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Time Restricted

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

Archives for September 2018

20 lb bag of rice

September 14, 2018 By spao 1 Comment

Days 20-22 – 20 lbs down & ready to break the fast!

Writing this on Day 22 of “fasting.” (I put “fasting” in quotation marks because of the small number of calories we actually do get to consume. This is really more a “fasting mimicking diet” than true fasting.)

Today we break the fast, so I had my final weigh in before we start chewing again!

Weight drop
During 22 days of fasting, I lost 9.8kg (21.6 lbs)!

I am down over 20 lbs (actually 9.8kg or 21.6 lbs) from my starting weight at 161.7 lbs to 140.1 lbs today. At 5’10”, I started at a BMI of 23.2 and am now at 20.1.

From day 3 on, we were expected to lose 200g-300g of fat per day, meaning only about 6kg of 9.8kg is fat loss.

The rest was water, bacteria and other tissue (excreted through enemas!), and, yes, some muscle!

At the beginning, we were told not to fret muscle loss (even heart muscle loss), as it will come back. For example, migratory birds lose muscle mass on every journey and rebuild it as they stop to refuel.

My aim here was to target loss of fat in and around my liver and pancreas, which I believe is causing the “signaling” issue associated with my high blood sugars and high blood pressure. For the last 10 days or so, through extended fasting and the absence of drugs, I’ve been living at the “altitude” of a normal person without metabolic syndrome, with morning blood sugars hovering around 100, and blood pressure at 120/80.

Blood Glucose drop
Blood sugars get normal around September 4th (Day 12)

 

Blood Pressure drop
Blood pressure gets normal by around September 3 (Day 11)

We will have to see how things go as I start chewing again. For now, the focus is on the right nutrition to replenish healthy cells into my system!

Results from morning nurse visits on Days 20-22

  • Blood pressure: 119/74, 121/76, 122/81 (Overall good!)
  • Blood sugar: 98, 97, 98 (3 days in a row below 100!))
  • Weight: 64.7 kg (142.3 lb), 64.0 kg (140.8 lb), 63.7 kg (140.1 lb)

Filed Under: Buchinger-Wilhelmi, Diabetes, Fasting

Buchinger Burnout

September 11, 2018 By spao 1 Comment

Days 16-19 – Overcoming “Buchinger Burnout”

A psychotherapist on staff here at Buchinger-Wilhelmi told us that after about 3 weeks here, people start getting a bit eager to go home!  It’s funny that today marks our third week here, and we’ve already been ramping down our participation in a lot of the group activities!

In addition to the cooking demonstrations, there have definitely been some good activities.  Since my Days 4-6 blog post, we’ve still continued to try more activities here, including:

  • medicine ball back workouts
  • blackroll fascial training
  • bosu power balance
  • Tai Chi
  • a psychotherapy session (these are individual, of course!)

However, due to “Buchinger burnout” (my own term), fasting day 18 for us was devoid of all activities, except watching an Asian cooking demonstration (European style).  We even skipped the daily walk!  Of course, that set us up for today (fasting day 19) where we got revitalized!

Know that even when you start to feel some burnout on a prolonged fast away from home, a little rest goes a long way!

So far, results are good with my blood pressure basically being normal for 11 of the past 14 days and the last 5 days consecutively.  Blood glucose is also trending down!

Blood Glucose - Day 19
Blood Glucose – Digestive Rest Day through Day 19

3 more days of fasting to go!

Results from morning nurse visits on Days 16-19

  • Blood pressure: 126/78, 116/73, 116/74, 113/79 (Overall good!)
  • Blood sugar: 100, 94, 88, 110 (Wish I were more consistent!)
  • Weight: 65.7 kg (144.5 lbs), 65.6 kg (144.3 lbs), 65.5 kg (144.1 lbs), 65.2 kg (143.4 lbs)

 

Icon made by Freepik from www.flaticon.com is licensed by CC 3.0 BY

 

Filed Under: Buchinger-Wilhelmi, Diabetes, Fasting

Two Selves

September 11, 2018 By spao Leave a Comment

Psychology of Fasting (“Two Selves”)

At our fasting clinic, we have met many people who are repeat visitors. So far, the record among our acquaintances here was an Egyptian gentleman who was on his 37th time here, attending 3 times per year now for over twelve years.

How could so many people want to submit themselves to long, periodic fasts?

