[0:00] blood pressure comes down joints seem to get better all symptoms seem to get better this is going to keep your eyesight this is going to keep you from [0:06] getting dementia renal disease proof of perpheral vascular disease and cancers. you are not [0:11] your habits you can do it [0:18]
i’ve been pretty excited about talking to you for a number of months now ever since i saw [0:24] some of your youtube videos so first of all thank you for making time to come onto the show
it’s a pleasure for me i’m honored actually and i’ve been watching [0:30] your shows too they’re amazing well
i think there’s a lot that we’re gonna share a common view on and um i want to [0:36] unpick a lot of that to start off though you were cardiologists you’re very [0:43] proactive about promoting the benefits of fasting with your patients and i guess across [0:49] society as a whole so right at the start of this conversation i wonder if you could outline what are the key benefits of [0:56] fasting that you have seen in your patients
dramatic [1:01] you know i’ve been a cardiologist for 30 years and i’ve tried everything but when i tried fasting i started seeing changes. [1:09] people began to lose weight. people’s blood pressures came down. diabetes got reversed the progression of [1:16] coronary artery disease went down. you see i had the benefit of seeing patients from day one so i saw that they were [1:22] having a second angioplasty another heart attack in two years five years i saw the numbers going down on those whom [1:30]. i was able to get them to lose weight through a die uh fasting program and i tried lots of [1:35] diet programs they didn’t seem to work - but fasting did so decreased blood pressure decreased diabetes [1:42]. uh re-hospitalization lv function seemed to stay good - which means that heart muscle function [1:49] continued to do well. patients mentally also seem to be doing better. so fasting gave me not just this [1:56] benefit but a lot more also my patients didn’t end up in the hospital with fractures or falls and had stronger [2:02] muscles and mentally they were better so i started seeing that just generally [2:08] patients were doing better. doctor’s telling me how come you’re adopted your patients don’t end up in the er with acute heart attacks [2:15] um. all these benefits i saw with fasting
with all these [2:21] you know quite different benefits that you’ve just outlined for us why is it do you think that [2:28] very few medical doctors are promoting fasting with their patients of course as [2:35] you’ve demonstrated it has huge benefits it’s very effective it’s also kind of [2:40] free of charge so why is there such a resistance among you know like our profession to [2:46] recommend this as a treatment?
it’s a tough sell and it takes time [2:52]. you see you’re only as good as getting into your patients brain can you get in [2:58] there and make them make those changes and that’s a tough one - yeah because all [3:03] you’re doing is you’re giving them the advice there’s no tools for me to give them there’s no tablets to give to them. [3:08] they’ve got to make that effort and all i got to do is get into their brain change the way they think [3:15] and if they get convinced that yes doc is telling me something that resonates inside me and and i’m gonna i’m gonna [3:22] make that change um then they’ll do it.
so the trouble is that most of those doctors are too busy [3:29] we’re actually taking care of disease processes rather than prevention. here we’re really talking about a lifestyle [3:36] change and that’s the hard part about fasting and talking to someone about fasting physicians find it very [3:42] difficult to talk to them about that because you can just tell them that okay these are the benefits that’s not good enough [3:48] um it takes much more than that it’s a deeper dive into the patient’s lifestyle [3:53]. how do you wake up in the morning? how do you feel in the morning? what are the main issues in your life? so it’s it’s [3:59] not just about fasting it’s about your relationships, who are you [4:04] um what’s your life all about. all that affects your diet - because see [4:10] fasting is also about it’s much more it’s about your whole life it’s about [4:16] who do you think you are and can you empower yourself to do it or are you just a slave to your day-to-day routines [4:24] and advertising so to get somebody to fast you really need to [4:30] change the whole outlook on who they are you are not your habits [4:36] you are not even your body you are something that can change [4:42] everything there’s a separate part of you besides your body even your mind [4:47] there’s a separateness there’s an awareness inside you and if i can get into that awareness [4:54] then i can empower you yeah and if i can empower you then i can make you fast
so [5:00] doing this whole thing it’s not easy for most physicians and uh you know even [5:05] even even people are dedicated to teaching people about diet it’s a hard sell and i think that our approach has [5:12] to change our approach i first look at patients and i have to empower them to say you know you are more than what you [5:19] think you are you can do it
your videos on youtube have been going [5:25] viral for a number of years now and you know i’ve read a lot of the comments and i’ve watched a lot of those videos and [5:33] i think what one of the many things people deeply resonate with you and your message about [5:40] is this real passion to help people and this real passion to empower people and [5:46] i want to sort of dive in there a little bit because you are you know a very well respected [5:52] cardiologist you literally go into people’s hearts you put in stents you do all this kind of stuff [5:58] in some ways you know as life-saving as putting a stent in someone’s heart potentially can be [6:05] you know it’s slightly disempowering isn’t it it’s kind of like well i’ve got to rely on the skill and ability of my [6:12] doctor to be good at what he does to be sharp on the day to have slept properly the night before right those [6:18] all these things are out of my control as a patient - whereas [6:23] pretty much everything you’re talking about and we’re going to go through in detail today it’s about putting the patient back in [6:30] control of their health and i guess i would argue their wider happiness as well [6:36]
absolutely absolutely and and that’s the thing that the patients have to take responsibility [6:43] because the medical profession the way it’s set up right now we just we’re not [6:48] in a position to do that we have to you know we don’t have enough resources we don’t have enough time so what we can do [6:54] is we can educate patients and we can throw light on the issues that have brought them to where they are now and [7:00] show them how they can get out of it show them empower them and educate them so that they make their decisions and [7:06] when they make their decisions they will do it and then it’s it’s it’s self-empowering it feeds back on [7:12] themselves and says look i was able to do this and i didn’t think i could do this and so that brings us to that issue that [7:19] there are so many layers of onions that we can peel off and fasting is the one [7:25] that really seems to me to open up aspects of their lifestyle which they [7:31] would not have otherwise looked at because fasting does bring in lots of issues into their life [7:38]. it opens up the introspection into their life it’s what’s going on what’s driving these things in my life yeah and that’s [7:44] what i like about fasting it’s it’s so different imagine if i just give them a diet and say okay you’re just gonna eat this um [7:51] okay they don’t eat that that’s it but in fasting it’s self-control it’s [7:57] it’s deeper thinking about the habits and all the other things that we’re [8:02] going to talk about
yeah in many ways fasting is [8:10] you know really swimming against the tide of societal norms [8:16] because we live in a society of abundance yet fasting is [8:24] self-imposed scarcity and you know we’re going to talk about fasting from foods and the benefits for [8:31] various different disease processes but also for promoting health and well-being but you could take it a little step [8:37] further couldn’t you we’re going to sort of link mind and body and heart all together [8:42] well it’s not just about fasting from food is it it’s it’s also we can take social [8:48] media fasts we can take alcohol fast we can take caffeine fast even that term fasting [8:54] it goes far beyond just food really doesn’t it
absolutely absolutely you have so much [9:00] insight into this you’ve just hit me onto something very important when we talk about our habits in fasting [9:07] you know addiction really to eating and this pattern - you also talked about digital addiction you almost just you [9:14] didn’t quite say it in that way but there is digital addiction there’s alcohol addiction there’s gambling addiction there’s other forms of [9:20] addictions and sugar addiction and all these things seem to go to that part of [9:26] the brain that gives us that reward so we’re living in a society [9:32] where it’s all about the instant rewards and when you prime yourself in one area [9:39] you can slip into other areas as well and that brings up this whole addiction thing that perhaps this pattern of [9:46] eating that we’ve developed and this addictive pattern of eating every few hours all the time it’s really an [9:52] addiction it is an addiction and it it seems to give us that instant reward and [9:58] doesn’t really matter what you’re eating but it’s the fact that you’re eating all the time and we need to get out of this [10:03] so we need to really look at our whole life to say that look the dopamine centers are primed already from a young [10:10] age and um yes we are addicted we’re an addicted society you know that the book [10:16] that i just finished reading a few months ago um dopamine nation i think it’s called [10:22] fascinating insights that you know you prime yourself in one area and then you’ll slip into another addiction very [10:28] easy. and i think that food is one of them yeah i am convinced that food is one of them [10:34] um so yeah no you’re absolutely right it is it’s a whole lifestyle and and i tell my patients that if you really want to [10:41] come off your current eating habits we need to look at your whole life as [10:46] well are you addicted to alcohol are you addicted to to caffeine are you addicted to sugar are you addicted to even [10:53] digital uh uh media um because it’s just the way we’re priming ourselves and when [10:59] they start looking to that they do see inside this oh my god he’s right you know i am probably addicted to this [11:05] pattern and i can get out of it
i’ve read that book dopamine nation i actually spoke to anna lemke who wrote [11:11] that just a few weeks ago on this show a great conversation i agree it’s a [11:16] it’s an awesome book um many of us have heard of fasting we’ve [11:22] heard that various religions have used fasting for years many of us [11:27] depending on what culture we have grown up in may know that our parents or our grandparents [11:32] would fast from time to time yet despite knowing that certainly in our current society [11:40] many of us aren’t taking that next leap many of us think you know what i know i’ve heard you say before that you were [11:46] a bit skeptical of fasting when you’re at medical school many of us probably have thought in the past that oh yeah [11:52] you know what did my grandparents know you know i’m not going to fast and what i’d love to do because i think [11:58] you do it so well is really go through what happens in the body [12:04] biochemically physiologically when we start fasting because i think for many people [12:09] they’re going to need that knowledge and that science to convince them that actually you know what [12:15] maybe i should give this a go
yeah yeah yeah no absolutely absolutely you know what fasting does it allows the [12:21] body to do what it was made to do you see we eat eat eat insulin comes in puts [12:26] everything into storage so you build up some fat. and then you’re supposed to live so when you live - you now start [12:33] utilizing your calories and you start burning the sugar when that goes out after maybe about four hours or five [12:39] hours then the you know glycogen stores in your liver and then your muscles start breaking down start giving you the [12:45] calories that you really need to burn so you can run do your day-to-day activities and all that and when you run [12:50] out of that by let’s say about 18 hours or 20 hours and then the body says hmm i need to start burning fat now - that’s what [12:57] you’re supposed to do that’s why you put on fat in the first place that’s why we have fat it’s a storage and then you [13:04] start burning that fat and therefore you start burning that fat. so the fat comes out comes into your liver gets converted [13:10] to some ketones perhaps and now you’re making ketones and the ketones are being utilized for energy. and then you go for [13:16] your next meal again.
so the body was made to do this. it was not made to just [13:21] pile on pile on pile on all the time - because that that results in increased fat stores [13:29] which you’ll never break down. so your body was supposed to do this from the [13:34] from the from the design. you’re supposed to do this so - the important thing is that when you eat [13:41].
and you’re taking calories your insulin level obviously goes up. why because insulin has to get that sugar out of the [13:47] bloodstream blood sugar must always come down - because otherwise you get damaged from that high glucose level in your [13:53] bloodstream. that’s why we treat diabetes right? because the blood sugar or the glucose rather attaches itself to [13:59] proteins - glycation end products and therefore these proteins become [14:05]- they become - dysfunctional.
so insulin says - i’m going to take the glucose out put it down into the blood into the [14:11] storage.(5)
- first place it puts it into is the liver.
- when the liver stores are full [14:16] then it spills over into the pancreas.
