Time Restricted

A blog on fasting, health, and other issues of midlife

Archives for August 2018

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Days 7-8 – It’s like Seattle here…

Travel tip:  If you come to Buchinger Wilhelmi on Bodensee, make sure you depart before the end of August!

Weather definitely changes quickly here.

We went from perfect sunny resort weather to clouds and rain — like Seattle!  We’ve got this for the next few days.

Weather in Ueberlingen
Weather in Ûberlingen for the next few days

We had a little break from the rain today right now (4pm here), so I took a photo of what this place looks like with cloud cover.

Buchinger Wilhelmi on a Cloudy Day
Buchinger Wilhelmi on a cloudy day

Fortunately, our morning walk today stayed on gravel roads to avoid the muddiness of the dirt trails, and we were provided umbrellas to take along with us.

The morning walk stayed on the gravel roads

And, even for the daily activities, Buchinger Wilhelmi handles the weather well with umbrellas at the entrance of every building.

Still, my wife and I agreed that if we ever came back, we’d schedule our trip two weeks earlier!

Results from morning nurse visits on Days 7-8

  • Blood pressure: 137/80, 115/78 – Still oscillating a bit!
  • Blood sugar: 106, 111 – Coming down!
  • Weight: 68.7kg (151.1b) , 68.4kg (150.5lb) – 300g per day is normal for fat burning

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Should you switch out a doctor you don’t like?

I have not had great historical success with doctors in the US in treating my diabetes.  My doctors have been too quick to insist on prescribing drugs that do not work over the long term for my situation, and they have not changed their views quickly enough to match as new data emerges.  Without exception, all of them warned me about the dangers of fasting without the time or the willingness to review the research.

Here at Buchinger-Wilhelmi, the doctors acknowledge that medicine is not a science but rather trial-and-error.  (For those interested, there’s a very good Freakonomics podcast series on this topic!)  My doctor here in Germany acknowledged that what she was originally taught (give diabetics frequent small meals per day) was wrong, which I knew to be true based on the progression of my own disease.  My German doctor and I even had a great conversation about Yoshinori Ohsumi, a 2016 Nobel Prize winner for his discovery of mechanisms for autophagy (self-reparation) in cells, triggered by fasting.  Upon getting here, I felt something with a doctor that I hadn’t felt in the past — a true willingness to engage in discussion rather than simply prescribing medicine or “standard of care.”

My experience in the US was not atypical. A study published in the Journal of General Internal Medicine found that:

On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors.  Also, only one in three doctors provides their patients with adequate opportunity to describe their situation.

The commentary in the release associated with this study goes on to say:

“If done respectfully and with the patient’s best interest in mind, interruptions to the patient’s discourse may clarify or focus the conversation, and thus benefit patients,” she [Naykky Singh Ospina] agrees. “Yet, it seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at the early stage in the encounter.”

Monday night, my wife and I attended a lecture here at Buchinger Wilhelmi on doctor-patient relationships.  Given that Buchinger Wilhelmi has a long history of utilizing alternative therapies for a worldwide audience that are not practiced in the guests’ home countries, they provide more formal instruction on this meaty topic.

It turns out there is rich history of medical ethics surrounding patient autonomy versus paternalism in making health care decisions, and the advocacy position that Buchinger takes here is that neither extreme is optimal.  The key is to have a relationship with your medical doctor.

This history stems back to Ancient Greece where priests and doctors were one in the same.  Challenges exist today because of the demands of the current healthcare system, so doctors (while many well-intentioned) are often under time pressure and have a tendency to “repair” rather than communicate.

Temptation Surplus Disorder
Credit: kevinspear.com

I walked away with several recommendations:

  • Ask questions that you have the right to ask.  For example, when prescribed a medicine, ask your doctor if they have actual clinical experience (and measured success) with the medicine over the long term.
  • Make sure your doctor is communicating with you in language you understand.  Too often doctors use very technical jargon to sound authoritative rather than to communicate to you in a way you can comprehend.  Force them to communicate.
  • Find something you like about your doctor.  The advocacy position here is that if you don’t like your doctor, or your doctor doesn’t like you, it simply won’t work at all.  To be fair to the doctor, initiate this on your own.  Even if you have to compliment your doctor on their apparel, try to break the ice in some way!

The advice: if you aren’t successful with these approaches, switch doctors!

From an interview with Giovanni Maio, German physician and professor of bioethics and medical ethics at the Albert-Ludwigs-Universität Freiburg:

Die Patienten haben doch eine große Macht, ich wundere mich immer, warum sie die nicht einsetzten. Sie können die Ärzte, die ihnen keine Zeit widmen, abstrafen. Einfach nicht mehr hingehen und einen anderen Arzt aufsuchen.