This fasting experience reminded me of the book Thinking Fast and Slow by Nobel Prize-winning economist Daniel Kahneman. Kahneman describes, in chapter 35, the concept of “Two Selves” — the “experiencing self” and the “remembering self.” In summary:

  • Experiencing self. The part of you that comes out when your doctor asks “How are you feeling right now?
  • Remembering self. The part of you that comes out when your doctor asks “How have you been over the last two weeks?

It turns out that these two selves play very different roles, and to cut to the chase, it is your remembering self that is actually in charge of future decisions. The specific example Kahneman describes is a person listening to a long symphony on CD (yes, this book was published seven years ago!) that had a scratch at the end. Even though the listener was in bliss for perhaps 40 minutes (the experiencing self), the scratch at the end “ruined the whole experience” (the remembering self.)

Through pure-lab experiments (forcing subjects to hold their hands in cold water) and through observed data of painful procedures (colonoscopies!), Kahneman describes two things learned about how we remember our experiences.

  • Peak-end rule.  What we remember most is how good or bad things were at their peak, and how our experience ends.
  • Duration neglect.  The total duration of the experience does not have an effect on ratings of the total experience.

In medical procedures, this observation has actually shown that patients have a better memory of the experience if a procedure is more gentle and ends even more gently, even if takes longer!

It is also the basis of the advice that it is better to take two one-week vacations than one two-week vacation.  Even though the experiencing self would view two weeks of total vacation in both situations as equal, the remembering self (who has duration neglect) gets more value out of having two unique sets of memories, even if they are shorter!

How does this apply to fasting?  Well, here at Buchinger-Wilhelmi, they have applied these principles to the fasting experiencing, whether they read Kahneman’s work or not!  Here’s how they take advantage of it.

  • Peaks are smoothed out.  Through the routine of morning tea & yogurt, every-other-day enemas, broth at lunch, hot liver compresses, tea in your room, and broth in the evening, they have successfully smoothed out any discomfort in fasting.  We’ve done water fasts before, and  the peaks are MUCH more uncomfortable.
  • Strong ending.  They have gourmet chefs on staff that prepare gourmet vegetarian meals for your “refeeding” making your stay end on a high note.  We got to preview this food on arrival day before we started fasting, and we know the ending will be strong!
  • Duration neglect.  They make every day and week very similar, with a pretty strict, stereotypical-German routine to ensure that your mind has no new stories to write.  This repetition enables the memory of every day to “blur” together.  The benefits of fasting are associated with burning 200g-300g of body fat per day, so  the most benefit comes from being able to stick it out the longest.  Buchinger has figured out how to allow someone like me to be here for 28 days without going crazy by blurring the memory of it.

I think this combination of factors is why we have met so many repeat visitors here!  The program works in large part because of the methodology!

If you’re interested in learning more about Two Selves, Kahneman also did a Ted Talk on this topic.

Filed Under: Fasting, Featured

September 7, 2018 By spao Leave a Comment

Days 12-15 – Resisting food temptation around us!

As we are progressing in our fast, the education here at Buchinger-Wilhelmi has shifted from “how to fast” to “how to eat” in preparation for returning home!  My wife and I now have been to 4 cooking demonstrations so far.  Those here at the end of their fasts get to partake in eating what was made during the demonstrations.  The rest of us just watch!

The funny thing is that it’s actually not hard to resist when there’s only one rule, and it’s simple – just don’t eat.

Even our doctor said that people at the clinic who are eating often go into the town (Überlingen) and get easily tempted by the ice cream shops or bakeries.  Once you’re eating, somehow it becomes more difficult to moderate it.  Calorie counting, portion control, and selecting what to eat can be much harder than following one simple rule.

This is why the clinic focuses so much on education about nutrition, most of which is common sense.  Plant-based diets are preferred.  When eating meat, use high quality proteins.  Use high quality oils.  Avoid processed foods.  Stay organic when possible.  You know the drill.

An interesting amount of education also goes into food’s effect on the gut bacteria.  If you haven’t checked out my previous blog article on gut bacteria, I encourage you to take a look.

The clinic also provides a set of recipes and meal planning designed to supply complete proteins and to keep portions under control.  The recipes are simple, catered to those who don’t have a lot of time in the kitchen.  In the one hour demo (whose results are pictured!), the food included (from left to right):

  • Fruit Sorbet
  • Kohlrabi (turnip cabbage) and apple salad
  • Goat cheese balls
  • Cucumber soup with lemon balm
  • Courgette (zucchini) Lasagne
  • Rice salad

I can’t tell you if they were any good, but people told me they were!  One more week of fasting to go!

