Dr Robert Szabo:Therapeutic Fasting
737 views • 11/8/2015
Dr Robert Szabo is a Melbourne-based GP who presented this talk at Low Carb Down Under in October 2015.
| 00:12 - 00:17 | What a great bunch of talks that we've had tonight |
| 00:16 - 00:21 | We've had some very clever doctors and engineers as well [laughter]. |
| 00:22 - 00:27 | I'd just like to thank Rod for inviting me to speak |
| 00:27 - 00:32 | and I wonder if we can get everyone to give him a round of applause for organising tonight [applause]. |
| 00:35 - 00:42 | Its a great bunch of people in the room and a lot of familiar faces and so I think its a good quorum that were getting. |
| 00:42 - 00:48 | By way of introduction, Im a GP as Rod was saying, in Balwyn mostly but in Bayswater as well. |
| 00:49 - 00:55 | Im a fair newcomer to LCHF, to low carb eating. Ive been doing it for about say 12 to 18 months. |
| 00:57 - 01:02 | And even more recently doing some fasting probably in the last 6 months, just some intermittent fasting. |
| 01:03 - 01:08 | But theres been really exciting results both sort of personally and also with my patients |
| 01:09 - 01:14 | that Ive been prescribing low carb and fasting for. |
| 01:12 - 01:17 | Just a brief history, a brief rundown of what well be talking about today. |
| 01:18 - 01:20 | Ill make it a fast, fast talk because I know that you all want to get home. |
| 01:21 - 01:26 | So, just a bit about my story, how I got involved with low carb and with fasting. |
| 01:26 - 01:31 | A history of fasting over the ages. |
| 01:31 - 01:34 | The scientific basis of therapeutic fasting. |
| 01:35 - 01:40 | And then a practical rundown of how to actually go about doing some, incorporating fasting in your life. |
| 01:42 - 01:45 | So my journey began about 3 years ago when I was first diagnosed with Type 2 Diabetes. |
| 01:46 - 01:51 | And it was a shock, because I was only 37 and I felt fine |
| 01:52 - 01:58 | and it was an insurance medical that I was having and came out with a blood sugar of 9 and HBA1c of 7.7 |
| 01:59 - 02:04 | I really was bowled over and couldnt believe that at first |
| 02:03 - 02:08 | had to get everything repeated and yes, it was that. |
| 02:09 - 02:14 | And went through all the usual hoops that I suppose somebody in my situation would be put through. |
| 02:14 - 02:17 | Went to an endrocronologist to make sure that it was in fact Type 2 diabetes |
| 02:17 - 02:21 | I was referred to a dietitian who said I was eating perfectly |
| 02:22 - 02:31 | and I was eating six small meals a day and whole oats in the morning, brown rice, chicken breasts, broccoli, very low fat. |
| 02:33 - 02:36 | And there was no change to my diet recommended. |
| 02:37 - 02:41 | And then there was a seminal day when a friend of mine whos a physiotherapist, Andrew White, |
| 02:42 - 02:47 | went to a talk that Rod had organised, the one that Tim Noakes was in, in August last year. |
| 02:48 - 02:53 | And came to me and said, Look I think Ive been to this low carb cult [laughter]. |
| 02:54 - 02:59 | Theyre talking about being able to cure diseases just by eating fat [laughter]. |
| 02:59 - 03:04 | And he was impressed because Tim Noakes was talking about it. |
| 03:03 - 03:10 | And I was very .. I secretly that night looked this all up, didnt tell him that I was that interested |
| 03:11 - 03:13 | because I hadnt told him that I had Type 2 Diabetes and I felt ashamed about that. |
| 03:14 - 03:20 | The more I read, the more like Ian described last night, I felt like Id fallen down a rabbit hole. |
| 03:21 - 03:25 | There was ALL this information about how you could cure yourself. |
| 03:25 - 03:30 | And so the next day after Id amassed that into my mind, I stopped my Metforman and stopped eating carbohydrates |
| 03:31 - 03:35 | and was astounded to find that my blood sugars were non-diabetic. |
| 03:36 - 03:38 | I thought how can that be? |
| 03:39 - 03:44 | You know, this is rediculously revolutionary that you can actually cure yourself just by eating a certain way. |
| 03:45 - 03:55 | 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. |
