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Tag: Weight Loss

  • 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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    Michael Greger M.D. FACLM

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  • Older Americans Are About to Lose a Lot of Weight

    Older Americans Are About to Lose a Lot of Weight

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    Imagine an older man goes in to see his doctor. He’s 72 years old and moderately overweight: 5-foot-10, 190 pounds. His blood tests show high levels of triglycerides. Given his BMI—27.3—the man qualifies for taking semaglutide or tirzepatide, two of the wildly popular injectable drugs for diabetes and obesity that have produced dramatic weight loss in clinical trials. So he asks for a prescription, because his 50th college reunion is approaching and he’d like to get back to his freshman-year weight.

    He certainly could use these drugs to lose weight, says Thomas Wadden, a clinical psychologist and obesity researcher at the University of Pennsylvania, who recently laid out this hypothetical in an academic paper. But should he? And what about the tens of millions of Americans 65 and older who aren’t simply trying to slim down for a cocktail party, but live with diagnosable obesity? Should they be on Wegovy or Zepbound?

    Already, seniors make up 26.6 percent of the people who have been prescribed these and other GLP-1 agonists, including Ozempic, since 2018, according to a report from Truveta, which draws data from a large network of health-care systems. In the coming years, that proportion could rise even higher: The bipartisan Treat and Reduce Obesity Act, introduced in Congress last July, would allow Medicare to cover drug treatments for obesity among its roughly 50 million Part D enrollees above the age of 65; in principle, about two-fifths of that number would qualify as patients. Even if this law doesn’t pass (and it’s been introduced half a dozen times since 2012), America’s retirees will continue to be prescribed these drugs for diabetes in enormous numbers, and they’ll be losing weight on them as well. One way or another, the Boomers will be giving shape to our Ozempic Age.

    Economists say the cost to Medicare of giving new drugs for obesity to just a fraction of this aging generation would be staggering—$13.6 billion a year, according to an estimate published in The New England Journal of Medicine last March. But the health effects of such a program might also be unsettling. Until recently, the very notion of prescribing any form of weight loss whatsoever to an elderly patient—i.e., someone 65 or older—was considered suspect, even dangerous. “Advising weight loss in obese older adults is still shunned in the medical community,” the geriatric endocrinologist Dennis Villareal and his co-authors wrote in a 2013 “review of the controversy” for a medical journal. More than a decade later, clinicians are still struggling to reach consensus on safety, Villareal told me.

    Ample research shows that interventions for seniors with obesity can resolve associated complications. Wadden helped run a years-long, randomized trial of dramatic calorie reduction—using liquid meal replacements, in part—and stringent exercise advice for thousands of overweight adults with type 2 diabetes. “Clearly the people who were older did have benefits in terms of improved glycemic control and blood-pressure control,” he told me. Other, smaller studies led by Villareal find that older people who succeed at losing weight through diet and exercise end up feeling more robust.

    Such outcomes are significant on their own terms, says John Batsis, who treats and studies geriatric obesity at the UNC School of Medicine. “When we talk about older adults, we really need to be thinking about what’s important to older adults,” he told me. “It’s for them to be able to get on the floor and play with their grandchildren, or to be able to walk down the hallway without being completely exhausted.” But weight loss can also have adverse effects. When a person addresses their obesity through dieting alone, as much as 25 percent of the weight they lose derives from loss of muscle, bone, and other fat-free tissue. For seniors who, through natural aging, are already near the threshold of developing a functional impairment, a sudden drop like this could be enfeebling. Wadden’s trial found that, among the people who were on the weight-loss program for more than a decade, their risk of fracture to the hip, shoulder, upper arm, or pelvis increased by 39 percent. An analogous increase has turned up in studies of patients who undergo bariatric surgery, Batsis told me.

    Read: Ozempic makes you lose more than fat

    The effect of dieting on muscle and bone can be attenuated, but not prevented, through resistance training. And obesity itself—which is associated with higher bone density, but perhaps also reduced bone quality—may pose its own fracture risks, Batsis said. But even when a weight-loss treatment benefits an older patient, what happens when it ends? People tend to regain fat, but they don’t recover bone and muscle, Debra Waters, the director of gerontology research at the University of Otago, in New Zealand, told me. That makes the long-term effects of these interventions for older adults very murky. “What happens when they’re 80? Are they going to have really poor bone quality, and be at higher risk of fracture? We don’t know,” Waters said. “It’s a pretty big gamble to take, in my opinion.”

    Villareal told me that doctors should apply “the general principle of starting slow and going slow” when their older patients are trying to lose weight. But that approach doesn’t necessarily square with the rapid and remarkable weight loss seen in patients who are taking semaglutide or tirzepatide, which may produce a greater proportional loss of muscle and bone. (For semaglutide, it appears to be about 40 percent.)

    Then again, when given to laboratory animals, GLP-1 drugs seem to tamp down inflammation in the brain; and they’re now in clinical trials to see whether they might slow the progression of Alzheimer’s disease and dementia. Their multiple established benefits could also help seniors address several chronic problems—diabetes, obesity, fatty liver disease, and kidney disease, for instance—all at once. “Such a ‘one-stop shop’ approach can lead to reduction of medication burden, adverse drug events, hypoglycemic episodes, medication costs, and treatment nonadherence,” one team of geriatricians proposed in 2019.

    Overall, Batsis remains optimistic. “As a clinician, I’m very excited about these medications,” he told me. As a scientist, though, he’s inclined to wait and see. It’s surely true that some degree of weight loss is a great idea for some older patients. “But the million-dollar question is: What’s the sweet spot? How much weight is really enough? Is it 5 to 10 percent? Or is it 25 percent? We don’t know.” Waters said that if Medicare is going to pay for people’s Wegovy, then it should also cover scans of their body composition, to help predict how weight loss might affect their muscles and bones. Wadden said he thinks that treatments should be limited to people who have specific, weight-related complications. For everyone else—as for the hypothetical 72-year-old man who is prepping for his college reunion—he counsels prudence.

    To some extent, such advice is beside the point. Older people are already on Ozempic, and they’re already on Trulicity, and some of them are already taking GLP-1 drugs as a treatment for obesity. Truveta reported that the patients in its member health-care systems who are over 65 have received 281,000 prescriptions for GLP-1 drugs across the past five years. Given the network’s size, one can assume that at least 1 million seniors, overall, have already tried these medications. Millions more will try them in the years to come. If we still have questions about their use, mass experience will start providing answers.

