62 individuals who replied claimed that they were still doing well. Now, there was no control group, so we don’t know if they would have done just as well or even better without the fast, and it was all self-reporting, so there may have been a response bias where participants tried to please the researchers. Who knows? Maybe they were afraid they’d get sent back to solitary if they didn’t respond affirmatively. We have no idea, but we do have good evidence for the short-term mood benefits.

    Why would fasting improve feelings of depression? In addition to the endorphins and the surge in serotonin, the so-called happiness hormone, when we fast, there is a bump in brain-derived neurotrophic factor (BDNF), which is considered to play a crucial role in mood disorders. Researchers have perked up rodents with it, but we aren’t rats or mice. What about us? Humans with major depression have lower levels of BDNF circulating in their bloodstream. Autopsy studies of suicide victims show only about half the BDNF in certain key brain regions, compared to controls, suggesting it may play an important role in suicidal behavior, as seen here and at 4:38 in my video. 

    We can boost BDNF with antidepressant drugs and electroshock; we can also boost it with caloric restriction. We can get a 70 percent boost in levels after three months of cutting 25 percent of calories out of our daily diet, as shown below and at 4:51.

    Is there anything we can add to our diets to boost BNDF levels so we can get the benefits without the hunger? We’ll find out next.

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    Michael Greger M.D. FACLM

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  • The Largest Study on Fasting in the World  | NutritionFacts.org

    The Largest Study on Fasting in the World  | NutritionFacts.org

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    The Buchinger-modified fasting program is put to the test.

    A century ago, fasting—“starvation, as a therapeutic measure”—was described as “the ideal measure for the human hog…” (Fat shaming is not a new invention in the medical literature.) I’ve covered fasting for weight loss extensively in a nine-video series, but what about all the other purported benefits? I also have a video series on fasting for hypertension, but what about psoriasis, eczema, type 2 diabetes, lupus, metabolic disorder, rheumatoid arthritis, other autoimmune disorders, depression, and anxiety? Why hasn’t it been tested more?

    One difficulty with fasting research is: What do you mean by fasting? When I think of fasting, I think of water-only fasting, but, in Europe, they tend to practice “modified therapeutic fasting,” also known as Buchinger fasting, which is more like a very low-calorie juice fasting with some vegetable broth. Some forms of fasting may not even cut calories at all. As you can see below and at 1:09 in my video The World’s Largest Fasting Study, Ramadan fasting, for example, is when devout Muslims abstain from food and drink from sunrise to sunset, yet, interestingly, they end up eating the same amount—or even more food—overall.

    The largest study on fasting to date was published in 2019. More than a thousand individuals were put through a modified fast, cutting daily intake down to about ten cups of water, a cup of fruit juice, and a cup of vegetable soup. They reported very few side effects. In contrast, the latest water-only fasting data from a study that involved half as many people reported nearly 6,000 adverse effects. Now, the modified fasting study did seem to try to undercount adverse effects by only counting reported symptoms if they were repeated three times. However, adverse effects like nausea, feeling faint, upset stomach, vomiting, or palpitations were “observed only in single cases,” whereas the water-only fasting study reported about 100 to 200 of each, as you can see below and at 2:05 in my video. What about the benefits though?

    In the modified fasting study, participants self-reported improvements in physical and emotional well-being, along with a surprising lack of hunger. What’s more, the vast majority of those who came in with a pre-existing health complaint reported feeling better, with less than 10 percent stating that their condition worsened, as you can see in the graph below and at 2:24 in my video. 

    However, the study participants didn’t just fast; they also engaged in a lifestyle program, which included being on a plant-based diet before and after the modified fast. If only the researchers had had some study participants follow the healthier, plant-based diet without the fast to tease out fasting’s effects. Oh, but they did! About a thousand individuals fasted for a week on the same juice and vegetable soup regimen and others followed a normocaloric (normal calorie) vegetarian diet.

    As you can see below and at 2:54 in my video, both groups experienced significant increases in both physical and mental quality of life, and, interestingly, there was no significant difference between the groups.

    In terms of their major health complaints—including rheumatoid arthritis; chronic pain syndromes, like osteoarthritis, fibromyalgia, and back pain; inflammatory and irritable bowel disease; chronic pulmonary diseases; and migraine and chronic tension-type headaches—the fasting group appeared to have an edge, but both groups did well, with about 80 percent reporting improvements in their condition and only about 4 percent reporting feeling worse, as you can see below and at 3:25 in my video. 

    Now, this was not a randomized study; people chose which treatment they wanted to follow. So, maybe, for example, those choosing fasting were sicker or something. Also, the improvements in quality of life and disease status were all subjective self-reporting, which is ripe for placebo effects. There was no do-nothing control group, and the response rates to the follow-up quality of life surveys were only about 60 to 70 percent, which also could have biased the results. But extended benefits are certainly possible, given they all tended to improve their diets, as you can see below and at 4:00 in my video.

    They ate more fruits and vegetables, and less meats and sweets, and therein may lie the secret. “Principally, the experience of fasting may support motivation for lifestyle change. Most fasters experience clarity of mind and feel a ‘letting go’ of past actions and experiences and thus may develop a more positive attitude toward the future.”

    As a consensus panel of fasting experts concluded, “Nutritional therapy (theory and practice) is a vital and integral component of fasting. After the fasting therapy and refeeding period, nutrition should follow the recommendations/concepts of a…plant-based whole-food diet…”

    If you missed the previous video, check out The Benefits of Fasting for Healing.

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    Michael Greger M.D. FACLM

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  • Can Fasting Be Healing?  | NutritionFacts.org

    Can Fasting Be Healing?  | NutritionFacts.org

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    Where did the idea of therapeutic fasting come from?

    The story of life on Earth is a story of starvation. Ash from massive volcanoes and asteroids blocked out the sun, which killed the plants, which then killed almost everything else. As Darwin pointed out: “Thus, from the war of nature, from famine and death, the most exalted object which we are capable of conceiving” arose—namely, us.

    “Among apes, humans are particularly well adapted to prolonged fasting.” Evolving in a context of scarcity is believed to have shaped “our exceptional ability to store large amounts of energy [calories] when food is available.” Of course, nowadays, our ability to easily pack on pounds is leading to modern diseases, like obesity and type 2 diabetes. But, without the ability to store so much body fat, we may not have made it to tell the tale.

    Scarcity wasn’t just caused by the asteroids millions of years ago. “All of Upper Egypt was dying of hunger,” reads an inscription on an Egyptian tomb from about 4,000 years ago, “to such a degree that everyone had come to eating his children…” Just hundreds of years ago, “[p]arents killed their children and children killed parents” and ate them, and “the bodies of executed criminals were eagerly snatched from the gallows.” Hunger wiped out as many as two-thirds of the population of Italy and one-third of the population of Paris. So, we don’t have to go back to ancient history. “Even the most secure and affluent populations of today need only trace their history back a short distance to find evidence of famines that would have impinged on their forebears.” For example, there have been nearly 200 famines in Britain over the last 2,000 years.

    Now, we tend to be suffering from too much food, which carries its problems, but “what about the consequences of not ever starving?” This was a question raised nearly 60 years ago. If our physiology is so well-tuned to periodic starvation, by eliminating that, might we be harming our overall well-being? We just didn’t know.

    The lack of research in the area of starvation was attributed to the “difficulty of securing willing human subjects.” So, what little we had may have come from unwilling subjects. Physicians within the Warsaw Ghetto made detailed accounts before they succumbed, and Irish Republican Army prisoners in Northern Ireland starved themselves to death after hunger striking up to 73 days. However, starvation isn’t necessarily the same as fasting, an issue raised in medical journals more than a century ago. “Starvation is normally a forced, mentally stressful, and chronic condition, whereas [therapeutic] fasting is voluntary, limited in duration, and usually practiced by people in adequate nutritional state”—that is, individuals who start with adequate nutrition.

    Therapeutic fasting? Where did we get this idea of fasting therapy? “Fasting for medical purpose”? As I discuss in my video The Benefits of Fasting for Healing, it may have originally arisen out of the observation that when people get acutely ill, they tend to lose their appetite, so maybe there’s something in the wisdom of our body to stop eating. That’s presumably where the whole “starve a fever” folklore came from.

    There was a sense that “fasting affords physiologic rest” for the body—not just for the digestive tract, but throughout—allowing the body to concentrate on healing. It was evidently “an open secret” that veterinarians used to hospitalize dogs with “various dyspeptic and metabolic ailments” only to fast them back to health. So, the theory went, maybe it might work for people, too.

