What a great bunch of talks that we've had tonight
We've had some very clever doctors and engineers as well [laughter].
I'd just like to thank Rod for inviting me to speak
and I wonder if we can get everyone to give him a round of applause for organising tonight [applause].
It’s a great bunch of people in the room and a lot of familiar faces and so I think it’s a good quorum that we’re getting.
By way of introduction, I’m a GP as Rod was saying, in Balwyn mostly but in Bayswater as well.
I’m a fair newcomer to LCHF, to low carb eating. I’ve been doing it for about say 12 to 18 months.
And even more recently doing some fasting probably in the last 6 months, just some intermittent fasting.
But there’s been really exciting results both sort of personally and also with my patients
that I’ve been prescribing low carb and fasting for.
Just a brief history, a brief rundown of what we’ll be talking about today.
I’ll make it a fast, fast talk because I know that you all want to get home.
So, just a bit about my story, how I got involved with low carb and with fasting.
A history of fasting over the ages.
The scientific basis of therapeutic fasting.
And then a practical rundown of how to actually go about doing some, incorporating fasting in your life.
So my journey began about 3 years ago when I was first diagnosed with Type 2 Diabetes.
And it was a shock, because I was only 37 and I felt fine
and it was an insurance medical that I was having and came out with a blood sugar of 9 and HBA1c of 7.7
I really was bowled over and couldn’t believe that at first
had to get everything repeated and yes, it was that.
And went through all the usual hoops that I suppose somebody in my situation would be put through.
Went to an endrocronologist to make sure that it was in fact Type 2 diabetes
I was referred to a dietitian who said I was eating perfectly
and I was eating six small meals a day and whole oats in the morning, brown rice, chicken breasts, broccoli, very low fat.
And there was no change to my diet recommended.
And then there was a seminal day when a friend of mine who’s a physiotherapist, Andrew White,
went to a talk that Rod had organised, the one that Tim Noakes was in, in August last year.
And came to me and said, “Look I think I’ve been to this low carb cult” [laughter].
“They’re talking about being able to cure diseases just by eating fat [laughter]”.
And he was impressed because Tim Noakes was talking about it.
And I was very .. I secretly that night looked this all up, didn’t tell him that I was that interested
because I hadn’t told him that I had Type 2 Diabetes and I felt ashamed about that.
The more I read, the more like Ian described last night, I felt like I’d fallen down a rabbit hole.
There was ALL this information about how you could cure yourself.
And so the next day after I’d amassed that into my mind, I stopped my Metforman and stopped eating carbohydrates
and was astounded to find that my blood sugars were non-diabetic.
I thought how can that be?
You know, this is rediculously revolutionary that you can actually cure yourself just by eating a certain way.
And so I guess as that sunk in, I had to sort of incorporate that into my practice, this revolutionary way in which you could treat disease.
And I guess the next most seminal thing that’s occurred in my professional/personal journey with this was then going to South Africa
to Cape Town in February and watching Jason Fung give his talk on fasting.
And that really had a profound influence.
I’ve since then incorporated that into my life and found it incredibly beneficial
and also prescribed fasting to lots of patients and that’s been just really potent at reversing a lot of their diseases.
One thing I wanted to say, why the yin and yang?
And that is that I guess the way I sort of reflect on this, the way I view a lot of the diseases that exist in the Western world these days
is an accumulation of dietary diseases,
an accumulation of dietary damage that we’ve done.
And by doing LCHF and by doing fasting what I consider that we’re doing is chipping away at that damage and bringing some balance back into our bodies.
And that’s sort of I guess what keeps me going if I am doing a fast, that’s the thing that keeps me plugging through my hunger,
knowing that I am chipping away at the dietary damage that I’ve accumulated. And bit by bit I think we can achieve balance.
So, in terms of the history of fasting, this is a beautiful etching from the 19th Century of Aboriginals in Australia at a campsite.
And you can see that it’s a time of plenty; you have hunters come back with a kill and there’s some fishermen in the background
with their nets catching their fish and everybody looks pretty happy and satiated.
So it’s obviously a time of plenty but there’s no doubt that a lot of the time these people would have been spending in an intermittent fast
whether it was for hours or days or perhaps even weeks.
There would have been times where ancient humans would have spent without food.
It was just a normal part of everyday life
and this was the case for at least a hundred thousand years or the time that humans have been on this planet.
So it’s quite a normal part of our existence as humans.