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    Daniel Engber

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  • Ozempic Makes You Lose More Than Fat

    Ozempic Makes You Lose More Than Fat

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    The newest and much-hyped obesity drugs are, at their core, powerful appetite suppressants. When you eat fewer calories than you burn, the body starts scavenging itself, breaking down fat, of course, but also muscle. About a quarter to a third of the weight shed is lean body mass, and most of that is muscle.

    Muscle loss is not inherently bad. As people lose fat, they need less muscle to support the weight of their body. And the muscle that goes first tends to be low quality and streaked with fat. Doctors grow concerned when people start to feel weak in everyday life—while picking up the grandkids, for example, or shoveling the driveway. Taken further, the progressive loss of muscle can make patients, especially elderly ones who already have less muscle to spare, frail and vulnerable to falls. People trying to slim down from an already healthy weight, who have less fat to spare, may also be prone to losing muscle. “You have to pull calories from somewhere,” says Robert Kushner, an obesity-medicine doctor at Northwestern University, who was also an investigator in a key trial for one of these drugs.

    Kushner worries about patients who start with low muscle mass and go on to become super responders to the drugs, losing significantly more than the average 15 to 20 percent of their body weight. The more these patients lose, the more likely their body is breaking down muscle. “I watch them very carefully,” he told me. The impacts of losing muscle may go beyond losing just strength. Muscle cells are major consumers of energy; they influence insulin sensitivity and absorb some 80 percent of the glucose flooding into blood after a meal. Extreme loss might alter these metabolic functions of muscle too.

    Exactly how all of this will affect people on Wegovy and Zepbound, which are still relatively novel obesity drugs, is too early to say. (You may have heard these same two drugs referred to as Ozempic and Mounjaro, respectively, which are their names when sold for diabetes.) These drugs cause a proportion of muscle loss higher than diet and exercise alone, though roughly on par with bariatric surgery. Lifestyle changes can blunt the loss, but pharmaceutical companies are on the hunt for new drug combinations that could build muscle while burning fat.

    The arrival of powerful weight-loss drugs has moved the field beyond simple weight loss, Melanie Haines, an endocrinologist at Massachusetts General Hospital, told me. That challenge is largely solved. Instead of fixating on the number of pounds lost, researchers, doctors, and ultimately patients can focus on where those pounds are coming from.

    Doctors currently offer two pieces of standard and unsurprising advice to protect people taking obesity drugs against muscle loss: Eat a high-protein diet, and do resistance training. These recommendations are perfectly logical, but their effectiveness against these drugs specifically is unclear, John Jakicic, a professor of physical activity and weight management at the University of Kansas Medical Center, told me. He is now surveying patients to understand their real-world behavior on these drugs.

    Fatigue, for example, is a common side effect. “When you’re tired, and you’re fatigued, do you really feel like exercising?” he said. Haines wonders the same about eating enough protein. The drugs are so good at suppressing appetite, she said, that some people might not be able to stomach enough food to get adequate protein. (Food companies have started pitching high-protein snacks and shakes to people on obesity drugs.)

    Read: The Ozempic plateau

    If patients stop taking Wegovy and Zepbound—and about half of patients do stop within a year, at least in real-world studies of people taking this class of drugs for diabetes—the weight regained comes back as fat more than muscle, says Tom Yates, a physical-activity professor at the University of Leicester. Muscle mass tends not to entirely recover. It’s “almost as if you’re better off staying where you are than going through cycles of weight loss,” he told me.

    Yet, he pointed out, the U.K. recommends Wegovy for a maximum of two years. In the U.S., patients who can’t afford the steep out-of-pocket price have been forced to stop when insurance companies abruptly cut off coverage or a manufacturer’s discount coupon expires. These policies are likely to trigger cycles of weight loss and gain that lead, ultimately, to net muscle loss.

    Meanwhile, drug companies are already thinking about the next generation of weight-loss therapies. “Wouldn’t it be great to have another mechanism that’s moving away from just appetite regulation?” Haines said. Companies are testing ways to preserve—perhaps even enhance—muscle during weight loss by combining Wegovy or Zepbound with a second muscle-boosting drug. Such a combination could, in theory, allow patients to lose fat and gain muscle at the same time.

    Years ago, scientists first became interested in potential muscle-enhancing drugs that mimic mutations found in certain breeds of almost comically ripped dogs and cattle. At the time, they hoped to treat muscle-wasting diseases. The drugs never quite worked for that purpose, but the trial for one such drug, an antibody called bimagrumab, found that patients also lost fat in addition to gaining lean mass. A start-up acquired the drug and began testing it for weight loss in combination with semaglutide, the active ingredient in Wegovy, or Ozempic. And last year, Eli Lilly, the maker of Zepbound, snapped up that company for up to $1.9 billion—in hopes of making its own combination therapy.

    Read: Are you sure you want an Ozempic pill?

    Pairing bimagrumab with an existing obesity drug could potentially maximize the weight loss from both. Losing weight tends to get harder over time; as you lose muscle, your body burns fewer calories. A drug that minimizes that muscle loss—or even flips it into muscle gain—could help patients boost the amount of energy their body expends, while Wegovy or Zepbound suppresses calories consumed. The mechanisms of how this might actually work in the body still need to be understood, though. Previous studies of bimagrumab found that patients grew more muscle, but they didn’t necessarily become faster or stronger. Haines, who is planning a small study of her own with bimagrumab, is most interested in how the combination affects not the structural but the metabolic functions of muscle.

    Bimagrumab is the furthest along of several drugs that tinker with the same pathway for muscle growth. The biotech company Regeneron recently published promising data on two of its muscle-enhancing antibodies paired with semaglutide in primates; a trial in humans is due to begin later this year. The start-up Scholar Rock is testing another antibody called apitegromab. Other companies are interested in combining the obesity drugs with different potential muscle boosters that work by mimicking certain hormones such as apelin or testosterone. If they succeed, the next generation of drugs could help sculpt a more muscular body, not just a smaller one. Eating less can only do so much to better your health.

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    Sarah Zhang

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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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  • Love Island star Amy Hart jokes she’s ‘shredding for the wedding’ with ‘less drastic version of having your jaw wired’

    Love Island star Amy Hart jokes she’s ‘shredding for the wedding’ with ‘less drastic version of having your jaw wired’

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    Love Island star Amy Hart is preparing for her wedding to fiancé Sam Rason following their engagement in September 2023.