    Beyond just freeing up all the resources that would normally be used for nutrient digestion and storage, there’s a concept that, during fasting, our cells switch over to some sort of protection mode. Why would fasting reduce free radical “oxidative damage and inflammation, optimize energy metabolism, and bolster cellular protection”? It’s the “that which doesn’t kill us makes us stronger” concept known as hormesis. That’s kind of the opposite of the “let the body rest” theory. It’s more like “let the body stress.” The stress of fasting may steel the body against other stresses coming our way. This was demonstrated perhaps most starkly in a set of cringe-worthy experiments in which mice were blasted with Hiroshima-level gamma radiation sufficient to kill 50 percent within two weeks, but of the mice who had first been intermittently fasted for six weeks before, not a single one died, as you can see in the graph below and at 4:33 in my video.

    It’s these kinds of dramatic data that led to extraordinary claims like therapeutic fasting could drive half of all doctors out of business. You don’t know until you put it to the test, and we’ll explore that next.

    There’s been an explosion in research interest in fasting over the last few years. Stay tuned for The World’s Largest Fasting Study.

    Due to my work on How Not to Diet, I have discussed several studies in videos that are already available to you on fasting and weight loss. Check out the related posts below.

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    Michael Greger M.D. FACLM

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  • Circadian Rhythms and Our Blood Sugar Levels  | NutritionFacts.org

    Circadian Rhythms and Our Blood Sugar Levels  | NutritionFacts.org

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    The same meal eaten at the wrong time of day can double blood sugar. 

    We’ve known for more than half a century that our glucose tolerance—the ability of our body to keep our blood sugars under control—declines as the day goes on. As you can see in the graph below and at 0:25 in my video How Circadian Rhythms Affect Blood Sugar Levels, if you hook yourself up to an IV and drip sugar water into your vein at a steady pace throughout the day, your blood sugars will start to go up at about 8:00 pm, even though you haven’t eaten anything and the infusion rate didn’t change.

    The same amount of sugar is going into your system every minute, but your ability to handle it deteriorates in the evening before bouncing right back in the morning. A meal eaten at 8:00 pm can cause twice the blood sugar response as an identical meal eaten at 8:00 am, as shown in the graph below and at 0:51 in my video. It’s as if you ate twice as much. Your body just isn’t expecting you to be eating when it’s dark outside. Our species may have only discovered how to use fire about a quarter million years ago. We just weren’t built for 24-hour diners. 

    One of the tests for diabetes is called the glucose tolerance test, which sees how fast our body can clear sugar from our bloodstream. You swig down a cup of water with about four and a half tablespoons of regular corn syrup mixed in, then have your blood sugar measured two hours later. By that point, your blood sugar should be under 140 mg/dL. Between 140 and 199 is considered to be a sign of prediabetes, and 200 and up is a sign of full-blown diabetes, as you can see in the graph below and at 1:37 in my video. 

    The circadian rhythm of glucose tolerance is so powerful that a person can test normal in the morning but as a prediabetic later in the day. Prediabetics who average 163 mg/dL at 7:00 am may test out as frank diabetics at over 200 mg/dL at 7:00 pm, as you can see in the graph below and at 1:53 in my video. 

    Choosing lower glycemic foods may help promote weight loss, but timing is critical. Due to this circadian pattern in glucose tolerance, a low-glycemic food at night can cause a higher blood sugar spike than a high-glycemic food eaten in the morning, as you can see below and at 2:05 in my video.

    We’re so metabolically crippled at night that researchers found that eating a bowl of All Bran cereal at 8:00 pm caused as high a blood sugar spike as eating Rice Krispies at 8:00 am, as you can see in the graph below and at 2:23 in my video.

    High glycemic foods at night would seem to represent the worst of both worlds. So, if you’re going to eat refined grains and sugary junk, it might be less detrimental in the morning, as you can see in the graph below and at 2:32 in my video.  

    The drop in glucose tolerance over the day could therefore help explain the weight-loss benefits of frontloading calories towards the beginning of the day. Even just taking lunch earlier versus later may make a difference, as you can see in the graph below and at 2:48 in my video.

    People randomized to eat a large lunch at 4:30 pm suffered a 46 percent greater blood sugar response compared to an identical meal eaten just a few hours earlier at 1:00 pm. A meal at 7:00 am can cause 37 percent lower blood sugars than an identical meal at 1:00 pm, as you can see below, and at 3:04 in my video.

    Now, there doesn’t seem to be any difference between a meal at 8:00 pm and the same meal at midnight; they both seem to be too late, as you can see below, and at 3:15 in my video.

    But, eating that late, at midnight or even 11:00 pm, can so disrupt your circadian rhythm that it can mess up your metabolism the next morning, resulting in significantly higher blood sugars after breakfast, compared to eating the same dinner at 6:00 pm the evening before, as shown in the graph below and at 3:32 in my video.

    So, these revelations of chronobiology bring the breakfast debate full circle. Skipping breakfast not only generally fails to cause weight loss, but it worsens overall daily blood sugar control in both diabetic individuals and people who are not diabetic, as you can see in the graph below and at 3:44 in my video.

    Below and at 3:53, you can see a graph showing how the breakfast skippers have higher blood sugars even while they’re sleeping 20 hours later. This may help explain why those who skip breakfast appear to be at higher risk of developing type 2 diabetes in the first place. 

    Breakfast skippers also tend to have higher rates of heart disease, as well as having higher rates of atherosclerosis, in general. Is this just because “skipping breakfast tends to cluster with other unhealthy choices, including smoking” and sicklier eating habits overall? The link between skipping breakfast and heart disease—even premature death in general—seems to survive attempts to control for these confounding factors, but you don’t really know until you put it to the test.

    Does skipping breakfast lead to higher cholesterol, for example? Yes, researchers found a significant rise in LDL (bad) cholesterol in study participants randomized to skip breakfast; they were about 10 points higher within just two weeks, as you can see below and at 4:45 in my video.

    The Israeli study with the caloric distribution of 700 calories for breakfast, 500 for lunch, and 200 for dinner that I’ve discussed previously found that the triglycerides of the king-prince-pauper group (those eating more at breakfast versus dinner) got significantly better—a 60-point drop—while those of the pauper-prince-king group got significantly worse (a 26-point rise). So, consuming more calories in the morning relative to the evening may actually have a triple benefit: more weight loss, better blood sugar control, and lower heart disease risk, as you can see below and at 5:18 in my video. 

    If you’re going to skip any meal, whether you’re practicing intermittent fasting or time-restricted feeding (where you try to fit all of your food intake into a certain time window each day), it may be safer and more effective to skip dinner rather than breakfast.

    I’m back with the next installment of the chronobiology series! I previously explored eating breakfast for weight loss (Is Breakfast the Most Important Meal for Weight Loss? and Is Skipping Breakfast Better for Weight Loss?), introduced chronobiology (How Circadian Rhythms Can Control Your Health and Weight), and looked at the science on eating more in the mornings than the evenings (Eat More Calories in the Morning to Lose Weight, Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper, and Eat More Calories in the Morning Than the Evening).

    Next, you’ll see How to Sync Your Central Circadian Clock to Your Peripheral Clocks.

    The series will wrap up in the next couple of weeks. See videos and blogs in related posts below.

    Note: The Israeli 700/500/200 study that I mentioned is detailed in the Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper video if you want to know more. Also, check the corresponding blog in related posts. 

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    Michael Greger M.D. FACLM

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  • 5 Best Online Nutrition Courses from Mindvalley Food Experts

    5 Best Online Nutrition Courses from Mindvalley Food Experts

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    Ask anyone, and chances are, they’d love to be healthy. But the food industry doesn’t make it easy.

    Fad diets. Magic weight-loss pills. Cryptic food labels that make you feel like you’re playing Battleships more than reading ingredients. (What the heck is E171 anyway?)

    You deserve a deeper understanding of the magic that happens when you nourish your body. And Mindvalley’s got just the thing: online nutrition courses—with 600,000+ having gone through them, it’s a testament to how powerful these treasure troves of expert-led guidance really are.

    Weight Loss Courses

    Fun fact: 34% of people surveyed by Forbes aimed to shed pounds for their 2024 goals. Only about 8%, though, tend to stick with their goals for one month.

    So if those unrealistic resolutions aren’t working for you, maybe you’d like to take a different approach, like joining weight-loss courses.

    Don’t be mistaken, though. The following are no diet programs; rather, they’re about food freedom.

    WILDFIT masterclass

    Mindvalley’s WILDFIT may just be one of the best online nutrition courses out there. And here’s why: While a lot of the fads out there are restrictive, this free masterclass helps you cultivate a healthy relationship with food.

    Because the bottom line is, healthy eating isn’t only about eating whatever you want whenever you want; it’s also not eating what you don’t want when you don’t want.

    About the trainer: Eric Edmeades is a world-renowned health and fitness coach who spent years studying the eating habits of the Hadza tribe in Africa. His WILDFITⓇ philosophy draws inspiration from their approach to food and wellness.

    Course duration: 60 minutes

    What you’ll learn:

    • Master the “habit hack” to conquer cravings and unhealthy eating patterns.
    • Unmask the hidden factors hindering your weight-loss efforts.
    • Explore the easiest way to transform your body through effortless lifestyle changes.
    • Identify the eight crucial ingredients your body craves for optimal health.
    • Activate your body’s natural fat-burning mechanism for weight loss and boundless energy.

