5-Day Fast: What Really Happens to Your Body | Dr. Pradip Jamnadas

0:00 The king of all hormones... is fasting. Doing time restricted feeding on a daily basis should become... part of your life. Stop... snacking. It's unnatural. You should only have two meals a day in a six hour interval. This is my recommendation number one. Now I got to tell you about stem cells because there's so much stories about all these treatments and I'm not downplaying them, I'm just saying that my fasting recommendations... boosts... your stem cell production more than... anything else. I know senescent cells are old... cells and these cells... have bad chemistry and they produce a lot of inflammatory molecules. So you take a senescent cells and put it amongst normal cells, it'll secrete all these chemicals around them and make all the other cells also dysfunction. In a fasting state, the senescent cells die off...

0:48 I've had a patient that fasted 183 days. He only had... water, black tea, black coffee, green tea, little bit of "MCT" oil, electrolytes in his water, and he went from 400 pounds to 210 pounds. He just looks so good. Look, you're going to get mad, okay? You have to take back your health. No one's going to take it back. Nobody. It's your responsibility. Doctor "J," it's great to have you back on the show... Last time we jumped right into the physiology of heart disease. This time I want to jump right into the practical, starting with your favorite modality, fasting. Why are you such a big fan? Well, first of all, thank you for having me back again. And yeah, that's my favorite topic, fasting, because

1:34 I have seen that fasting touches on so many different aspects of the physiology that is relevant to the prevailing problems that people have today, which is basically inflammation... And we know coronary artery disease is an inflammatory condition, so we know that type 2 diabetes, hyperinsulinemia, joint disease, even mental fog, mental diseases, premature aging, all of this touches on diet and fasting. So I stumbled upon fasting basically because the physiology during fasting is such that it touches all these different things... So I go to conferences, for example, and we talk about, oh yes, if you want to reduce

2:20 this particular condition, let's say, for example, autoimmune disease. And they would talk about the mechanisms and the chemistries of it all, or they talk about hyperinsulinemia and they talk about the mechanisms of it and obesity and aging. And at the end of it I would turn around and say there's one thing you can do that touches all these different physiologies... and improves it and that's fasting. And how did I stumble upon it? I stumbled upon it because of patience. I listened to my patients. My patients told me those who were fasting... were fasting for religious reasons. Others were fasting because they were overweight. But they would come in and tell me that, hey, "Doc," I started fasting and my joint pains went away within a week.

3:07 Or I started fasting, and look what happened to my blood pressure. My blood pressure went down. My patients who had sleep apnea started fasting, and they were telling me that the sleep apnea was gone just by losing only 15 pounds. Just by 15 pounds, because it changed the way... their breathing was. So I started listening to them, and I said, there's something into this fasting stuff. So with coronary artery disease as an inflammatory condition, I automatically became interested in fasting. And the more I read about fasting, I am convinced that fasting is supposed to be your natural way of living... Look, fasting is not a fancy thing to do it's part of your physiology. You're supposed to fast. You are made to fast. Your design was one of fasting.

3:53 In 2 million years of evolution, you are supposed to be fasting. You were made during that fasting just the same way as you are made with your bacteria, for example, and the environment... in which you live. Same way you were supposed to be fasting... And I realized... that's why fasting... makes your physiology better. That's why... fasting improves insulin resistance, reverses... type 2 diabetes, brings blood pressure down, reduces the rate of progression of coronary artery disease, improves joint pain, inflammation, gut health, microbiome, because it's supposed to be built into your physiology and today's... lifestyle. -- Fasting is out. It's gone. We eat so frequently,

4:39 and we eat processed foods. So putting the two together, I started implementing fasting into my own practice. And I've been doing that for about 10 years now. And honestly, if I could put fasting into a pill, I'll give it to everybody, because fasting has given me and my patients... the best results, which I wouldn't have otherwise. And losing weight, by the way, is not what fasting was all about. They did lose weight, but they lost weight because their physiology got better, because their hormones got better, because the inflammation in their body got better, and they felt better, and they could now move around more. That's why they lost weight. It wasn't a weight loss program. This is not a weight loss program. This is a... metabolic maintenance program... That's what this is. This is optimization of your

5:26 physiology, correcting the derangements caused by modern man, modern living. That's what fasting is all about. All right, let's take it from the top. Somebody brand new to fasting, say, I'm a patient of yours... metabolically unhealthy. How do you begin with them? Okay, it starts by how often are you eating now, because you're metabolically unhealthy. So obviously I need to know what you're doing now. First question, how many meals a day do you have? And the answer is usually three meals a day with two snacks or two meals and two snacks... What do you eat? Well, I eat a traditional breakfast, which is going to be some cereal and then some juice with it and maybe an egg. And then I'll have a snack in the middle of the day,

6:12 which is a sandwich, and I'll eat... a fruit with it. And then I'll have lunch. And what do you eat for lunch? Oh, I usually go out and I go to... a fast food place and I'll eat something and then another snack in the afternoon or in the evening. What do you eat? I'll usually find out that they're eating out a lot. They're eating in restaurants. I have to take a history because that tells me how they got metabolically sick. So that's the first part of the history that I take... Then I explain to them... that you are metabolically ill. And what does that really mean? We go into those details, but basically I tell them that you want to change these metabolic things... You need to change your relationship to food because food is not about nutrition only. Food is sending signals and messengers...