This is a beautiful mosaic from a bassilica in Venice from the 11th Century
and shows Jesus before he started preaching and went into the dessert and fasted for 40 days
and the devil's depicted in between the images of Jesus, tempting him with food,
(the basket down the very end) and Jesus resisting that temptation.
It’s a really good example of how over our neolythic past, our farming history as humans
most cultures and religions have had fasting as an integral part of the process of becoming pure, of cleansing our mind, cleansing our bodies.
It’s been I think virtually every religion has fasting as an integral part of that cleansing process.
So I guess the point is obviously that this is not new; this is old.
So fast forward to today and we’re actually encouraged to do the opposite of fasting which is snacking.
This is actually taken from the current Australian government ‘Shape Up’ website
which is meant to inform us on how to make good food choices.
We’re told in there to avoid large portions because this leads to weight gain.
We’re told to eat regular meals, so in other words avoid large portions, make sure you eat small portions
and eat them regularly, never skip meals and particularly never skip breakfast.
And then below that there’s a big heading called ‘Snack Suggestions’ and these are some of the things that are listed:
So fruit smoothies, popcorn, raisin toast, bananas, grapes and low-fat yoghurt.
So I guess if we sort of compare where we were last slide. This is massive.
This is a radical shift and this is new. This is only in the last few decades that we’ve had this shift.
And I guess the question I’d like to pose is what is this doing to our physiology?
Now I’ll probably skip through some of these slides. This is a little bit about insulin and how it will vary throughout a 24 hour cycle.
I’ve actually borrowed this slide from Jason Fung; so thank you Jason.
You guys probably already have a pretty good idea that insulin is there to regulate our blood sugars.
It is also heavily involved in regulating fat metabolism so the higher your insulin, the less you can access your body fat.
It’s locked away to you which is why the green section where you’re having your three meals means that you can’t burn fat, you’re storing fat.
The blue areas would indicate areas where times when you could be burning fat.
And then if we consider what snacks do to that graph [laughter]
you can see that we’re not burning much fat and I guess obviously over time this is going to lead to net fat accumulation.
And just going a bit further with what Marty was talking about before with insulin-resistance and obesity,
this graph shows again with three meals over a 24 hour period, insulin levels in obese people and in non-obese (or normal-weight) people.
So the line at the bottom is our normal-weight people (with the spikes) and then the obese population at the top.
So obviously obese people have a much higher insulin, both their base-line insulin and also their spike insulin
is much higher than the normal-weight individuals. And we need to make more insulin obviously to overcome the resistance to keep our blood sugars down
and like Marty mentioned the higher your insulin obviously the hungrier you’re going to be, the more you’re going to eat.
So no wonder obese peole eat more; they’re hungry.
The other interesting thing that a high insulin is going to do obviously is make you tired and you’ll move less.
And one of the mechanisms for that is leptin blockade.
So, leptin, another hormone that your fat cells are producing that your brain needs a constant supply of to feel vigorous, energetic, wanting to move.
It turns out high insulin is a potent blocker of leptin.
So we’ve got these obese people who are eating a lot because they’re hungy, and not moving very much because their leptin’s blocked
and it puts a really different slant on obesity from what we’re told by the standard advice which is gluttony and sloth.
What we’re actually dealing with is a hormonal problem. Simple. Fix hormones, you fix the problem.
And of course when it comes to insulin resistance, then there’s a whole list of things that we’re probably already familiar with a lot of those things:
obesity, diabetes, inflammatory conditions, gout, and the three things that I consider to be really the biggest contributors to this
is a high carbohydrate diet, high fructose diet or high sugar diet and snacking, so frequent eating.
And what’s interesting is that the main difference between being really obese and non-diabetic
or having Type 2 Diabetes and not being that overweight is really just your ability to make insulin.
So someone who’s an enormous person but not diabetic can make a lot of insulin and therefore their sugars are normal.
Whereas that guy who’s not that overweight but has Type 2 Diabetes, just cannot make that much insulin
so it doesn’t take that long to overtake their resistance.
And I think I was that guy. I was only 10kg heavier than I am now when I was diagnosed.
Now this slide might take a little bit of getting your head around so I’ll go through it properly.
But it’s really critical to get your head around if you’re that person who’s got onto low carb eating and still struggling to lose weight. Just can’t shift it.
This slide, I hope you’ll get it by the end of it, and that is insulin-resistance is perpetuated by high insulin,
high insulin causes insulin-resistance. And it’s a loop.
And I guess, something I was thinking about to perhap explain this is it’s a little bit like someone who is a really, really serious alcoholic.