    What the students are saying: “WILDFIT has been an eye-opening experience, for not just myself but for those around me who have watched my progress in losing 25 pounds and four pants sizes in a matter of three months.” — Josh Finkelstein, product manager; Washington, United States

    Breaking Up with Sugar Quest

    Is sugar good or bad? That’s the million-dollar question.

    But the answer isn’t as simple as “yes” or “no.” According to Eric, there are bad sugars and bad relationships with sugars. 

    So if you’re struggling to kick the sugar addiction (as so many of us are), Breaking Up with Sugar might just be the course you need.

    The best part? It’s one of the very few nutrition online courses that you can access for free.

    About the trainer: Eric Edmeades is an “accidental” wellness expert who’s passionate about empowering people to achieve food freedom. His online nutrition courses, WILDFIT and Breaking Up with Sugar, draw on the principles of behavioral psychology to do just that.

    Duration: 66 minutes

    What you’ll learn:

    • Learn to identify true hunger cues and break the cycle of mindless snacking.
    • Master techniques to curb sugar urges and prevent future relapses.
    • Experience the positive impact of a sugar-free lifestyle on your overall well-being.
    • Gain awareness of your eating habits and make informed choices about what you consume.
    • Optimize your metabolism and support healthy weight management naturally.

    What the students are saying: “Thanks to Breaking Up With Sugar, I have developed the willpower to speak against these notions and cravings with a vengeance.” — Shelby Co Board of Education, educator; Memphis, United States

    Gut Health Courses

    Science is finally catching up with what our grandmothers always knew: a healthy gut is the foundation of a healthy you. Even research has shown that what you eat can affect everything, from your immunity to your mood.

    Want to learn more? Explore these nutrition courses online.

    Smarter Not Harder Quest

    Smarter Not Harder is a Quest that’s available on Mindvalley. The great thing is, you can gain access to the first few classes for free. 

    It’ll give you a taste of the revolutionary approach to helping you optimize your health and performance without breaking a sweat.

    About the trainer: Dave Asprey is the founder of Upgrade Labs and is widely known as the “Father of Biohacking.” He believes in leveraging cutting-edge science and ancient wisdom to unlock human potential.

    Duration: 4 hours

    What you’ll learn:

    • Learn how to optimize your energy, brain function, stress levels, physical fitness, hormones, and even spirituality for holistic well-being.
    • Discover science-backed strategies to combat fatigue and experience sustained vitality throughout the day.
    • Sharpen your cognitive function and achieve peak productivity with Dave’s biohacking techniques.
    • Learn how to promote healthy aging and unlock a higher quality of life as you get older.
    • Implement biohacking practices to accelerate post-workout and injury recovery, leaving you feeling your best.

    What the students are saying: “I’ve been following Dave Asprey’s work for a while, but this quest has been a game-changer for me. In just 12 lessons, I’ve implemented Dave’s tips and improved many areas in my life. Now I sleep better, have more energy, and have less stress.” — David Priego, sales director; Madrid, Spain

    Mindvalley Viome Certified Nutrition Coach program

    The Mindvalley Viome Certified Nutrition Coach program, co-created by Viome’s innovative technology and Mindvalley’s coaching expertise, equips you to become a certified nutrition coach.

    Led by Naveen Jain, the visionary founder of Viome, this program dives deep into gut health and the secrets of nutrition science.

    Duration: 3 months

    What you’ll learn:

    • Learn how to leverage gut microbiome testing to personalized meal planning that optimizes your health.
    • Gain a deep understanding of the gut microbiome and its influence on overall health and disease.
    • Develop the skills and frameworks to guide yourself and others towards lasting transformations.
    • Discover science-backed strategies to combat inflammation and strengthen immunity.
    • Explore the potential to build a successful coaching business if you desire.

    What the students are saying: “Before the certification, my life was a guess from the nutrition point of view. I was looking for information on the internet and from real-case scenarios where I could get inspired regarding nutrition and supplements.

    After taking the nutrition coaching program with Mindvalley and Viome, I turned to precision nutrition and had an overview of what I needed to follow tailored to my internal system activity.” — Victor Vilceanu, university institutional researcher; Weimar, Germany

    Intermittent Fasting Course

    This trendy wellness practice has gained traction over the years—and for good reason. There are tons of benefits to intermittent fasting, and here’s a course you can explore to learn more:

    Beyond Fasting masterclass

    Beyond Fasting is a masterclass that goes beyond the basics, unveiling the science behind intermittent fasting to help you achieve optimal results.

    This online health course equips you with powerful techniques to supercharge your weight loss, boost longevity and immunity, and unlock a new level of well-being.

    About the trainer: A passionate advocate for holistic wellness, Ronan Diego draws on his experience and scientific research to design innovative fasting protocols for transformative results.

    Duration: 56 minutes

    What you’ll learn:

    • Separate fact from fiction and discover why the “standard approach” might not be serving you.
    • Learn how to personalize your fasting schedule to target specific goals, like weight loss or mental clarity.
    • Explore how intermittent fasting can promote healthy aging and extend your lifespan.
    • Discover how to leverage fasting to maximize your exercise benefits and burn more fat.
    • Master a simple mind hack to stay disciplined and consistent with your fasting routine.

    What the students are saying: “My most valuable lesson learned was to practice mindful eating. Fasting and eating healthy go much more beyond physical benefits. I achieved to melt down stubborn fat, my mind is more alert during the day, and at night my restful sensation improved by doing fasting.” — Nadya Veliz, vice-president of Sporting Goods; San Miguel Allende, Mexico

    FAQ

    What are the benefits of taking an online nutrition course?

    There are a ton of benefits to taking online nutrition courses, especially for anyone seeking to improve their health and understanding of food. They’re flexible, so you can learn at your own pace and on your own schedule. This is especially convenient if you’re working and have a family.

    Many courses are free or very affordable compared to traditional in-person classes. What’s more, you’ll gain access to a wide range of expertise from qualified professionals, often featuring the latest research and trends in nutrition science.

    Not only that, there’s often a supportive community, so you can interact with other students, keeping you motivated on your wellness journey.

    What are some things to consider when choosing an online nutrition course?

    Choosing the right online nutrition course depends on your specific goals and learning style. Here are a few things to consider:

    • Choose the course curriculum that aligns with your interests, whether it’s weight loss, disease prevention, or overall healthy eating.
    • Check the credentials of the instructors and make sure they’re qualified professionals in nutrition or a related field.
    • See if they offer a well-structured format with clear learning objectives and engaging delivery methods.

    Additionally, it’s always advisable to check out the student reviews to get a sense of the overall learning experience. For example, you can view what students say about Mindvalley’s online nutrition courses at Mindvalley Stories.

    Can I get a certificate for completing an online nutrition course?

    Yes, many online nutrition courses, like that at Mindvalley, award certificates of completion.  These certificates can serve as a testament to your newfound knowledge and commitment to healthy eating.

    Remember, though, that these certificates might not qualify you to become a registered dietitian or nutritionist. (With that being said, with the Mindvalley Viome Certified Nutrition Coach program, you’ll receive an internationally recognized certification to be able to coach others through their health transformation.)

    It’s always advisable to check the course description to see if certification is included and its intended purpose.

    Great Change Starts Here

    Ready to take charge of your health and unlock your full potential?

    With the Mindvalley Membership, you’ll have unlimited access to over 100 programs, including the life-changing WILDFIT, Smarter Not Harder, and Beyond Fasting. Plus, don’t miss out on:

    • An intelligent AI that tailors your learning journey based on your interests.
    • Over 1000 guided meditations and healing sounds enhance your mental clarity and emotional well-being.
    • A vibrant community on the Mindvalley Connections private social network for inspiration and support.

    As Vishen, the founder of Mindvalley, says, “Baby steps lead to bigger steps.” And your first one can be only a click away.

    Welcome in.

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    Tatiana Azman

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  • Lose Weight by Eating More in the Morning  | NutritionFacts.org

    Lose Weight by Eating More in the Morning  | NutritionFacts.org

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    A calorie is not a calorie. It isn’t only what you eat, but when you eat.

    Mice are nocturnal creatures. They eat during the night and sleep during the day. However, if you only feed mice during the day, they gain more weight than if they were fed a similar amount of calories at night. Same food and about the same amount of food, but different weight outcomes, as you can see in the graph below and at 0:18 in my video Eat More Calories in the Morning to Lose Weight, suggesting that eating at the “wrong” time may lead to disproportionate weight gain. In humans, the wrong time would presumably mean eating at night. 

    Recommendations for weight management often include advice to limit nighttime food consumption, but this was largely anecdotal until it was first studied experimentally in 2013. Researchers instructed a group of young men not to eat after 7:00 pm for two weeks. Compared to a control period during which they continued their regular habits, they ended up about two pounds lighter after the night-eating restriction. This is not surprising, given that dietary records show the study participants inadvertently ate fewer calories during that time. To see if timing has metabolic effects beyond just foreclosing eating opportunities, you’d have to force people to eat the same amount of the same food, but at different times of the day. The U.S. Army stepped forward to carry out just such an investigation.