6:58 Food is a messenger to your body. These chemicals that coming in, they change your physiology. So you need to use food to change your physiology... It got bad... because you gave it the wrong message. You sent the wrong chemicals down into your gut and these messenger molecules... messed up your physiology. That's why you're metabolically sick. That's why your "HDL" is low, that is why your triglycerides are high. That's why your insulin level is high. That's why you've gained so much weight. That's why you have poor sleep, that's why you're getting joint discomfort, and that's why you're getting increasing coronary calcium. That's why you've got a fatty liver as well going on. -- I come back to the diet and say, now... because... of this modern lifestyle eating that you had,

7:44 we need to go back to fixing your physiology... by changing your food. First thing you need to do is stop eating so frequently... That's the first thing you need to do. Now watch, I didn't say you need to change what you eat first. I said you need to eat less frequently. That is more important. So... if you eat less frequently... and you're still eating some of the food that you normally ate, let's say you eat out every evening and then you do go out for lunch in a fast food place, but now you're only having two meals within a six hour period. That is still a great start to reversing your physiology than eating five times a day. So eating more frequently is more deleterious than eating the wrong type of food...

8:29 That's the first thing I noticed. That's the first thing. Because the body is more forgiving... when you eat less frequently. You see? So if I'm looking for efficacy, what am I getting? Is it the food that must change or is it the frequency? It's the frequency that's the most important thing... So I tell them right away, let's skip breakfast. Because honestly, I don't like breakfast. Now, there's always people that are going to say, oh, breakfast is very good. But I've yet had a patient who's told me that they skipped breakfast and they ended up in the hospital. They got gallbladder disease or they had trouble... No, no, it is true. Patients who start skipping breakfast, there's a small percentage of patients who can get gallbladder disease, but those are patients who already were predisposed to gallbladder disease.

9:19 So I don't think I've not seen it in any of my patients. So the first thing I tell them is you need to skip... the breakfast. Number two, all snacks need to go. Snacks are unnatural. You are not supposed to snack. Nature does not... encourage snacking. You're not made like that. The third thing is you got to eat in a window period. 18/6. That is my favorite. So that's what I do. The next step I tell them is 18/6, you need to start eating two meals in a six hour window. And I explain how they should do that... The rest of the time they're drinking only water or fluids that have no calories. And I do that in a metabolically sick patient. And I make them do that for about one month.

10:04 Then after one month they're getting used to this idea now. If they're still metabolically deranged after a month, then I step it up. The next step is going to be that, three times a week you're going to skip the lunch also and only go to dinner. And they do that... And then I monitor them. I'm seeing how much weight loss they've had. I'm monitoring their metabolic condition. And now they are eating... one meal a day, three times a week. So it depends on my goal and my metabolic parameters. ---- I'm just doing it, if it's weight loss... that I'm looking for and that's my final goal, then it's different from my metabolic goal. What is my goal with you? - My goal is... metabolic... Is my goal with you just weight loss?

10:51 What are you coming here for? So it is defined by that, but generally speaking, it's slow and steady. You cannot take somebody who's eating five meals a day, three meals a day, and straight away go to fasting because... you will get a failure... And my success rate is because I bring them into fasting gently. Look, you cannot just start fasting right away because you will go through what is known as keto flu. Keto flu, I'll explain what that is. So what happens is that in the first 12 hours or so, you've burnt out the glycogen that's in your liver and in your muscles... And then after that, for the next eight or nine hours, you have some gluconeogenesis going on, but your ketones haven't kicked in. Ketones come from fat

11:37 because you have two types of physiology. Glucose metabolism or fat metabolism... Your fat metabolism stuck because you never used it. You never used it for a long time. And you can't just turn it on like that. You got to prime the pump. So if you think that you're going to go straight into a fasting program. I'm sorry, you're going to fail. You're going to fail miserably, and you'll feel lousy, and then you're just going to shut the book on it. And that's wrong because you just denied yourself something that is so valuable to your physiology. So you need to understand. So education is really important. So I do educate the patients. Say you got to watch my videos. You got to read my articles that I give you in my office. You have to turn on your... ketogenesis, and you do it gradually.

12:24 And the only way that the ketones will come in... is that free fatty acids need to be released from your fat stores. And the only way your fat stores will release... fat... is if your insulin level comes down. So if you have severe hyperinsulinemia which is basically very rampant nowadays. It may take you... 20 hours... before your insulin level comes down, and then you start generating some ketones... So depending on the patient, 18 hours, sometimes 20 hours, sometimes 24 hours, before I notice some ketones spilling into their urine. So I motivate the patient, say, you want to know how good you're doing... and you want to know whether... your fat stores,

13:10 especially the visceral fat. Visceral fat, that's the fat in your liver, around your pancreas, around your pericardium, ectopic fat, the fat that's in your coronary arteries, for example. If you want to mobilize all these fats, which are the bad fats. Go home and buy some keto sticks. Measure the ketones in your urine. You will know when you're making ketones, so don't be dismayed. So I make them a partner in this. Don't get... dejected that you're not making ketones at 15 or 16 hours. Of course you're not. Maybe you will later on. Like Doctor "J," I stopped making ketones very early in my day. By about 15 hours, I'm already well into my ketogenesis because I've primed my pump.