This is a person who drinks a bottle of Scotch everyday but still goes to work.
They’re incredibly resistant to alcohol and they have a high alcohol intake
and if you were to say drop their alcohol intake down to about half a bottle of Scotch per day,
they’d be less resistant to their alcohol but they’d still be resistant.
They’d still have a high degree of alcohol-resistance
and I guess in a similar way someone who’s gone from a high carb diet down to a low carb diet, still is provoking insulin
I guess, Marty was talking a lot about that in the sense that what foods are going to be producing insulin or stimulating insulin.
You’re still stimulating insulin and so if you’re on a moderate protein, high fat diet, protein stimulates insulin about 40% to that of carbohydrate,
fat does about 5% of carbohydrate
You’re still producing a lot of insulin. It may not be as much as what you were when you had a high carbohydrate diet
but it’s still a lot of insulin and especially if you’re resistant, it’s going to be much higher than what it ought to be.
That’s going to perpetuate your resistance
which is going to mean you’re going to need to make more insulin which is going to perpetuate your resistance.
So that’s kind of the loop that we’re getting into.
But don’t dispair because fasting fixes this.
And this is a really interesting, just a little study and it was of a group of healthy individuals who were going through Ramadan.
In Ramadan, people only eat from dusk til dawn, so they can only eat during a 12 hour period of the day. So 12 hours from dawn til dusk, no food.
And the two columns were ‘Pre-Ramadan’, so base-line, and then four weeks into Ramadan.
And as you’d expect them being healthy individuals their glucose was normal both levels, they weren’t diabetic
but there was a dramatic decrease in their insulin.
You can sort of see a very significant decrease in insulin four weeks into Ramadan.
And this is really interesting because they were normal, healthy individuals.
So even supposedly non-insulin resistant individuals had a massive drop in their insulin.
And this just sort of brought home with these other two graphs.
This one, these were markers of insulin-sensitivity and insulin-resistance
calculated by measuring fasting glucose, fasting insulin and comparing the two.
So you can see that after 4 weeks, they became a lot more sensitive to insulin and less resistant.
This is a schematic graph of the physiological stages.
Because so by now I’m sort of hoping that you’re all raring to go to try some fasting
but you’re wondering how your body’s going to respond to that and what’s going to actually happen in your body.
This is in terms of insulin, glucose and ketones, gives you a bit of an idea over a few days what would occur if you had a meal at the beginning.
This is in terms of insulin, glucose and ketones, gives you a bit of an idea over a few days what would occur if you had a meal at the beginning.
The first phase of fasting is that 6 hour period initially, which is called the 'feeding' phase
and it’s really where you get the spike of glucose, spike of insulin.
They come to baseline at about 6 hours after you’ve eaten, then beyond that the glucose is maintained through glycogenolysis.
Then beyond that the glucose is maintained through glycogenolysis, so you’re releasing glucose from glycogen from liver and muscle, for about 24 hours.
And that runs out after about 24 hours and then into Day 2 you go through gluconeogenesis so you’re still manufacturing glucose
still running on glucose predominantly, manufacturing from amino acids, glyceral, lactate.
And it’s really sort of after Day 2 that the magic begins and that’s when you go into full-blown ketosis. You can sort of see ketones coming up here.
And progressively as each day goes on and your insulin’s gradually coming down, glucose is gradually coming down
and so I guess the take-homes here are that in my mind, fasting begins 6 hours after you’ve last eaten.
So I guess we probably do a mini-fast every night really – unless we’re getting up and having a snack at 2am [laughter]..
So that 6 hours post last meal is really the beginning and the time beyond that is re-sensitsation time.
And I guess the other thing to take home is that beyond two days, so Days 3, 4, 5, that’s when you’re in full-blown fat-burning.
So now I’ve got your ears all pricked up. How do you get started?
I’d recommend to go up to 5 days and there’s really minimal risk in terms of fasting up to 5 days for most people
and there’s some caveats to that which I’ll go through.
Start short, just get your body used to what that feels like.
You could even just start with fasting for 12 hours and then gradually extending and experiment.
It’s ‘horses for courses’ you know I’ve tried to get people to fast in various ways and I can suggest the same thing to different people
and some people will fall into the groove of a particular way of fasting, other people it won’t suit. So experiment.
I fast 24 hours every week and I find that’s really easy,
and I did my first 4 day fast recently and it wasn’t all that hard as well and I’ll probably keep doing that every few moths.