Translated from German:

The patients have a great power, I always wonder why they did not use them. You can penalize the doctors who do not devote time to them. Just do not go and see another doctor.

There’s the answer to the question from Germany.

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Days 4-6 Still Alive and Well!

Thanks to all those who messaged me privately about the temporary pause in blogging! We are still alive and well!

We’ve been immersed in the Buchinger experience, and we’ve been taking advantage of the program! Even though we’re not allowed to use mobile phones outside our rooms, I had to use something to keep track of where to be!  The image above is a screen shot of our schedule over the last three days!  The program here runs from 6am to 8:30pm.

Buchinger uses a very holistic approach to fasting and well-being, which combine medicine and complementary therapies.  Some highlights from the last three days include:

  • abdominal sonogram – basically imaging my organs.  While doctors can’t tell things like the quantitative fat composition of the liver (that would require MRI), they can detect chronic liver disease, which I don’t have!  My results look “normal.”
  • breathing physiotherapy – basically a Swiss massage to encourage breathing.  As a lifelong allergy sufferer, I can tell you this really works!  The problem is that the results are temporary!  I felt great for a couple hours, and then with all the nature here, I was back to “normal!”  🤧
  • group meditation – While not that different from what I’ve done in the past (I went to Spirit Rock a few years ago), there are always good reminders to take away from these types of activities when doing both sitting and walking meditation.
  • personal training – I am at least starting to address the issues of my shoulders rolling forward.  The trainer asked me right off the bat, “You use a computer a lot, don’t you?”  Ouch.
  • painting workshop – just a chance to explore creatively.  Here’s an impressionist painting I did inspired by one of our hikes.
Painting inspired by one of our hikes
Painting inspired by one of our hikes

And, we’ve had a couple of really cool hikes!  (You can click on the images to get more information about the sights!)

St Leonard Birnual Basilica Hike
St Leonard Birnual Basilica Hike
Sipplingen - 7 Churfirsten Hike
Sipplingen – 7 Churfirsten Hike

Future topics deserving of their own blog posts include:

Stay tuned!

Results from morning nurse visits on Days 4-6

  • Blood pressure: 143/89, 134/84, 113/81 – Coming down!
  • Blood sugar: 145,134, 137 – Still needs work!
  • Weight: 71.3kg (156.9lb) , 69.9kg (153.8), 69.5kg (152.9) – Already slowing down, as most of the water weight is now gone!

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Day 3 – Walk good 👍, Enema bad 👎

Today was good and bad.

Walk good.  👍

On Sundays, the walks here at Buchinger Wilhelmi start at 8:30am instead of the usual 6am time both to attract a bigger group and to allow for longer excursions. Today, we went to the highest lookout point between Lake Constance and the Danube, referred to locally as the “Höchsten Aussichtspunkt.”  It was a nice, leisurely 4 mile walk, and we were rewarded with a great view at the end!

Sunday Walk at Buchinger Wilhelmi
Sunday walk at Buchinger Wilhelmi to start off the day!

Enema Bad 👎

While the walk was a great start to the day, the middle of the day took a downward turn.

Once fasting, you get an enema every other day here at Buchinger Wilhelmi.  The issue here is that fasting reduces your stimuli to poo, but having small quantities of food means that small amounts of digestive juices and bile are still produced, the mucous membrane peels away, and intestinal bacteria and epithelial cells must be removed.

The argument they make here is that while some people view enemas as unnatural, brushing your teeth is also unnatural but necessary due to modern nutrition.  Intellectually, this all make sense to me.

However, my candid opinion is that the enema has the potential to be a day-wrecking event.  I was admittedly pretty uncomfortable not only having the tube stuck up by butt, but also having the nurse fill up my bowels with water.  The upside is that, unlike the Glauber salts which required me to stay by the bathroom for 5 hours, the flushing process with an enema is fast.  I was ready to leave the vicinity of the bathroom in a few minutes.  Sill, the downside is that I was feeling a little queasy afterwards.  I really didn’t even want the vegetable consommé that was brought to my room, but I drank it anyway.

Hot Liver Compress Saves the Day 😅

The saving grace immediately after my broth was the hot liver compress!  I was unconscious at 1pm once I got my hot liver compress and felt much better after finally awakening!  My wife and I walked to the Überlinger Töpfermarkt, an annual pottery market on the lakefront, and enjoyed both the scene and the work of the artisans.  After that, I was totally ready for (and enjoyed!) the light gazpacho at dinner time!

Überlinger Töpfermarkt
Browsing at the annual Überlinger Töpfermarkt after the hot liver compress!

There really is a system here at Buchinger Wilhelmi to even handle the unpleasantries of intestinal cleansing!