    Amy – who has baby Stanley, 10 months, with Sam – shot to fame on the dating show’s fifth season back in 2019. But she’s come a long way since the days of gathering round the famous fire pit.

    These days, when she’s not busy on Question Time, she’s hosting the Love Island: Morning After podcast and acting as an agony aunt to her one million Instagram followers – all while running around after “speed-crawler” Stanley.

    Here, the “chronic oversharer” exclusively tells ED! about her pre-wedding diet, her rather unusual weight-loss technique and why she always has the last word when it comes to fat-shaming trolls…

    Amy Hart is marrying Sam Rason in September (Credit: Splash News)

    Love Island star Amy Hart finds love

    Amy announced her engagement to Sam last September, six months after welcoming baby Stanley. They’re getting married during a four-day wedding extravaganza in Spain, 12 months after “nice boy” Sam popped the question.

    Stanley will play a role in their nuptials, “depending on how naughty he is at the time”. Amy said: “He’s started to speed crawl so I have a feeling he’s going to be a runner. We’ve got someone designated to look after him. But he’ll have a cute little suit like Sam’s. He loves to party.”

    She added: “We went on a cruise recently and, when he was on the dance floor, he was laughing his head off. He loves people.”

    Speaking about the wedding, Amy said she’s got her dress and now just has to figure out who to invite. “It’s a four-day wedding, so people have two days to get to know each other. Amber Gill from Love Island is coming on her own. So anyone who doesn’t know someone, on those first two nights, I’ll push them in the direction of each other.”

    So has she had any bridezilla moments yet? “No, not really. I’m so laid back I’m horizontal. I used to be more highly strung but then I had a lot of therapy and now I’m laidback Luke,” she laughed.

    Amy Hart in a bikini on Love Island
    Amy found fame on Love Island in 2019 (Credit: ITV)

    ‘A less drastic version of having your jaw wired shut!’

    With the wedding eight months away, Amy revealed she’s currently “shredding for the wedding”. However, she admitted that her scales “haven’t moved” for a year, which left her “convinced” something was wrong.

    Amy, who’s an ambassador for fertility and conception online department store femme health, went online and ordered herself a thyroid test. And she said the results came as a bit of a shock.

    I just need to stop eating so many snacks.

    “I bought a thyroid test off femme health the other day because I was convinced there was something wrong,” she said.

    Amy added: “I was like these scales haven’t moved for the past year. I probably do eat too many snacks but I’ve been on two-week all-inclusive cruises and it hasn’t gone up. So I thought it must be my thyroid. So I got the test, did it at home, no no, nothing wrong. I just need to stop eating so many snacks,” she said candidly.

    However, as well as her wedding diet, Amy is also working on her smile, and it seems that’s having more of an impact than she imagined on her weight loss.

    “So now I’ve got my Invisalign in which means I can’t pick. The worst thing is when I’m cooking Stanley’s food, it’s all really nice, I cook it all from scratch. So I’m like a spoonful for Stanley, a spoonful for me. But now I’ve got my Invisalign in I can’t do that which is perfect,” she explained.

    “It’s like a less drastic version of having your jaw wired shut!”

    Having the last word with trolls

    Trolling is something Amy has sadly become accustomed to post-Love Island. And comments about her weight are often left by some of her more unsavoury followers. However, speaking to ED!, she revealed how she manages to put the keyboard warriors firmly in their place.

    “They do and they don’t bother me,” she said. “I do think who are you to even say that? But because everyone is obsessed with catching influencers out, I’m obsessed with catching people out.

    “So my favourite thing to do is, when someone sends a really horrible message, especially if it’s an older woman, they’re not very savvy and they often have the same profile picture on Instagram and Facebook, I always look them up.

    “Invariably they’ve always shared something about being kind or you never know what someone’s going through so don’t be horrible. So I screenshot it and send it back to them and go: ‘Is this you?!’

    “I probably should just block them but I just love it! And of course they don’t come back to me and say sorry.”

    Love Island star Amy Hart on baby number two

    After the wedding, Amy has grand plans for new husband Sam. She told us: “We’re getting married in September so we’ll try for a second baby after that.”

    Amy, who was vocal about freezing her eggs before meeting Sam, added: “I feel like I haven’t really started my fertility journey. With my egg freezing I feel like that’s my preparation, my fertility future proofing if you like. My pregnancy was unplanned, so that was really easy, but now it’s that pressure and I’m a bit apprehensive.”

    Ever the oversharer, she added: “I’ve got a coil in at the moment and I’m trying to think about when is the best time to get it taken out. I know it’s painful for a lot of women but I literally didn’t feel it going in. I think my womb was still traumatised from having Stanley!”

    Amy Hart holding a newspaper
    Love Island star Amy Hart is an ambassador for femme health (Credit: Inspired Content)

    Busting the fertility taboo

    Amy’s team-up with femme health sits nicely with her followers.

    “I’m a chronic oversharer and I think it comes from being ex cabin crew. They say it takes someone 18 months to admit they’re struggling with life and cabin crew it’s before the landing gear comes up on take-off. People have told me about their bowel movements, their sex life, everything. So now I take my chronic overshare to the world. For me it feels really natural.”

    She added: “I’m really lucky, I have a great family, great friends and not everyone has that. I’ve had messages from people before saying: ‘I haven’t told anyone else yet but I’ve got to tell you, I’m pregnant!’ I love that.

    “A big part of my job is things that aren’t written in my contract and that’s the wider circle of communication with my followers. I’m a brand ambassador but to my followers I’m their channel of communication. I see it as a big part of my job as an influencer.

    “I’m not money motivated. I wish I was sometimes,” she quipped. “I only want to work with nice brands. And a lot of the brands only want to work with nice people. So it’s always a nice experience. And if people take the time to send a lovely message I’ll always reply and say that’s really kind, thank you so much.”

    YouTube video player

    Amy is brand ambassador for femme health, the world’s first fertility and conception online department store, launched to help the 1 in 7 people trying to conceive. Led by women, for women, femme health is a light-hearted yet supportive platform for fertility and women’s health.

    Read more: Inside Emily Atack’s colourful love life as she prepares for her first baby

    Join the debate on our Facebook page @EntertainmentDailyFix.



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    Nancy Brown

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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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  • Does Fasting Benefit Weight Loss?  | NutritionFacts.org

    Does Fasting Benefit Weight Loss?  | NutritionFacts.org

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    Like the keto diet, fasting for one or two weeks can actually slow the loss of body fat rather than accelerate it.

