<div dir="ltr"> <div dir="ltr"> <div style="font-family: georgia, serif, serif, EmojiFont;">In this episode, Jason Fung, nephrologist and best-selling author, shares his experiences utilizing an individualized approach to fasting to successfully treat thousands of overweight, metabolically ill, and diabetic patients, and why being a doctor who specializes in kidney disease gives him a unique insight into early indications of metabolic disease. We also have a great discussion on insulin resistance where Jason makes the case that we should actually think of hyperinsulinemia as the underlying problem. We also discuss the difference between time-restricted feeding, intermittent fasting, and dietary restriction (e.g., low-carb) and how they can be used to attack the root cause of T2D, metabolic syndrome, and obesity. We also have a fascinating discussion about the limitations of evidence-based medicine which leads to a conversation where we compare and contrast the scientific disciplines of medicine and biology to theoretical physics. </div> <div style="font-family: georgia, serif, serif, EmojiFont;"> </div> <div style="font-family: georgia, serif, serif, EmojiFont;"> <span class="contextualExtensionHighlight ms-font-color-themePrimary ms-border-color-themePrimary ident_1172_1183" tabindex="0">We discuss:</span><br /> <ul> <li>Comparing scientific disciplines: Medicine and biology versus physics [7:25];</li> <li>The limitations of evidence-based medicine [12:30];</li> <li>Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50]</li> <li>Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30];</li> <li>Why the common treatments for type 2 diabetes seem to make things worse [42:30];</li> <li>How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15];</li> <li>Insulin and weight gain, and using fasting to empty the cells of glucose [59:30];</li> <li>The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15];</li> <li>NAFLD and hyperinsulinemia: A vicious cycle [1:08:30];</li> <li>Are the features and symptoms of diabetes actually protective? [1:12:15];</li> <li>Is obesity causing insulin resistance or is it the other way around? [1:17:30];</li> <li>What role does inflammation play in obesity? [1:21:45];</li> <li>CVD and cancer: Diseases of too much growth? [1:27:30];</li> <li>How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45];</li> <li>Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15];</li> <li>Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00];</li> <li>Why people think that fasting is bad for you [1:55:15];</li> <li>Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30];</li> <li>A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00];</li> <li>Keys to a successful fast [2:12:45];</li> <li>Muscle loss during fasting, and why Jason isn't worried [2:24:45];</li> <li>Will fasting help a healthy person live longer? [2:31:30];</li> <li>Does fasting cause gallstones? [2:38:45]; and</li> <li>More.</li> </ul> <p><span style="white-space: pre-wrap;">Learn more at <a href="http://www.peterattiamd.com/">www.PeterAttiaMD.com</a><br /> Connect with Peter on <a href="Facebook.com/PeterAttiaMD">Facebook</a> | <a href="Twitter.com/PeterAttiaMD">Twitter</a> | <a href="Instagram.com/PeterAttiaMD">Instagram</a>.<br /></span></p> </div> </div> </div>
Actionable Insights
1. Understand Hyperinsulinemia as Root Cause
Recognize that metabolic syndrome and type 2 diabetes stem from cells being ’too full’ of glucose and fat (an overflow problem) due to chronically high insulin (hyperinsulinemia), rather than cells being unable to absorb glucose. This shifts the focus from ‘insulin resistance’ to ‘hyperinsulinemia’ as the underlying problem.
2. Prioritize Lowering Insulin
To address hyperinsulinemia and its associated diseases, the primary treatment strategy should be to lower insulin levels and reduce overall body glucose, rather than increasing insulin or forcing glucose into already full cells.
3. Utilize Fasting to Lower Insulin
Implement fasting as the most potent method to significantly lower insulin levels and force the body to utilize stored fuel, thereby emptying excess glucose and fat from cells.
4. Consider Aggressive Therapeutic Fasting for Severe Conditions
For severe metabolic diseases like non-healing diabetic foot ulcers, consider medically supervised, aggressive fasting protocols (e.g., a seven-day water fast followed by 36-hour fasts three times a week) to rapidly reverse the condition.
5. Individualize Fasting Protocols
Tailor fasting regimens to individual needs, considering the severity of the condition, age, urgency, and personal willingness, rather than adhering to a one-size-fits-all approach.
6. Prioritize Safety During Fasting
Always stop fasting immediately if you feel unwell, and then seek medical advice, as safety is paramount and regimens can be adjusted or alternative strategies pursued.
7. Cultivate Supportive Fasting Environment
Recognize that the psychological challenges of fasting are often greater than the physical ones; actively create a supportive environment and community to aid in adherence and success.
8. Start with Time-Restricted Eating
Begin by restricting your eating window (e.g., between 12 pm and 8 pm) to reduce eating frequency and break the habit of constant consumption, which can help lower insulin and improve metabolic health.
9. Manage Fasting Sleep Issues
Expect potential sleep difficulties during fasting due to sympathetic nervous system activation; acknowledge it as temporary and consider using supplements like phosphatidylserine and GABA (if available over-the-counter) to aid sleep.
10. Supplement Magnesium, Use Bone Broth
Supplement magnesium, especially if you are a type 2 diabetic, to prevent cramps. If experiencing dizziness or other issues during fasting, consider consuming bone broth with salt to replenish electrolytes and feel better.
11. Periodic Fasting for Longevity
For healthy individuals, engage in periodic fasting (e.g., 14-hour daily fasts, occasional longer fasts) to regularly lower insulin levels, which can reduce the risk of chronic diseases linked to hyperinsulinemia (e.g., heart disease, cancer, Alzheimer’s, type 2 diabetes, obesity).
12. Question Risks of Inaction
When considering new treatments, always evaluate the risk of not doing something (e.g., continuing conventional treatments that lead to worsening conditions) against the risk of trying a new, potentially beneficial intervention.
13. Monitor Kidney Health Markers
For longevity and early detection of vascular damage, regularly monitor kidney function indicators such as cystatin C creatinine and microalbumin (urinary albumin excretion).
14. Avoid Very Low-Fat Diets
Avoid very low-fat diets, as they can lead to bile sludge and gallstone formation by reducing the necessary flow of bile; ensure adequate fat intake to stimulate proper gallbladder function.
15. Embrace Clinical Flexibility
Avoid rigid, dogmatic approaches in treatment; be prepared to adjust strategies based on individual patient responses, as clinical practice often proves theoretical assumptions wrong.
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