Results from morning nurse visits on Days 12-15

  • Blood pressure: 112/75, 120/78, 130/71, 98/70
  • Blood sugar: 96, 102, 96, 104
  • Weight: 66.6 kg (146.5 lbs), 66.3 kg (145.9 lbs), 65.6 kg (144.3 lbs), 65.7 kg (144.5 lbs)

Filed Under: Buchinger-Wilhelmi, Diabetes, Fasting

Bacteria

September 6, 2018 By spao Leave a Comment

Gut bacteria and Type II Diabetes

Why do we care about our gut bacteria?

It turns out that despite that our gut bacteria (our “microbiome”) is only about 1-2kg of weight in our colons, our gut bacteria has at least as many genes as we (the “hosts”) do! It turns out that our microbiome has a major influence on our immune system, our metabolism, and our health!

Increasingly, there have been multiple studies linking diseases with a reduced microbiome diversity (“dysbiosis”), including Type 2 diabetes.  The association has been strong.  For example, a 2010 study titled “Gut Microbiota in Human Adults with Type 2 Diabetes Differs from Non-Diabetic Adults” concluded that “type 2 diabetes in humans is associated with compositional changes in intestinal microbiota. “

Of course, that association alone does not show causality, or even possibility for therapy, but there has been recent evidence that even the blood glucose lowering effects of metformin may actually work by altering gut bacteria.

“Transplantation of the gut microbiota from patients before and after treatment to bacteria-free mice showed that the metformin-modified microbiota may at least partially explain the good effects of metformin on blood glucose control”, says Fredrik Bäckhed.

Also, experiments that induce dysbiosis demonstrate that the condition can lead to fatty-liver disease, a precursor to diabetes, establishing a relationship much stronger than association.

Changing the gut bacteria through diet

Choosing right nutrition has shown to be an effective therapy for dysbiosis.  A study titled “Diet rapidly and reproducibly alters the human gut microbiome” demonstrates that changes in diet can alter microbiome effectively within days.

The authors explain this ability to rapidly alter microbiome is likely related to evolution:

Our findings that the human gut microbiome can rapidly switch between herbivorous and carnivorous functional profiles may reflect past selective pressures during human evolution. Consumption of animal foods by our ancestors was likely volatile, depending on season and stochastic foraging success, with readily available plant foods offering a fallback source of calories and nutrients

What affects the microbiome positively?

  • Prebiotics (fiber).  Non-processed plant-based foods contain prebiotics and have a positive effect on the composition and the activity of the microbiome. Prebiotics cannot be digested by the body and are fermented in the large intestines by the microbiome into short-chain fatty acids, which have been shown to improve glucose tolerance, the lipid profile, and obesity.  A 2017 study showed that inulin (a prebiotic) prevented metabolic syndrome.
  • Probiotics.  Probiotics are good bacteria that are either the same as or very similar to the bacteria that are already in your body.  Foods with probiotics include some yogurts, cheeses, kefir, sauerkraut, and kimchi.  There remains some debate as to whether probiotic supplementation positively affects the microbiome in healthy individuals, summarized well in a recent Gizmodo article.

In a series of experiments involving mice and healthy human volunteers, the Israeli researchers found that probiotics only sometimes do what they’re advertised to do: change the makeup of our gut’s bacterial environment, known as the microbiome.

Still there are studies demonstrating some promise of using probiotic supplementation to treat diabetic individuals.  Per a review in Science Daily:

The present meta-analysis suggests that consuming probiotics may improve glucose metabolism by a modest degree, with a potentially greater effect when the duration of intervention is ≥8 weeks, or multiple species of probiotics are consumed.

Negative factors include:

  • High Fat.  High fat (HF) diets reduce Bifidobacterium and has been associated with metabolic disease, according to a 2014 paper citing numerous studies.

The relationship between HF feeding and the development of a low-grade inflammatory tone and metabolic disease have been attributed to reduced numbers of Bifidobacterium and a higher plasma endotoxin (Gram-negative bacteria-derived lipopolysacchaide) concentration..

  • Excessive meat.  Meat-based diets cause some gut bacteria to produce TMA (trimethylamin), which your liver turns into TMAO (trimethylamin N-oxide).  While a causal relationship has not yet been established, there is a compelling association between Type II diabetes and TMAO.

…this study has supported a meaningful association between plasma concentrations of TMAO and incidence of type 2 diabetes mellitus in a Chinese population. Establishing a causal correlation requires more, multi-centre studies among other ethnical populations.

  • Antibiotics.  Antibiotic exposure comes not just from prescriptions but also from our farm animals and our crops.  A very readable article in The Atlantic cited a study regarding prescription use..