    Fasting obviously causes consistent, dramatic weight loss, as shown in the graph below and at 0:09 in my video Is Fasting Beneficial for Weight Loss?, but how do fasted individuals do long-term? Some research groups reported “extremely disappointing long-term effects,” as you can see in the graph below and at 0:19 in my video. 

    Average subjects started at about 270 pounds and, in the six months before the fast, continued to gain weight as obese persons tend to do. After 24 days of “inpatient starvation,” they experienced a dramatic 27-pound weight loss. Then, what do you think happened?

    They gained it all back and more, though one could argue if they had not fasted, they might have weighed even more at that point, as seen in the graph below and at 0:45 in my video. 
    In another study with follow-ups ranging up to 50 months, only 4 out of 25 “superobese” patients achieved even partial sustained success. Based on these kinds of data, some investigators “concluded that complete starvation is of no value in the long-term treatment of obese patients.” 
     
    Other research teams reported better outcomes. One series with about 100 individuals found that 60 percent retained at least some weight loss at follow-up or even continued losing. The follow-up periods varied from 1 to 32 months with no breakdown as to who fasted and for how long, though, making the data hard to interpret. In another study, 62 patients were down an average of 16 pounds after fasting for 10 days. After one year, 40 percent of the group had retained at least 7 pounds of that weight loss. 
     
    As you can see below and at 1:37 in my video, when you put together six such studies, hundreds of obese subjects fasted for an average of 44 days and lost an average of 52 pounds. And, around one or two years later, 40 percent retained at least some of that weight loss. So, most gained back all of the weight they had lost, but 40 percent is extraordinary for a weight-loss study. 

    Following a hundred obese individuals getting treated at a weight-loss clinic with a standard low-calorie diet, researchers found that only one out of a hundred lost more than 40 pounds and only about one in ten lost even 20 pounds, with overall successful weight maintenance at only two patients over two years, as seen below and at 2:08 in my video. That’s why having a control group is so important. What may look like a general failure may actually be a relative success compared to more traditional weight-loss techniques. 

    Researchers new to the field may find it “clearly disappointing” that the “overall results of follow-up for 12 months or more” found that “two-thirds of the patients were ‘failures’ and more than one-third actually regained all the weight lost.” But, 12 percent were labeled successes, maintaining 59 pounds of weight loss two years later. As you can see in the graph below and at 2:42 in my video, the subjects lost massive amounts of excess weight and kept it off. 

    In a direct comparison of different weight-loss approaches at the same clinic, five years after initiating a conventional low-calorie approach, only about one in five was down 20 pounds compared to nearly half in the group who instead had undergone a few weeks of fasting years previously. By year seven, as you can see in the graph below and at 3:03 in my video, most of those instructed on daily caloric restriction were back up to their original weight or had even exceeded it, but that was only true for about one in ten in the fasted group. In an influential paper in the New England Journal of Medicine on seven myths about obesity, fallacy number three was identified as: “Large, rapid weight loss is associated with poorer long-term weight-loss outcomes, as compared with slow, gradual weight loss.” In reality, the opposite is true. The hare may end up skinnier than the turtle.  

    As shown in the graph below and at 3:39 in my video, researchers set up a study comparing the sustainability of weight loss at three different speeds: six days of fasting, three weeks on a very-low-calorie diet of 600 calories a day, or six weeks on a low-calorie diet of 1,200 calories a day. 

    The question is: What happened a year later? At one year, the fasting group was the only one that sustained a significant loss of weight, as you can see below and at 3:55 in my video. 

    What happened nine years later? “Therapeutic Fasting in Morbid Obesity” is the largest, longest follow-up study I could find. At least some of the fast-induced weight losses were maintained a year later by the great majority. After one year, 90 percent remained lighter than they had started, but after two years, three years, four years, and seven years, fewer and fewer patients maintained their weight loss. By nine years later, that number dropped to fewer than one in ten. By then, almost everyone had regained the weight they had initially fasted away, as you can see in the graph below and at 4:17 in my video. “Many patients thought that the temporary loss was worth the effort,” though. As a group, they had lost an average of about 60 pounds. They described improved health and quality of life and claimed that “reemployment was facilitated and earnings increased” during that period of time. But the fasting didn’t appear to result in any permanent change in eating habits for the vast majority. 
    The small minority for whom fasting led to sustainable weight loss “all admit to a radical change in previous eating habits”; indeed, fasting only works long-term if it can act as a jumpstart to a healthier diet. In a retrospective long-term comparison of weight reduction after an inpatient stay at a naturopathic center, those who fasted lost more weight at the time, but they were back to the same weight at around seven years, as you can see in the graph below and at 5:14 in my video. 

    It’s no surprise since most reported returning to the same diet they had been on before. However, those who were placed instead on a healthier, more whole food, plant-based diet were more likely to make persistent changes in their eating and, seven years later, were lighter than when they started, as you can see in the graph below and at 5:36 in my video. 

    Why can’t you have it both ways, though? Use fasting to kickstart a big drop, then start a healthier diet. The problem is that the big drop is largely illusory, as you can see in the graph below and at 5:48 in my video. 

    Fasting for a week or two can cause more weight loss than caloric restriction, but, paradoxically, it may actually lead to less loss of body fat. How can eating fewer calories lead to less fat loss? Because during fasting, your body starts cannibalizing itself and burning more of your own protein for fuel. Emperor penguins, elephant seals, and hibernating bears can survive by just burning fat without dipping into their muscles, but our voracious big brains appear to need at least a trickle of blood sugar. If we aren’t eating any carbohydrates, our body is forced to start turning our protein into sugar to burn. Even getting just a few grams of carbs—from adding honey to water when fasting, for instance—can cut protein loss up to 50 percent.  

    What about adding exercise to prevent the loss of lean tissues during a fast? That may make it worse! At rest, most of your heart and muscle energy needs can be met with fat, but if you start exercising, some of the blood sugar meant for your brain starts getting snatched up and your body may have to break down even more protein. 
     
    As you can see in the graph below and at 7:00 in my video, less than half of the weight loss during the first few weeks of fasting ends up coming from your fat stores. So, even if you double your daily weight loss on a fast, you may be actually losing less body fat. 

