Here is the question I have been asked repeatedly in my clinic over the last year: “Is fasting a good idea for me? I have heard it is the best way to lose weight.”
Those of you who know and follow Metabolic Effect already know how we would answer this question. If you have been following us for any length of time, you know we only have one rule of nutrition we live by and that is, “do what works for you”.
We have been called the Sherlock Holmes of the weight loss industry because when we work with clients, we don’t look for off-the-shelf-protocols or one-size-fits-all solutions. We work with the client to create a diet, exercise, and lifestyle program that fits their unique metabolic expression, psychology, and personal preferences. In other words, we help them create a plan that is tailored rather than trying to find one that does not quite fit.
So, my answer to the question usually goes like this: “It certainly can be. There are incredible benefits to fasting for your health. Whether or not it will result in sustained fat loss depends on you. It does have a large potential to backfire on you, so you need to know how to use it intelligently. Can it be incorporated into your healthy lifestyle, or will it result in metabolic compensations and yo-yo weight regain? In other words, there is nothing wrong with trying it. Just do it with the mindset of a detective not a dieter. Gather information along the way to see if it is a good fit for you, and don’t be afraid to adjust to fit your needs.”
Those who know Metabolic Effect well, would have expected an answer such as this. Our acronym, ME, tells you all you need to know about our approach to health, fitness, and fat loss.
Consider the Expert
What I am not sharing with people when I give this answer are my serious doubts that it actually will work for them. Mostly because I have come to see trial and failure a key part of success for my clients. It is an integral part of the journey that moves the person from a dieter to a lifestyler.
My doubts about fasting and fat loss for the average Joe or Jane come from 20 plus years in the personal training world. They also come from 6 years at one of the nation’s premier natural medical schools, (Bastyr University). A school where education in therapeutic fasting was a big part of the curriculum. The doubts also arise from 10 years in an integrative medicine practice with thousands of patient contacts of all ages, sexes, and levels of metabolic fitness (not just young male weight lifters). My specialty throughout my health, fitness, and medical career has been primarily weight loss, and I have gained a large amount of clinical experience including in the realm of fasting.
I bring my background up to make an important point before I get to the meat of this blog. That point is, what constitutes an expert in an area and the different types of experts? There are basically 3 types of experts: Role model experts, researcher experts, and results getter experts.
- Role Models- These people are fit and healthy and have been able to achieve personal success in weight loss. They can be very inspirational. The problem is, their experience translates to very few. That is because they are unique, as are the rest of us. What works for one, does not necessarily work for another. This is a lesson that we hardheaded humans continue to ignore causing a lot of wasted time and energy. Unfortunately, because of human nature, role model experts may lack the insight and humility to realize their limitations, and can wrongly assume, if it worked for them it will work for all.
- Researcher Experts- These experts have a formal education in the field, but primarily read and study research versus running a clinical practice. They study the Internet blogs and read the latest books. Their emphasis is on studying absolutely everything. These experts provide us with a huge amount of value, but can become short-sighted regarding their knowledge. They have gathered a ton of information and have the tendency to believe that knowledge provides all the answers. But that knowledge often lacks experience. Wisdom is the combination of knowledge AND experience and is too frequently lacking in the researcher expert. You can recognize these types quickly when they quote a favorite book or research study to bolster their points. These types can fall prey to what I call “chasing the research dog’s tail”. Their opinions and views often mirror exactly the latest book, study, or blog they have immersed themselves in and can be completely divorced from the nuance and gray that is the world of individualized weight loss. Some say, and I agree, that research is an inadequate tool to study individual effects. More on that HERE.
- Results Getter Experts- These are the experts who work with real people in the trenches. Their job is to deliver people results. Their pay and their reputation depends on being able to do that. They often get a first hand glimpse of the differences among people. How one person responds to one approach and another does not. How one person lives to eat and another eats to live. They see nuance, and they live in a world of gray.
Obviously all three expert types have value, and I personally respect, admire, and learn from people from all three categories. But if you were a top level sprinter who wanted to get to the next level who would you seek as a coach? One of your peers who already made it? A PHD in exercise physiology who knows the research on sprinting better than anyone in the world? Or an Olympic caliber coach who has trained hundreds of different runners and has brought home multiple medals for his or her athletes? No brainer, right? Viewing weight loss through that same lens may be helpful.