| 03:56 - 04:03 | And I guess the next most seminal thing thats occurred in my professional/personal journey with this was then going to South Africa |
| 04:03 - 04:08 | to Cape Town in February and watching Jason Fung give his talk on fasting. |
| 04:09 - 04:12 | And that really had a profound influence. |
| 04:13 - 04:18 | Ive since then incorporated that into my life and found it incredibly beneficial |
| 04:18 - 04:25 | and also prescribed fasting to lots of patients and thats been just really potent at reversing a lot of their diseases. |
| 04:26 - 04:29 | One thing I wanted to say, why the yin and yang? |
| 04:30 - 04:37 | 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 |
| 04:38 - 04:43 | is an accumulation of dietary diseases, |
| 04:44 - 04:46 | an accumulation of dietary damage that weve done. |
| 04:48 - 04:59 | And by doing LCHF and by doing fasting what I consider that were doing is chipping away at that damage and bringing some balance back into our bodies. |
| 04:59 - 05:06 | And thats sort of I guess what keeps me going if I am doing a fast, thats the thing that keeps me plugging through my hunger, |
| 05:07 - 05:13 | knowing that I am chipping away at the dietary damage that Ive accumulated. And bit by bit I think we can achieve balance. |
| 05:14 - 05:24 | So, in terms of the history of fasting, this is a beautiful etching from the 19th Century of Aboriginals in Australia at a campsite. |
| 05:24 - 05:30 | And you can see that its a time of plenty; you have hunters come back with a kill and theres some fishermen in the background |
| 05:30 - 05:35 | with their nets catching their fish and everybody looks pretty happy and satiated. |
| 05:36 - 05:43 | So its obviously a time of plenty but theres no doubt that a lot of the time these people would have been spending in an intermittent fast |
| 05:44 - 05:48 | whether it was for hours or days or perhaps even weeks. |
| 05:49 - 05:52 | There would have been times where ancient humans would have spent without food. |
| 05:52 - 05:53 | It was just a normal part of everyday life |
| 05:53 - 06:01 | and this was the case for at least a hundred thousand years or the time that humans have been on this planet. |
| 06:01 - 06:05 | So its quite a normal part of our existence as humans. |
| 06:07 - 06:15 | This is a beautiful mosaic from a bassilica in Venice from the 11th Century |
| 06:16 - 06:18 | and shows Jesus before he started preaching and went into the dessert and fasted for 40 days |
| 06:18 - 06:25 | and the devil's depicted in between the images of Jesus, tempting him with food, |
| 06:26 - 06:30 | (the basket down the very end) and Jesus resisting that temptation. |
| 06:31 - 06:36 | Its a really good example of how over our neolythic past, our farming history as humans |
| 06:36 - 06:47 | most cultures and religions have had fasting as an integral part of the process of becoming pure, of cleansing our mind, cleansing our bodies. |
| 06:48 - 06:57 | Its been I think virtually every religion has fasting as an integral part of that cleansing process. |
| 06:58 - 07:03 | So I guess the point is obviously that this is not new; this is old. |
| 07:04 - 07:12 | So fast forward to today and were actually encouraged to do the opposite of fasting which is snacking. |
| 07:13 - 07:18 | This is actually taken from the current Australian government Shape Up website |
| 07:19 - 07:23 | which is meant to inform us on how to make good food choices. |
| 07:23 - 07:26 | Were told in there to avoid large portions because this leads to weight gain. |
| 07:27 - 07:32 | Were told to eat regular meals, so in other words avoid large portions, make sure you eat small portions |
| 07:33 - 07:38 | and eat them regularly, never skip meals and particularly never skip breakfast. |
| 07:39 - 07:44 | And then below that theres a big heading called Snack Suggestions and these are some of the things that are listed: |
| 07:45 - 07:49 | So fruit smoothies, popcorn, raisin toast, bananas, grapes and low-fat yoghurt. |
| 07:49 - 07:54 | Shocking [laughter]. |
| 07:55 - 08:02 | So I guess if we sort of compare where we were last slide. This is massive. |