    In an NIH-funded study, obese individuals were placed on an 800-calorie-a-day diet for two weeks and steadily lost about a pound of body fat a day. They were then switched to about two weeks of zero calories and started losing more protein and water. On average, though, they only lost a few ounces of fat daily. When they were subsequently switched back to the initial 800-calories-a-day diet for a week, they rapidly replaced the protein and water, so the scale registered their weight as going up, but their body fat loss accelerated back to the approximate pound a day. The scale made it look as though they were doing better when they were completely fasting, but the reality is they were doing worse. So, during the five-week experiment, they would have lost even more body fat had they stuck with their calorie-restricted diet rather than completely stopping eating in the middle. They would have lost more body fat by eating more calories. Fasting for a week or two can interfere with the loss of body fat, rather than accelerate it. You can see a series of graphs depicting this from 7:13 in my video, including the one below. 

    This is the follow-up to Benefits of Fasting for Weight Loss Put to the Test. It seems fasting may only work long-term if it can act as a jumpstart to a healthier diet, and just fasting for a week or two can be counterproductive, like the keto diet. Is it even safe to fast longer than that? Find out in Is Fasting for Weight Loss Safe?. 
     
    For more on the keto story and more on fasting for weight loss, see related videos below. 
     
    I’ve done my third live webinar on fasting, Fasting and Cancer. Those videos are also on NutritionFacts.org. 

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    Michael Greger M.D. FACLM

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  • Putting the Benefits of Fasting for Weight Loss to the Test  | NutritionFacts.org

    Putting the Benefits of Fasting for Weight Loss to the Test  | NutritionFacts.org

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    For more than a century, fasting has been used as a weight-loss treatment.

    I’ve talked about the benefits of caloric restriction. Well, the greatest caloric restriction is getting no calories at all. Fasting has been branded “the next big weight loss fad,” but it has a long history throughout various spiritual traditions, practiced by Moses, Jesus, Muhammed, and Buddha. In 1732, a noted physician wrote, “He that eats till he is sick must fast till he is well.” About one in seven American adults today report taking that advice, “using fasting as a means to control body weight,” as I discuss in my video Benefits of Fasting for Weight Loss Put to the Test. 
     
    Case reports of the treatment of obesity through fasting date back more than a century in the medical literature. In 1915, two Harvard doctors indelicately described “two extraordinarily fat women,” one of whom “was a veritable pork barrel.” Their success led them to conclude that “successive moderate periods of starvation constitute a perfectly safe, harmless, and effective method for reducing the weight of those suffering from obesity.” 
     
    The longest-recorded fast, published in 1973, made it into the Guinness Book of World Records. To reach his ideal body weight, a 27-year-old man fasted for 382 days straight, losing 276 pounds, and managed to keep nearly all of it off. He was given vitamin and mineral supplements so he wouldn’t die, but no calories for more than a year. In the researchers’ acknowledgments, they thanked him “for his cheerful co-operation and steadfast application to the task of achieving a normal physique.” 
     
    In a U.S. Air Force study, more than 20 individuals at least 100 pounds overweight and most “unable to lose weight on previous diets” were fasted for as long as 84 days. Nine dropped out of the study, but the 16 who remained “were unequivocally successful” at losing 40 to 100 pounds. In the first four days, the subjects were noted as losing as much as four pounds a day, which “probably represents mostly fluid,” mostly water weight as the body starts to adapt. But, after a few weeks, they were steadily losing about a pound a day of mostly straight fat. The investigator described the starvation program as “a dramatic and exciting treatment for obesity.” 
     
    Of course, the single most successful diet for weight loss—namely no diet at all—is also the single least sustainable. What other diet can cure morbid obesity in a matter of months but practically be guaranteed to kill you within a year if you stick with it? The reason diets don’t work, almost by definition, is that people go on them, then they go off of them. Permanent weight loss is only achieved through permanent lifestyle change. So, what’s the point of fasting if you’re just going to go back to your regular diet and gain right back all of that lost weight? 
     
    Fasting proponents cite the psychological benefit of realigning people’s perceptions and motivation. Some individuals have resigned themselves to the belief that weight loss for them is somehow impossible. They may think “that they are ‘made differently’ from those of normal weight” in some way, and no matter what they do, the pounds don’t come off. But the rapid, unequivocal weight loss during fasting demonstrates to them that with a large enough change in eating habits, it’s not just possible, but inevitable. This morale boost may then embolden them to make better food choices once they resume eating. 
     
    The break from food may allow some an opportunity “to pause and reflect” on the role food is playing in their lives—not only the power it has over them but the power they have over it. In a fasting study entitled “Correction and Control of Intractable Obesity,” a patient’s personality was described as changing “from one of desperation, with abandonment of hope, to that of an eager extravert full of plans for a promising future.” She realized that her weight was within her own power to control. The researchers concluded: “This highly intellectual social worker has been returned to a full degree of exceptional usefulness.” 
     
    After a fast, newfound commitment to more healthful eating may be facilitated by a reduction in overall appetite reported post-fast, compared to pre-fast, at least temporarily. Even during a fast, hunger may start to dissipate within the first 36 hours. So, challenging people’s delusions about their exceptionality to the laws of physics—thinking they are “made differently”—with “short periods of total fasting may seem barbaric. In reality, this method of weight reduction is remarkably well tolerated by obese patients.” That seems to be a recurring theme in these published series of cases. In the influential paper “Treatment of Obesity by Total Fasting for up to 249 Days,” the researchers remarked that the “most surprising aspect of this study was the ease with which the prolonged fast was tolerated.” All of their patients “spontaneously commented on their increased sense of well-being, and in some, this amounted to frank euphoria.” They continued that, although “treatment by total fasting must only be prescribed under close medical supervision,” they “are convinced that it is the treatment of choice, certainly in cases of gross obesity.” 
     
    Fasting for a day can make people irritable and feel moody and distracted, but after a few days of fasting, many report feeling clear, elated, and alert—even euphoric. This may be in part due to the significant rise in endorphins that accompanies fasting, as you can see in the graph below and at 5:48 in my video. Mood enhancement during fasting is thought to perhaps represent an adaptive survival mechanism to motivate the food search. This positive outlook towards the future may then facilitate the behavioral change necessary to lock in some of the weight-loss benefits. 

    Is that what happens, though? Is fasting actually effective over the long term? There are articles with titles like “Death During Therapeutic Starvation for Obesity.” Is fasting even safe? We’ll find out next. 
     
    This is the sixth in a 14-part series on fasting for weight loss. In case you missed any of the others, see the related videos below. 