    In their first set of experiments, Army researchers had people eat a single meal a day either as breakfast or dinner. The results clearly showed the breakfast group lost more weight, as you can see in the graph below and at 1:35 in my video. When study participants ate only once a day at dinner, their weight didn’t change much, but when they ate once a day at breakfast, they lost about two pounds a week. 

    Similar to the night-eating restriction study, this is to be expected, given that people tend to be hungrier in the evening. Think about it. If you went nine hours without eating during the day, you’d be famished, but people go nine hours without eating overnight all the time and don’t wake up ravenous. There is a natural circadian rhythm to hunger that peaks around 8:00 pm and drops to its lowest level around 8:00 am, as you can see in the graph below and at 2:09 in my video. That may be why breakfast is typically the smallest meal of the day. 

    The circadian rhythm of our appetite isn’t just behavioral, but biological, too. It’s not just that we’re hungrier in the evening because we’ve been running around all day. If you stayed up all night and slept all day, you’d still be hungriest when you woke up that evening. To untangle the factors, scientists used what’s called a “forced desynchrony” protocol. Study participants stayed in a room without windows in constant, unchanging, dim light and slept in staggered 20-hour cycles to totally scramble them up. This went on for more than a week, so the subjects ended up eating and sleeping at different times throughout all phases of the day. Then, the researchers could see if cyclical phenomena are truly based on internal clocks or just a consequence of what you happen to be doing at the time.  

    For instance, there is a daily swing in our core body temperature, blood pressure, hormone production, digestion, immune activity, and almost everything else, but let’s use temperature as an example. As you can see in the graph below and at 3:21 in my video, our body temperature usually bottoms out around 4:00 am, dropping from 98.6°F (37°C) down to more like 97.6°F (36.4°C). Is this just because our body cools down as we sleep? No. By keeping people awake and busy for 24 hours straight, it can be shown experimentally that it happens at about the same time no matter what. It’s part of our circadian rhythm, just like our appetite. It makes sense, then, if you are only eating one meal per day and want to lose weight, you’d want to eat in the morning when your hunger hormones are at their lowest level. 

    Sounds reasonable, but it starts to get weird.

    The Army scientists repeated the experiment, but this time, they had the participants eat exactly 2,000 calories either as breakfast or as dinner, taking appetite out of the picture. The subjects weren’t allowed to exercise either. Same number of calories, so the same change in weight, right? No. As you can see in the graph below and at 4:18 in my video, the breakfast-only group still lost about two pounds a week compared to the dinner-only group. Two pounds of weight loss eating the same number of calories. That’s why this concept of chronobiology, meal timing—when to eat—is so important. 

    Isn’t that wild? Two pounds of weight loss a week eating the same number of calories! That was a pretty extreme study, though. What about just shifting a greater percentage of calories to earlier in the day? That’s the subject of my next video: Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper. First, let’s take a break from chronobiology to look at the Benefits of Garlic for Fighting Cancer and the Common Cold. Then, we’ll resume checking other videos in the related posts below.

    If you missed the first three videos in this extended series, also check out related posts below. 

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    Michael Greger M.D. FACLM

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  • Milk Hormones and Female Infertility  | NutritionFacts.org

    Milk Hormones and Female Infertility  | NutritionFacts.org

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    Dairy consumption is associated with years of advanced ovarian aging, thought to be due to the steroid hormones or endocrine-disrupting chemicals in cow’s milk.
     
    When it comes to the amount of steroid hormones we are exposed to in the food supply, dairy “milk products supply about 60–80% of ingested female sex steroids.” I’ve talked about the effects of these estrogens and progesterone in men and prepubescent children, and how milk intake can spike estrogen levels within hours of consumption. You can see graphs illustrating these points from 0:25 in my video The Effects of Hormones in Milk on Infertility in Women. In terms of effects on women, I’ve discussed the increased endometrial cancer risk in postmenopausal women. What about reproductive-age women? Might dairy hormones affect reproduction? 
     
    We’ve known that “dairy food intake has been associated with infertility; however, little is known with regard to associations with reproductive hormones or anovulation.” How might dairy do it? By affecting how the uterus prepares, or by affecting the ovary itself? Researchers found that women who ate yogurt or cream had about twice the risk of sporadic anovulation, meaning failure of ovulation, so some months there was no egg to fertilize at all. Now, we know most yogurt is packed with sugar these days. Even plain Greek yogurt can have more sugar than a double chocolate glazed cake donut, but the researchers controlled for that and the results remained after adjusting for the sugar content, “which suggests that the risk of anovulation was independent of the sugar content included in many flavored yogurt products.” We don’t know if this was just a fluke or exactly what the mechanism might be, but if women skip ovulation here and there throughout their lives, might they end up with a larger ovarian reserve of eggs? 
     
    Women are starting to have their first baby later in life. As you can see in the graph below and at 2:02 in my video, there’s been a rise in women having babies when they’re in their late 30s and 40s.

    We used to think that women’s ovarian reserve of eggs stayed relatively stable until a rapid decline at about age 37, but now we know it appears to be more of a gradual loss of eggs over time. The graph below and at 2:22 in my video charts a steady loss starting at peak fertility in one’s 20s.

    This measures “antral follicle count,” which is an ultrasound test where you can count the number of “next batter up” eggs in the ovaries, as you can see below and at 2:31 in my video. It is probably the best reflection of true reproductive age. It’s a measure of ovarian reserve—how many eggs a woman has left.

    What does this have to do with diet? Researchers at Harvard looked at the association of various protein intakes with ovarian antral follicle counts among women having trouble getting pregnant. “Even though diminished ovarian reserve is one of the major causes of female infertility, the process leading to reproductive senescence [deterioration with age] currently is poorly understood. In light of emerging population trends towards delayed pregnancy, the identification of reversible factors (including diet) that affect the individual rates of reproductive decline might be of significant clinical value.”

    The researchers performed ultrasounds on all the women, studied their diets, and concluded that higher intake of dairy protein was associated with lower antral follicle counts—in other words, accelerated ovarian aging. The graph below and at 3:39 in my video shows what counts look like in nonsmokers: Significantly lower ovarian reserve (12.7 antral follicle counts) at the highest dairy intake, which would be like three ounces of cheese a day, compared to the lowest dairy intake (16.9 antral follicle counts).

    What do these numbers mean in terms of biological age? Is 16.9 down to 12.7 really that much of a difference? As you can see below and at 3:58 in my video, when you look at women with really robust ovaries, a follicle count of 16.9 is what you might see in a 36- or 37-year-old, whereas 12.7, which is what you can see in women eating the most dairy, is what you might see in a really fertile 50-year-old. So, we’re talking year’s worth of ovarian aging between the highest and lowest dairy consumers.

    While it wasn’t possible for the researchers to “identify the underlying mechanism linking higher dairy protein intake to lower AFC,” antral follicle count, they had educated guesses. (1) It could be the steroid hormones and growth factors or (2) “the contamination of milk products by pesticides and endocrine disrupting chemicals that may negatively impact” the development of these ovarian follicles and egg competence.

    “Regarding the former [the hormones], studies suggest that commercial milk (derived from both pregnant and non-pregnant animals) contains large amounts of estrogens, progesterone, and other placental hormones that are eventually released into the human food chain, with dairy intake accounting for 60–80% of the estrogens consumed. Dairy estrogens overcome [survive] processing, appear in raw whole cow’s and commercial milk products, are found in substantially higher concentrations with increasing amounts of milk fat, with no apparent difference between organic and conventional dairy products…” Hormones are just naturally in cows’ bodies, so they aren’t just in the ones injected with growth hormones. And, once these bovine hormones are inside the human body, they get converted to estrone and estradiol, the main active human estrogens. Following absorption, bovine steroids may then affect reproductive outcomes.

    The researchers asserted that further studies are needed and that “it is imperative that these findings are reproduced in prospective studies designed to clarify the biology underlying the observed associations. The latter might be crucial given that consumption of another species’ milk by humans is an evolutionary novel dietary behavior that has the potential to alter reproductive parameters and may have long-term adverse health effects.”

    The video I mentioned about the effects of these estrogens and progesterone in men and prepubescent children is The Effects of Hormones in Dairy Milk on Cancer.

    I talk about the effect of dairy estrogen on male fertility in Dairy Estrogen and Male Fertility.

    How else might diet affect fertility? See related posts below. 

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    Michael Greger M.D. FACLM

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  • Skip Breakfast to Lose Weight?  | NutritionFacts.org

    Skip Breakfast to Lose Weight?  | NutritionFacts.org

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    Breakthroughs in the field of chronobiology—the study of our circadian rhythms—help solve the mystery of the missing morning calories in breakfast studies.