It is my opinion, that the information being put out on intermittent fasting, suffers from experts who are primarily role models and researchers and lack results getter credentials. This is not always a bad thing. Many of these experts are brilliant and have helped loads of people understand how this dietary strategy can be used. But without the input of the results getter, fasting is becoming another protocol that over-reaches and exaggerates is usefulness. It is not a tool for everyone, and I am using my results getter credentials in this blog to illuminate the less talked about side of fasting.
A Day in my Clinic
Case #1: Here is what happened in my clinic the other day. My second client of the day was an in-person client (I see many of my clients via phone and Skype). He was overweight and wanting help. He was accompanied by his wife.
When I asked him to take me through a typical day in his life, his wife immediately said, “If the day ended at 5′oclock he’d be the skinniest man on the planet.” He and she then went on to explain that he does not eat breakfast or lunch, and in fact eats nothing until he gets home every evening. At that point he then “eats like he is possessed”, as his wife put it.
I chuckled on the inside. Saying to myself, “he is an intermittent faster”. Truth is I see this type of pattern very frequently. A person who eats nothing or very little all day and then gorges themselves between the hours of 5 and 11, before passing out and doing it all over again the next day.
We even have a name for this here at Metabolic Effect. We call it “continuous meal”. It is incredibly common and completely illustrates the potential downside of fasting and meal skipping, that it makes me feel as if some of the intermittent fasting proponents either have zero clinical experience or work with nothing but twenty something bodybuilders.
Case #2: Later that day I am on the phone with a client who just completed her first two weeks of alternate day fasting. She eats 12 meals weekly. 2 per day M-F and then 1 big meal on Saturday and 1 big one on Sunday. She says her body fat is under 20% for the first time since she started measuring it. She is in her mid 30s. She is excited and is doing wonderfully on this approach.
Case #3: Same day. Last client of the day. She is a first office call. She is a Paleo dieter, Crossfitter, and intermittent faster (eating in a window of only 8 hours per day). She is exhausted constantly. Feels she has a “broken metabolism” because she is not only not losing weight, but also feels her body is getting more “flabby”. She has constant cravings for junk food and every now and then finds herself in an eating frenzy taking in multiple thousands of calories at one sitting. Libido gone. Hunger constant. And a “wired but tired” feeling at night that keeps her from sleeping.
3 different people, 3 different outcomes. Such is the case when working in a clinical setting. I am hoping a glimpse into my practice helps you understand this one critical point:
[tweetherder]one person’s perfect fat loss plan is another person’s formula for being fat or flabby.[/tweetherder]
Misconceptions About Fasting
Here are some misconceptions the Internet fasting gurus often bring up. I am adding in the clinicians observations.
Fasting & Blood Sugar
The people who say you should never skip meals make the point that doing so can lower blood sugar and lead to cravings later. Those who advocate fasting will point to studies showing blood sugar numbers stay stable in people despite clinical signs of hypoglycemia (low blood sugar).
This is where the nuance and the gray come in. The idea that all people are going to have drops in blood sugar and go on a Cheesecake Factory binge if they skip a meal or fast is untrue. Many people skip meals every single day and do just fine. So the idea that everyone must eat 6 meals daily to lose weight is false. For some this approach may be the reason they can’t lose. Common sense and clinical experience tells us that eating frequently works for many, but certainly not all.
Equally naive, in my opinion, is assuming skipping meals or fasting is the solution for all and that the body is able to access blood sugar simply because blood glucose is normal. This belief shows a misunderstanding of insulin resistance, a condition present to some degree or another in almost all overweight and obese individuals. And insulin resistance makes the metabolism behave differently than a twenty something weight lifter. Those who are insulin resistant are suffering from “cellular hypoglycemia”. Think of a diabetic. They can be deprived of glucose in their cells despite having blood sugar levels many times above normal.
While the brain does not require insulin to access glucose, insulin signaling in the brain is heavily involved in glucose regulation in the body. By the same token, a lack of glucose in any cell or tissue that needs it will result in alarm bells that ultimately reach the brain and force it to respond. This is why you see such severe hypoglycemic effects in some people even when blood sugar is normal, or even high. It is not “all in their head” as some fasting role models and research experts have suggested.
Fasting indeed can cause glucose regulation issues and lead to compensatory eating later despite normal blood sugar levels. For these types, fasting to lose weight may be the worst solution to start with. Case #1 above illustrates this point well. This patient, when taking a fasting blood sugar, has high normal blood sugar. Yet suffers what looks like hypoglycemic episodes all day and uses coffee to overcome this.