- more calories coming? there’s more glucose then it goes into the muscles [14:22]
- and it stores everything and from there into the skin
and that’s the way it was supposed to be - but now when we continue [14:29] to do that we just keep piling it on piling it on we never get a chance to burn it down and we’re supposed to burn [14:35] it down. so the biochemistry of the body was made for feeding [14:40] fasting cycles. and this is the way the the other the bioengineering of our body was. but we [14:47] became dysfunctional because as food became more available we just kept piling it on and on and on and on.
and [14:53] that’s the problem that we have today is exactly what you said excessive calories [14:58] too frequently. so our insulin levels stay high all the time so that’s the [15:04] biggest problem i found as a cardiologist you’re eating all the time - you’re stimulating your insulin all the time. [15:10] insulin stays high - stays high, never gets a chance to come down. and because your insulin doesn’t come [15:17] back down again, you’re always in a storage mode. this high insulin is the [15:22] problem. we’ve hormonally changed.(5) because we’re eating too frequently. we’re not designed to eat that frequently. insulin [15:29] is supposed to go up then come back down again up and back down. we stay up all the time [15:35].
so your body develops in a simple terms insulin resistance. now the next time you eat you need even [15:42] more insulin - because just like wearing a jacket - you first feel it, then you don’t feel it. the body -when it has high levels [15:49] of insulin all the time - it becomes insensitive to it and that’s what’s happening. we are a hormonally modified [15:56] human being. now we’re becoming insulin resistant and this insulin resistance [16:01] results in higher and higher insulin levels.
and that’s the problem i found - and i just want to digress a little bit [16:06] - i’ll tell you how i came to this in my practice. what was happening is patients were coming in with heart [16:12] attacks and hardening of the arteries and angina. and i said okay there must be a cause and i look for it and the [16:19] cholesterol most of the time was okay. blood pressure was okay. they were not diabetic. and i see all this hardening of [16:25] the arteries. and i’m wondering why so. about 12 15 years ago i started doing [16:31] sugar tests on them and i found that they actually had mild diabetes - what we call glucose intolerance or impaired [16:37] fasting glucose. so the sugars were just slightly high but not enough to make them a diabetic. so i said okay fine so [16:43] i should put these patients on something to sensitize them and make them better. and i put them on metformin and i got a [16:49] lot of resistance from a lot of physicians in the community, plus patients.(4) uh but the outcomes were better! [16:55] they actually did better.
then i started doing insulin testing in my office. and i started doing this when i read uh some [17:01] information from uh from a physician uh who wrote a book on on on insulin, and he [17:08] got kraft - so it’s called the kraft test - so now what we do is we give them sugar [17:14] water patients and we measure the sugar levels going up and back down again. and said okay it went up a little bit not [17:21] too bad. but i looked at the insulin response and it was massive.(5) in these patients i took 100 patients [17:27] and i saw that they were making so much insulin. and i said this is ridiculous! why are you making so much insulin? well [17:34] that insulin resistance. and then i linked the fact that it’s the high insulin level [17:41] - that’s actually causing the hardening of the arteries because the sugar levels are okay.(5)
of course what happens is over time [17:48] - it’s taking a gallon of insulin to bring your sugar levels under control. eventually even that’s not enough - so [17:54] then the sugar level goes up, and then they go to the doctor and they say oh yeah sugar levels are high or your hemoglobin a1c level is high [18:02] - now you’re a diabetic. well guess what - it’s too late. you already have all the hardening of the arteries. you’ve done so [18:08] much damage to your arteries, you probably did it for 15 to 20 years.(5) and that’s the discovery and that’s what [18:14] really motivated me to make these changes in my patients to say that - look you know i got to get that insulin level [18:20] down.
and it is that high insulin level that really motivated me yeah to really do [18:26] the fasting program. because i said - okay - how am i going to get insulin levels down? how do i do that? i don’t have a drug. [18:32] so that’s why look the whole thing comes down to insulin for me. it was now as [18:37] things happen i discovered more and more fun things that in this fantastic journey. but the bottom line is it was [18:44] the high insulin level that really got me into this. because i found that when i brought the insulin levels down, my [18:49] coronary artery disease - atherosclerosis - just went down. patients did so much better and that high insulin level. the [18:57] only thing i know that really helps to bring that insulin level down, besides metformin and a few [19:03] other drugs, really, is fasting. yeah because when you don’t eat - guess what - you don’t make insulin. [19:10] that’s it. your insulin levels plummet. and then the next time you eat you make insulin [19:16] - but a much less amount - because you’re not sensitive.
so this fasting i got into it through [19:23] this way - not because i’ve i just wanted to make them reduce weight, yeah? not because i just want to reduce blood pressure. it [19:30] was really the insulin that got me into fasting.
then of course i discovered as time went on that - my god - the blood [19:37] pressures were coming down, and i realized that insulin is a vasoconstrictor - it reduces nitric oxide [19:43] in your blood vessels. so therefore your blood vessels can’t dilate now that brings me to hypertension. [19:49] that i said - oh my god - i was taught and you were taught that 95 of hypertension is essential. [19:57] and this very word essential - there’s nothing essential about hypertension.(5) you don’t need it. [20:04] so should we explain to non-medical listeners what does that term essential [20:09] mean when we say essential hypertension? what do we mean by that - which means we don’t know the cause of [20:15]? it it’s idiopathic.(5) idiopathic is another word we use which means we don’t really know clearly what the cause is.(5) it’s just [20:22] something that just happens. so this essential hypertension is not really essential - you don’t really need it. and i [20:28] found through my own experiences here that the fasting brought the blood pressures down [20:35]. and i said okay - so what’s the correlation? it’s insulin. let’s start reading more about insulin and sure [20:40] enough - when you give patients an insulin shot the blood pressure goes up, yeah? yeah - take them off - instantly come down. [20:47] insulin causes nitric oxide depletion in the blood vessels. nitric oxide by the way is a vasodilator. nitric oxide is a [20:55] natural endogenous product that makes your blood vessels dilate. and then when nitric oxide goes down, vaso-constricts, [21:01] this is a dynamic state that you’re supposed to have. you walk into a cold room your vaso constricts - that [21:08] means your blood vessels go down.(To prevent heat loss?) when you go into a hot room your vasodilator. that’s a normal response. this nitric [21:14] oxide is most essential in our body. it is so important for blood vessels that [21:19] in fact there was a noble prize awarded for this nitric oxide as you know. so for the audience to realize that [21:25] insulin, when it comes down, your nitric oxide production goes up - [21:31] and therefore you vasodilate appropriately. your blood vessels are not imprisoned anymore - and blood pressure [21:37] started coming down. i said this is amazing because for the first time in my life, i felt that the patients [21:43] were doing something that was actually bringing their blood pressures down. i mean - we always tell patients we have high blood pressure okay, avoid excess of [21:49] salt and go do some exercises - and those are fine because they also can improve [21:54] nitric oxide production.(5) but this was a very powerful one when i brought that insulin levels down on these patients [21:59] through fasting blood pressures just plummeted. and i had to actually take patients off blood pressure medications [22:05]. yeah so yeah that’s a huge thing - that i found with insulin. so fasting [22:10] seemed to me the the best way to to really make the patient’s blood [22:17] pressures come down.
and i found that the weights came down. the question is why did the weight come [22:23] down? well insulin in a bottom line for all your listeners insulin just is a storage [22:28] molecule. yeah. puts everything in storage. so when the insulin levels come down, [22:33] the storage padlocks are taken off - so your fat can now be mobilized now.(5) [22:39] there’s of course - i can go into all the enzymes that are involved and and the and the hormone dependent lipase et [22:45] cetera et cetera et cetera - but the bottom line is when insulin levels come down now your fat pads are available - [22:52] yeah - for metabolism. and i found that the fats just started coming off the patients and when i would look at these [22:59] patients who do the fasting program - look at them and they look great. it’s not like their [23:05] faces are all you know - the excess of skin hanging off or they have skin hanging off their arms - no. [23:12] fasting patients seemed to lose weight in a more beautiful way. they were actually losing [23:19] fat but they were also losing the right amount of skin as well.(4)
yeah because you [23:25] see - prior to this - prior to this - i used to tell patients okay you want to cut your calories to [23:31] only 850 calories a day and you’re going to have uh four meals a day each one is going to be this much and the patients [23:38] would come back. sure they lost some weight. they would lose a lot actually sometimes. but they would look terrible [23:44]. they would look absolutely terrible. their faces their skin and and plus they were miserable - because [23:51] they just never didn’t feel good yeah eating small amounts of food. [23:57] frequently this advice that we gave patients previously that hey cut your calories [24:03] down by eating four small meals a day or nibble throughout the day - [24:08] totally wrong in clinical experience. they lost temporary weight they all [24:13] would put it back on again. she did it for years, i did it for 15 years, and i was sick and tired of it. [24:19] they would come back miserable saying - “doc my life’s miserable. i only eat this much and i just feel terrible. i’m hungry [24:25] all the time.” and i look at them they’re sure they even look miserable and their skin was just so when patients were [24:32] fasting, they would come back and they were laughing.
they were they were so happy - [24:38] the mood was better. and i said so why is this guy’s mood so good? he hasn’t eaten for two days now [24:43] and he says doc my mood is better than it ever was before. i’m sleeping better as well [24:49] and he empowered himself. and i said no this is psychological. he’s just you know [24:54] - he was able to do it. so he’s feeling good about himself. he says no doc i do feel good that i was able to do it [25:02] and and i am self-empowered; but also they felt better. and then of course as i [25:07] do the research i see that there are many substances that are produced during fasting and one of them is bdnf, which is [25:14] a big word for brain derived neurotropic factor. what that really basically means is - look- when you are fasting [25:22] does nature want you to just crawl into your into your cave and fall asleep and [25:28] just just just just die? no nature wants you to go out there find your kill or your prey or your find [25:36] your berries or something so it actually makes your brain more alert, [25:43] and rejuvenates your brain and you actually now there’s data to show that you can actually grow new cells as well [25:50] in prolonged fasting. so what happens is that you actually become more wide-eyed [25:55] and bushy-tailed! and that’s what i saw with the patients too that they were they were so happy when [26:00] they walked into my office you’re walking to carriages office laughing and joking. this is fantastic so [26:06] and then so that’s something and then i found that the the energy levels - they just not [26:12] only felt better mentally, and and and their mood was better - but they said that they moved around better. so i said what [26:19] does that mean? this is where - look my aches and pains went away. i said - come on. He said - “yes i only lost 15 pounds so far [26:25] but my joint pains are all gone!” no wait a second - why is that why did the [26:30] joint pains go? you don’t take off that much weight to take them off your knee! well there’s [26:36] inflammation and i found that inflammation went down in this patient.(5) so i said okay so how do i measure [26:42] inflammation? so i looked at the crp levels on these patients and i found that the crp (is a [26:48] blood test and your audience would know that this is a test that we do to look for inflammation - [26:53] micro inflammation in your blood vessels) and i found that they were coming down now. you know how hard it was for me to [27:00] bring these inflammatory markers down i mean you know we give statins and that does bring down cr - but i found [27:07] that these patients were fasting the crp levels came down and perhaps [27:13] a lot of the inflammation in the joints was getting better because the inflammation went down. [27:19]
so i said okay that’s fine what else are you feeling? he said “well you know what my my stomach feels good too [27:26]”. “so wait a second - come on guys - i mean you’re fasting and how can this be happening to you?” this is yeah less [27:32] bloating uh my bowel movements are better um, i’m not getting so gassy and i don’t [27:38] get that fatigue after eating - you know i just i just feel so down [27:44]. of course they’re not eating. but when they do eat, after the meal, they feel so much better. so they are eating [27:51] after when they break the fast - but they’re feeling better.