| 08:02 - 08:07 | This is a radical shift and this is new. This is only in the last few decades that weve had this shift. |
| 08:09 - 08:13 | And I guess the question Id like to pose is what is this doing to our physiology? |
| 08:15 - 08:22 | Now Ill probably skip through some of these slides. This is a little bit about insulin and how it will vary throughout a 24 hour cycle. |
| 08:23 - 08:27 | Ive actually borrowed this slide from Jason Fung; so thank you Jason. |
| 08:28 - 08:32 | You guys probably already have a pretty good idea that insulin is there to regulate our blood sugars. |
| 08:32 - 08:39 | It is also heavily involved in regulating fat metabolism so the higher your insulin, the less you can access your body fat. |
| 08:39 - 08:49 | Its locked away to you which is why the green section where youre having your three meals means that you cant burn fat, youre storing fat. |
| 08:49 - 08:54 | The blue areas would indicate areas where times when you could be burning fat. |
| 08:54 - 08:59 | And then if we consider what snacks do to that graph [laughter] |
| 09:00 - 09:05 | you can see that were not burning much fat and I guess obviously over time this is going to lead to net fat accumulation. |
| 09:06 - 09:12 | And just going a bit further with what Marty was talking about before with insulin-resistance and obesity, |
| 09:12 - 09:23 | 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. |
| 09:23 - 09:28 | So the line at the bottom is our normal-weight people (with the spikes) and then the obese population at the top. |
| 09:29 - 09:36 | So obviously obese people have a much higher insulin, both their base-line insulin and also their spike insulin |
| 09:36 - 09:45 | 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 |
| 09:45 - 09:50 | and like Marty mentioned the higher your insulin obviously the hungrier youre going to be, the more youre going to eat. |
| 09:51 - 09:53 | So no wonder obese peole eat more; theyre hungry. |
| 09:53 - 09:59 | The other interesting thing that a high insulin is going to do obviously is make you tired and youll move less. |
| 09:59 - 10:04 | And one of the mechanisms for that is leptin blockade. |
| 10:05 - 10:13 | 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. |
| 10:13 - 10:16 | It turns out high insulin is a potent blocker of leptin. |
| 10:17 - 10:25 | So weve got these obese people who are eating a lot because theyre hungy, and not moving very much because their leptins blocked |
| 10:25 - 10:35 | and it puts a really different slant on obesity from what were told by the standard advice which is gluttony and sloth. |
| 10:36 - 10:42 | What were actually dealing with is a hormonal problem. Simple. Fix hormones, you fix the problem. |
| 10:43 - 10:48 | And of course when it comes to insulin resistance, then theres a whole list of things that were probably already familiar with a lot of those things: |
| 10:49 - 11:00 | obesity, diabetes, inflammatory conditions, gout, and the three things that I consider to be really the biggest contributors to this |
| 11:01 - 11:06 | is a high carbohydrate diet, high fructose diet or high sugar diet and snacking, so frequent eating. |
| 11:07 - 11:12 | And whats interesting is that the main difference between being really obese and non-diabetic |
| 11:13 - 11:18 | or having Type 2 Diabetes and not being that overweight is really just your ability to make insulin. |
| 11:18 - 11:25 | So someone whos an enormous person but not diabetic can make a lot of insulin and therefore their sugars are normal. |
| 11:25 - 11:30 | Whereas that guy whos not that overweight but has Type 2 Diabetes, just cannot make that much insulin |
| 11:30 - 11:35 | so it doesnt take that long to overtake their resistance. |
| 11:35 - 11:40 | And I think I was that guy. I was only 10kg heavier than I am now when I was diagnosed. |
| 11:41 - 11:47 | Now this slide might take a little bit of getting your head around so Ill go through it properly. |
| 11:48 - 11:53 | But its really critical to get your head around if youre that person whos got onto low carb eating and still struggling to lose weight. Just cant shift it. |