And here is a major point to keep in mind. Just because a solution seems the most expedient, does not mean it actually is. Sometimes slow and steady is far better than speedy and reckless. The fastest way to lower insulin levels may seem like fasting, but in an emergency everyone running for the exits as fast as they can at the same time causes more harm, not less. An organized, non-panicked approach often works best here. This would be eating small frequent meals with adequate protein. The same diet doctors prescribe to “true” hypoglycemics.
Fasting and The Stress Response.
The fasting proponents say skipping meals and fasting has no effect on cortisol. The “eat more frequently advocates” say skipping meals raises cortisol. Again, read all the research you would like on fasting and cortisol. I can tell you first hand that in many, not all, cortisol is either acutely elevated when missing a meal and/or the cortisol rhythm becomes disrupted in the same way that chronic stress or over-training impacts cortisol. It can cause a “reverse cortisol curve” where rather than starting high in the morning and dropping low in the evening, the cortisol is lower in the morning and higher in the evening. This is what I expect to see from client #3 above when her adrenal stress test returns.
It is my opinion that cortisol is often used as a “catch-all” phrase when it comes to stress reactions. Yes, cortisol is raised during stress, but it is often delayed compared to the immediate release of the catecholamines (adrenaline and noradrenaline). It is also often blamed for the long-term consequences of stress on weight gain when neuropeptide Y (NPY) probably should take some of the blame. More on that HERE.
The point I am making is that stress reactions involve more than cortisol, and any negative stress reactions as a consequence of fasting involve more than cortisol.
In many, again not all, going without food is a stress to the body. In response to that stress the body will release adrenaline and then cortisol. The purpose of this is to raise blood sugar and burn fat. This is the same thing that happens in short intense exercise by the way.
It is wrong to assume this stress reaction is always a bad thing. In fact, it is this very response that ramps up fat burning and delivers the sometimes hugely beneficial fat loss that some intermittent fasters achieve.
However, it is also wrong to assume this reaction is always a good thing. An over-exaggerated adrenaline and cortisol response can lead to muscle wasting in some, as well as hunger, energy fluctuations, and severe cravings that will derail any diet. In case #1 and case #3 above, this stress reaction was likely contributing to or causing the negative effects.
This same response, when repeated chronically, leads to the peripheral sympathetic nervous system releasing NPY. NPY, along with the hormone ghrelin, are what I call the “yo-yo hormones” because they are likely part of the reason many dieters end up gaining more fat than they started with after diets, including fasting programs.
Ghrelin and HGH
Ghrelin is a hormone released from the stomach that makes us hungry. When it is high you are hungry, and when it is low you are not. Research has also shown ghrelin does several other things. It raises HGH. It induces cravings. It increases the enzyme LPL (our bodies major fat storing enzyme).
So you may think some of this is good and some of this is bad, and you would be right. It depends. For this discussion, it is useful to remember that hormones are tricky. They do not work in isolation, but rather their ultimate action is determined by the total hormonal environment (i.e. cortisol is fat burning in the context of HGH and testosterone, but fat storing in the context of insulin). Hormones also function by the Goldilocks principle, too much or too little is no good, amounts need to be just right.
And that is the issue here with fasting. For some, the total hormonal environment is such that fat is burned and muscle is maintained. For others, fat and muscle might both be lost. Still for others, fat may be slow to go and muscle much faster. This is why one person can fast and look great. Another can fast and end up being flabby. Another can fast and lose fat and muscle and have their fat distribution shift to the midsection.
Too much ghrelin or HGH is not a good thing. Excess HGH can actually lead to insulin resistance. Too much ghrelin can lead to constant cravings and increased fat storing potential. Both of these things are a recipe for yo-yo weight regain. What looked like a great solution in the short-term ends up being a long-term disaster for fat loss. Again, this is true for some, not all.
Fasting in Context
Taking the discussion further, it is also important to not look at fasting in an isolated fashion. A person training with weights who also engages in fasting is very different than a person fasting who is not weight training. Many of the negative effects of fasting come from not understanding how to properly pair training with it.
Fasting 16 to 24 hours day after day while being in a fast paced stressful job and then engaging in multiple high intensity metabolic conditioning or cardiovascular workouts several times a week is likely not a great solution for the vast majority people. However, pairing fasting days with relaxation days and non-exercise days, and then eating normally during training days is entirely different.
It is important in all these discussions to look at the big picture which is why a sole focus on what the research says is not wise. Focusing on research immediately blinds you to the multi-factorial nature of lifestyle and the individual metabolic expression and stress susceptibility of each person.