their guts are better. their joints are better. their minds are better. i just said “oh god! this [27:58] is crazy. this is crazy” so that’s what really yeah i got so excited about fasting. as you can tell though it’s just [28:04] - it is amazing journey.
yeah it’s you know what’s incredible is hearing you talk about this with this [28:11] incredible passion. you know you have seen really really [28:16] sick patients you’ve been inside their body. you’re obviously you know there was there was clearly a [28:22] frustration at some point you know why am i keep doing this with all these patients they keep coming in what else can i do what you’re talking about with [28:28] fasting it’s not giving more things to someone or you’ve got to [28:34] add this into your life you’ve got to take more medications take more supplements [28:40] go and go to the gym more right because most of the things we advise we’re [28:46] asking them to do more add more things in actually this is very very simple at its [28:51] core we’re asking them to do less. we’re saying actually don’t cook um we’ll get we’ll get into [28:57] the specifics but i’m just saying sort of 30 000 foot viewers it’s kind of like well [29:03] i’m going to save you some money you can eat less. i want to save some time you don’t have to cook this is going to help improve your sleep [29:09]. your cognitive function it’s kind of it’s very interesting. it’s something so simple that pretty much every religion [29:16] has as part of its kind of culture and tradition. yet it’s so alien to us [29:23] in the way that we currently live or as doctors - the way we currently practice isn’t it [29:28]
absolutely absolutely and you know on this journey they find out something about themselves yeah yeah i’m talking [29:34] about what they find out they find out that they are not the hunger they are not the craving. [29:42] that they are something i mean i’m just going to say in first person -
“i am something beyond [29:48] my hunger i am beyond my body and beyond my habits i’ve suddenly realized that i [29:54] am in charge that i don’t have to have breakfast if i’m not hungry i don’t have to have [30:00] breakfast and now doc tells me that’s good for me lunch comes around [30:06] are you hungry or have you been a victim of just it’s one o’clock so i have to eat” so when the [30:12] patients suddenly realize that gosh i don’t have to eat because i’m not hungry of course if you’re not hungry and now [30:19] they’re empowering themselves they realize that there’s another part of themselves a real inner [30:26] amness - my my awareness- the the real me - which is beyond my body beyond my [30:32] feelings beyond my sensations and i have control over it now i found that that seems to empower [30:39] patients more. because you start them out first doing this this this dietary stuff okay learn how to just skip meals. then [30:46] all of a sudden it roller coasters and they themselves become so empowered they say -" whoa whoa whoa what have you done" he [30:53] says “well you know doc you told me too fast i haven’t eaten for 48 hours”. i said “yeah but i didn’t tell you i tell you 48 [30:59] hours”. so what i’m saying is that it empowers them even more because they’ve realized -
“yes [31:05] i have control. i have regained my control over my eating habits. i don’t [31:10] have to eat because it’s uh one o’clock in the afternoon - i have to go downstairs to the cafeteria to eat. i don’t have to [31:16] do that if i’m not hungry and when i am hungry my ghrelin(=hunger pang harmone) levels have gone up. [31:22] they’ll stay up for about an hour. doc told me. and then it’ll come right back down, and my hunger will be gone. [31:28] so now i’m empowering myself that - yeah - i can do it. i’m going to wait it out for one hour. i drink a glass of water. doc [31:35] told me to drink a glass of water and yeah sure enough my hunger went away. i moved on. yeah doc told me to keep my [31:41] mind busy - go and do your chores at one o’clock, go do your shopping at one o’clock, or pay your bills at one o’clock [31:47] and your time will pass and before you know it you’ll be back to work at two o’clock and you’ll have [31:52] no problems till the evening.”
yeah - so i think that self-empowering the patients this way [31:58] they’re taking control and they’re looking back and they’re getting positive feedback - “oh yeah i have regained control”. yeah - [32:04] so you know because compliance is such a big problem. so when i did that the compliance with medications also [32:10] improved because the patients just they - they they took control. yeah yeah [32:18] yeah.
i mean there’s so many things to kind of follow up on there you mentioned that actually when people fast [32:26], they often get more energy and more mental clarity and this is very alien to as you say how [32:32] most of us have been brought up. and i think kids are still being brought up you have to eat regularly and i give an example from my own life which is [32:40] my son is 11 years old currently and every saturday morning we try and do [32:46] something called park run which is a five kilometer run in the local town [32:51]. now just to be clear i am not giving anyone medical advice with their children at the moment - so this doesn’t [32:56] get misunderstood presents. but i know my son i know his health well i know what he’s capable of and we run at nine [33:03] o’clock and my son loves food right he loves foods. but actually he’s realized that actually [33:09] he runs better and feels better when he runs at nine if he doesn’t eats so he said “daddy don’t need to eat”. i said “no [33:16] you don’t want to eat that’s fine” right - which is not what i would have been told at that age i can tell you what do we know you’re gonna need to eat [33:22] so you’ve got energy for your run so on a saturday morning he gets up let’s say at seven [33:29] he’ll probably have you know i’ll probably keep reminding him stroke nudging him to have two glasses of water - [33:35] um but then we’ll go and do a run together at nine let’s say nine till half nine then we nip to the supermarket [33:41] we come back and what i’ve started doing with him is i say to him i don’t know how do you feel now you [33:47] know you missed breakfast and he’ll say often - daddy actually feel really good- like i [33:52] could think really clearly. so first of all kids get this stuff right and i’m [33:58] delighted that my son is actually uh showcasing some of the stuff that you are [34:03] talking about at the age of 11. i tell you i certainly was not - i was very much eat from the minute you get up go [34:09] downstairs i have your bowl of cereal and still be eating last thing at night. but i remember just going to my room with big bowls of muesli and milk and [34:17] just i was eating all the time.
so that was one thing i wanted to say um but the second thing i wanted to talk [34:23] about was what you said about i am not the hunger i thought that was so powerful dr jamnadas [34:29]. because i think many people these days have forgotten what real hunger is and then if they [34:37] ever experience hunger it’s like i need to eat now because i’m hungry it’s like well you could just sit [34:42] with your hunger and see what happens so just a couple of points there and uh yeah i’d love you to share your sort of [34:48] view on that
absolutely. now the experience with the son is so empowering. so [34:53] he’s he and all of us have realized - there’s a you know that we are a hybrid engine. so you have your metabolism [35:00] that’s based on glucose and everyone needs to understand that sugar and glucose that is the the ultimate [35:05] currency that we use to produce atp. but there’s another currency in the body and that currency is ketones [35:12]. so when everything’s put into storage and you’ve depleted the glycogen in your liver [35:19], because you’ve been exercising now then you need your fat stores that’s another source of energy. so when the fats kick [35:26] in, and your ketones start going up - you will feel different when the ketones are in your body. so that feeling of [35:33] euphoria that feeling that the patients feel empowered and your sound feels so good after running on an empty stomach [35:40] - of course partly because of endorphins that are produced, which is very good; but the other product is this ketones. we all [35:47] make ketones. we are supposed to make ketones. the trouble is when we eat so frequently you turn ketones off. [35:53] we must all experience some degree of ketogenesis in our life - in our day to day, maybe at least two to three times a [36:00] week.(5) you should become significantly ketone that does not really mean that you need to fast for three days or four [36:06] days. no - look when we cut down on the amount of carbohydrates [36:12] - simple sugars and we we will go into ketogenesis [36:17] sooner and sooner in a fast. so that’s adaptation. you’re adapting your metabolism if you’re eating a lot [36:24] of carbs and sugars all the time, then stop eating you will start producing ketones maybe at 24 36 hours. but if you [36:32] already on a diet that cuts out processed foods sugars [36:38], simple starches, all the refined products - now your body will start making ketones at a much [36:44] earlier stage. so maybe by about 15 16 hours also some people start [36:49] making substantial amounts of ketones. now those ketones when they are being used in your metabolism - you will [36:56] experience what your son experienced. “i feel great. my exercise turns better. my thinking is better.” so it’s a different [37:02] chemistry - you’re using in your body and i think all of us all of us need to go [37:07] into some degree of ketone production - because it has multiple other benefits [37:12] to being ketone production and in ketone production there’s a whole new biochemistry that’s going on in the body, [37:18] which we need because one is anabolic what putting on on on all the time. when [37:25] you in the ketosis now the body is cleaning up and becoming efficient so [37:30] it’s another metabolism that we need to engage and we just don’t engage enough of it and now on the fasting program is [37:37] when i’m seeing that the reparative processes all kick in.
now i’m going to say this again the [37:43] reparative process in your body is kicking in at a higher level when you are doing your fasting. how do i say that? [37:50] oh actually blood pressure comes down. joints seem to get better. all symptoms seem to get better. [37:56] patients look better. but now there’s data showing that these patients live longer - [38:03] less cancer as well and we know about the chemistry that is [38:08] induced, of which one of them is called autophagy - where the cells actually recycle [38:13] all the inner parts to become more efficient and mitochondria [38:18] recycle as well always - called mitophagy. so these autophagy and mitophagy which is [38:26] recycling your biochemistry of your cells does not occur in a fed state. [38:32] it occurs much more when you in a fasting state. so we supposed to have [38:38] that. we’re supposed to do it. that’s what our life cycle was supposed to be - yeah?
yeah it’s it’s [38:45] it’s interesting as you speak you remind me very much of a conversation i had with dr william lee [38:52] uh very very recently on the podcast who’s done a lot of research into [38:57] comparing food as medicine compared to drugs, and dr lee talks about these [39:04] defense systems that we have inside our body he’s got these five he talks about these five defense systems and he talks [39:09] about using food as medicine to support these defense systems and you know there are things like you know [39:16] inflammation the immune system the gut microbiome, stem cells, dna [39:22] and it’s interesting he talks about what particular foods have been shown [39:27] to support those various defense processes. but also what you’re talking about [39:34] is the withdrawal of foods at prescribed set intervals also [39:41] activates these natural defense processes that the body have got and i find that really really [39:47] fascinating that actually what we’re trying to do is support the body’s natural defenses [39:53] we’re trying to support that body’s own natural resilience that’s there - if we and modern life kind of gets out [40:01] of the way we’re getting in the way and actually stopping this stuff from working but what you’re talking about is [40:06] let’s get out the way and we’re going to naturally kick all of these kind of different systems into gear [40:13]
yes all right now dr lee amazing so he talks about the foods that you want to [40:19] to to consume to bring about these beneficial changes right and the mechanisms are immunity of course and [40:25] stem cells as you mentioned and and and your gut microbiome which we know now [40:30] plays a huge role in your day-to-day health. now fasting impacts on all of them yeah exactly [40:38] after you finish your fast and then when you have your meal you get you get stem cell mobilization. [40:45] so after a fast you’re getting you’re getting more stem cells mobilized from your bone marrow now. what are stem cells? [40:51] stem cells will go into the circulation go to the parts of the body and they already have messages on them [40:58] tagging them where to go what to do the body has immense internal signals so [41:03] these stem cells go exactly and hone in exactly where they need to go and create [41:08] the new cells and repair the body because maybe those cells that were senescent died maybe certain [41:16] organs dysfunctional cells died and these stem cells move in and we know that we know this is stem cell [41:23] mobilization occurs with fasting.