    Where did this whole “breakfast is the most important meal of the day” concept come from? “The Father of Public Relations,” Edward Bernays, infamous for his “Torches of Freedom” campaign to get women to start smoking back in the 1920s, was paid by a bacon company to popularize the emblematic bacon-and-eggs breakfast. The role of public relations, he wrote in his book Propaganda, is the “conscious and intelligent manipulation of the organized habits and opinions of the masses….” Public relations specialists thereby “constitute an invisible government, which is the true ruling power of our country….”

    Breakfast is big business. Powerful corporate interests, such as the cereal lobby, are blamed for “perpetuating myths such as the value of consuming breakfast.” An editorial in The American Journal of Clinical Nutrition urged nutrition scientists to speak truth to power and challenge conventional wisdom when necessary “even when it looks like we are taking away motherhood and apple pie.” “Actually,” the editorial concludes, “reducing the portion size of apple pie might not be a bad idea, either.”

    So, should we “break the feast” and skip breakfast to lose weight? As I discuss in my video Is Skipping Breakfast Better for Weight Loss?, though “the advice to eliminate breakfast will surely pit…nutritional scientists…against the very strong and powerful food industry,” skipping breakfast has been described as “a straightforward and feasible strategy to reduce total daily energy [caloric] intake.” Unfortunately, it doesn’t seem to work.

    Most randomized controlled studies of breakfast skipping found no weight-loss benefit to omitting breakfast. How is that possible if skipping breakfast means skipping calories? The Bath Breakfast Project, a famous series of experiments run not out of a tub, but the University of Bath in the UK, discovered a key to the mystery. Men and women were randomized to either eat breakfast (defined as taking in at least 700 calories before 11:00 am) or fast until noon every day. As you can see in the graph below and at 2:15 in my video, as in other similar trials, the breakfast-eating group ate a little less throughout the rest of the day but still ended up with hundreds of excess daily calories over the breakfast skippers.

    Those who ate breakfast consumed more than 500 more calories a day. Over six weeks, that would add up to more than 20,000 extra calories. Yet, after six weeks, both groups ended up with the same change in body fat, as you can see below and at 2:36 in my video. How could tens of thousands of calories just effectively disappear? 

    If more calories were going in with no change in weight, then there must have been more calories going out. And, indeed, as you can see in the graph below at 2:52 and in my video, the breakfast group was found to spontaneously engage in more light-intensity physical activity in the mornings than the breakfast-skipping group. Light-intensity activities include things like casual walking or light housecleaning, not structured exercise per se, but apparently, enough extra activity to use up the bulk of those excess breakfast calories. There’s a popular misconception that our body goes into energy conservation mode when we skip breakfast by slowing our metabolic rate. However, that does not appear to be true. But, maybe our body does intuitively slow us down in other ways. When we skip breakfast, our bodies just don’t seem to want to move around as much. 

    The extra activity didn’t completely make up for the added calories consumed by the breakfast group, though. We seem to still be missing about a hundred daily calories, suggesting there may be another factor to account for the mystery of the MIA morning calories. Recent breakthroughs in the field of chronobiology—the study of our body’s natural rhythms—have unsettled an even more sacred cow of nutrition dogma: the concept that a calorie is a calorie. It’s not just what we eat, but when we eat. Same number of calories, different weight loss, depending on meal timing.  

    Just to give you a taste: As you can see in the graph below and at 4:11 in my video, the exact same number of calories at breakfast are significantly less fattening than the same number of calories eaten at supper. Mind-blowing!

    A diet with a bigger breakfast causes more weight loss than the same diet with a bigger dinner, as shown below and at 4:23 in my video. Because of our circadian rhythms, morning calories don’t appear to count as much as evening calories. So, maybe breakfast should be the most important meal of the day after all. 

    If you missed my last video, catch up with Flashback Friday: Is Breakfast the Most Important Meal for Weight Loss or Should It Be Skipped?. 

    Did I pique your interest in chronobiology? If so, you’re in luck. See more in the related posts below. 

    For some breakfast inspiration, check out A Better Breakfast and my recipe videos for a vegetable smoothie and a grain bowl from The How Not to Die Cookbook. 

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    Michael Greger M.D. FACLM

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  • The Pros of Early Time-Restricted Eating  | NutritionFacts.org

    The Pros of Early Time-Restricted Eating  | NutritionFacts.org

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    Calories eaten in the morning count less than calories eaten in the evening, and they’re healthier, too.
     
    Time-restricted feeding, where you limit the same amount of eating to a narrow evening window, has benefits compared to eating in the evening and earlier in the day, but it also has adverse effects because you’re eating so much, so late, as you can see below and at 0:12 my video The Benefits of Early Time-Restricted Eating. 

    The best of both worlds was demonstrated in 2018 when researchers put time-restricted feeding into a narrow window earlier in the day. As you can see below and at 0:28 in my video, individuals who were randomized to eat the same food, but only during an 8:00 a.m. to 3:00 p.m. eating window, experienced a drop in blood pressure, oxidative stress, and insulin resistance, even when all of the study subjects were maintained at the same weight. Same food, same weight, but with different results. The drops in blood pressure were extraordinary, from 123/82 down to 112/72 in five weeks, and that is comparable to the effectiveness of potent blood-pressure drugs.


    The longest study to date on time-restricted feeding only lasted for 16 weeks. It was a pilot study without a control group that involved only eight people, but the results are still worth noting. Overweight individuals, who, like most of us, had been eating for more than 14 hours a day, were instructed to stick to a consistent 10- to 12-hour feeding window of their own choosing, as you can see below and at 1:17 in my video. On average, they were able to successfully reduce their daily eating duration by about four and a half hours and had lost seven pounds within 16 weeks. 

    They also reported feeling more energetic and sleeping better, as seen in the graph below and at 1:32 in my video. This may help explain why “all participants voluntarily expressed an interest in continuing unsupervised with the 10-11 hr time-restricted eating regimen after the conclusion of the 16-week supervised intervention.” You don’t often see that after weight-loss studies. 

    Even more remarkably, eight months later and even one year post-study, they had retained their improved energy and sleep (see in the graph below and 1:55 in my video), as well as retained their weight loss (see in the graph below and 1:58 in my video)—all from one of the simplest of interventions: sticking to a consistent 10- to 12-hour feeding window of their own choosing. 
    How did it work? Even though the study “participants were not overtly asked to change nutrition quality or quantity,” they appeared to unintentionally eat hundreds of fewer calories a day. With self-selected time frames for eating, you wouldn’t necessarily think to expect circadian benefits, but because they had been asked to keep the eating window consistent throughout the week, “metabolic jet lag could be minimized.” The thinking is that because people tend to start their days later on weekends, they disrupt their own circadian rhythm. And, indeed, it is as if they had flown a few time zones west on Friday evening, then flew back east on Monday morning, as you can see in the graph below and at 2:40 in my video. So, some of the metabolic advantages may have been due to maintaining a more regular eating schedule. 


    Early or mid-day time-restricted feeding may have other benefits as well. Prolonged nightly fasting with reduced evening food intake has been associated with lower levels of inflammation and has also been linked to better blood sugar control, both of which might be expected to lower the risk of diseases, such as breast cancer. So, data were collected on thousands of breast cancer survivors to see if nightly fasting duration made a difference. Those who couldn’t go more than 13 hours every night without eating had a 36 percent higher risk of cancer recurrence. These findings have led to the suggestion that efforts to “avoid eating after 8 pm and fast for 13 h or more overnight may be a beneficial consideration for those patients looking to decrease cancer risk and recurrence,” though we would need a randomized controlled trial to know for sure. 
     
    Early time-restricted feeding may even play a role in the health of perhaps the longest-living population in the world, the Seventh-day Adventist Blue Zone in California. As you can see in the graph below and at 3:55 in my video, slim, vegetarian, nut-eating, exercising, non-smoking Adventists live about a decade longer than the general population. 

    Their greater life expectancy has been ascribed to these healthy lifestyle behaviors, but there’s one lesser-known component that may also be playing a role. Historically, eating two large meals a day, breakfast and lunch, with a prolonged overnight fast, was a part of Adventist teachings. Today, only about one in ten Adventists surveyed were eating just two meals a day. However, most of them, more than 60 percent of them, reported that breakfast or lunch was their largest meal of the day, as you can see below and at 4:26 in my video. Though this has yet to be studied concerning longevity, frontloading one’s calories earlier in the day with a prolonged nightly fast has been associated with significant weight loss over time. This led the researchers to conclude: “Eating breakfast and lunch 5–6 h apart and making the overnight fast last 18–19 h may be a useful practical strategy” for weight control. The weight may be worth the wait. 


    For more on fasting, click here. 
     
    My big takeaway from all of the intermittent fasting research I looked at is, whenever possible, eat earlier in the day. At the very least, avoid late-night eating whenever you can. Eating breakfast like a king and lunch like a prince, with or without an early dinner for a pauper, would probably be best. 
     