    My book How Not to Diet is all about weight loss. You can learn more about it and order it here. 

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    Michael Greger M.D. FACLM

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  • The 8 Best Full-Body, No-Equipment Exercises, According to Trainers – POPSUGAR Australia

    The 8 Best Full-Body, No-Equipment Exercises, According to Trainers – POPSUGAR Australia

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    While we’ll always love a dumbbell, kettlebell, or resistance band workout, there’s something empowering about knowing that all we really need to challenge our muscles is ourselves. Yes, we’re talking about bodyweight workouts. Though they’re sometimes overlooked, the right combination of full-body, no-equipment exercises can help you achieve any goal, from building strength to working up a sweat.

    “Bodyweight exercises refer to moves that use your own body weight to provide resistance against gravity,” says Tara Nicolas, a Nike Training Club trainer. And while you might think that bodyweight exercises are naturally easier than moves that require equipment, you’d be wrong.

    “I personally learned that the hard way during the pandemic,” Nicolas says. With gyms closed and at-home weights on serious backorder, the trainer turned to full-body, no-equipment exercises to get her sweat on – and ended up more exhausted than she’d thought possible.

    “Using equipment is fun, but you have ‘help’ in a way. With bodyweight exercises, you have to create all the force on your own, and when you get tired, you can’t flub it. It’s like, I have to pick my own ass up off this floor,” Nicolas says.

    So while bodyweight workouts can leave you just as tired and sore as powerlifting, there are full-body, no equipment exercises for every level of fitness. And Nicolas notes that bodyweight workouts can be a “safe space” for people who are intimidated by heavier weights – or have used them before and gotten injured.

    They can be super functional too. “Bodyweight exercises mimic what you’re going to do in the real world, and encourage you to have more body awareness,” Nicolas says.

    No-equipment exercises can also be surprisingly fun, because they encourage you to get out of the gym and find new ways to move your body – whether you’re incorporating bodyweight moves into a dance cardio class, or getting outdoors and using a park bench to support your workout.

    The following eight full-body, no-equipment exercises aren’t a full workout, but represent a selection of moves you can plug into your routine to strengthen your muscles and get your heart rate up.

    Listen to your body and modify as needed; bear crawls or inchworms might not be the right moves for people with wrist pain, for instance, and some people may need to work their way up to a full squat jump.

    And one last piece of advice? Grab a sweat towel – you’ll probably need it.

    – Additional reporting by Abbey Stone and Mirel Zaman

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    Maggie ryan

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  • The Ozempic Plateau

    The Ozempic Plateau

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    The latest weight-loss drugs are rightly hailed as game changers for obesity, but in an important way, they are just like every other method of managing weight: They work only to a point for weight loss. The pounds melt off quickly at first and then gradually and then not at all. You can’t lose any more no matter what you do. You’ve hit the weight-loss plateau.

    It happens with dieting. It happens with bariatric surgery. And it happens now with both semaglutide (better known as Ozempic or Wegovy, depending on whether it’s prescribed for diabetes or weight loss) and tirzepatide (better known as Mounjaro or Zepbound). Weight loss triggers a set of powerful physiological changes in the body, which evolved over millions of years to keep us alive through periods of food scarcity. “Everybody plateaus,” says Jamy Ard, an obesity doctor at Wake Forest University. Exactly when varies quite a bit from person to person, but it happens after losing a certain percentage of body weight—meaning some people might plateau while still meeting the criteria for obesity.

    For Wegovy, it’s after losing, on average, 15 percent, usually more than a year into starting the drug. For Zepbound, it’s about 20 percent. These numbers are higher than is sustainable through diet and exercise alone, but they also do not reach the 30 percent achievable via the gold standard of bariatric surgery.

    These differences matter because they suggest that the level of the plateau is not permanently fixed. Recent advances in understanding the gut hormones that these drugs are designed to mimic hint at a possibility of even more powerful weight-loss drugs. Scientists are now testing ways to push the plateau down further; a drug could one day be even more effective than bariatric surgery.

    Read: Ozempic is about to be old news

    All of this raises an unsettled question: “How much weight loss is enough?” says Jonathan Campbell, who studies gut hormones at Duke. In studies, even 5 to 15 percent weight loss can substantially reverse high blood pressure, high blood sugar, and high cholesterol. Yet a patient who starts at 375 pounds with a BMI of 60 might still find themselves ineligible for a joint replacement that requires a BMI below 40, flawed as BMI may be. Or they may simply want to look thinner. The explosion of weight-loss drugs has reopened thorny questions about how they should be used, but nevertheless, pharmaceutical companies are racing ahead to develop more and more powerful ones.

    Weight loss is easiest at the beginning, before your body starts actively working against it. “Your brain doesn’t know you’re trying to lose weight on purpose,” Ard says. And once it notices, “it thinks that something is wrong.” So your body tries very, very hard to compensate.

    First of all, you become hungrier, obviously. And not just because you want to eat as much as you did before; you actually want to eat more than you did prior to losing weight. “With every one kilogram you lose, your appetite goes up above baseline by 90 or so calories per day,” says Kevin Hall, who studies metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases. At the same time, your body looks for ways to conserve energy. Your muscles work more efficiently, for example, Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero. Here is your plateau. This is, all told, a remarkably elegant and robust system, if what you wanted to do is to maintain your weight.

    If you’re in fact trying to lose more weight, the plateau is psychologically frustrating. The same diet, the same exercise routine, the drug on which you were just losing weight will seem to have stopped working—but they haven’t. (If they did actually stop working, you would be regaining weight.) But your body is now fighting so hard against the weight loss that it requires a persistent effort just to keep the weight off, Hall says. Should you ease up, the weight will come right back, as seen in yo-yo dieting or weight regain after stopping Wegovy or Zepbound.

    The only way to get past a plateau is to up the intensity or number of interventions. Doctors might recommend, for example, bariatric surgery and a weight-loss drug. But in the future, novel drugs might be able to pharmacologically up the intensity. The progression from Wegovy to the more effective Zepbound has in fact already brought us one step closer.

    Wegovy and Zepbound both belong to a class of drugs that mimic a gut hormone called GLP-1. Both of these drugs bind GLP-1 receptors in the brain, which seems to reduce hunger. Zepbound goes a step further, though. It can also bind receptors for a second gut hormone, called GIP. Years ago, researchers noticed that bariatric surgery changes the balance of gut hormones in the body, including GLP-1 and GIP. This—and not just the physical shrinking of the stomach—is now understood to be a key driver of weight loss, to the point that bariatric surgery is sometimes called “metabolic surgery.” These observations inspired research into drugs that target not just GLP-1 but also GIP and other hormones. Essentially, they’re performing metabolic surgery with a drug rather than a scalpel.