you talk about growth hormone growth hormone you want to increase your growth hormone [41:29] growth hormone as you know goes down after the age of 30 plummets really goes around growth hormone is responsible for [41:36] muscle building and growth hormone production skyrockets when you’re fasting - because your body makes much [41:43] more growth when you you more than taking shots so if you exercise in a fasting state [41:49], you’ll actually put on more muscle mass. which is what your son is going to come back and tell you that dad i’m putting on more muscle in my [41:56] fasting state when i exercise it then then if i exercise it’s because of growth hormone
so there’s another - [42:02] immunity. your immunity gets better when you’re fasting [42:08] during your fast your body is developing mechanisms to to [42:13] strengthen itself and immunity does go up and we know that that certain foods people do the same thing but [42:20] there you go now imagine the power if we joined all this together so eat the right foods eat the foods to improve [42:26] your immunity as well and do the fasting as well this is just i think that the future [42:33] is so exciting in this area where people like you and dr lee and [42:39] come together and we’re gonna we’re gonna change things and say look we need to change what we’re eating [42:44] we need to change the sourcing of our foods and we need to broaden our outlook.
look up the microbiome i didn’t even [42:50] talk about the microbiome just now so fasting does affect the microbiome yeah it does [42:56] and when you know that that’s a whole new area that’s so dynamic in the the life of the half-life of of bacteria in [43:03] the gut changes uh so we know that when we’re fasting certain bacteria are gone [43:08] and we know that the types of foods that we’d affect our microbiome but fasting itself also affects the [43:14] microbiome. yeah so i love fasting because it does have positive effects on the microbiome and we know that that’s [43:20] huge i never believed about the microbiome stuff until about five years [43:25] ago but the data now coming out is so compelling for me yeah as a cardiologist [43:32] in fact i just saw a patient yesterday and i advised him that he needs to be eating pro probiotic foods and fermented [43:38] foods and he’s like but doc i’m here for my uh my coronary calcium score which was so high [43:46]. you know so it’s just fascinating stuff
yeah it really is and it’s it’s again it’s that [43:51] one thing [Music] fasting that’s hitting so many different things isn’t it it’s reducing your insulin it’s [43:58] encouraging autophagy you know we’ve not mentioned really apoptosis yet it’s encouraging apoptosis [44:04] stem cell production growth hormone so many different things are being activated and actually if we could get a [44:10] drug to do any one of those we’d be sort of shouting about it but but this one thing does all of them which is [44:16] which is incredibly fascinating. look i really want to understand because um i want to talk more about the science a [44:22] bit later on in this conversation but in terms of getting really practical for people [44:27] like if we if we compare fasting to let’s say movements right so people if they want to move more [44:34] they know they could start off with a 15-minute walk around the block you know they want to do a bit more they [44:40] make it 30 40 minutes around the block uh then they might start jogging some people might want to do a 5k [44:46] or a 5k walk or even a run a 10k some people want to do a marathon right so there’s different grades of movement [44:54]. and so what are the different grades of fasting you know where can people start [45:00] you know super super simple what are the benefits of that level and then how can people progress up [45:07] depending on their state of health depending on their goals you know i think that would be quite a useful way [45:12] at looking at fasting and making it really practical for people
yeah right good great question so my [45:19] general advice in my office and and all my nurse practitioners do the same thing with our patients is- look the first thing you need to do is cut out all the [45:25] sugars. because if you go into a fasting with your regular diet pattern, you can have a [45:32] very nasty experience. you’re going to feel very hungry. you’re going to go through withdrawal from sugar. you’re going to feel terribly hungry, sweaty. you [45:39] may even actually have worse symptoms. so the first thing we’re going to do is look we explain to the patients that [45:45] your body is not supposed to consume so much sugar. you know we consume about about more [45:52] than 10 to 20 teaspoons of sugar a day in one form or the other. so the first [45:58] thing i tell my patients is look you need to get rid of all artificial foods. sugar is manufactured sugar is [46:04] artificial sugar is a poison for the body. you need to cut out all sugar [46:10]. all processed foods - processed foods anything that is made in a factory anything that has a barcode on it is [46:16] suspect. anything that’s been pulverized anything that has been made into a powder - get rid of everything. you need to [46:24] eat foods in their natural whole form and that’s the first thing you do so. [46:30] forget fasting right now the first thing you’re going to do is just change your diet. i want you to eat whole foods. so i [46:35] have a chaat in my office - that’s the anti-inflammatory diet and it contains all the whole foods. i said when you look [46:40] at the food in your plate you need to be able to recognize it - yes this is what this is this is what it is and this is a [46:45] lot of meat and chicken and fish - i said no problem as long as it is grass-finished meat, [46:52] organic chicken organic eggs and you can have some some turkey but you must have [46:57] vegetables in their normal natural state. and first thing you need to do is do [47:02] that so get rid of all the bread all the bagels pastries, [47:08] all the things that are coming in a box spaghetti included, pasta included, i said -[47:13] look right now just get rid of all those things i want you to eat a natural diet so eat as much as you want - [47:20] but of the right food and i want you to do that for approximately two to three weeks [47:26]. no fasting right now. no no fasting right now. so that way they get used to that [47:31] idea.
yeah that i’m going to first just change my diet and then after two to three [47:38] weeks then i bring them back inside and i say okay so now that you’ve been doing this, how do you [47:43] feel? is it dark? i really didn’t feel much now. i said - now you’re going to learn to skip meals. so step number two [47:49] is skip meals. wake up in the morning. i’m not hungry for breakfast - skip it [47:55]. come around to lunch - have your lunch, have your dinner. next day uh have breakfast - but skip your lunch [48:02]. the next day skip your dinner. so learn to just skip meals and look - you felt fine. nothing bad happened. you were [48:09] perhaps a little hungry you got over it by drinking a glass of water. drink lots of water during the day time. so i do [48:14] that for another two weeks or so.
see i’m doing it gradually - just like your athlete you can’t go to your 5k [48:20] right now - you first need to build into it so for a couple of weeks. i make them just skip meals randomly. then i sit down [48:26] with them and say now this week five days a week i want to have only two meals and these two meals [48:32] are going to be within six hours of each other so that you’re going to have 18 hours [48:37] that you’re not going to eat at all - and only drink water. no calories in those 18 hours whatsoever you can have water. [48:44] black tea, black coffee - but no calories whatsoever. and they say - oh gosh that’s great and they do that [48:51] for about two weeks. so for two weeks monday to friday two meals [48:56] within a six hour window period. so they’re 18 hours they are fasting they do that for two weeks. weekends - i let [49:03] them have fun because they’re with their family. so i said you can have breakfast you can have lunch dinner - but no snacks in between. so most you’re gonna have on [49:09] weekends is three meals. on the weekends. then they do that for another two weeks [49:14].
then i say okay now is when you’re really going to start your fasting monday wednesday and friday - i want you [49:22] to skip that second meal. also now you’re only going to eat one meal on monday wednesday and friday that’s it. rest of [49:29] the days during the week - you’re going to have your two meals. weekends you can still have your three meals. so i gradually get them into that and [49:36] most of the time patients are able to do it. when i go there when i try to make them go to once a day eating or [49:43] time restricted feeding within a six-hour window from the get-go my failure rate is much higher. so i make [49:49] them do it gradually. yeah yeah.
and then they self-empower themselves and then eventually i come to a three-day [49:55] water fast which we can talk about. yeah yeah the biochemistry of that i mean i love that.
you know i love chatting to [50:00] fellow clinicians uh i love chatting to researchers as well. i must be honest but [50:06] clinicians like yourself - you know you’ve got the real life experience - not just what does the [50:11] laboratory study say, what happens in the lab.. now that you’re dealing with real patients who are probably quite [50:17] scared and you know that that sort of protocol you just took us through just to make it [50:23] really clear for people you know what types of patients are you recommending this and you’re a [50:30] cardiologist. of course you know you practice in america. i don’t know the exact differences on who gets referred [50:36] to a cardiologist in america compared to here in the uk - so my guess would be that people are [50:42] you know sick on some level you know they’ve either got angina already. [50:47] uh maybe they’ve already got ischemic heart disease. maybe they have already had a heart attack. [50:52] you know you’re obviously seeing those kinds of patients. but then we can take it one step further which is that we know in america there was a recent [50:58] study - wasn’t that well not that recent - a few years ago now. they’re showing that maybe over 80 percent of [51:04] americans are not in good metabolic health which is really quite incredible. so i’m [51:10] imagining pretty much all of your patients who come to see a cardiologist are [51:16] already metabolically unhealthy or already having a degree of insulin resistance. [51:22] and therefore problems with their health and well-being. so you know maybe help us through that a little bit because what i [51:28] want to be really clear on someone who feels that they’re in good health. they’re of - you know - a decent [51:34] weight. they don’t have any health problems. is that the approach that they should be doing as well? are you specifically [51:40] talking about patients who are already a little bit sick? [51:46]
no what i’m talking about here applies to just about everybody. in fact it’s more [51:53] than eighty percent i think it applies to more than ninety percent of it now. of course the cohort that i see in my [51:58] office are patients who already have coronary artery disease or they already have had a heart attack so those [52:03] patients are kind of easy for me to to to convince that - hey listen you already had a heart attack. now you want another [52:10] one. well you already have had two stents and then you’re going to get the third one. so you need to do this and i’m going [52:15] to put you on this program.
okay that’s fine but then there’s another cohort of patients who come to me and [52:20] i do a coronary calcium score and it’s high but they’re asymptomatic and [52:26] they’ve passed their stress test. so let me just tell everybody who doesn’t know about coronary calcium score because this is so important. [52:32] and i’ll tell you why really it’s important. so it’s a ct scan. low level radiation of [52:38] the heart - and it looks at the amount of calcium buildup in your coronary arteries. so it tells you - you already have [52:44] atherosclerosis. so there’s no guessing that oh yeah - you know your cholesterol, your blood pressure, your weight and [52:50] therefore your risk of having a heart attack in the next 10 years is such and such it’s plugged into a formula. no this [52:57] is - do you have the disease yes or no. do the scan - yes you have disease. do the stress [53:02] test - pass my stress test. why why did i pass my stress test when there’s calcium in my arteries. well you pass the stresses [53:10] because your blockage in your artery caused by the calcium is less than 70 percent. [53:17] because it takes a blockage more than 70 to reduce the blood flow in it and then you may have symptoms. or you may pass i [53:25] mean failure stress test.
can we just back can we just back it up a second for people - like what is ischemic heart [53:31] disease? what is atherosclerosis? what is a stress test? because i think there will be some people listening who [53:36] probably may not be familiar with those terms and i think it would be quite useful to sort of set that foundation if you don’t mind [53:43]
yeah yeah they’re very important. so atherosclerosis is the buildup of plaque [53:49] in the walls of the arteries and they occur everywhere - in your neck, in your brain, in your legs - but most importantly [53:55] in your heart. so when the artery the walls of the arteries develop calcium in them it’s atherosclerosis.(4) you [54:02] cannot get atherosclerosis without calcium - actually you can but very little. most of the time there’s a lot of [54:08] calcium with it. so the calcium is a surrogate for the plaque buildup in the walls of the arteries, [54:15] and that calcium buildup the atherosclerosis can cause two problems - it can narrow your artery down on the [54:22] inside - so the pipe becomes narrowed and therefore that causes ischemic heart [54:27] disease - lack of circulation, lack of blood flow going down that artery. therefore the muscle is [54:33] deprived of blood and the patient may experience pressure tightness, heaviness in the chest - particularly on exertion [54:40] - that’s called angina. so angina chest pain is because of lack of circulation due to the plaque which [54:48] is picked up by the calcium.