    For more on fasting, fasting for disease reversal, and fasting and cancer, check the related videos below.  

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    Michael Greger M.D. FACLM

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  • What the Science Says About Time-Restricted Eating  | NutritionFacts.org

    What the Science Says About Time-Restricted Eating  | NutritionFacts.org

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    Are there benefits to giving yourself a bigger daily break from eating? 
     
    The reason many blood tests are taken after an overnight fast is that meals can tip our system out of balance, bumping up certain biomarkers for disease, such as blood sugars, insulin, cholesterol, and triglycerides. Yet, as you can see in the graph below and at 0:20 in my video Time-Restricted Eating Put to the Test, fewer than one in ten Americans may even make it 12 hours without eating. As evolutionarily unnatural as getting three meals a day is, most of us are eating even more than that. One study used a smartphone app to record more than 25,000 eating events and found that people tended to eat about every three hours over an average span of about 15 hours a day. Might it be beneficial to give our bodies a bigger break? 

    Time-restricted feeding is “defined as fasting for periods of at least 12 hours but less than 24 hours,” and this involves trying to confine caloric intake to a set window of time, typically ranging from 3 to 4 hours, 7 to 9 hours, or 10 to 12 hours a day, which results in a daily fast lasting 12 to 21 hours. When mice are restricted to a daily feeding window, they gain less weight even when fed the same amount as mice “with ad-lib access.” Rodents have such high metabolisms, though, that a single day of fasting can starve away as much as 15 percent of their lean body mass. This makes it difficult to extrapolate from mouse models. You don’t know what happens in humans until you put it to the test. 
     
    The drop-out rates in time-restricted feeding trials certainly appear lower than most prolonged forms of intermittent fasting, suggesting it’s more easily tolerable, but does it work? Researchers found that when people stopped eating from 7:00 p.m. to 6:00 a.m. for two weeks, they lost about a pound each week compared to no time restriction. Note that “there were no additional instructions or recommendations on the amount or type of food consumed,” and no gadgets, calorie counting, or record-keeping either. The study participants were just told to limit their food intake to the hours of 6:00 a.m. and 7:00 p.m., a simple intervention that’s easy to understand and put into practice. 
     
    The next logical step? Put it to the test for months instead of just weeks. Obese men and women were asked to restrict eating to the eight-hour window between 10:00 a.m. and 6:00 p.m. Twelve weeks later, they had lost nearly seven pounds, as you can see in the graph below and at 2:18 in my video. This deceptively simple intervention may be operating from several different angles. People not only tend to eat more food later in the day, but eat higher fat foods later in the day. By eliminating eating in the late-evening hours, one removes prime-time snacking on the couch, a high-risk time for overeating. And, indeed, during the no-eating-after-7:00-p.m. study, the subjects were inadvertently eating about 250 fewer calories a day. Then, there are also the chronobiological benefits of avoiding late-night eating. 

    I did a whole series of videos about the role our circadian rhythms have in the obesity epidemic, how the timing of meals can be critical, and how we can match meal timing to our body clocks. Just to give you a taste: Did you know that calories eaten at dinner are significantly more fattening than the same number of calories eaten at breakfast? See the table below and at 3:08 in my video. 

    Calories consumed in the morning cause less weight gain than the same calories eaten in the evening. A diet with a bigger breakfast causes more weight loss than the same exact diet with a bigger dinner, as you can see in the graph below and at 3:21 in my video, and nighttime snacks are more fattening than the same snacks if eaten in the daytime. Thanks to our circadian rhythms, metabolic slowing, hunger, carbohydrate intolerance, triglycerides, and a propensity for weight gain are all things that go bump in the night.  


    What about the fasting component of time-restricted feeding? There’s already the double benefit of getting fewer calories and avoiding night-time eating. Does the fact that you’re fasting for 11 or 16 hours a day play any role, considering the average person may only make it about 9 hours a day without eating? How would you design an experiment to test that? What if you randomized people into two groups and had both groups eat the same number of calories a day and also eat late into the evening, but one group fasted even longer, for 20 hours? That’s exactly what researchers at the USDA and National Institute of Aging did. 
     
    Men and women were randomized to eat three meals a day or fit all of those same calories into a four-hour window between 5:00 p.m. and 9:00 p.m., then fast the rest of the day. If the weight-loss benefits from the other two time-restricted feeding studies were due to the passive calorie restriction or avoidance of late-night eating, then, presumably, both of these groups should end up the same because they’re both eating the same amount and they’re both eating late. That’s not what happened, though. As you can see below and at 4:49 in my video, after eight weeks, the time-restricted feeding group ended up with less body fat, nearly five pounds less. They got about the same number of calories, but they lost more weight. 

    As seen below and at 5:00 in my video, a similar study with an eight-hour eating window resulted in three more pounds of fat loss. So, there does seem to be something to giving your body daily breaks from eating around the clock.


    Because that four-hour eating window in the study was at night, though, the participants suffered the chronobiological consequences—significant elevations in blood pressure and cholesterol levels—despite the weight loss, as you can see below and at 5:13 in my video. The best of both worlds was demonstrated in 2018: early time-restricted feeding, eating with a narrow window earlier in the day, which I covered in my video The Benefits of Early Time-Restricted Eating. 


    Isn’t that mind-blowing about the circadian rhythm business? Calories in the morning count less and are healthier than calories in the evening. So, if you’re going to skip a meal to widen your daily fasting window, skip dinner instead of breakfast. 

    If you missed any of the other videos in this fasting series, check out the related videos below. 

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    Michael Greger M.D. FACLM

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  • A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

    A Look at the 5:2 Diet and the Fasting-Mimicking Diet  | NutritionFacts.org

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    What are the effects of eating only five days a week or following a fasting-mimicking diet five days a month? 
     
    Instead of eating every other day, what if you ate five days a week and fasted for the other two? As I discuss in my video The 5:2 Diet and the Fasting-Mimicking Diet Put to the Test, the available data are similar to that of alternate-day fasting: About a dozen pounds of weight loss was reported in overweight men and also reported in overweight women over six months, with no difference found between participants on the 5:2 intermittent fasting regimen and those on a continuous 500-calories-a-day restriction. The largest trial to date found an 18-pound weight loss within six months in the 5:2 group, which isn’t significantly different from the 20 pounds lost in the continuous calorie restriction group. Weight maintenance over the subsequent six months was also found to be no different.
     
    Though feelings of hunger may be more pronounced on the 5:2 pattern than on an equivalent level of daily calorie cutting, it does not seem to lead to overeating on non-fasting days. One might expect going two days without food may negatively impact mood, but no such adverse impact was noted for those fully fasting on zero calories or sticking to just two packets of oatmeal on each of the “fasting” days. (The oatmeal provides about 500 calories a day.) Like alternate-day fasting, the 5:2 fasting pattern appeared to have inconsistent effects on cognition and on preserving lean mass, and it also failed to live up to the “popular notion” that intermittent fasting would be “easier” to adhere to than daily calorie restriction. 
     
    Compared to those in the continuous-restriction control group, fewer subjects in the 5:2 pattern group expressed interest in continuing their diet after the study was over. This was attributed to quality-of-life issues, with 5:2 fasting participants citing headaches, lack of energy, and difficulty fitting the fasting days into their weekly routine. However, as you can see below and at 1:53 in my video, there has yet to be a single 5:2 diet study showing elevated LDL cholesterol compared with continuous calorie restriction at six months. Nor has it been shown for a year. This offers a potential advantage over alternate-day regimens. 

    Instead of 5:2, what about 25:5, spending five consecutive days a month on a “fasting-mimicking diet” (FMD)? Longevity researcher Valter Longo designed a five-day meal plan to try to simulate the metabolic effects of fasting by being low in protein, sugars, and calories with zero animal protein and zero animal fat. By making the diet plant-based, he hoped to lower the level of the cancer-promoting growth hormone IGF-1. He indeed accomplished this goal, along with a drop in markers of inflammation, after three cycles of his five-days-a-month program, as you can see below and at 2:33 in my video. 

    One hundred men and women were randomized to consume his fasting-mimicking diet for five consecutive days per month or maintain their regular diet the whole time. As you can see in the graph below and at 2:47 in my video, after three months, the FMD group was down about six pounds compared to the control group, with significant drops in body fat and waist circumference, accompanied by a drop in blood pressure. 

    Those who were the worst off accrued the most dramatic benefits, as seen in the graph below and at 3:04 in my video. What’s even wilder is that three further months after completion, some of the benefits appeared to persist, suggesting the effects “may last for several months.” It’s unclear, though, if those randomized to the FMD group used it as an opportunity to make positive lifestyle changes that helped maintain some of the weight loss. 