13:56 So you as a patient... need to understand what that means, otherwise you're going to just fail... miserably... So as they do more and more of this, the patient notices that, my goodness, yes, I did make ketones only on my "OMAD" days, which is one meal a day... only on those days. But on the other days, I wasn't making much ketones until about 20 hours, or actually 18 hours, right before I break my fast. So I have to educate the patients slowly, then gradually more and more fasting. And then after they've done that for another three weeks or so, then I say, now you are ready. Now you're ready to do a prolonged fast. That means a three day water fast, or a five day water fast,

14:41 or even a seven day water fast down the road... But by this time, they will now be able to successfully do it. So "Jesse," it's not just about start fasting tomorrow. No, your body has to readjust itself. The metabolism has to change and it has to change gradually... So the first thing is the frequency of the eating. And then of course, we talk about what to eat, which we can talk about, of course, but you got to stay away from all that garbage. Modern man food. You got to go back to real food. Real food not products. Don't eat a product. So basically, there's some degree of stunning. You got to stun the patient... Wait a second, you mean I'm not eating food?

15:27 No, you're not. You're not eating food. You're eating products. Now, who told you to eat products? And suddenly the patient turns and says, oh, my, yes, I am eating products. What is a product? A product is food that has been changed into something else. It's not the way nature presented it... Even skim milk is a product because cows don't deliver skim milk straight out. We make skim milk. So it's no longer a natural product. So then we talk about food. So I stun them about the food choices. And all of a sudden by using phrases like this, that you're eating a product, I motivate my patient to look at your food and define it for me. Define it.

16:13 Is this real food or am I eating a product? And if I'm eating a product, why, -- who told me this was normal to eat?.. And I'm... training them all to understand that your body is not made to consume a product. Your body was made to -- consume real food. So gradually we change their... eating habits as well. If I throw too many things at one time to them, it does kind of throw them off and it makes it more difficult. But a gradual change in the shopping habits is very important. So we do do a lot of education on what to eat as well. All right, we're going to come back to what to eat, but I want to stick on fasting here for a bit. And I noticed when you were easing somebody into fasting,

17:00 the angle you took was dropping breakfast and then even dropping lunch. What I'm curious about is depending on the person and their metabolism, where they're at on this journey, and also depending on what their lifestyle dictates. Their work, family obligations. What do you think about flipping that around and having breakfast and lunch and then skipping dinner? Great question. I knew you were going to ask me this, because if you're given a choice, that's what you should do. But today's lifestyle for most people is that they come home for dinner. - For example, I have dinner in the evenings only... with my wife because I can't have lunch with her because I'm too busy. And if I skip dinner with her,

17:45 I don't think I'll make a very happy wife. - My lifestyle means that I have to eat dinner in the evening. So I try to get over by 6 o'clock because we want to get to bed. I want to get to bed. And my dinner there has to separate by three hours. So depending on your lifestyle, try to have lunch... I think that lunch is the most important meal and I'll tell you why. Because every organ has a circadian rhythm to it. And the circadian rhythm of your liver and your gut is such that they are most... active in the middle of the day... So you are more likely to digest your food more easily without the detrimental hormonal derangements that we get by eating lunch... now. So if you're going to do 18/6, you can do breakfast and lunch.

18:31 You are absolutely right. And lunch is actually more beneficial. I use the example of the dinner because that's just for working people. And even for me, that's what's happened. But one day I will go to lunch. If I have less... obligations here at work, eventually I'll have lunch. Now you can bring lunch to work as well. But I usually work through my lunch as well... So there you go. But yeah, lunch is better. You are absolutely right. So you got to individualize. It's what suits you. So long as you do some time restricted feeding. That's what it's called. Time restricted eating, time restricted feeding, that is now a conscious part of what you need to do. It was previously... done unconsciously because food was never available all the time.

19:17 We didn't have all the conveniences, we didn't have refrigeration, we didn't have the convenience of food all the time... So it was there all the time. You always... were supposed to do time restricted feeding. That's how you evolve. You made a kill, you ate it now and then you eat it again... before it gets bad and you are done. And then maybe you're not going to eat again for another day or so before you make another kill. But it was in that time. By the way, let me talk about time. Look, how many generations do you think have gone by for "Homo sapiens?" -- We would say total is... probably anywhere between 15,000 generations. How many generations have we had in the agricultural...

20:02 revolution? And the answer is probably about 500 generations we've spent in the agricultural revolution. How many generations have we spent... in the industrial revolution eating this way now in the modern life. - And it's very little, it's less than 50 generations. So... for the most of our existence, our genetics is used to eating in a totally different way. And now it's totally different. How can you adapt? That is why I always talk about this, look, if you want to continue eating this way and eating the type of food also this way and the frequency of eating, you will eventually adapt. 10,000 years from now. Then you'll adapt to it.