| 11:54 - 12:03 | This slide, I hope youll get it by the end of it, and that is insulin-resistance is perpetuated by high insulin, |
| 12:03 - 12:08 | high insulin causes insulin-resistance. And its a loop. |
| 12:09 - 12:16 | And I guess, something I was thinking about to perhap explain this is its a little bit like someone who is a really, really serious alcoholic. |
| 12:16 - 12:21 | This is a person who drinks a bottle of Scotch everyday but still goes to work. |
| 12:21 - 12:27 | Theyre incredibly resistant to alcohol and they have a high alcohol intake |
| 12:28 - 12:33 | and if you were to say drop their alcohol intake down to about half a bottle of Scotch per day, |
| 12:35 - 12:40 | theyd be less resistant to their alcohol but theyd still be resistant. |
| 12:40 - 12:45 | Theyd still have a high degree of alcohol-resistance |
| 12:45 - 12:55 | and I guess in a similar way someone whos gone from a high carb diet down to a low carb diet, still is provoking insulin |
| 12:55 - 13:02 | I guess, Marty was talking a lot about that in the sense that what foods are going to be producing insulin or stimulating insulin. |
| 13:02 - 13:12 | Youre still stimulating insulin and so if youre on a moderate protein, high fat diet, protein stimulates insulin about 40% to that of carbohydrate, |
| 13:12 - 13:17 | fat does about 5% of carbohydrate |
| 13:17 - 13:22 | Youre still producing a lot of insulin. It may not be as much as what you were when you had a high carbohydrate diet |
| 13:22 - 13:29 | but its still a lot of insulin and especially if youre resistant, its going to be much higher than what it ought to be. |
| 13:29 - 13:31 | Thats going to perpetuate your resistance |
| 13:31 - 13:34 | which is going to mean youre going to need to make more insulin which is going to perpetuate your resistance. |
| 13:34 - 13:38 | So thats kind of the loop that were getting into. |
| 13:38 - 13:42 | But dont dispair because fasting fixes this. |
| 13:44 - 13:53 | And this is a really interesting, just a little study and it was of a group of healthy individuals who were going through Ramadan. |
| 13:53 - 14:06 | 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. |
| 14:07 - 14:13 | And the two columns were Pre-Ramadan, so base-line, and then four weeks into Ramadan. |
| 14:13 - 14:17 | And as youd expect them being healthy individuals their glucose was normal both levels, they werent diabetic |
| 14:18 - 14:20 | but there was a dramatic decrease in their insulin. |
| 14:20 - 14:24 | You can sort of see a very significant decrease in insulin four weeks into Ramadan. |
| 14:25 - 14:30 | And this is really interesting because they were normal, healthy individuals. |
| 14:31 - 14:36 | So even supposedly non-insulin resistant individuals had a massive drop in their insulin. |
| 14:37 - 14:42 | And this just sort of brought home with these other two graphs. |
| 14:42 - 14:45 | This one, these were markers of insulin-sensitivity and insulin-resistance |
| 14:45 - 14:50 | calculated by measuring fasting glucose, fasting insulin and comparing the two. |
| 14:50 - 14:55 | So you can see that after 4 weeks, they became a lot more sensitive to insulin and less resistant. |
| 14:56 - 15:01 | This is a schematic graph of the physiological stages. |
| 15:02 - 15:08 | Because so by now Im sort of hoping that youre all raring to go to try some fasting |
| 15:08 - 15:13 | but youre wondering how your bodys going to respond to that and whats going to actually happen in your body. |
| 15:08 - 15:13 | 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. |
| 15:14 - 15:23 | 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. |
| 15:23 - 15:29 | The first phase of fasting is that 6 hour period initially, which is called the 'feeding' phase |
| 15:30 - 15:33 | and its really where you get the spike of glucose, spike of insulin. |
| 15:34 - 15:38 | They come to baseline at about 6 hours after youve eaten, then beyond that the glucose is maintained through glycogenolysis. |
| 15:38 - 15:46 | Then beyond that the glucose is maintained through glycogenolysis, so youre releasing glucose from glycogen from liver and muscle, for about 24 hours. |