    Dr. Longo created a company to market his meal plan commercially, but, to his credit, says “he does not receive a salary or a consulting fee from the company…and will donate 100% of his shares to charity.” The whole diet appears to be mostly dehydrated soup mixes, herbal teas like hibiscus and chamomile, kale chips, nut-based energy bars, an algae-based DHA supplement, and a multivitamin dusted with vegetable powder. Why spend 50 dollars a day on a few processed snacks when you could instead eat a few hundred calories a day of real vegetables? 
     
    How interesting was that? All-you-can-eat above-ground vegetables for five days would have the same low amount of protein, sugars, and calories with zero animal protein or animal fat. But we’ll probably never know if it works as well, better, or worse because it’s hard to imagine such a study ever getting done without the financial incentive. 

    To learn more about IGF-1, see my video Flashback Friday: Animal Protein Compared to Cigarette Smoking.
     
    In this series on fasting, I’ve covered several topics, including the basics of calories and weight loss, water-only fasting, and the types of alternate-day fasting, see them all in the related videos below. 
     
    I close out the series with videos on time-restricted eating: Time-Restricted Eating Put to the Test and The Benefits of Early Time-Restricted Eating. 
     
    If you want all of the videos in one place, I’ve done three webinars on fasting—Intermittent Fasting, Fasting for Disease Reversal, and Fasting and Cancer—and they’re all available for download now. 

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  • Is Our Life Expectancy Extended by Intermittent Fasting?  | NutritionFacts.org

    Is Our Life Expectancy Extended by Intermittent Fasting?  | NutritionFacts.org

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    Alternate-day modified fasting is put to the test for lifespan extension. 

    Is it true that alternate-day calorie restriction prolongs life? Doctors have anecdotally attributed improvements in a variety of disease states to alternate-day fasting, including asthma; seasonal allergies; autoimmune diseases, such as rheumatoid arthritis and osteoarthritis; infectious diseases, such as toenail fungus, periodontal disease, and viral upper respiratory tract infections; neurological conditions, such as Tourette’s syndrome and Meniere’s disease; atrial fibrillation; and menopause-related hot flashes. The actual effect on chronic disease, however, remains unclear, as I discuss in my video Does Intermittent Fasting Increase Human Life Expectancy?. 
     
    Alternate-day fasting has been put to the test for asthma in overweight adults, and researchers found that asthma-related symptoms and control significantly improved, as did the patients’ quality of life, including objective measurements of lung function and inflammation. As you can see in the graphs below and at 0:56 in my video, there were significant improvements in peak airflow, mood, and energy. Their weight also improved—about a 19-pound drop in eight weeks—so it’s hard to tease out the effects specific to the fasting beyond the benefits we might expect from weight loss by any means. 

    For the most remarkable study on alternate-day fasting, you have to go back more than a half-century. Though the 2017 cholesterol findings were the most concerning data I could find on alternate-day fasting, the most enticing was published in Spain in 1956. The title of the study translates as “The Hunger Diet on Alternate Days in the Nutrition of the Aged.” Inspired by the data being published on life extension with caloric restriction on lab rats, researchers split 120 residents of a nursing home in Madrid into two groups. Sixty residents continued to eat their regular diet, and the other half were put on an alternate-day modified fast. On the odd days of the month, they ate a regular 2,300-calorie diet; on the even days, they were given only a pound of fresh fruits and a liter of milk, estimated to add up to about 900 calories. This continued for three years. So, what happened? 
     
    As you can see below and at 2:16 in my video, throughout the study, 13 participants died in the control group, compared to only 6 in the intermittent fasting group, but those numbers were too small to be statistically significant. 

    What was highly significant, though, was the number of days spent hospitalized: Residents in the control group spent a total of 219 days in the infirmary, whereas the alternate-day fasting group only chalked up 123 days, as you can see below and at 2:38 in my video. 


    This is held up as solid evidence that alternate-day fasting may improve one’s healthspan and potentially even one’s lifespan, but a few caveats must be considered. It’s not clear how the residents were allocated to their respective groups. If, instead of being randomized, healthier individuals were inadvertently placed in the intermittent fasting group, that could skew the results in their favor. As well, it appears the director of the study was also in charge of medical decisions at the nursing home. In that role, he could have unconsciously been biased toward hospitalizing more folks in the control group. Given the progress that has been made in regulating human experimentation, it’s hard to imagine such a trial being run today, so we may never know if such impressive findings can be replicated. 

    Well, that was interesting! I had never even heard of that study until I started digging into the topic.  

    Check out my fasting series and popular videos on the subject here.  

    For more on longevity, see related videos below.



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    Michael Greger M.D. FACLM

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  • How Safe Is Alternate-Day Intermittent Fasting?  | NutritionFacts.org

    How Safe Is Alternate-Day Intermittent Fasting?  | NutritionFacts.org

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    Eating every other day can raise your cholesterol. 
     
    Are there any downsides to fasting every other day? For example, might go all day without eating impair your ability to think clearly? Surprisingly, as I discuss in my video Is Alternate-Day Intermittent Fasting Safe?, the results appear to be “equivocal.” Some studies show no measurable effects and the ones that do fail to agree on which cognitive domains are affected. Might the cycles of fasting and feasting cause eating disorder–type behaviors, like bingeing? So far, no harmful psychological effects have been found. In fact, there may be some benefit. However, the studies that have put it to the test specifically excluded those with a documented history of eating disorders, for whom the effects may differ. 
     
    What about bone health? No change in bone mineral density was noted after six months of alternate-day fasting despite about 16 pounds of weight loss, which would typically result in a dip in bone mass. However, the researchers did not note any skeletal changes in the control group either, and they lost a similar amount of weight using continuous caloric restriction. They suggested this is because both groups tended to be “more physically active than the average obese American,” getting about 1,000 to 2,000 more steps a day. 
     
    Proponents of intermittent fasting suggest it can better protect lean body mass, but most of the intermittent trials have employed less accurate methods of body composition analysis, whereas the majority of continuous caloric restriction trials used “vastly more accurate techniques.” So, to date, it is not clear if there’s a difference in lean mass preservation. 
     
    Improvements in blood pressure and triglycerides have been noted on intermittent fasting regimens, though this is presumed to be due to the reduction in body fat since the effect appears to be “dependent on the amount of weight lost.” Alternate-day fasting can improve artery function, too, as you can see in the graph below and at 1:55 in my video, though it does depend on what you’re eating on the non-fasting day. For study participants randomized to an alternate-day diet high in saturated fat, their artery function worsened despite a ten-pound weight loss, whereas it improved, as expected, in the lower-fat group. The decline in artery function was presumed to be because of the pro-inflammatory nature of saturated fat. 

    A concern has been raised about the effects of alternate-day fasting on cholesterol. After 24 hours without food, LDL cholesterol may temporarily bump up, but this is presumably because so much fat is being released into the system by the fast. As you can see in the graph below and at 2:33 in my video, an immediate negative effect on carbohydrate tolerance may stem from the same phenomenon—the repeated elevations of free fat floating around in the bloodstream. After a few weeks, though, LDL levels start to drop as the weight comes off. However, results from the largest and longest trial of alternate-day fasting have given me pause. 


    A hundred obese men and women were randomized into one of three groups: alternate-day modified fasting (25 percent of their baseline calories on fasting days and 125 percent calories on eating days), continuous, daily caloric restriction (75 percent of baseline), or a control group instructed to maintain their regular diet. So, for those going into the trial eating 2,000 calories a day, they would continue to eat 2,000 calories a day in the control group. The calorie-restriction group would get 1,500 calories every day, and the intermittent-restriction group would alternate between 500 calories a day and 2,500 calories the next. 
     
    As you can see in the graph below and at 3:32 in my video, with the same overall, average, prescribed calorie cutting in the two weight-loss groups, they both lost about the same amount of weight, but, surprisingly, the cholesterol effects were different. In the continuous calorie-restriction group, the LDL levels dropped as expected compared to the control group as the pounds came off. 

    But, in the alternate-day modified fasting group, they didn’t, as you can see below, and at 3:55 in my video. At the end of the year, the LDL cholesterol in the intermittent fasting group ended up being 10 percent higher than in the constant calorie-restriction group—despite the same loss of body fat. Given that LDL cholesterol is a prime causal risk factor for heart disease, our number one killer—or is even the prime risk factor—this strikes a significant blow against alternate-day fasting. If you want to try it anyway, I would advise you to have your cholesterol monitored to make sure it comes down with your weight. 


    If you’re diabetic, you must talk with your physician about medication adjustment for any changes in diet, including fasting of any duration. Even with proactive medication reduction, advice to immediately break the fast should sugars drop too low, and weekly medical supervision, people with type 2 diabetes who fasted for even just two days a week were twice as likely to suffer from hypoglycemic episodes compared to an unfasted control group. We still don’t know the best way to tweak blood sugar medications to prevent blood sugar from dropping too low on fasting days. 
     
    Even fasting for just one day can significantly slow the clearance of some drugs (like the blood-thinning drug Coumadin) or increase the clearance of others (like caffeine). Fasting for 36 hours can cut your caffeine buzz by 20 percent. So, consultation with your medical professional before fasting is an especially good idea for anyone on any kind of medication. 