20:49 It'll be too late for us. In the meantime, it's going to be very, very difficult. And look what's happening. We have an epidemic, as you know, of chronic diseases. And we're spending more money on chronic diseases which are all... self-inflicted wounds. Exactly what they are, self-inflicted... wounds. And we need to wake up to this. So basically, I sit down with the patients, we have this conversation... and it does shake them up quite a bit to understand that these are self-inflicted wounds. -- What's becoming apparent really quick is the fact that what you're doing here with fasting and getting rid of these processed foods... is you're saying, let's try and live like we have over the past

21:35 however many years, as our ancestors did, but not remove ourselves from modern life... How do we still get the proper inputs but be in this modern world so we can make our genes happy... and live a happy life? Yeah, so modern, we are very fortunate. We should be very glad that we're living in a modern age also because we do have the conveniences of these food. We don't need to go out and hunt anymore. I don't have to climb up the tree to go and get some honey anymore. And I don't have to make a kill... and then walk all the way back for four hours after my meal, back to... my home. So modern man has given us everything. We've taken it for granted. I can go out... today

22:21 and source my food. I'm not telling you to go out and hunt. Make the right... choices in your foods. So go out, don't go to the supermarket once a week, go there every day, buy fresh food, fresh fish, chicken, turkey, fresh eggs. Buy in small quantities. - Get rid of convenience. Because conveniently... you will die. Conveniently... you'll get sick. So modern man, I have a car, I can jump in my car and go to the supermarket. Buy daily, buy small amounts daily. So yes, modern living can amalgamate with... the food choices that I'm saying.

23:07 And don't go in the inner aisles of the supermarket, stay on the outside. And -- that way modern life, so convenient for us. We can do this, but you have to consciously do it. So... I don't think that there's a breach in the two between... the way our ancestors did it. Yes, they did, out of necessity at the time and they had to go out and hunt and fish and do all these things. And they only came across a few... foods here and there once in a while. And in fact, that's why, by the way, that's why for millions of years, we have a dopamine center that was a reward center. And the reward center was for what?..

23:54 It was for calories. So when you suddenly found lots of calories in nature. Let's say you suddenly came across some honey and you consumed it. The... brain, the dopamine center lit up and you felt a sense of reward... And if you continue to do that, reward, reward, reward, you become addicted. So what's happened in man today is... there's one part of this, "Jesse," is that... I think that people are addicted, and they're addicted to the food because the... types of foods that we are eating today, caloric, dense food, processed foods, makes us addicted to it. Because we have that...

24:40 innate physiology in us... You all have dopamine centers, you all have rewards. We need a reward center. Without a reward center, the human experience... would be meaningless. So what's happened is that I'm not saying that the food industry has exploited it, but our lifestyle has made it such that our reward center has been hijacked. Hijacked by your food. So I also talk to my patients about this, that, realize that there's a possibility that you are addicted now. Therefore, consciously eat now and consciously be aware of the symptoms that you may be going through. For example, so you started your fasting program. Doc, I'm shaking like crazy...

25:27 I get these sweats, and I have cravings for the food. And I say, but didn't we talk about this, that perhaps you are addicted? Yes. Because again, it's your... paleolithic mechanisms... that are kicking in over here, that your dopamine center, the addiction, is there. And what you're going through is true withdrawal. Because I put a continuous glucose monitoring on you. And it's not that your blood sugar has... dropped. It's not that you are hypoglycemic, although you will feel good when you go out and eat again some junk food. And you'll say, oh, I had some calories, I've ate some chips, or I had... sugary food, and I feel so much better after. That's just because you just

26:14 got your shot. -- I think that... education, that's why I love what you doing, because what you doing here also, with everything that you do, you're educating... everybody. And this is important to us because a lot of people don't understand, addiction is... real. It does happen. And it's the same dopamine center, by the way, for heroin or for gambling and other centers. - And even smoking and nicotine and sugar, all of them share the same dopamine pathway... And that's a slippery slope because you can fall easily if you're addicted to one into another... and into another. So I teach them all this, that, listen, this could be addiction. And the way to overcome this addiction

27:01 is become consciously aware of it. And just like my alcoholic patients, I'll put them in the hospital for three days. And after three days, the cravings do go away. So long as they don't take alcohol again the same way your cravings will... go away... It's not going to be end of the world. You're not going to die. Yes, you're going to feel terrible for... maybe a day or two and you may get some shakes here and there, but eventually... your addiction will go away. It'll only take... maximum a week, but your addictions will go away. You got to give patients encouragement. Patients need to know that nothing comes for free... You are going to go through some hard times. That is why fasting is not to be done only on your own. You need a group of people around you, maybe a spouse, maybe a brother,

27:49 sister, somebody, a friend that is going to help you do the fasting because you need somebody to support you in the right way. Of course, some people can support you in the wrong way and encourage you to start eating again. But no, that is why when you're making these changes, it's nice to have somebody. And the trouble today with the medical profession is that we don't have the support... system for this type of stuff. Imagine you came to see me and you said, okay, "Doc," I've got sleep apnea, hypertension, diabetes, and I want to do all this stuff. And I said to you, okay, you're going to do it. And you go through all this and you want to walk into my office and come see me in 48 hours again as a patient. --- Your insurance company will be crying out aloud. That's the problem.