and a positive stress test now positive stress [54:53] test stress test is where you exercise. you or we use chemicals you assimilate and exercise [54:59] and it can tell us the consequences - the consequences of the blockage - is my [55:05] blockage more than 70 or less than 70? if it is more than 70 it may reduce the [55:12] blood flow in the muscle and will pick that up on the stress test. the stress test can be a nuclear stress test or an [55:19] ekg stress test. but now if your blockage is more than 70 - you are [55:24] more likely to experience chest pain and the effects of the lack of circulation in the heart muscle. and depending on the [55:30] location of that blockage and how much muscle is getting the effects of the lack of circulation your cardiologist [55:37] may opt to either put your medicines or if you’re having very bad symptoms maybe even put a stent inside - which we can [55:44] talk about but what i really want to stress here is that you can have a blockage [55:49] atherosclerotic calcium latent blockage that is less than 70 [55:56] you pass your stress test you have no chest pain and those are the patients that i’m seeing in my office now - because [56:02] they’re coming in and they’re getting the chronic calcium score which they would not have otherwise.
yeah because you go to your primary care physician’s [56:08] office and they say oh yeah your stress test is good your cholesterol’s fine your blood pressure’s okay - yeah keep [56:13] going and the guy gets a heart attack within a year or two years - and so what happened to me? well because you already [56:18] had the plaque - you just didn’t know it, so the coronary ct scan that we do [56:24] low level looking for the calcium picks up the calcium in the walls of the arteries and quantitates it [56:30] on a score that goes from like zero to four thousand. it’s over 100 [56:36] is significant between 100 and 400 is is very significant. but over 400 is [56:43] critical - that means you really have a lot of calcium in the walls of the arteries so these are the patients who [56:49] coming in they do the scan and i see that they have all this calcium in the walls of it now i turn [56:55] around to them and say did you know that you already have atherosclerosis you already got it [57:00] and we have studies that show that that coronary calcium is going to [57:06] predict whether you’re going to have a heart attack or a coronary event or a stroke or even total mortality more accurately [57:13] than all the other blood tests put together.
so now i say - now do i have your attention? you already have see you’ve [57:19] got to motivate the patient and this is my this is my carrot - look you have atherosclerosis. now i want [57:27] you to do my program. now i’m going to look for some parameters on your blood test. i’m going [57:33] to see what’s causing this calcium buildup and the patient said - i’m fine. i said - yeah but you didn’t just build this [57:38] up, something is making your coronary calcium build up, so let’s find out what it is. so i do a kraft test - i do a full [57:45] physical examination. i’ll do tests advanced lipid panel. these are tests that i do in the office to see and then [57:51] i might even inquire into the gastrointestinal health. i will do a [57:57] whole evaluation to see why this patient is building up this atherosclerosis and [58:02] part of the treatment program is going to be my fasting program which i think is the number one program for this. so [58:09] those patients um are very happily motivated because i show them the chronic calcium score - i said look [58:15] look at your picture. this is it. check it out. you got this calcium.
another group of patients - they come in [58:22] the 80 percent that you’re referring to have metabolic syndrome - so for the for the sake of the audience, i’m just going to tell everyone what metabolic syndrome [58:28] is okay. this is a derangement of your metabolism and basically it means that you’re [58:34] you’re overweight your body mass index is greater than 25 and you have [58:40] an increased abdominal girth. all the weight is around the belly and there’s actually a ratio that you can do [58:46] between the waist and the belly. the belly is increased and then the hdl the cholesterol is low. [58:55] the triglycerides are high and they have borderline high blood pressure. [59:03] now when you look at all these numbers - what’s the common theme that comes to mind? from everything i’ve already said [59:09] is insulin. it’s all about an insulin lowers your hdl, increases your triglycerides, [59:15] increases your abdominal girth - because all the fat is down there. remember what insulin does - insulin puts all your [59:20] calories - excess calories and frequent calories. and because of the high insulin levels - puts it well into the liver, [59:26] pancreas and visceral gut. and that fat is totally different from the fact that [59:32] you put on all over your body when you overeat. you mean i overeat just eating a lot of fats and you know okay that’s [59:38] different. but the fats that are produced under the influence of insulin [59:44] by the liver de novo lipogenesis the new fats that are created the glucose has to [59:50] be converted into storage product. the storage product is that fat - that fat in the liver gets deposited in the liver, [59:57] pancreas, visceral gut - is very inflammatory.(4) composition is totally different you do a biopsy of it you’ll [1:00:02] find inflammatory cells in it that are producing tons and tons of interleukin-6 and neutron across. bad stuff [1:00:09]. so metabolic syndrome although you have these basic features when you do additional biochemistry on them you will [1:00:16] find that they have increased crp level which is a blood test for inflammation [1:00:21] and if you can do even further testing you will find that they have very high interleukin six or two minerals factors [1:00:26] and they have small dense ldl particles indicative of inflammation. so these patients come into [1:00:33] the office for prevention or they sent to me because they have a low hdl [1:00:38] and and these are the patients that also do the the the fasting program. so some patients are [1:00:45] motivated to go into my fasting program and lose the weight. that way you see the weight by the way i gotta tell everybody [1:00:51] the weight is a side effect of the metabolism that’s gone wrong.(4) yeah [1:00:56] you fix the metabolism the weight comes down as a side effect.(4) yeah it’s not [1:01:01] really a weight loss program - it’s a metabolic program in which one of the side effects is that your weight comes [1:01:07] back down to the way it’s supposed to be.(5) it comes back the way it was supposed to be so um so these patients come in and [1:01:14] and they get referred to me so i almost invariably do a coronary calcium score on them, but even if the coronary calcium [1:01:21] score is not very high - the metabolic derangements are going to make coronary calcium in the future and [1:01:27] i motivate these patients to start making the lifestyle changes by showing them that their metabolism is off now these metabolic tests are not being [1:01:33] offered by every doctor’s office and and nobody because it takes a lot of effort - yeah and the insurance companies [1:01:39] sometimes don’t want to pay for it - like the advanced lipid panel sometimes they pay for it, sometimes they don’t. so what i did in my office i [1:01:46] developed a program where it’s a cash paying if the insurance doesn’t pay for it okay. this is how much it’s going to [1:01:52] cost you but get the test done it’s a good investment. and i have to show them that that it’s going to change the life [1:01:58].
yeah so but you’re absolutely right that this metabolic derangement is it’s not 80 [1:02:04] it’s probably more than that yeah yeah and it’s very because i’m seeing it in children, i mean i just the other day i [1:02:10] saw a mother bring in her 16 year old and i was like you - know and i said - you [1:02:15] i’m not a pediatric cardiologist but there you go - she had all the derangements already at the age of 16.
yeah this is this is so [1:02:24] it’s so fascinating and i think you know i think i’ve read a study where they’re saying nowadays atherosclerosis [1:02:31] starts in some children even under the age of 10. i believe you can see in some kids which is [1:02:38] you know you know clearly no one wants to be hearing that no parent wants that for their child. we don’t really want that [1:02:44] across society what i find really interesting is that the different groups of patients [1:02:51] who come in to see you - you know they’re proper - the ones who’ve already got established heart disease and obviously [1:02:57] hopefully a lot of them will be motivated to go okay doc tell me what to do and i’ll do it. but you’ve also got [1:03:03] some who are probably coming in for prevention - you know what’s the state of my heart what’s the state of my bloods [1:03:08] you know is there anything i need to do and the approach i can see is is [1:03:14] very similar - but you also you know - you’re sort of encouraging them [1:03:19] to go all out and cut out all of the uh highly processed foods -you know [1:03:24] you’re saying all breads or pastas which which for many people is very difficult [1:03:30]. now some people in the uk at least would call that quite extreme okay. [1:03:35] now i also have used that approach successfully with my patients so i can i’ve absolutely seen the value of that [1:03:41] but i think it’s worth talking about that. does everyone need to go to that extreme and [1:03:46] i know a lot of breads these days are highly processed - they’ve got about 10 15 different ingredients in [1:03:52], they have a high glycemic index - they spike our blood sugar; whereas i know some of the kind of german breads [1:03:59] uh like the rye bread sometimes and some of the uh like the in the uk at least the square-shaped german breads often [1:04:05] can have a much lower uh sugar response so i guess what i’m trying to get at is [1:04:12] all patients presumably say look i’m going to try it but they can’t do the whole thing the way you would [1:04:18] ideally want them to. um you know are there some common obstacles are there some sort of common [1:04:23] compromises you have to make with people when they can’t go the whole way?
no no you’re absolutely right i mean if [1:04:29] you you grew up on toast and white bread and it’s gonna be very hard to do so it. just depends on the stats now they’re [1:04:36] coming purely for prevention - they’re not overweight but they do have some family history [1:04:42]. it might be difficult for me to convince them that hey listen you need to cut out all the all the bread but clearly if [1:04:48] they’re overweight - you know - it’s basically convincing the patient look you’re overweight [1:04:53], you have metabolic disease uh i can see some parameters here on the blood tests uh or you already have coronary calcium [1:04:59] in your arteries and then explain to the the consequences of that that is not just that you’re gonna get a heart [1:05:05] attack - you’re also at risk of getting dementia when you grow older, you’re going to get [1:05:11] peripheral vascular disease, you’re going to get renal failure - such a big link between kidney disease and heart disease [1:05:16]. i said so take a pic, what would you want what do you want - and cancers - obesity is also related to cancer. so sitting down [1:05:23] and between myself and my staff explain to the patients - that listen this is not just about about your heart, this is also [1:05:29] about your whole life. this is a really a holistic approach. this is gonna [1:05:34] affect everything this is going to affect the way you’re going to retire and what your retirement going to be like and are you going to be aware of [1:05:40] your own retirement and you’ll be able to think - because alzheimer’s is going off the roof too. i mean we have a huge increase [1:05:46] in the amount of dementia that’s going on and i’m one of those who believes that much of that is also vascular. it’s [1:05:52] all vascular. i think everything here as old as your arteries. you know yeah um so so what’s your arterial age [1:05:59].(5) let’s look at that and so i think that making these dietary changes and cutting out the bread - yes you’re absolutely [1:06:05] right it’s a difficult one to sell, but at least even if they cut down or move to pump a nickel bread or or even [1:06:12] sourdough bread is better because at least it has some benefit on the microbiome but at least make some [1:06:17] compromises. start start - at least do something. um [1:06:23]
yeah yeah and i think that that’s that that’s the key thing is motivating the patient to think more long-term also and [1:06:28] not just think coronary artery disease. everything that i tell the patients to do for their heart, i tell them straight [1:06:34] up front - this is going to keep your eyesight, this is going to keep you from getting dementia, your renal disease, this [1:06:40] is going to help you from hopefully also decrease your risk of cancer, joint disease, back problems, i [1:06:46] mean - name it -it it it really has so many ramifications. so yeah so again it comes [1:06:51] down to what we said right in the beginning of this talk - that we have to motivate the patient. i need to get into your brain [1:06:57] make a change in you so that you know that this is the right thing to do and then it resonates with you [1:07:04]. yes this is right and then see the practical results of it and it’s a slow process - [1:07:10] gradual process.
but you know we’ve done this yeah we’ve gotten patients off blood pressure medication, got them off [1:07:15] insulin(5) - you know the biggest achievements i’ve had in the last few years now is getting patients off [1:07:20] insulin. and it makes me feel so good when i do that - and all through this program they come in and already taking [1:07:26] 25 units of insulin twice a day yeah and now they’re on nothing and the a1cs are [1:07:32] so good.