Fat Loss is a Journey
In the Internet fasting world there are two very influential and bright educators. One is Martin Berkhan of www.leangains.com and one is Brad Pilon of www.eatstopeat.com. I have to admit I have never read any of Martin Berkan’s material, but many whom I respect in the industry think very highly of him. I have however spent time with Brad Pilon’s work, which I think is excellent and a must read for anyone interested in a fasting lifestyle.
One of the most brilliant things I have ever heard in the nutrition world came out of Brad Pilon’s book. It is a saying that was familiar to me through my interest and reading of Eastern philosophy in undergrad. It is an often quoted verse from zen Buddhist philosophy. Paraphrasing from memory, “Before the journey to enlightenment I saw mountains as mountains, rivers as rivers and trees as trees; during my journey mountains were no longer just mountains, rivers were more than just rivers, and trees were now more than trees; then I achieved enlightenment and I once again saw mountains as mountains, rivers were again just rivers and trees were simply trees.”
Pilon uses this quote to illustrate that this is often what happens with food. Before we learn about nutrition, food is just food and drink is just drink. During the process of learning we make food and drink mean all kinds of things, sometimes adapting extreme viewpoints and becoming a member of a “nutrition team”. During my journey, I was a member of the vegetarian team, the macrobiotic team, the Paleo team, and the Atkin’s team among others. But after substantial knowledge and practice, all of that falls away and we once again see food and drink as it were, just food and drink.
The larger point I think Pilon makes is that it all does not have to be so complicated and going without food has always been a simple and natural part of the rhythm of life. Thus, fasting is normal, healthy, and can be a great simple strategy to fat loss without the constant and often ridiculous obsessions with food.
I agree with his sentiment completely. But there is one very important point to make in this regard. He, I, and many other experts who have arrived at this viewpoint did so because we took the journey. Without the journey we would not have been able to come out on the other side and see things clearly from a new perspective.
The journey is required if you are truly going to master nutritional approaches to health, fitness, and fat loss. Too often fasting is being recommended to people who don’t have the experience or insight that only the journey can provide. This is why it often fails. In my opinion, this is why most “programs” fail.
When it comes to fasting, or any way of eating for that matter, each person must take the journey. And like with any journey, it is useful to have a GPS. Not a map that gives you specific instructions, but rather a compass that tells you you are heading in the right direction and landmarks to give you a clue if you are getting close, have arrived, or gone too far. So let me give you a blueprint based on my clinical experience of how you may want to take this journey of fasting, or any nutrition program.
Is Your HEC in Check? Are You Losing Fat? Are You Getting Healthier?
In my clinical experience I use three factors to find the perfect diet and exercise lifestyle for my clients. I teach everyone how to use these. The perfect diet for a person is created, not found, and the journey is what allows the creation process to unfold. The three factors guideposts are:
- Is your HEC in check? HEC stands for hunger, energy, and cravings. These three parameters are biofeedback clues for you to conduct your metabolic detective work with. Balancing, or learning to control these three factors is critical if you are going to turn any diet into a lifestyle. On a scale of 1 to 10, with 10 high and 1 low, your hunger and cravings should be less than 5. Your energy should be 6 or more. At ME our clients assess HEC weekly assigning an average to each. But that is not all that is required. There are two other parameters to consider.
- Are you losing fat? Remember, weight loss and fat loss are not the same. You could be losing weight and be losing a considerable amount of water, or worse muscle, rather than fat. After HEC is stable, make sure you are measuring fat loss. If you are losing mostly fat you are doing great. Now you have 2 of the 3 components in place.
- Is your health improving? There are 3 main reasons people go on diet and exercise program in the first place…(1) to look good, (2) to feel good, and (3) to live longer. With HEC balanced you will likely feel better than you have in a long-time. If you are losing fat you are going to look better too. But, you also want to know if you are making a difference in health and longevity. For that, it is about labs and clinical signs and symptoms. Is your blood pressure improving? Is your heart rate decreasing? Is your blood sugar more balanced? Are you sleeping better without snoring? Is your doctor happy with your blood lab numbers?
If all three of the above factors are true, you have created the perfect lifestyle for you and that may or may not include fasting.
How We Do it at the Metabolic Effect Clinic
We rarely start with fasting because most of those new to the fat loss lifestyle have not taken enough of the journey and have not developed enough mindfulness to be hungry without going on a pizza and cheesecake binge later in the day to make it work. They lack key understandings about what it takes to make a lasting lifestyle change. That being said, there are those who have taken enough of the journey and/or have the right metabolic balance that fasting might be perfect for. Here is how we make these assessments normally and progress someone we think may benefit from fasting:
Step 1= Start with frequent eating, but begin a night time fasting regime where food is only consumed within a 12 hour time period. We advocate from 8am to 8pm.