    If you missed it, check out Alternate-Day Intermittent Fasting Put to the Test. 
     
    So, with ambiguous cognitive, lean mass, and bone effects, plus these cholesterol findings, I wouldn’t suggest alternate-day fasting for weight loss, but dropping pounds isn’t the only thing this way of eating is purported to do. Check out Does Intermittent Fasting Increase Human Life Expectancy?. 
     
    For other types of intermittent fasting, total fasting, and more on fasting, check out the related videos below. 



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  • Putting Alternate-Day Intermittent Fasting to the Test  | NutritionFacts.org

    Putting Alternate-Day Intermittent Fasting to the Test  | NutritionFacts.org

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    Does eating every other day prevent the metabolic slowing that accompanies weight loss, or does it improve compliance over constant, day-to-day caloric restriction? 

    Rather than cutting calories day in and day out, what if you instead ate as much as you wanted every other day or for only a few hours a day? Or, what if you fasted two days a week or five days a month? These are all examples of intermittent fasting regimens, as you can see below and at 0:10 in my video Alternate-Day Intermittent Fasting Put to the Test, and that may even be how we were built. Three meals a day may be a relatively novel behavior for our species. For millennia, “our ancestors could not eat three meals every day. They consumed meals much less frequently, and often consumed one large meal per day or went for several days without food.” 

    Intermittent fasting is often presented as a means of stressing your body—in a good way. There is a concept in biology called hormesis, which can be thought of as the “that which doesn’t kill you makes you stronger” principle. Exercise is the classic example: You put stress on your heart and muscles, and as long as there is sufficient recovery time, you are all the healthier for it. Is that the case with intermittent fasting? Mark Twain thought so: “A little starvation can really do more for the average sick man than can the best medicines and the best doctors. I do not mean a restricted diet, I mean total abstention from food for one or two days.” 
     
    But, Twain also said, “Many a small thing has been made large by the right kind of advertising.” Is the craze over intermittent fasting just hype? Many diet fads have their roots “in legitimate science,” but over time, facts can get distorted, benefits exaggerated, and risks downplayed. In other words, “science takes a back seat to marketing.” At the same time, you don’t want to lose out on any potential benefit by dismissing something out of hand based on the absurdist claims of overzealous promoters. You don’t want to throw the baby out with the baby fat. 
     
    Religious fasting is the most studied form of intermittent fasting, specifically Ramadan, a month-long period in which “Muslims abstain from food and drink from sunrise until sunset.” The effects are complicated by a change in sleeping patterns and also thirst. The same dehydration issue arises with Yom Kippur when observant Jews stop eating and drinking for about 25 hours. The most studied form of intermittent fasting that deals only with food restriction is alternate-day fasting, which involves eating every other day, alternating with days consuming little or no calories. 
     
    At rest, we burn about a 50:50 mix of carbohydrates and fat, but we usually run out of glycogen—our carbohydrate stores—within 12 to 36 hours of stopping eating. At that point, our body has to shift to rely more on our fat stores. This metabolic switch may help explain why the greatest rate of breakdown and burning of fat over a three-day fast happens between hours 18 and 24 of the 72 hours. The hope is to reap some of the benefits of taking a break from eating without the risks of prolonged fasting. 
     
    One of the potential benefits of alternate-day fasting over chronic calorie restriction is that you get regular breaks from feeling constant hunger. But might people become so famished on their fasting day that they turn the next into a feasting day? After your fasting day, if you ate more than twice as much as you normally would, that presumably would defeat the whole point of alternate-day fasting. Mice fed every other day don’t lose weight. They just eat roughly twice as much food in one day as non-fasted mice would regularly eat in two days. That is not, however, what happens in people. 
     
    Study participants were randomized to fast for a day and a half—from 8:00 p.m. to 8:00 a.m. the second morning after beginning. Fasting for 36 hours only led to people eating an average of 20 percent more the day after they broke the fast, compared to a control group who didn’t fast at all. That would leave the fasters with a large calorie deficit, equivalent to a daily caloric restriction of nearly a thousand calories a day. This particular study involved lean men and women, but similar results have been found amongst overweight or obese subjects. Researchers typically found only about a 10 to 25 percent compensatory increase in calorie intake over baseline on non-fasting days, and this seems to be the case whether the fasting day was a true zero-calorie fast or a modified fast day of a few hundred calories, which may lead to better compliance. 
     
    Some studies have found that participants appeared to eat no more, or even eat less, on days after a day-long mini-fast. Even within studies, great variability is reported. In a 24-hour fasting study where individuals ate an early dinner and then had a late dinner the next day after skipping breakfast and lunch, the degree of compensation at the second dinner ranged from 7 percent to 110 percent, as you can see in the graph below and at 4:40 in my video. This means that some of the participants got so hungry by the time supper rolled around that they ate more than 24 hours’ worth of calories in a single meal. The researchers suggested that perhaps people first try “test fasts” to see how much their hunger and subsequent intake ramp up before considering an intermittent fasting regimen. Hunger levels can change over time, though, dissipating as your body habituates to the new normal. 


    In an eight-week study in which obese subjects were restricted to about 500 calories every other day, after approximately two weeks, they reportedly started feeling very little hunger on their slashed calorie days. This no doubt helped them lose about a dozen pounds on average over the duration of the study, but there was no control group with whom to compare. A similar study that did have a control group found a similar amount of weight loss—about ten pounds—over 12 weeks in a group of “normal weight” individuals, which means overweight on average. For these modified regimens where people are prescribed 500 calories on their “fasting” days, researchers found that, from a weight-loss perspective, it did not appear to matter whether those calories are divided up throughout the day or eaten in a single meal. 
     
    Instead of prescribing a set number of calories on “fasting” days, which many people find difficult to calculate outside of a study setting, a pair of Iranian researchers came upon a brilliant idea of unlimited above-ground vegetables. Starchy root vegetables are relatively calorie-dense compared to other vegetables. Veggies that grow above the ground include stem vegetables (like celery and rhubarb), flowering vegetables (like cauliflower), leafy vegetables (like, well, leafy vegetables), and all of the fruits we tend to think of as vegetables (like tomatoes, peppers, okra, eggplant, string beans, summer squash, and zucchini). So, instead of prescribing a certain number of calories for “fasting” days, researchers had subjects alternate between their regular diet and helping themselves to an all-you-can-eat, above-ground vegetable feast (along with naturally non-caloric beverages, like green tea or black coffee) every other day. After eight weeks, the subjects lost an average of 13 pounds and two inches off their waist, as you can see below and at 6:59 in my video. 


    The same variability discovered for calorie compensation has also been found for weight loss, as seen in the graph below and at 7:10 in my video. In a 12-month trial in which subjects were instructed to eat only one-quarter of their caloric needs every other day, weight changes varied from a loss of about 37 pounds to a gain of about 8 pounds. The biggest factor differentiating the low-weight-loss group from the high-weight-loss group appeared to be not how much they feasted on their regular diet days, but how much they were able to comply with the calorie restriction on their fast days. 

     
    Overall, ten out of ten alternate-day fasting studies showed significant reductions in body fat. Small short-term studies show about a 4 to 8 percent drop in body weight after 3 to 12 weeks. How does that compare with continuous calorie restriction? Researchers compared zero-calorie, alternate-day fasting head-to-head to a daily 400-calorie restriction for eight weeks. Both groups lost the same amount of weight, about 17 pounds, and, in the follow-up check-in six months later after the trial had ended, both groups had maintained a similar degree of weight loss; both were still down about a dozen pounds, as you can see below and at 8:10 in my video. 


    The hope that intermittent fasting would somehow avoid the metabolic adaptations that slow weight loss or improve compliance doesn’t seem to have materialized. The same compensatory reactions in terms of increased appetite and a slower metabolism plague both continuous and intermittent caloric restriction. The longest trial of alternate-day fasting found that “alternate-day fasting may be less sustainable” than more traditional approaches. By the end of the year, the drop-out rate of the alternate-day fasting group was 38 percent, compared to 29 percent in the continuous calorie-restriction group.  

    Although alternate-day fasting regimens haven’t been shown to produce superior weight loss to date, for individuals who may prefer this pattern of calorie restriction, are there any downsides? Find out in my video Is Alternate-Day Intermittent Fasting Safe?. 
     
    I packed a lot into this one. Bottom line: Fasting doesn’t appear to provide an edge over traditional calorie cutting, but if you prefer it, why not give fasting a try? Before you do, first check out Is Alternate-Day Intermittent Fasting Safe?.  

    What about total fasting? For that and even more, check out the related videos below.

    I have a whole chapter on intermittent fasting in my book How Not to Diet—order now! (All proceeds I receive from my books are donated to charity.) 



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    Michael Greger M.D. FACLM

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  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

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    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

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    Michael Greger M.D. FACLM

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