28:35 The system is wrong. Whereas you should be able to call me up. So that's why I have a clinic now. So you can at least call up, speak to somebody, get some help, understand what's going on and give them the encouragement to say no, that's perfectly normal. -- I understand what happened to you... Don't worry, you're going to be okay. Take a face cloth, put it on your head. Take some nice deep breathing. Go drink lots of water right now. Take some "MCT" oil. Take some electrolytes in your water. And lie down for a few minutes. And after 15, 20 minutes, you're going to feel a lot better... It will go away. This will pass... Hunger, this will also pass...

29:22 Your ghrelin level will fall after one hour. Ghrelin... is the hormone that makes you feel hungry. It never stays up forever and ever, otherwise you die. After one hour, the ghrelin levels come down, the hunger's gone. Oh, my God. What happened to my hunger? Well, it doesn't stay forever. Nobody starts getting hungry at 1 o'clock and by the time 6 o'clock comes, they're going to eat an elephant. No, it's not going to happen like that. Your hunger is gone by three o'clock. So we got to teach people about these things that hunger will come, it'll go. Withdrawal symptoms will come, they will go. And as time goes on, it will... get better... Now, you need to be smart. You need to know that if you're a diabetic, you might want to do continuous glucose monitoring.

30:08 But... education... in a diabetic patient means if you're taking insulin, you need to stop it when you're fasting, especially when you're doing prolonged fasts. If you're taking diabetes medicines, you need to stop it because your glucose levels may plummet. But if you're not a diabetic, you don't even need to do continuous glucose monitoring... because your sugar levels will never become hypoglycemic. They may go down to 60, but you do not become hypoglycemic and then start getting seizures or something like that, unless you continue to take insulin... Insulin will drop your sugar levels, but fasting will bring it down to normal, bring it down to 70, 65, but never into the 50 or 40 range. So a lot of education... for the patients...

30:54 is needed when they're doing all this. - Early in the conversation, I heard you say something when we were talking about easing somebody into these fasts for the first time and depending on their goal, it being a bit different whether they're trying to regain metabolic health or lose weight. And obviously, if they're regaining metabolic health, one of the side effects will be weight loss. But talk about that nuance... between how you'd set up those fasts for those two different situations. You're absolutely right. - If it's for metabolic change, I don't want my patients to lose too much weight, although they will lose weight, and it'll be visceral fat. So let me just

31:39 tell you a little bit about visceral fat... So... fatty liver... is visceral fat. Fat around your pancreas is visceral fat. The fat that you can pinch on your belly, put your hand on it, and you squeeze your fat on your belly... That is just subcutaneous fat. There is a totally different... physiology of that fat from the visceral fat. Visceral fat is... toxic... If you did a biopsy of it, it's full of inflammatory cells, lots of inflammatory cells, and they'll be producing lots of cytokines. And that's why they destroy even that organ... That's where the liver can get destroyed by people say, oh, it's just a... fatty liver. No, it's not. It's an inflammatory condition.

32:26 So it's important in metabolic patients that I want their metabolic... The fat that's in the liver and the fat that's around the pancreas has to go away. So they will lose some weight. When they start doing this, you can... do an ultrasound of your liver to look at the fat. You can also... now measure... visceral fat. There are some machines that are available. The "DEXA" scan machines can measure visceral fat. And... you can also do it on a "CT" scan, which I just started doing, to look and quantitate the visceral fat. So on my metabolic patients, I'll have a parameter to follow to say that, yes, you did lose 20 pounds, but it came out mostly from your visceral fat.

33:12 And here's the numbers. You don't have to do all that. You don't have to be that fancy... But in metabolic patients, they will lose some weight. -- The weight loss will be mostly visceral. And my patient's first words out of the mouth is that my stomach went down. If you are lean everywhere and you have a big stomach, you have a problem. And that stomach will be --- tight. There's not too much fat to squeeze on it, but it's out there. And when that goes in, in metabolic patients, they're going to lose weight. But that's what I'm looking for, because the first place that you lose the fat is the visceral fat... So... first and foremost, look at yourself in the mirror. If you're not... fat

33:57 but you have a belly, you have a problem. If you look at you sideways and your belly is sticking out, but looking from the back, you look great. You have a problem. If you're a man and your waistline... is more than 35 inches, you have a problem. If it's a woman and it's more than 33, 34, there's a problem. There may be. And look not everyone's going to have a problem. They are metabolically normal obese patients. They don't have inflammation, they don't have metabolic disease, they don't have high "CRPs," they don't have a low "HDL," they don't have a high triglyceride and they don't have high blood pressure. They don't have visceral fat. So not every obese patient is metabolically deranged.

34:45 If you're metabolically deranged, the fat from your belly has to go, so when they lose weight, I'm not asking them to lose total body fat. And many patients come to me and say, oh, my muscles are going to be gone and I'm going to become... frog legs. And I say, that's absolutely not true. In fact, if you take two cohorts of patients, one is on a low calorie diet, but spaced out five times a day versus the one who's doing fasting. The one who's doing fasting will actually maintain more muscle mass. And I want you to know that because... fasting makes you lose preferentially the fat that's in your ectopic fat first, the visceral fat. The colonic restriction patients,

35:30 they will lose fat everywhere, a little bit from the visceral fat, subcutaneous fat and from the muscles as well... And this study has been done and has been shown because the physiology of fasting is different from caloric restriction. Calorie restriction spread over the day is different from no calories all day long and then calories only in a time restricted fashion. In a... fasting program the growth hormone levels go up the longer you fast... Growth hormone maintains muscle mass. You get "BDNF," brain derived neurotropic factor. You also get autophagy, which of course we can talk about all these beautiful things that happen to the body in the fasting state.