If you really wanted to get quick results, you could do a 4 or 5 day fast, you could do alternate day fasts: fast one day, eat the next.
And mix it up. Some people do 8/16, so that you eat all of your food within 8 hours of every day for example from 11am to 7pm, fast the rest of the time.
So there’s all different ways of actually incorporating fasting into your life.
And a mini-fast is a good way to start too by just reducing the number of meals that you have.
So only have two meals a day, for example, which is what I do everyday
which when you don’t get the hunger, when you’re a low carb eater, it’s not that difficult to do.
Now the important thing is to drink lots of fluids and I’d recommend for most people, unless they have medical conditions, 3 litres of fluid per day
and that would include clear fluids: water, mineral water, broth, tea or coffee, preferably with no milk
but if that’s going to be the difference between you getting through the fast or not getting through the fast then add a teaspoon of milk if you want to.
And for multiple day fasts, getting some sodium into your system is a good idea too,
either through some salty bone broth or salt tablets, 5-10 per day is good, you can get them from the chemist.
And it’s ok to exercise and it’s ok to go to work.
People are often a little bit nervous about how they’re going to perform and their energy, their concentration.
It’s ok, it’s ok. It’s not that bad.
Common side-effects: hunger, goes without saying. And it usually decreases after about Day 3 it actually goes away.
So that’s why I don’t recommend people do two-day fasts
because you know there’s this thing in human psychology that you remember an experience by how it finished
and at the end of Day 2 you’re usually at your most hungry [laughs].
That’s before the ketones have really started to surge and you start to decrease your hunger.
So that does dissipate.
You can get a bit aggitated, a bit light-headed.
You maintain your metaboloic rate through adrenaline and that’s actually what makes you burn calories.
So, when you’re feeling a little bit jittery, know it’s doing you good. So just keep reminding yourself of why you’re doing it.
Diarrhea can occur, some people get a bit of diarrhea. It’s usually not very bad, goes away when you start eating.
But overall, what people notice is that it increases their focus in fact and their efficiency at work.
and I know the day that I fast at work, everything gets done, and I’m out of there like you wouldn’t believe.
Reports are done. Notes are done. You become highly efficient.
So who shouldn’t fast?
Anyone who’s pregnant, any children and anyone who’s light, so a BMI of less than 20
and certainly if you’ve got any medical conditions including diabetes, don’t fast without any medical supervision.
Well obviously if you’re not going to be drinking enough, then dehydration, particularly if you go for longer.
These are all more common the longer you go. Electrolyte disturbance, so you can become low in sodium if you don’t replace [it], if go for too long.
If you go for 24 hours, you probably don’t really need to replace or be careful with sodium.
If you’ve got heart failure, then at 3 litres you might flood yourself because the fluid might just sit in your lungs and you’re going to clear it as well.
So again that is imprtant to adjust and monitor any medical conditions.
If you’re on medications, if you’re diabetic, Type 1 or Type 2 diabetic,
you need to modify your insulin, maybe stop some tablets if you’re diabetic otherwise you might get a low blood sugar.
And then 'refeeding syndrome' is actually something that’s really important to consider.
Particularly if people are a little bit lighter in weight.
It won’t occur in less than or a fast of up to 5 days.
Refeeding syndrome is a complex thing that mostly occurs, has been desribed in people who are anorexic
and if they haven’t eaten for a very long time, you know have a BMI of 15 and suddenly start eating,
they can kill themselves it can literally be fatal through a whole bunch of electrolyte disturbances.
But really if you’re fasting up to 5 days, that’s not going to be a problem
especially if you’re overweight, that’s certainly not going to be a problem.
So, in summary, fasting has always been a part of the human experience
and I would even posit to say that it’s required for our bodies to function optimally.
As we know insulin resistance is the basis of most of our modern diseases
and it’s a dietary disease and it’s therefore curable through dietary manipulation.
And fasting in my experience is the quickest, most potent way of reversing insulin resistance.
So for more information, obviously Jason Fung is a guru, intensivedietarymanagment.com is his website.
Dietdoctor.com has lots of information.
If you’ve got any medical conditions if you needed any supervision, then - blatant plug - but you can come and see me [laughs].
And Vicki Kuriel (who’s also in the room) and I are in discussions about opening a clinic called the low-carb clinic next year
which will be specifically for Type 2 Diabetes reversal and obesity treatment [applause]
and integrating a dietetic and medical approach for people who have got medical conditions along those lines.
Captioning by Dr Linda Komesaroff