    Read: Did scientists accidentally invent an anti-addiction drug?

    Exactly why Zepbound outperforms Wegovy is still unclear. One obvious hypothesis is that it mimics a second gut hormone; the more hormonal pathways it can influence, perhaps, the more body parts it affects and the more weight loss it triggers. And a recent clinical trial of retatrutide, a further modified derivative of Zepbound that mimics a third hormone called glucagon, demonstrated even greater weight loss: 24 percent at the highest dose.

    A second hypothesis suggests that the difference between Wegovy and Zepbound still goes back to GLP-1. Although both drugs bind that receptor, they tickle it slightly differently, setting off slightly different chain reactions. Wegovy seems to also activate some cellular machinery that acts as a break, possibly limiting its efficacy. This suggests another strategy for fine-tuning gut-hormone drugs: Companies have so far focused on trying to design one drug that binds to multiple hormone receptors, like a master key that can open three different locks. This was a practical choice, Campbell says, because trying to study three separate new drugs in clinical trials would be a logistical “nightmare.” But the optimal combination for weight loss might actually require individual keys that can jigger individual receptors in just the right way—that is, a double or triple combination of drugs.

    It may also eventually be possible to keep increasing the dosage of GLP-1 drugs to push the weight-loss plateau down. Right now, the dose is limited by what people are willing to tolerate. The drugs can cause severe nausea, vomiting, and diarrhea, so they have to be ramped up slowly over many weeks to induce tolerance and minimize side effects. But Novo Nordisk is trialing the drug in Wegovy at up to 16 milligrams a week, more than six times the current maximum dose. Tinkering with other gut-hormone pathways could also help with side effects. GIP receptors, for example, are found in neurons whose activation might suppress nausea, which may in part be why Zepbound seems to have slightly milder side effects.

    Zepbound is likely the first of many leveling-ups from single-action GLP-1 drugs. Even as the science advances, no safe method of losing weight is meant to eliminate the weight-loss plateau—and indeed, you wouldn’t want to keep losing weight indefinitely. But lose more weight? Pharmaceutical companies are betting on a market for that. With obesity drugs projected to become a $100 billion industry by 2030, they are eager for a slice of that massive pie. “The dollar signs are so big now,” Campbell says. Zepbound is the newest weight-loss drug on the block, but it too may eventually be old news.

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    Sarah Zhang

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  • Any Pitfalls with Restricting Calories?  | NutritionFacts.org

    Any Pitfalls with Restricting Calories?  | NutritionFacts.org

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    How may we preserve bone and mass on a low-calorie diet? 
     
    One of the most consistent benefits of calorie restriction is that blood pressure improves in as little as one or two weeks. Blood pressure may even be normalized in a matter of weeks and blood pressure pills discontinued. Unfortunately, this can work a little too well and cause orthostatic intolerance, which can manifest as lightheadedness or dizziness upon standing and, in severe cases, may cause fainting, though staying hydrated can help. 
     
    What about loss of muscle mass? In the CALERIE trial, which I profile in my video Potential Pitfalls of Calorie Restriction, 70 percent of the body weight the subjects lost was fat and 30 percent was lean body mass. So, they ended up with an improved body composition of about 72 percent lean mass compared to 66 percent in the control group, as you can see at 0:51 in my video. And, even though leg muscle mass and strength declined in absolute terms, relative to their new body size, they generally got stronger. 

    Is there any way to preserve even more lean mass, particularly among older individuals who naturally tend to lose muscle mass with age? Increased protein intakes are commonly suggested, but most studies fail to find a beneficial effect on preserving muscle strength or function whether you’re young or old, active or sedentary. For example, during a 25 percent calorie restriction, researchers randomized overweight older men and women to either a normal-protein diet with 4 grams for every ten pounds of body weight or a high-protein diet with about 8 grams per ten pounds. That doubling of protein intake had no discernible effect on lean body mass, muscle strength, or physical performance. As you can see below and at 1:48 in my video, most such studies found the same lack of benefit, but when they’re all put together, one can tease out a small advantage of about one or two pounds of lean mass over an average of six months. 

    Unfortunately, high protein intake during weight loss has also been found to have “profound” negative metabolic effects, including undermining the benefits of weight loss on insulin sensitivity. As you can see in the graph below and at 2:14 in my video, if you lose 20 pounds, you can dramatically improve your body’s ability to handle blood sugars, compared to subjects in a control group who maintained their weight. But, if you lose the exact same amount of weight on a high-protein diet, getting about an extra 30 grams a day, it’s like you never lost any weight at all. 


    Though you can always bulk back up after weight loss, the best way to preserve muscle mass during weight loss is to exercise. The CALERIE study had no structured exercise component, and, similar to bariatric surgery, about 30 percent of the weight loss was lean mass. In contrast, that proportion was only about 16 percent of The Biggest Loser contestants, chalked up to their “vigorous exercise program.” Resistance training even just three times a week can prevent more than 90 percent of lean body mass loss during calorie restriction. 
     
    The same may be true of bone loss. Lose weight through calorie restriction alone, and you experience a decline in bone mineral density in fracture risk sites, such as the hip and spine. In the same study, though, those randomized to lose weight with exercise did not suffer any bone loss. The researchers concluded: “Our results suggest that regular EX [exercise] should be included as part of a comprehensive weight loss program to offset the adverse effects of CR [caloric restriction] on bone.” 
     
    It’s hard to argue with calls for increased physical activity, but even without an exercise regimen, the “very small” drop in bone mineral density in the CALERIE trial might only increase a ten-year risk of osteoporotic fracture by about 0.2 percent. The benefits of calorie restriction revealed by the study included improvements in blood pressure and cholesterol, as you can see in the graph below and at 3:54 in my video, as well as improved mood, libido, and sleep. These would seem to far outweigh any potential risks. The fact that a reduction in calories seemed to have such wide-ranging benefits on quality of life led commentators in the AMA’s internal medicine journal to write: “The findings of this well-designed study suggest that intake of excess calories is not only a burden to our physical homeostasis [or equilibrium], but also on our psychological well-being.” 
     


    Check out my other videos on calorie restriction, fasting, intermittent fasting, and time-restricted eating in the related videos below. 