36:17 You get stem cell mobilization. All these things happen in a fasting state. In a caloric restriction state, these findings are not there. So the physiology is totally different... You have to do the fasting. So in the metabolically deranged patients, they will lose some weight... And when they are eating, when they are eating, I'm not asking them to count calories. I don't count calories. It's very simple. Eat... real... food. Life is complicated already. Don't be taking pictures of them and saying, oh, I got so many fats and so much carbs and so much this. It gets too complicated. Life is complicated already. Just simplify.

37:02 You have metabolic disease. You're going to do time restricted feeding. When you do eat, I can't tell you what to eat. You may be Chinese or you may be Indian or you may be American or you may be European. You're going to eat what you normally eat. But whatever you eat. However you cook it, however you do it, make it all... natural so it has to be real food. And don't kill your food. That means don't overcook it. And we'll talk about this advanced glycation end products, burning foods and the way you cook it. And don't put wrong ingredients into it... like vegetable oils and stuff like that... So my feeding pattern is very simple. You metabolically say, okay, fine, I'm not counting your calories, I'm not restricting how much you eat.

37:48 Also, when you do eat. You will sit down and eat till you feel good and then walk off the table. But you're going to be eating real food. Now, my obese patient. He's a little bit different. He needs to lose a lot of weight... So I'll just give you an example. I just saw a patient of mine yesterday who came about seven or eight weeks ago... and he was, he was quite obese. And I gave him this introductory pattern of what to do. And I wrote it all out for him that, for two weeks you're going to do the time restriction in a 18/ 6 fashion. And then you're going to start giving me a three day water fast and then go back to eating one meal a day for seven to eight days and then do another three day water fast. Because with him I was far more aggressive...

38:34 because I wanted him to lose weight. He came back, he already lost 46 pounds. And he... was doing the urine tests and he says that when I'm fasting... now by 30 hours, my urine dipstick, which cost pennies, showed that my ketones were dark blue off the chart. Now, as a patient, you know how good he felt when he saw that blue. You need to do that so you motivate yourself. All this blue stuff, where is the blue stuff coming from? These ketones, they're coming from your liver. How did they get to your liver? It came from fatty acids being converted to ketones... in your liver.

39:21 Where did the free fatty acids come from? They came from fat. Every molecule... of ketones that you saw in your urine came from fat. You're basically peeing away. You're peeing away some of your fat. Now take that home. So the difference in him was we wanted him to lose weight. So what he was doing is excellent. He was doing three day water... fast and then five to six days of "OMAD" again and then three day water fast and five to six days. I won't do that to my metabolic patient. My metabolic patient is more gradual. This guy's going to lose a lot of weight. And also what he was eating was very important.

40:06 So with this particular patient. I did tend to make sure that his meals, of course, are not huge, massive meals. But I already knew that he was having problems with certain types of foods. So I had basically asked him to restrict his diet to only the foods that he was not allergic to. So he was basically eating... fish, chicken, turkey and eggs and a little bit of vegetables on the side. So he was on a modified carnivore diet... And he started losing a lot of weight and that enhanced his ketogenesis, you see. So I'm manipulating him a little bit more than I did by metabolic patient. My metabolic patient I'm a little bit more careful with. And... so I'm individualizing a lot. I'm very aggressive with obese patients. So

40:52 "Jesse," I've had a patient... that fasted for 183 days. 183 days... he had... no food. He only had... water, black tea, black coffee, green tea, little bit of "MCT" oil, electrolytes in his water. And he went... from 400 pounds to 210 pounds. And when he walked in here. Nobody knew that he... lost all this weight. He just looked so good. Now how come he looked so good? Because his skin was not hanging under his arm and his face didn't look like it was a skeleton with the skin just hanging over it. Oh my goodness, look at him. No,

41:38 his skin was nice. His belly, he didn't have an apron. Now you know what I'm talking about, where the patients have lost all this weight all of a sudden and all the skin is there and now they have to go for plastic surgery to remove it... And the question is why didn't that happen? Why didn't that happen? Because when you do... fasting and you get autophagy as well, and the fasting physiology takes away some of the... skin as well, so your skin actually retracts. It's not just getting rid of only fat. Because if I did a total body liposuction on you, you'll be left with all the skin. So in my diet program, my weight loss program, my fasting programs, I see that my patients skins are better

42:27 under their arms. They don't have this thing hanging out versus those who do it in other ways. Including... drugs, by the way, weight loss drugs. I've seen it in them because remember, not every patient's going to follow my advice. Some of them come in here and they've already been given drugs. Yes, they've lost 40 pounds or 30 pounds, but I can tell from the moment they walk in through the door, I can see their face and I can tell them that, yes, you've been on drugs and I can see their arms and the belly. It's a different type of weight loss. Fasting is a different... type of weight loss. And... it's the weight loss that... millions of years of evolution has supported and your physiology has supported you.