yeah you you love it and i bet the patients love it as well - don’t they.
oh gosh coming off insulin, coming off [1:07:39] blood pressure medications, yeah coming off cholesterol medication, you know how many patients walk into my [1:07:44] office and and there are tons of statins and and i do a coronary study on them [1:07:50] and the score is zero - score is zero. they have no coronary calcium and they’re taking all these [1:07:56] statins and they’re hobbling around with all these muscle aches and pains and i’ll just stop the statin so that’s [1:08:01] another thing you know - empowering patients to know that you know there’s no one treatment for all that - yes your cholesterol level is a little high [1:08:09] and therefore you have to be on a statin. i try to individualize the treatment for the patients based on [1:08:15] what’s doing to your body - you know. you have you have a decent advanced lipid panel [1:08:20] and we can make some dietary changes here so that you don’t get any more coronary cancer - but you don’t have to be [1:08:26] on a statin empowering the patients to do that as well
yeah what what uh you know thinking [1:08:32] about your approach and because i’ve been using similar approaches with my patients for a number of years now and [1:08:39] i think we see a different subset because i’m a general practitioner and you’re a cardiologist. of course [1:08:46] there’s a huge crossover given how common type 2 diabetes is, how common metabolic [1:08:51] syndrome is and but it’s interesting so [1:08:56] you go before you approach any form of fasting, you have a three week period where you [1:09:03] you know “try and clean up the diets”. you try and reduce the processed foods that they’re [1:09:08] going to consume increase the whole natural foods which is just going to put them in a much better state for when you then [1:09:15] bring in your 18-hour fast - so which i which is really interesting i i [1:09:21] take quite a softly softly approach. i guess i always start with a 12-hour fast which some people wouldn’t even call a [1:09:28] fast um but i think pretty much every human being should be able to go for 12 [1:09:33] hours in every 24 hours without eating food and if you can’t currently that’s okay [1:09:39] but it would indicate that you are you know you have some sort of dysfunction some metabolic dysfunction somewhere [1:09:46] otherwise you would be able to. because some people you know say i really struggle with that and i say okay it doesn’t mean that [1:09:51] that’s not a good thing for you it just means at the moment your biochemistry and physiology is not able to support [1:09:57] that. so let’s let’s work on that and get you to a point where you can and then yeah for the right patient i also [1:10:03] increase it up gradually um. so i find that super interesting [1:10:08] as as kind of just to notice a difference because there’s no right or wrong in that. there’s just we’re all trying to empower our patients and we’re [1:10:15] all kind of biased i guess by our own experiences as to what we have found uh working with patients so i found that [1:10:22] really interesting. also are most of your patients men? and the reason i ask that is because [1:10:30] of course heart disease we hear a lot about killing men of course it affects women [1:10:35] as well um but also there is this question mark that many people have over fasting as [1:10:42] - okay it kind of works for men, but maybe it’s not so good for women. um i have my [1:10:47] own view on that but i i wonder if you could share some of your thoughts on that?
yeah so the first part was uh 12 hours [1:10:54] vs 18 hours. um you know there’s two things that i can concern about when [1:11:00] patients start fasting. one is the withdrawal um [1:11:05] and i think that withdrawal is it comes in two shapes - uh there’s mental withdrawal that it’s i’m a pavlovian [1:11:12] reflex i have to eat at eight o’clock in the morning - i’ve done that for so many years. the other one is a true [1:11:18] biochemical addiction at the level of the brain - so [1:11:24] that really concerns me. that that’s why i do this period to come in because that gets them [1:11:29] rid of the addiction. because i think addiction is a real issue right they addicted pavlovian wise, but also [1:11:35] biochemically in the brain and some of them really do go through withdrawal symptoms and they say you know i felt [1:11:40] terrible, i started sweating, and i had this intense cravings, and and and i said [1:11:47] god this sounds like heroin withdrawal and i think it’s real. so that’s why i do this just skipping [1:11:54] meals and gradually getting into it but once how long does that take that’s the question how long does that take and in [1:12:00] my experience i’ve been doing this three weeks. at the end of three weeks i can pretty [1:12:06] confidently say that the patients have gone through their withdrawals yeah and they’re going to be now okay to take on [1:12:12] the 18 hours and that’s why i do it that way. and the withdrawals are very real because the foods have addictive [1:12:19] properties. sugar is definitely addictive. we know that we know dairy products have um caseomorphine - um which actually [1:12:28] are addictive. so you crave those things - that you that that doc has told you to to skip the meals on and all that. but i [1:12:35] think that after three weeks they’re done and i tell patients it’s not gonna be easy the first three weeks you’re gonna get a lot of cravings - you need [1:12:41] social support. you need to your structure your life you need to do your shopping during the times that you’re gonna be eating that meal. otherwise you [1:12:48] keep your mind busy and you got to get your seven hours of sleep and so yeah so [1:12:54] what that the withdrawal issue is very important that’s why i do this gradual stuff
and then the answer to the second part [1:13:00] that women definitely women are not exempt from CAD and heart disease and [1:13:05] and something that applies to you and me is asian women too. did you know did you [1:13:10] know that the instance of coronary artery disease in indian women is actually higher than indian men?(5) [1:13:17] but it’s just that they don’t get diagnosed and and they don’t seem to complain that much - so they don’t come to to to the [1:13:24] doctor’s office. but actually i’ve seen worse coronary artery disease in indian women in my office than in [1:13:31] indian men. and in indians in general they have far more coronary artery disease than [1:13:38] caucasians. so it’s a huge problem so i think that women are are certainly [1:13:45] a a a population that is not exempt from coronary artery disease. now the fasting programs in women there are some data to [1:13:52] suggest that they may not benefit as much as as men but overall i think that [1:13:58] what i’ve seen is that they also seem to benefit just as much. um so i i don’t make much distinction [1:14:04] between men and women. they come in here -i work them up the same way um. i’m very aggressive with the women as well. yeah [1:14:11] especially especially women from south asia - when they walk in they’ve got my [1:14:16] antennas. in fact any south asian that walks into my office my antennas are up - because [1:14:22] they are what i call toffees you know. they thin on the outside, they fat on the inside. and and they’re [1:14:28] metabolically very deranged and there are specific things that i tell them [1:14:33] about fasting and dietary recommendations for their diet, and the reasons [1:14:39] have to do with vitamin k2 as well which i’m finding absolutely fascinating.
yeah [1:14:45] so now i i very much appreciate that perspective thank you first of all for sharing that [1:14:50] you’re seeing lots of coronary artery disease potentially worse in south asian women the south asian men i don’t think [1:14:56] that is commonly known. i did not know that and actually i’m now thinking of people and women in my family i’m [1:15:02] thinking why okay maybe instead of thinking about the the men we need to start thinking about the women as well [1:15:07] in terms of you know prevention in terms of getting early screening done, blood tests maybe, [1:15:13] you know coronary calcium score, or you know whatever might be available to people. um my experience of fasting in inverted [1:15:21] commas - because fasting can mean so many different things to so many different people is yeah i have seen some women [1:15:27] with hormonal uh problems uh i’m not talking about necessarily insulin hormonal [1:15:33] problems i’m talking more about kind of around the menopause let’s say or estrogen progesterone sort of imbalance [1:15:38] issues - i found with some women uh it can be a bit challenging for fasting and some [1:15:44] women don’t do so well but i’ve also found many women who thrive on it. so i think a lot of the time people i’ve [1:15:51] noticed this on social media a lot of people trying to oh it doesn’t work for women it’s like well what do you mean 100 of women all the [1:15:57] time? it’s like you know and this is why i love talking to real life clinicians it’s like well we see that not [1:16:03] everything works for everyone all of the time and we have to tweak our view depending on what we see. and [1:16:09] you know when we make these kind of gross generalizations that are fascinating doesn’t work for women [1:16:15] it’s like well we put like let’s say there’s that subsection of women who who thrive on [1:16:20] fasting well they get put off they think oh it’s not for me and it’s kind of like well there’s no [1:16:25] one-size-fits-all in anything and you see enough patience you kind of realize that there’s very few although fasting [1:16:31] might be one of them i guess you might argue but do you know what i mean i kind of feel these days [1:16:36] we get too polarized on these things and it and we we just miss the kind of [1:16:42] nuance that’s actually there.
oh no you’re absolutely right and this is the new medicine we’re going to [1:16:47] become more individual okay why is this lady not able to enter into my fasting [1:16:53] product she really needs to her bmi is 42 and she has all this stuff going on. there may be other reasons she may have [1:16:59] so much stress in her life you know. she may have financial problems that she can’t buy the right kinds of [1:17:04] foods that i want her to buy. she may be in a very dysfunctional relationships and that may be causing so many problems [1:17:10] for her. she may not be sleeping at night a simple thing she may have undiagnosed obstructive sleep apnea- which is why [1:17:16] during the daytime she has so much fatigue, tiredness and she’s never going to develop enough willpower to enter into my program until [1:17:24] i get her good night’s sleep. so maybe put a cpap on her for the time being and then see that oh yeah now she can abide by [1:17:30] the the principles of the fasting. so you know it just means looking deeper into [1:17:36] the why weren’t you able to do this - that there are there are obvious factors why you cannot? where’s your willpower? why on [1:17:43] don’t you have the willpower? let’s look into this and we don’t always find the answers to [1:17:48] everything - but but i think that looking at them overall so sleep apnea is a huge issue by the way i mean yeah massive [1:17:55] problem that i find so often times temporarily i do put them on a cpap mask and say that you’re going to have more [1:18:01] uh energy mental energy and clarity and and less neurodysfunctional during the [1:18:06] daytime and therefore you will be able to to abide by the diet but the goal is really [1:18:12] to lose the weight so that we can get you off the cpap eventually yeah.
so but back to the kind of therapeutic use of [1:18:18] fasting so you do this kind of three week program where they unprocess their diet [1:18:25] then you put them on this kind of 18-hour fast so they’re having two meals a day over six hours and then for 18 [1:18:31] hours they’re not consuming anything. we must talk about any contraindications like insulin or blood [1:18:48] sugar medications at some point - just to make sure that you know people who are listening who want to try stuff that [1:18:53] we’ve we’ve covered that.
but also i want to go a bit further because i know you have used [1:18:59] 24-hour fasting with patients. i know you have used three-day fasts and you have [1:19:05] also shared in previous conversations some very powerful statistics one in particular i [1:19:12] remember on a seven-day fast you shared a statistic a bit of research from boston in terms of what that does to [1:19:19] your lifetime cancer risk. so maybe you could talk about some of these longer fasts and then practically how do people [1:19:25] start going about that
yes yes so absolutely so at all times [1:19:30] they are supposed to take their blood pressures twice a day - make sure that the blood pressure not going down to - because they do not stop the blood pressure [1:19:37] medications right off the bat. so all the blood pressure medication reduction will be done depending on your blood pressure [1:19:42] readings.
as far as blood sugar is concerned - if they aren’t oral agents i’ll continue those oral agents while [1:19:49] they’re doing the 18 hour fast periods. even the 24 hour fast i’ll keep them on [1:19:54] it and i will ask them to monitor their blood sugars.