Step 2= Continue with the 12 hour fast, but reduce your eating frequency down to three meals (breakfast, lunch, and dinner) and one preemptive snack. For instance if you tend to be hungry and have cravings every evening, we would have you eat a small protein and/or non-starchy vegetable snack at 2:30 or 3.
Step 3= Reduce your meal intake to 2-3 meals per day.
Stage 4= For those whose metabolism is very balanced, or for whom fasting appeals to them, we often move them to a program where they may eat just one big meal at the end of the day, fast 1-3 times per week or fast every other day (alternate day fasting).
I wrote these in steps, but the truth is they can either be followed in sequence, or you can skip right to the ones that you feel will work. The idea is to find the eating pattern that works best for you. The right eating pattern should keep you full and satiated, eliminate cravings, and keep your energy nice and balanced. In other words, remember to keep your HEC in check. If you pay close attention to these “biofeedback clues” you will know how often to eat, what to eat, and how much to eat.
One little note here. One of the major hidden benefits of fasting is also its major downfall. You will feel hunger and be exposed to food cues constantly. For almost all beginners this is too powerful of an urge to overcome. But, feeling hunger and practicing being mindful when others are eating and you are not and not giving into the urge is something those of us who have used fasting can do, that others cannot. And this skill, I believe, comes from taking the journey. We have learned to “surf the urge” of hunger. We know it will rise, peak and fall just like a wave, and it does not control us because we have practice with it. This is a skill that when learned is one of the most beneficial tools someone can have. Fasting gives you plenty of practice with this.
Signs Fasting is not Working For You:
- If you feel uncontrollable hunger coming back strongly, energy lows, and strong cravings, you can begin to use some of our hunger and craving strategies and/or go back to the more frequent eating strategy.
- In our clinic, and our fasting program, we use a very beneficial fasting strategy we call “modified metabolic fasting”. This is a fasting strategy where certain foods can be eaten whenever and certain amino acids are used to blunt some of the negative hormonal effects of fasting. Since our experience is women fare worse than men with fasting, these modified fasts are often what we use for female fasters.
- If you start noticing difficulty sleeping and/or a “wired but tired” physiology during the day, this is a sure sign fasting is not for you.
- The “flabby and crabby” metabolism is another sign. This is where you become moody and irritable, and you also notice you’re losing muscle mass and are not as “tight” as you were before. This also comes along with fat distribution shifts toward the belly.
- Your strength and endurance begin to fall. If you are an exerciser, and you start noticing performance decreasing in the gym, this is a sure sign you are not recovering adequately between workouts, and fasting might be working against you. If you are purely seeking fat loss, you may not be too worried about this, but it is an early sign things may be working against you.
- A few other self-evaluations you can give yourself are the pupil dilation test, the waking heart rate test, and the heart rate recovery test (see descriptions below). All of these can give a glimpse into how your nervous system is holding up under the stress of any diet or exercise program.
Pupil dilation= Go into a darkened, but not completely dark bathroom (you need to see your pupils). Shine a small flashlight to the side of your eye and watch the pupils. They should constrict tight and hold for 30s to 1 minute. If they pulsate or dilate again before this, it may indicate adrenal stress. Measure frequently and you can see this change as well as the effect fasting may be having. This is a clinical tool we use to assess adrenal stress.
Waking heart rate= Take your heart rate first thing in the morning before getting out of bed. An increase in waking heart rate may indicate over-reaching or over-training, including a stress response to dieting.
Heart rate recovery= HRR is a measure of how fast the heart recovers from exertion and is an indication of nervous system stress. While training, monitor the resiliency of heart rate recovery. A workout that is too stressful as a result of the workout itself or poor nutrition, will result in a less efficient HRR and is an indication that fasting (or any other stressful dietary regime, with all else being equal) may need to be reconsidered.
The best take home is to realize fasting may or may not work well and has the potential to backfire. I regard fasting as something that can be very, very healthy and beneficial for fat loss. However, I have seen it fail for the vast majority of beginners who have tried it. Young male weight lifters and advanced fat loss practitioners seem to be the ones who do best with it. It certainly can be a great addition to the fat loss lifestyle but should be approached with caution and viewed through the context of what works best for the individual.