43:15 --- He's an extreme... But I've got... dozens and dozens of patients that have... fasted 50 days, 40 days, and they had dire circumstances that... bad diabetes, joint disease, sleep apnea, just name it. They were basically... dying. And you got to do this. But they come back... feeling amazing. And their energy levels are extremely high, by the way, because look, one thing you need to understand. When they get into ketogenesis, these patients feel amazing, their energy levels are good. I feel amazing when I'm in ketones. -- My brain functions better,

44:02 my reflexes are faster, my memory is great. -- By the end of the day, people say to me, doctor, at 5:30, you're still so sharp, because I'm probably making a lot of ketones at that time. - So ketogenesis does give you a certain effect that is just very useful. So I find that patients feel lousy. So... backtracking... day one, a little bit hard, but "Doc," I managed day number two a little bit harder. I got really hungry at the end of the second day, so I really, really had to force myself to just to go to bed... takes a little bit of "MCT" oil. I took the electrolytes, they did make me feel better... And then I went to bed. Third day, I began to feel a little bit nicer, but it was also kind of a rough day. But

44:49 by the time my fourth day came around, I felt good. I did not go through any problems. I was full of energy. And on my fifth day, I was really on top of my game. I actually even went to the gym because you told me to exercise in a fasting state. So I went to the gym. I felt really good on the fifth day. And honestly, "Doc," I could have gone on, but you told me to do five days, so I stopped at five days. So how often do I hear this? I hear this all the time. It's not "Doc," I was miserable on the second day, and third and fourth was even worse. And on the fifth day, I was just terrible. No, they get better. So the endurance is important. So again, educating the patient, giving them the support.

45:37 Support how? How?.. You need a coach. You need a team that you can call. Hey, you call my team that I have over here, for example, this is what I'm going through. This is what I'm feeling. And we can guide you through how to get through that. But the worst day usually is the third day. But after the third day, prolonged fasting becomes easier and easier to do, and you just got to get mad. Look, you got to get mad. - Just get mad because... you have to take back your health. No one's going to take it back. Nobody. Nobody. It's your responsibility. And this is something that I tell patients that

46:22 it's your responsibility, and you need to take your life back. Do you love yourself? Do you deserve it? Do you deserve better health? Do you deserve better relationships? Do you deserve more out of life? So part of this is all psychology as well. Talking to patients and motivating them to say, this is what's at the end of this tunnel here. Let's do it. And you just got to get determined, and you just got to say, that's it. I'm going to do this. That's what I want. So doing this is really, really important. That is why I'm saying that... fasting touches on metabolic obesity, joint dystonia, coronary calcium atherosclerosis, inflammation we talked about the plaque ruptures,

47:08 all that goes down. Inflammation. The gut. Oh, my goodness. We can talk about the gut. The gut changes completely. Of course, the patient comes to me on the third day. -- I used to have a bowel movement every day... Now I'm having a bowel movement every other day. And I said, well, nothing went in, so nothing will come out. That's okay. Nothing wrong with that. Oh, but you told us that you need a good bowel movement a day. I say, yeah, when you're eating, you need a good bowel movement at least once a day. -- --- There's some things that they need to get used to water. Now, I can tell you more about water. Why is water and electrolytes so important.

47:53 And now I'm going to explain to you why it's important. So don't try to do dry fasts. --- 10 glasses of water with electrolytes at least once a day. Why do I do that? Because as your insulin level comes down. Your sodium level in your body goes down because insulin holds on to sodium. So now when your insulin levels come down, you're going to pee out the sodium into your urine. So you can get intravascular volume depletion very quickly. When you are fasting, patients come back and tell me, hey, I was fasting and I made more urine on the days that I was fasting. Well, of course... because you're getting what is known as natural

48:40 salt coming out in your urine, the salt that your body held onto because your insulin levels are coming down, and therefore it's releasing that salt. So you can get intravascular volume depletion... So you need your electrolytes if you're getting cramps. You need to take electrolytes. So the electrolytes that I use is called "LMNT." -- Sometimes I just take Celtic salt, half a teaspoon, put it in a glass of water, shake it up, drink it... Sometimes I take Himalayan salt, put it in there, shake it up, drink it at least once a day, especially if you're getting cramps. I do do that because that electrolytes are really important. If you're feeling terrible, getting a headache, you're lethargic, you're feeling tired, what are you supposed to do?

49:26 First things first, take your blood pressure. Make sure it's not too low. If your blood pressure is low, you have a problem, you call your caregiver and say, my blood pressure usually runs 120. It's now only 90. You probably vary volume depleted and electrolyte depleted. So if you're taking blood pressure medications, you need to stop that... And then I tell them, okay, fine, you just need to be rehydrated, come into the office and maybe I'll give you an "IV." Don't do that to every patient. But occasionally, maybe 1 out of 20 patients, I'll put them in the office for an hour or so and give them some saline and then off they go. But you can do this... How? Drink water. At least 10 glasses of water a day. Put some electrolytes in, at least one or two glasses a day. So you're going to get there,

50:12 and they come with the minerals and everything else. What is "MCT" oil for fasting? "MCT" oil is a short chain fatty acid. It's immediately available to the body as soon as it goes in for metabolism... And... who's metabolizing this? Who's using it? It's your mitochondria. So obviously, how are you going to feel? Mitochondria starts utilizing it immediately. It's a great energy source immediately for your body. So you're feeling down because... maybe your ketones haven't kicked in yet. Maybe it's day number two and your ketones haven't kicked in yet. You take some exogenous "MCT" oil and you will find that you'll feel so much stronger and so much better.