now continuous glucose [1:19:59] monitoring - the the little uh devices i only advise those on on [1:20:05] patients who are on insulin when i’m fasting them, because i want to make sure that the insulins don’t [1:20:10] drop off. but when a patient is taking insulin and he does the 24-hour fast - i drop the insulin [1:20:18] levels by half first - i mean insulin dosage by half and i monitor the blood sugars and then [1:20:24] when they go beyond 24 hour fast i stop insulin completely - completely completely. [1:20:30] i stop it completely because i don’t want them to become hypoglycemic. so oral agents i will continue [1:20:37], insulin i will discontinue if i’m doing more than 24 hours but i monitor the blood sugars very closely.
and then that [1:20:43] brings me to a little longer fast before. i go to longer fest i make them do a 36 hour [1:20:49] fast. so i’ll make them do that once a week once a week - means that [1:20:55] evening rolls around skip that meal also and then have yourself a breakfast. treat [1:21:01] yourself with a breakfast the next day and that brings it to 36 hours. so i make [1:21:06] them do at least one 36 hour fast for maybe you know two consecutive weeks - and [1:21:12] then i’ll take them to higher levels.
can i just kind of can i just clarify that- so [1:21:17] the 36 hour fast the way you have found it most beneficial for most of your patients is what you [1:21:23] skip one evening meal to the next evening meal? when when does that fasting time i know you can do it any way you [1:21:29] want - but what have you found to work can we just clarify that
yeah so the patients already are used to [1:21:35] having only one meal a day okay, so then i’ll say skip that one meal and then have the next meal when you’re [1:21:42] supposed to have them that’ll bring you to 36 hours so for most patients these days they’re having the evening meals because it’s more social. having it okay [1:21:48] okay so they’ll skip breakfast they’ll skip lunch evening comes around they’re supposed to eat and i tell them skip it [1:21:55] and go and have breakfast the next day that brings them to 36 hours.
i guess if they’re already used to having one meal [1:22:01] a day then actually skipping that evening meal [1:22:06] is kind of - i don’t know just go to bed early as well - you know - sort of you know [1:22:11] it’s yeah i like that so what stage do you take them from this two meal a day which is this uh you know this six hour eating [1:22:18] window you know. you you do that initially for the 18 hour fast then you take them to 24 hours - to you with just one meal a day. [1:22:25] is that how you do it?
that’s exactly how i do it and then they’re doing one meal a day five days a week [1:22:31] weekends they’re gonna have two meals they do that for two weeks and then i say okay you’ve been doing [1:22:36] this for two weeks now you’ve been having only one meal a day next few weeks [1:22:42] one day a week you’re going to go to 36 and the way you’re going to do it is you’re going to skip that one meal also [1:22:48] and then have a breakfast the next day. so i’ll bring you to the and i want to see how you feel and most of them come back saying [1:22:55] i just missed the meal in the evening i watched the movie and went to bed. so why am i going from 24 to 36 [1:23:04] because i want to get them ready for longer fast - especially if they tremendously overweight and they’re metabolically deranged [1:23:10]. what’s the biochemical advantage between 24 and 36 [1:23:16] at by 36 hours almost all of them will be in some degree of ketogenesis [1:23:23]. so it’s hard to know who’s going to start spilling ketones at 18 hours, 24 [1:23:29] hours, 30 or 32 hours. it’s hard to know that - so when i prime them [1:23:36] then i’m finding that there’s longer and longer periods of ketogenesis - that means they go into ketone production at 16 [1:23:42] hours so long as they made their dietary changes gradually got into this the ketogenesis [1:23:48] phase starts a little bit sooner - at about 16 hours and the most motivated patients say that - oh i want to know. i [1:23:54] said okay if you want to know then go to the pharmacy and pick up some keto sticks and just test your urine and tell [1:24:01] me when you started spilling the ketones.(5) so after 24 hour fast [1:24:07] almost all of them are spelling ketones. and when they’re spilling ketones i know [1:24:13] what’s going on with their physiology. at that point i know that they’re getting the benefits of some degree of autophagy, [1:24:20] growth hormone, bdnf production and mitophagy. i know [1:24:26] that’s happening because they’re spilling ketones. so spilling ketones so that’s another motivating thing in the [1:24:32] patient who’s showing me the interest and the ones i really want them to be - yes give them the tool take this home [1:24:38] check your ketones that’s what i find so fascinating so by 36 hours of making the ketones so [1:24:44] they’ll do that for a couple of weeks where they now went to 36 hour fasts [1:24:49] once a week for two weeks. now at that point, depending on how motivated they feel and how well they [1:24:55] are doing now i’ll go to more prolonged fasts and my favorite fast is the three-day [1:25:00] water fast and most of the - i’m telling you greater than 95 of them - when they’ve graduated [1:25:07] to this point where they’ve gradually gone and done all this they’re able to do the three-day water fast with no [1:25:13] difficulty whatsoever. and if they get cramps then i tell them okay [1:25:19] take a glass of water and put a pinch of salt in it, and just just down it and you’ll feel better.(5) but most of them [1:25:25] don’t because they’ve adapted themselves if you go into a three-day water fast too quickly you’re going to get more cramps - but more importantly you’re going [1:25:31] to go through what is known as keto flu and you just feel terrible and achy and just feel really bad.(4) so i do it [1:25:37] gradually but i must make them go to a three-day water fast. i use it in that case i also use it in patients who are [1:25:44] able to lose weight but then they reach a plateau - so now they’re weighing 230 pounds and i [1:25:50] want them to have more weight loss. so they’ve been doing this now for a month and they said look doc i just can’t shed [1:25:56] any more weight - now i’ve done everything you’re saying, and i’ll put them on a three-day water fast and lo and behold [1:26:01] they’ll start losing weight again. so i use that in patients who have reached a plateau going to the three-day water [1:26:08] fast
thank you for sharing that i think something i didn’t want to bring up today um because [1:26:14] i know a lot of people and again we’re all influenced by the online world or the patients that [1:26:20] we’ve seen or the online world that we inhabit and you know i spoke to david sinclair this [1:26:28] harvard professor who talks about aging in a very very profound and novel way [1:26:33] and you know when i put out that episode with david a lot of people are saying [1:26:39] look asking people to skip meals is very triggering for people with [1:26:44] eating disorders and i know eating disorders are on the rise uh massively all over [1:26:51] the world certainly here in the uk and in america so i think we need to be careful about [1:26:56] that uh i think it’s worth me uh just flagging that here that potentially this advice is not for [1:27:03] people with eating disorders that’s a sort of separate issue well i’d welcome your perspective on that um but also [1:27:11] you know is it possible that we take these things to extremes i guess there would be some people we [1:27:17] mentioned anna lemke’s book before dopamine nation and um that we are all we’re living in a world of addicts now and that you know [1:27:23] she mentions that the smartphone is the modern day hypodermic needle which i thought was a very provocative way but but i i actually [1:27:30] completely agree with her of talking about it that’s health there’s physical [1:27:36] biochemical health but there’s also this kind of emotional health and our mental well-being [1:27:43] do you think as much as you love fasting do you think some people [1:27:49] they can sort of overdo it and get so addicted to kind of that feeling of [1:27:54] fasting and actually go to an extreme which potentially could become problematic
i think you’re right it can [1:28:01] happen fortunately i haven’t seen it here with somebody i tell them stop now stop stop this is enough now you should [1:28:06] be eating two meals a day and you know i think that the pattern you need to settle down in [1:28:13] is for you i think that two meals a day in a six or eight hour window period may [1:28:19] be a nice thing for you to do chronically to maintain what you’ve gained the benefits that you’ve already [1:28:24] gained. um then i haven’t seen any patients who ignored that and continued to do the three-day water fasts on a [1:28:32] weekly basis or whatever or two weekly basis - i haven’t seen that but but you are absolutely right that there are some [1:28:38] patients who clearly have an eating disorder and they clearly have a type of addiction and they’re going up at night [1:28:44] and then they creep downstairs and they’re eating away five bars of chocolates and all this kinds of stuff and those patients clearly do need help [1:28:50] and i will not deal with those on my own i will supervise it but i’ll send them to a psychologist that actually [1:28:57] specializes in addictions because they have to really spend time with that patient about addiction behavior and [1:29:02] it’s not just behavior about the food there may be other issues that are actually triggering um because see you [1:29:08] you slide from one addiction to the other to the other to the other so so you can’t take off this alone on its own [1:29:13] until you also take care take care of the sugar and maybe the the cell phone and other digital gadgets that gives you [1:29:19] the instant gratifications and and there may be even be other issues he may be a gambler for you know or have other type [1:29:25] of deviant behavior addictions so no you’re absolutely so recognizing those with the [1:29:32] biggest problems and addiction is a huge problem and it’s becoming more more [1:29:37] known now that uh the addiction is to not only sugar but it’s also addicted uh [1:29:43] to to to process food content yeah processed foods and the content of [1:29:48] processed foods um are very addictive yeah and i think that that’s why you [1:29:53] want to change the the type of food that you so you’re getting rid of all the addictive substances in the food the [1:29:59] addictive sugar in the food and then addictive behaviors in other aspects of your life as well yeah so so it’s it’s [1:30:06] really looking at the whole thing it’s it’s it’s a huge problem it’s a huge problem and yes we are an addicted [1:30:11] nation um yeah we and that’s why it’s making it so easier for us to become addicted to food later [1:30:18] on in life because it starts at a very young age and you’re very getting addicted to gadgets um and instant [1:30:23] gratification.