| 15:46 - 15:58 | And that runs out after about 24 hours and then into Day 2 you go through gluconeogenesis so youre still manufacturing glucose |
| 15:57 - 16:04 | still running on glucose predominantly, manufacturing from amino acids, glyceral, lactate. |
| 16:04 - 16:12 | And its really sort of after Day 2 that the magic begins and thats when you go into full-blown ketosis. You can sort of see ketones coming up here. |
| 16:14 - 16:19 | And progressively as each day goes on and your insulins gradually coming down, glucose is gradually coming down |
| 16:20 - 16:27 | and so I guess the take-homes here are that in my mind, fasting begins 6 hours after youve last eaten. |
| 16:28 - 16:33 | So I guess we probably do a mini-fast every night really unless were getting up and having a snack at 2am [laughter].. |
| 16:33 - 16:43 | So that 6 hours post last meal is really the beginning and the time beyond that is re-sensitsation time. |
| 16:43 - 16:52 | And I guess the other thing to take home is that beyond two days, so Days 3, 4, 5, thats when youre in full-blown fat-burning. |
| 16:52 - 16:58 | So now Ive got your ears all pricked up. How do you get started? |
| 16:58 - 17:06 | Id recommend to go up to 5 days and theres really minimal risk in terms of fasting up to 5 days for most people |
| 17:06 - 17:10 | and theres some caveats to that which Ill go through. |
| 17:10 - 17:13 | Start short, just get your body used to what that feels like. |
| 17:13 - 17:20 | You could even just start with fasting for 12 hours and then gradually extending and experiment. |
| 17:21 - 17:27 | Its horses for courses you know Ive tried to get people to fast in various ways and I can suggest the same thing to different people |
| 17:27 - 17:36 | and some people will fall into the groove of a particular way of fasting, other people it wont suit. So experiment. |
| 17:37 - 17:42 | I fast 24 hours every week and I find thats really easy, |
| 17:42 - 17:52 | and I did my first 4 day fast recently and it wasnt all that hard as well and Ill probably keep doing that every few moths. |
| 17:52 - 17:58 | 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. |
| 17:59 - 18:09 | 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. |
| 18:09 - 18:12 | So theres all different ways of actually incorporating fasting into your life. |
| 18:14 - 18:18 | And a mini-fast is a good way to start too by just reducing the number of meals that you have. |
| 18:18 - 18:22 | So only have two meals a day, for example, which is what I do everyday |
| 18:22 - 18:26 | which when you dont get the hunger, when youre a low carb eater, its not that difficult to do. |
| 18:27 - 18:34 | Now the important thing is to drink lots of fluids and Id recommend for most people, unless they have medical conditions, 3 litres of fluid per day |
| 18:34 - 18:43 | and that would include clear fluids: water, mineral water, broth, tea or coffee, preferably with no milk |
| 18:44 - 18:48 | but if thats 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. |
| 18:48 - 18:53 | And for multiple day fasts, getting some sodium into your system is a good idea too, |
| 18:54 - 19:03 | either through some salty bone broth or salt tablets, 5-10 per day is good, you can get them from the chemist. |
| 19:03 - 19:08 | And its ok to exercise and its ok to go to work. |
| 19:08 - 19:17 | People are often a little bit nervous about how theyre going to perform and their energy, their concentration. |
| 19:17 - 19:20 | Its ok, its ok. Its not that bad. |
| 19:20 - 19:27 | Common side-effects: hunger, goes without saying. And it usually decreases after about Day 3 it actually goes away. |
| 19:28 - 19:33 | So thats why I dont recommend people do two-day fasts |
| 19:35 - 19:38 | because you know theres this thing in human psychology that you remember an experience by how it finished |
| 19:38 - 19:41 | and at the end of Day 2 youre usually at your most hungry [laughs]. |
| 19:41 - 19:46 | Thats before the ketones have really started to surge and you start to decrease your hunger. |
| 19:47 - 19:49 | So that does dissipate. |