     

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    Michael Greger M.D. FACLM

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  • I followed the lion diet for 1,000 days

    I followed the lion diet for 1,000 days

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    I have been on the lion diet for more than 1,000 days, as of October 11, 2023.

    I was having severe gut problems when I heard about this crazy diet where you only eat ruminant meat, water, and salt—and that’s it. Ruminant animals are just those that bring up food from their stomachs to chew it again, such as cows and sheep.

    I’d heard stories about how this diet had helped to heal people of so many ills. Doctors had no answers for me so I thought: What the heck? What have I got to lose? I might as well give this a try before I give up on everything.

    I had a family to support and I couldn’t do that if I wasn’t healthy or alive. I felt this could save my life so I had to give it a shot. At my heaviest, I weighed 302lbs. Now I’m down to 183lbs.

    I was a complete insomniac when I started. I could not get to sleep at night and I could not wake up in the morning.

    Now, when I’m ready to go to bed I close my eyes when my head hits the pillow and I’m out. And when it’s time to get up in the morning, I’m able to jump up and get going in a way I couldn’t before. I used to snore at night too, keeping my wife up all the time. But not anymore.

    Dante Ferrigno before and after his 1,000 days doing the lion diet.
    Dante Ferrigno

    I had breathing problems that would make it hard for me to do any type of exercise for any even a short period of time. I would try to go walking for 30 minutes a day when I was close to 300lbs and even that was too much for me.

    Now, when I want to get exercise I just jump right in and do it, even if I’m out and about—I’ll stop and do push-ups or squats right in the middle of nowhere. I don’t care who’s watching.

    I love having the body that I always wanted to have. Here I am at 50 years old and I’m in the best health of my life. Even when I was 17 years old I didn’t feel as good as I do now—and I’m the same weight as I was then.

    I had high blood pressure at the start. Now I don’t have those problems. The last time I went to the doctor my blood pressure numbers were just about as perfect as you could ask for.

    Prior to eating the way, I was starting to have kidney issues too, but since I started eating this way my kidney function has improved. I had low testosterone and I was on replacement therapy for several years—but I’ve been off that for nearly a year and a half.

    My testosterone has actually gone up by at least 50 percent, and that was the last time I checked, which was over six months ago.

    My lipid panel is excellent. My HDL cholesterol—the “good” kind—is up. My triglycerides are way down. And even my LDL cholesterol—the “bad” kind—is within the normal range.

    I used to take medicines for allergies, digestion, and an upset stomach, as well as a ton of supplements. Now I don’t take anything except a couple of supplements for things that I think a lot of people suffer from, such as low iodine and low vitamin D.

    I’ve been through a tough time financially in the past three years, so anybody who says they can’t afford to do a carnivore way of eating isn’t considering the right things.

    I don’t make a lot of money, but it’s enough to provide for my family every month by the grace of God. And that’s only on one income.

    Yet somehow every month I’m able to eat the meat that makes my body healthy and like it was when I was young, and all my bills still get paid, even though prices are ridiculous right now.

    Granted, I did cut a few things out of my life to make that happen. I quit vaping, drinking, smoking, and buying junk food every time I stop for gas.

    I’ve noticed a few other beautiful side effects I put down to this way of eating, including that I no longer have pain from inflammation all the time, and I don’t get sick as easily as I used to.

    My immune system feels like it’s working like it should for the first time in my life.

    I used to have all this red skin that stung all the time, but now it looks clear and clean. And I used to have all this pain in my gut, which is gone now, too.

    Some people complain that they can’t go to the bathroom because of an all-meat diet, and that they need some roughage, but I have no trouble at all.

    I’m much more active now at 50 years old than I ever was in my entire life until now. I’m able to get more done; I can focus on two jobs at the same time; and I started playing basketball recently, something that I’ve never done before.

    I don’t even understand the rules of basketball for the most part but I’m able to get out there and keep up with guys that are a lot younger than me doing something that I didn’t think I would ever be doing.

    And I attribute it all to the lion diet.

    I love eating meat, so the diet comes natural to me, and it is very simple for shopping and deciding what to make every meal.

    Do I miss some things? Yes. I am a sugar addict, so whenever I see it in the form I used to love it in—cheesecake, yellow cake, ice cream, brownies, etc—it can be pretty hard to resist.

    But so many times that has led to the painful reality of reintroducing sugar into a system that has been working fine only producing sugar from the food consumed, rather than using sugar in the food consumed.

    I can be physically in pain for 24 hours or more, feel sickly for up to a couple weeks, and my blood sugar numbers stay haywire for several days after consuming sugar.

    Some say this is the problem with a carnivore diet; that it makes you more sensitive to sugar.

    But I think it’s simply that the negative effects are more easily noticed because you are no longer desensitized to the harm caused by such things. It’s like reintroducing a drug.

    I’ve experimented with some other foods on my diet, but I found that my body is resistant to them; perhaps due to developing leaky gut from years of eating ultra-processed food, fast food, seed oils, and all the garbage in our food supply.

    Right now, I have found freedom in this way of eating like I never thought possible. It has changed me physically, mentally, and even spiritually. I found that by quitting those vices I’ve been able to fall more in line with what the scriptures tell me to do as a believer in the Lord Jesus Christ.

    I find that this has been a wonderful blessing for me. Some Christians ask me why I don’t eat vegetables still. I say so many of them are genetically modified to be sweeter, or they’re sprayed with things like glyphosate to kill pests off.

    Ultimately, I found eating only meat has worked fantastic for me and now I stick with it more than ever. I don’t have a desire to experiment anymore because the troubles that I’ve had doing that haven’t been worth it.

    I live a totally different life now. I’m no longer a slave to advertising for food. I’m no longer a slave to the food system. I’m no longer a slave to the health care system. I fired my doctors; I only have one family doctor now who understands my carnivore diet.

    I’m not throwing doctors under the bus, but it’s nice not to have to go back to one and ask for permission to buy the things that I used to just treat the symptoms that were making me sick, fat, and unhealthy.

    Now that I’ve got 1,000 days in the can and I’m about to turn 51, I’m looking forward to whatever is coming next. The lion diet has changed my life for good.

    Dante Ferrigno runs the Ferrigno Freedom channel on YouTube where he posts videos about his journey with the lion diet.

    All views expressed are the author’s own.

    Do you have a unique experience or personal story to share? Email the My Turn team at myturn@newsweek.com.