i want to move on to the mental benefits shortly of fasting because i think there’s a real [1:30:29] uh important piece there that we touched on a couple of times in the conversation already. before i do [1:30:35] i sort of feel that that there’s so much um divisiveness and [1:30:42] um you know frankly fighting about different diets [1:30:47] that i think sometimes gets so unhelpful for the general public [1:30:53] um they see doctors who they admire saying this diet has got this evidence this is really good and they see another [1:30:59] doctor who they admire say this type is really good it has all this evidence and i think and i know this from talking to [1:31:04] patients and talking to the public that many people find this incredibly confusing i [1:31:10] i really like fasting for the right person in the right state of health i kind of see it as the [1:31:16] great unifier in many ways because [1:31:21] as long as you are metabolically able to do that fast [1:31:28] you know whether you choose to eat meat and fish or whether you choose to be [1:31:33] vegan if you are whole food primarily you’re not having uh much processed food at all in your [1:31:40] diets then you’re still gonna get benefits from fasting right - whether you’re low carb or whether you’re vegan and you [1:31:46] know it’s interesting that video that you did on fasting fasting for survival on youtube which is you know had [1:31:52] millions of views i was reading through the comments just before this conversation dr jamadas and [1:31:59] the top comments was it really i think encompasses everything that you stand [1:32:05] for he i think said he was mostly plant-based and he started off following [1:32:12] your advice with a whole food mostly plant-based diets, i think he started off with 18-hour fasts he moved up to [1:32:18] 24-hour ones i can’t quite remember then he moved to maybe one three-day one every six months [1:32:24] and he’s documented his health journey over two years and it is utterly remarkable that you put out a video on [1:32:31] youtube and you have completely empowered that guy to transform his life. so first of all [1:32:36] just i want to acknowledge you for that that’s just one off millions of people who’ve seen that video and changed their [1:32:41] lives so that’s just incredible work that you’re doing but what do you think about this concept that fasting could be the great unify no [1:32:48] matter what tribe you belong to you can still get involved with fasting and yields [1:32:54] and and reap many of those benefits
yeah you’re absolutely right um the [1:33:01] various dietary programs that have come out have confused the public it’s confused the physicians as well yeah i [1:33:06] mean my patients come and say that i’m following this diet that diet and nothing happened and this one’s too hard for me and and this one’s too [1:33:13] restrictive for me and it doesn’t fit with my lifestyle i understand that i understand that [1:33:18] fasting forgives you. fasting in a sense forgives you for [1:33:24] certain foods that that you may then consume (5)- and actually think about it this way also [1:33:30] you eat that slice of bread after a fast your insulin response is totally different in the fasting state than in a [1:33:37] fed state - you’re going to make less insulin for the same slice of bread in a fasting state. so it’s and the [1:33:45] the the type of food that they consume so when i first started out i was years [1:33:50] and years and years ago - i’ll say oh you got to be a vegetarian you got you got to drop all meats and being in united [1:33:56] states how many patients are going to become vegetarian right - so and then as the data [1:34:02] came out and i started studying more and more i changed i decided that hey there’s something [1:34:08] wrong with this you know people should be able to eat [1:34:14] ancestral foods and what they grew up with, but the problem was processed foods when [1:34:22] we take the foods and we process them we change them and all the additives that we put into and the way we grow our food [1:34:28] or where we we we get our meats has changed. so i said no no no this is not [1:34:34] right - when i studied non-vegetarian diets [1:34:40] around the world how come that is low incidence of heart disease. there are populations that eat [1:34:46] only meat and only drink milk and blood or the populations that only eat starches and a lot of it and they also [1:34:53] live long. what’s the commonality what is the commonality in all of them the common areas no processed foods [1:35:00] no additives right, no no sugar, so they they all had [1:35:05] simple diets. so then i came up with my own plan and i said listen you what do you like to eat what do you like to eat [1:35:12] so you want to eat red meat okay - then eat grass-finished meat because that will have more nutrients in it the fats [1:35:17] will be the right kind of fats you will not have all those omega-6s in there you you’ll have more natural fats in there [1:35:23] and if you’re only eggs chicken. so i let them do that and i said but you got to also introduce [1:35:29] plants in your diet because you need the plants not for you yeah you’re going to get some some water soluble vitamins etc into your system [1:35:36] when you eat plants and but it’s really for your gut bacteria.(4) so again i had to read a lot about the [1:35:42] microbiome to understand that the fiber is hugely important [1:35:47] very important and and so i tell eat your vegetables as well. so this is my [1:35:53] diet plan yeah it’s not so restricted just stay away from anything that your great-great-grandfather wouldn’t eat and [1:35:58] no processed foods anything in a packet box barcode stay away from anything made into a flour and that’s been a hard one [1:36:06] the flour one yeah also inside that’s everywhere it’s a huge huge problem.
i i love this um [1:36:13] you know i’m so enjoying speaking to you there’s a real kind of there’s just a beautiful energy there’s [1:36:20] also this kind of real life practicalness that you know what it’s like when these patients come in and [1:36:26] you’ve gotten your head the ideal thing but you got to work with people and their taste and their preferences and their culture and what they want and i [1:36:33] really do strongly feel that too many people these days on social media commentate they look at the science and [1:36:38] go oh this is what everyone needs to do it’s like it’s just not how it works in real life in my experience you know [1:36:44] people are different they’ve got different desires they’ve got different cultures different preferences so i [1:36:49] really like that you’ve mentioned all the kind of physical benefits the biochemical benefits when we have a [1:36:57] period of not taking in food a period of fasting but there’s also something really [1:37:02] powerful isn’t there like you have touched on several times [1:37:09] but what it does for you when you know oh i can go 12 hours without food i can [1:37:14] go 18 hours wow actually i can go 24 hours and i don’t actually need [1:37:20] to put something in my mouth i think we shouldn’t [1:37:25] undervalue just what that does for someone you know i think it’s freedom it’s freedom from a dependency on foods [1:37:34] addictive foods processed foods sugar it means that you can go about you’re out on the train station or the airport and [1:37:40] there’s no good food to have cool just don’t eat take the flight don’t eat it there’s a real freedom which many people feel that [1:37:47] they are they’re in chains i guess to the food industry and to their their hunger and their stomach so [1:37:55] you know can you speak a little bit about that and why you feel that’s so important
yeah i i love the the fact that you use [1:38:02] that word freedom because you know i said okay it empowers a patient but it is a real freedom it’s a freedom that [1:38:08] that they know that what their behavior resulted in no [1:38:14] adverse effect and that they were able to overcome this which they never thought they could overcome so these [1:38:19] little hurdles that they’re overcoming in their diet actually has huge repercussions in other aspects of their [1:38:27] life and really honestly it it percolates into the into the workplace into their family life um in [1:38:36] their social interactions uh with their friends um and i’ve seen that these people they just they just become more [1:38:43] more uh self-confident um and
and i think it’s because [1:38:50] we introduce terms to them like that’s who you are [1:38:55] the real you - so it opens up a new aspect of their [1:39:00] existence that there is a part of me that’s separate and apart from my body and from [1:39:06] my mind and my cravings and my stomach and my feelings and and all these things and that’s the real me. and of course you [1:39:12] know this gets into some of that part that i have a huge interest in [1:39:18]- which is - who are you? yeah yeah what you know? who are you really? um [1:39:24] where is the you uh and why can’t you that that you [1:39:31] change uh your behavior of course you can because you need to change your identification. so this is an [1:39:37] identification change that i see the patients doing they realize that they are in charge, that that them inside them not the body [1:39:44] not the mind, is actually an awareness and amness - and i am. and that is huge [1:39:51] huge and i found that people who have done this program over the last few years they actually get work promotions [1:39:58] they actually become better supervisors they become just better family uh members and and [1:40:05] caregivers miraculous .yeah one thing because it’s showing them that yes you [1:40:11] are in charge look you can do it you can do it and they just self-empower themselves it feels so good [1:40:17] self-confidence just goes off the roof.
and i think that that that there’s a you know i’m learning more about this um [1:40:23] but but i think it does boil down to to because that also brings me to stress management. because [1:40:30] one of the things we do tell our patients is that you if you start getting stressed out during all this these periods where [1:40:37] you’re getting into the fasting period - you need to go out and do some some meditation. we tell them and we show them [1:40:43] how to meditate and i have a very simple meditation technique where i just basically ask the patients to okay just [1:40:50] close your eyes and just concentrate on your breathing only and when a thought comes [1:40:57] let the thought go don’t follow up on it because then another thought will come [1:41:02] in a few minutes don’t follow up on it. wait. just come back to your breathing [1:41:08]. concentrate on your breathing as the breath goes in and out and you will find that there’ll be gaps [1:41:14] in between your thoughts that get longer and longer and longer and my patients have all said yes you’re absolutely right. there’s blankness i said well that [1:41:20] blankness when you don’t have a thought or when you’re not thinking of something that’s you.(5) that’s [1:41:26] the real you. and when you come out of this for 15 20 minutes you will realize that there is that you [1:41:33] in you and you can make up your mind about anything you can you can do anything it will empower you and you’ll [1:41:39] feel less stressed out. you’ll feel less compelled, you’re less automatic, you will be [1:41:45] you you will become as you said - that word that you - you’ll have freedom, you’ll have freedom. [1:41:50]
and i find that fascinating so you see this whole thing. i said this in the beginning that you [1:41:55] know fasting seems to open up those that onion into all different parts of your [1:42:00] life. you know it’s just amazing stuff. i mean i love it.
i i just love it and um [1:42:06] if and when we have our second conversation i could see us going deep into who we are spirituality and [1:42:12] i i really do feel that’s a missing piece in medicine like it’s not just about telling someone what they should [1:42:18] do for their health. i mean people don’t really do what other people say in the long term in my experience. they might do [1:42:24] initially to get them going but at some point it has to change [1:42:30] from being the doctor’s plan to being my plan. at some point it needs to be like they [1:42:35] go on your three week unprocess your diet uh sort of regime. they start [1:42:40] fasting at some point maybe after a month two months - three months [1:42:46] you want that self-empowerment piece where it’s like yeah okay the doc’s guided me but i know [1:42:51] what i’m doing now i want to eat this way, i want to fast like this - because i [1:42:56] feel good when i do it so i’m now doing it not because he told me to [1:43:01] but because i want to and i think that you know - i you know i like to. i teach doctors i i always talk to him [1:43:08] about this this is a really important piece of the puzzle another thought. i had is [1:43:13] fasting is you know initially at least a difficult thing for many people to do and we kind of know that [1:43:20] when humans do difficult things whether it’s fasting for 24 hours when [1:43:25] you find it hard or whether it’s completing a half marathon when you know six months ago you can walk round the [1:43:32] block. what it does for us in terms of who we are and our self-esteem and our [1:43:38] confidence. it’s very very powerful isn’t it so i really love that you are bringing that [1:43:44] up also in the concepts of fasting
we have to you you know that there’s a huge [1:43:50] in health there’s a huge component of your of your your your mental being and and your understanding of who you are [1:43:56] and your role in in in in your life and the people around you um so i one of my interests and maybe we [1:44:03] can talk about this on other occasions is is you know - what are your relationships like? especially with your [1:44:09] mother - because that’s going to tell you how long you’re going to really live(4) - it’s amazing or [1:44:14] you know when my patients are in the hospital how many people come visit them after open-heart surgery determines how [1:44:20] quickly they’re going to recover from open heart surgery!(5) same surgery - what’s going on here? so we can you know [1:44:25] there’s huge repercussions on how patients healthy depending on their social and then how do they view [1:44:31] themselves in society and their role and and and the hierarchy in society and [1:44:37] that seems to also dictate uh outcomes in health - irrespective of how much [1:44:42] healthcare provide uh facilities are available to them. so there’s all these other social [1:44:48] determinants of health that are extremely important and i think that we don’t talk about that enough [1:44:55] and i think that that’s something that we need to talk about because in cardiology besides my fasting my other aspect is is i do want to get into all [1:45:02] that with my patients to see that you know - health is defined by [1:45:08] you basically metabolize your psychosocial [1:45:13] being you metabolize it into your body. so be careful about your thoughts - about who you are [1:45:20] and how you’re interacting with the world and everything that’s going around you - because in an instantaneous moment [1:45:26] you’re actually metabolizing it into physiology in your body - yeah fascinating stuff and i have lots of data on that [1:45:32] lots of it
well we are definitely going to have a second conversation because i think we’ve not even scratched the surface [1:45:38] of that uh just to finish off this conversation dr jammed us firstly thank you for your time i know you’re a super [1:45:44] busy cardiologist this podcast is called feel better live more when we feel better [1:45:50] we get more out of our lives and i wonder if we’re at the end of this conversation [1:45:56] you could share with your decades of experience as a cardiologist with all [1:46:02] the patients you’ve seen can you share with my listeners with my viewers some of your very top tips that they can [1:46:09] think about applying into their lives immediately after this conversation finishes [1:46:18]
- number one - eat only natural foods in its natural [1:46:23] state
- number two - eat infrequently [1:46:30], only when you are hungry.
- number three - sleep at least seven hours a day [1:46:38]
- number four - find pleasure in your life and activities [1:46:44] so that you don’t metabolize bad physiology from bad [1:46:50] habits. so find happiness. find pleasure in your life.
um and if you do these four things [1:46:58] you’ll find your health will turn around completely.
dr jaminas you’re incredible man you’re [1:47:03] doing incredible work thank you for joining me on the show and i’ll see you very soon no no thank you very much look [1:47:09] forward to it if you enjoyed that conversation with a real life working medical doctor i think you are really [1:47:15] going to enjoy this one this is probably the most effective diet that’s ever been promoted on the planet this protects our [1:47:21] body against decay disease and the root causes of aging is not only good for you but will make you [1:47:28] live longer