| 19:49 - 19:52 | You can get a bit aggitated, a bit light-headed. |
| 19:52 - 19:58 | You maintain your metaboloic rate through adrenaline and thats actually what makes you burn calories. |
| 19:59 - 20:07 | So, when youre feeling a little bit jittery, know its doing you good. So just keep reminding yourself of why youre doing it. |
| 20:08 - 20:14 | Diarrhea can occur, some people get a bit of diarrhea. Its usually not very bad, goes away when you start eating. |
| 20:14 - 20:19 | But overall, what people notice is that it increases their focus in fact and their efficiency at work. |
| 20:20 - 20:25 | and I know the day that I fast at work, everything gets done, and Im out of there like you wouldnt believe. |
| 20:25 - 20:29 | Reports are done. Notes are done. You become highly efficient. |
| 20:30 - 20:35 | So who shouldnt fast? |
| 20:35 - 20:40 | Anyone whos pregnant, any children and anyone whos light, so a BMI of less than 20 |
| 20:40 - 20:45 | and certainly if youve got any medical conditions including diabetes, dont fast without any medical supervision. |
| 20:45 - 20:47 | Complications? |
| 20:47 - 20:51 | Well obviously if youre not going to be drinking enough, then dehydration, particularly if you go for longer. |
| 20:52 - 21:00 | These are all more common the longer you go. Electrolyte disturbance, so you can become low in sodium if you dont replace [it], if go for too long. |
| 21:00 - 21:04 | If you go for 24 hours, you probably dont really need to replace or be careful with sodium. |
| 21:04 - 21:14 | If youve got heart failure, then at 3 litres you might flood yourself because the fluid might just sit in your lungs and youre going to clear it as well. |
| 21:14 - 21:18 | So again that is imprtant to adjust and monitor any medical conditions. |
| 21:18 - 21:23 | If youre on medications, if youre diabetic, Type 1 or Type 2 diabetic, |
| 21:25 - 21:30 | you need to modify your insulin, maybe stop some tablets if youre diabetic otherwise you might get a low blood sugar. |
| 21:32 - 21:37 | And then 'refeeding syndrome' is actually something thats really important to consider. |
| 21:38 - 21:43 | Particularly if people are a little bit lighter in weight. |
| 21:43 - 21:48 | It wont occur in less than or a fast of up to 5 days. |
| 21:49 - 21:54 | Refeeding syndrome is a complex thing that mostly occurs, has been desribed in people who are anorexic |
| 21:55 - 22:00 | and if they havent eaten for a very long time, you know have a BMI of 15 and suddenly start eating, |
| 22:00 - 22:05 | they can kill themselves it can literally be fatal through a whole bunch of electrolyte disturbances. |
| 22:05 - 22:10 | But really if youre fasting up to 5 days, thats not going to be a problem |
| 22:10 - 22:13 | especially if youre overweight, thats certainly not going to be a problem. |
| 22:13 - 22:18 | So, in summary, fasting has always been a part of the human experience |
| 22:19 - 22:24 | and I would even posit to say that its required for our bodies to function optimally. |
| 22:26 - 22:31 | As we know insulin resistance is the basis of most of our modern diseases |
| 22:31 - 22:36 | and its a dietary disease and its therefore curable through dietary manipulation. |
| 22:37 - 22:43 | And fasting in my experience is the quickest, most potent way of reversing insulin resistance. |
| 22:45 - 22:53 | So for more information, obviously Jason Fung is a guru, intensivedietarymanagment.com is his website. |
| 22:54 - 22:58 | Dietdoctor.com has lots of information. |
| 22:58 - 23:05 | If youve got any medical conditions if you needed any supervision, then - blatant plug - but you can come and see me [laughs]. |
| 23:05 - 23:17 | And Vicki Kuriel (whos also in the room) and I are in discussions about opening a clinic called the low-carb clinic next year |
| 23:17 - 23:20 | which will be specifically for Type 2 Diabetes reversal and obesity treatment [applause] |
| 23:20 - 23:28 | and integrating a dietetic and medical approach for people who have got medical conditions along those lines. |
| 23:29 - 23:30 | Thank you. |
| 23:30 - 23:32 | Captioning by Dr Linda Komesaroff |
No comments yet.