The study, recently published in mBio, found that just one weeklong course of antibiotics changed participants’ gut microbiomes, with the effects sometimes lasting as long as a year. After all, antibiotics don’t discriminate—as they attack the bad bacteria, the good ones are vulnerable too.

Further, a Danish population study revealed an association (not causal) between Type 2 diabetes and antibiotic use.

In this nationwide register-based study, we find an increased OR for risk of type 2 diabetes with increasing exposure to antibiotics.

Fasting and the Microbiome

Fasting is actually one powerful way to positively affect the microbiome. During fasting, the diversity of microbiome increases.

  • Fasting reduces size of intestines. This creates a “housing crisis” where the total number of bacteria decreases.
  • Fasting also creates an “energy crisis” and the good bacteria wins, correcting the diversity.

There is also some additional research on intermittent or “every other day fasting” (EODF) that was described in Cell Metabolism, which describes how intermittent fasting prompts the gut bacteria increase the development of beige-fat (the type that burns white fat!).

These findings provide a new gut-microbiota-driven mechanism for activating adipose tissue browning and treating metabolic diseases.

Of course, more research is required here, but I am not waiting for the research to effect changes for myself!

Refeeding and Beyond

After fasting, there must be a good “refeeding” period to feed the microbiome the right nutrition, as the size of the intestines and the energy supplies returns to normal.

The recommended refeeding at the fasting clinic Buchinger-Wilhelmi consists of:

  • Fresh vegetables, fruits, whole-gain products and nuts, preferably organic
  • Fewer animal products; less meat
  • As little processed food as possible
  • As little refined carbohydrates as possible (white flour, sugar)

In addition, regular and intermittent fasting is recommended on top of dietary changes.

Note here that ketogenic (high fat / medium protein) is NOT recommended here because of its effects of high fat and animal protein on the microbiome.

Filed Under: Diabetes, Fasting, Featured

Myth busting

September 4, 2018 By spao Leave a Comment

Gradual weight loss efficacy is a myth…

Do you believe any of the following?

  • Exercising over time produces cumulative weight loss based on calories in versus calories out
  • Setting realistic weight loss goals is important to keep people motivated
  • Losing weight gradually (1-2 lbs per week) creates more sustainable weight loss

If so, you are not alone!

The problem is these commonly held beliefs are actually myths that persist despite refuting evidence.

I would encourage you to read an interesting article “Myths, Presumptions, and Facts about Obesity” from the prestigious New England Journal of Medicine, January 31, 2013.

Using more rigorous studies, the article cites evidence of actual observations, not assumptions.

Some excerpts:

  • The body actually compensates for sustained calorie inputs or outputs; it’s not calories-in / calories-out for weight loss

For example, whereas the 3500-kcal rule predicts that a person who increases daily energy expenditure by 100 kcal by walking 1 mile (1.6 km) per day will lose more than 50 lb (22.7 kg) over a period of 5 years, the true weight loss is only about 10 lb (4.5 kg)…

  • “Realistic” weight loss goals do not help

Indeed, several studies have shown that more ambitious goals are sometimes associated with better weight-loss outcomes…

…

Furthermore, two studies showed that interventions designed to improve weight-loss outcomes by altering unrealistic goals resulted in more realistic weight-loss expectations but did not improve outcomes.

  • Losing weight fast is more effective in the long-run than losing weight gradually

Within weight-loss trials, more rapid and greater initial weight loss has been associated with lower body weight at the end of long-term follow-up.

There are even more results in this analysis, including myth busting surrounding the number of calories expended during sexual intercourse!  (I won’t give you the answer here!)

So why do these myths continue?

Net is that we don’t force scientific method and evidence-based rigor into our beliefs.

We are influenced by:

  • repeated media exposure to claims
  • cognitive dissonance – we don’t like to hear contradictory evidence to ideas that are important to us
  • confirmation bias – we only seek data supporting claims we have already accepted as true
  • ability to be swayed by persuasive (yet fallacious) arguments

Topics related to weight loss and obesity aren’t the only areas where these factors influence us.

Read the article and be careful what you believe in!

Filed Under: Fasting, Featured

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Stephen Pao is the author of the Time-Restricted blog. Following a Type II diabetes diagnosis in 2003, Steve began experimenting with alternative approaches to managing the disease, including prolonged fasting as a complement to a low-carb lifestyle. By day, Steve is a consultant and board advisor to early stage technology companies. Steve and his wife are empty nesters, with two college-aged daughters across the country.

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