Note: We also heard from others here that you can opt out of the enemas in favor of other laxatives.

Results from morning nurse visit

  • Blood pressure: 165/85 – higher than yesterday.  This isn’t supposed to happen!  We’ll check on this tomorrow!
  • Blood sugar: 109 – getting closer to “normal!”
  • Weight: 71.3kg (156.9 lbs) – down yet another 0.6 kg from the day before

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Day 2 – Almost too comfortable!

I was not looking forward to Day 2 of the fast.  At Buchinger Wilhelmi, that fear is unfounded.

The “Do it Yourself” Experience

I’ve tried water fasting before on my own, and Day 2 is always miserable.  Day 1 is usually easy because you get to burn your glycogen stores.  It’s Day 2 when your body goes into gluconeogenesis, and things can get uncomfortable!

Glucose Response Curve
THE GLUCOSE RESPONSE CURVE. True hunger occurs when glycogen stores are depleted, so that gluconeogenesis can be avoided. (Source: Nutrition Journal, 2010)

The Buchinger Experience

Here at Buchinger, day 2 is a breeze.

Inputs and Outputs

Part of the Buchinger formula to get to ketogenesis (fat burning) without the pain is through careful control of what comes out of your body and what goes in!  A summary:

  • cleaning out intestines with Glauber salts on day 1 to avoid hunger
  • a morning tea and yogurt (honey if you’re not diabetic)
  • vegetable consommé at lunch and dinner times (today we had chard broth at lunch time and tomato brother at dinner time!)

Outside the clinic, this is referred to as a fasting mimicking diet, where you still consume small amounts of food but “trick” your body to get the same therapeutic benefits of fasting!

Hot Liver Compress and Tea

The other thing starts on Day 2 is a hot liver compress.  The concept is to heat the liver to improve blood circulation and liver function during the fast.

Every day at about 11:45am, the nurse places a wet towel over your upper abdomen, puts a hot water bottle over the towel, and then swaddles you snugly using another cloth.  I don’t know whether it really makes the liver function better, but it definitely put me to sleep in the middle of the day, and made me feel great!  Quiet time at the clinic lasts at the clinic until 2pm.

After that, you get hot tea served in your room!

This felt like such an awesome mid-day pampering.  My wife joked that she’s never going home!

Results from morning nurse visit

  • Blood pressure: 157/89 – a tiny bit higher
  • Blood sugar: 141 – back to where it was on Wednesday morning
  • Weight: 71.9kg (158.2 lbs) – down yet another 0.8 kg from the day before

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Day 1 – The Glauber salt experience

Today is our first day of fasting, and there is a system here at Buchinger-Wilhelmi.

The easy part

To start off the fasting, I was given two supplements to be taken through the duration of the fast.

Note that diabetics should take magnesium supplements anyway, as diabetics excrete magnesium along with the glucose through the urine.

Supplements - Magnesium and Basica
https://time-restricted.com/wp-content/uploads/2018/08/supplements.jpg”> Supplements given to us for our first day of fasting at Buchinger Wilhelmi[/caption

The hard part

Warning: this is a bit gross.

Right after my morning nurse visit, I was given my Glauber salt.  Basically, you get three things:

  • A pitcher of salt water
  • A glass of diluted lemon juice for taste (the salt water doesn’t taste so good)
  • A pot of peppermint tea to drink ½ hour after the Glauber salt

Then I was instructed to stay by the toilet for the next 5 hours.  Good advice.

For me, this wasn’t as bad as it sounded.  While excreting liquid feces out my butthole is never pleasant, at least this was not accompanied by the chills or dizziness that comes with food poisoning.  This was sort of a “clean” diarrhea experience, if there is such a thing!  (Update: my wife read this and told me I omitted a key piece of packing advice.  Bring Charmin from the US.  The toilet paper here at the clinic is a bit “rough!”)

The doctor here told me that cleaning out the digestive system prevents people from getting hungry, and I have to admit that was true.  I did not feel hungry at all.

That said, this is a pretty traumatic start, and both the doctors and nurses sagely advise to take it easy the day of Glauber salt.  There are many activities on the calendar here at Buchinger Wilhelmi, and I didn’t take advantage of any of them today!

By 6pm, both my wife and I were ready to take our vegetable consommé in the salon.  She had the pumpkin broth.  I had the turnip broth.  Both were good!  We also got to meet a few folks who shared the common experience.  I actually kind of enjoyed the bonding, and I think it’s a key part of the experience fasting as a group.

Results from morning nurse visit

  • Blood pressure: 152/88 – basically unchanged
  • Blood sugar: 121 – actually down from the day before despite all those carbs!
  • Weight: 72.7kg (159.9 lbs) – down 0.8 kg from the day before