50:58 Women, if they take more than a tablespoon. They can get some loose bowel movements more than men. You can take a tablespoon a day without any difficulty. In most patients, you can even take 2 tablespoons if you get used to it. So I do use "MCT" oil in my patients to help them overcome the fast. -- And then I do use green tea and black... tea, black coffee. In some patients, I do add some fat... because they say, Doc, absolutely, I'm so hungry. --- I'm going to basically break my fast and I'll tell them, okay. You like coffee? Yes, I missed the cream... All right.

51:45 Put a little bit of butter in it. So they'll take a small piece of butter, maybe a quarter teaspoon, even half a teaspoon, and they'll put it in their hot coffee. And you'll be surprised... what it does. It doesn't break the fast, but it satiates the patient immediately. His hunger goes away, and he's able to come through. So all these are little clues that I give the patients that they can actually do - during the fast. They should not do other supplements that come with colorings and artificial flavorings and... sweeteners. No, you're fasting. You want to detoxify because part of fasting is also detoxification, which we haven't even talked about yet because we've been talking about metabolism... But fasting, what it does to your microbiome and what it does to...

52:33 your detoxification, that's a... huge topic which we can talk about. But fasting touches on all these different aspects. So don't toxify yourself while you're trying to detoxify through fasting. So very important stuff. Yeah. Getting into some specifics here with the "MCT" oil, how do you feel about the liquid versus the powder?.. And then there are different carbon chains. The "C8," the "C10." Do you find a certain one's better than others? Not really I don't even differentiate. And whether you use the powder or the oil... makes no difference to me whatsoever... Absolutely. I'm a practical person. As long as it worked for you, I'm fine. See, there are some people who slit hairs about these things. Oh, the oil versus the powder.

53:19 I'm very practical, down to earth. What's my purpose of giving you "MCT?" To make you feel better so that you can hold on to your fast. Because that's my goal with you... Make you fast and don't break your fast. So I have no problems with that whatsoever. Yeah, yeah... And I don't get into the "C8," "C10" stuff because I don't think it's clinically that relevant. -- I haven't seen too much data on that either. -- What about exogenous ketones? Jumping right over that step of converting the "MCT" into ketones and just putting them right into the body. How do you feel about that? There is information on that and there is data to show that. "Rhonda Patrick" talks about that as well

54:06 with "Dominic" and they talk about that. And yes, it does help. Have I done it to many patients? I can tell you I've probably done it to a handful of patients where I've given them exogenous ketones because they do become an immediately available... energy source. So when would I probably do that? When would I do that, give them exogenous? Somebody who really needs to do the fasting absolutely has to do it... And they just not able to overcome the lack of energy, the symptoms of extreme fatigue, tiredness that they're feeling... Then... I sometimes may say that, okay, you need to go out and get some exogenous ketones into your system

54:52 temporarily. - And I might do that, but I exhaust all other possibilities. So that's the last resort. But it does work, by the way. -- It does work. Does it makes your symptoms better?.. Does it improve your overall physiology of the weight loss, the goal? No, it doesn't. Because the ketogenesis that you get from fasting... and the subsequent biological effects, which is the autophagy, the brain derived neurotropic factor, the stem cell mobilization... will not occur when you inject the other substances, "IV." It's a different physiology. Yes, you're going to feel a little bit better, but you're not going to get all that other benefit because ketogenesis is just one part.

55:38 Your ketones are there, yes, but they are a product of your physiology that changes. That's one thing that changes. But there's a whole bunch of other chemistry that's in the background... because of the fasting, not because of just the ketones. Now ketones themselves are helpful because they burn better and they're an energy source for the brain as well as the rest of the body. But... if you just get ketones only, you're still missing out on all the other biochemistry that occurs because of fasting. Fasting is not only about an energy source, it's truly... about your metabolism. It's about "mTOR," it's about "AMP," it's about your "NAD," "NADH" ratios, it's about your stem cells, which we can talk about also. Oh my goodness, and it's all about your brain derived neurotropic failure growth hormones.

56:24 All these things change with fasting. Fasting is the way. There's no real shortcut. There's no shortcut. I can hack --- your symptoms with some supplements, but that's about it. That's not the goal though. So earlier you went through what it would feel like for a patient to go through five days of fasting. You've named all these benefits that we'll get from fasting. Why don't we overlay on top of all this, when somebody stops eating, they just had their last meal, they're going to embark on a five day fast. Let's go through and talk about the different physiology changes, these different benefits you've been talking about when they kick in... and really take our time

57:11 and explain all these magnificent benefits somebody will get. In the first 12 hours, it's basically going to be your glycogen that's going to be depleted from your liver and from your muscles. And that's an immediate... energy source like your current... account. It's cash coming straight out. Then... the gluconeogenesis comes in and that will sustain you for probably another six to eight hours, maybe nine hours. But at some point you're going to run out of glucose and you're going to start making ketones. Now you and I, we all, by the way, make some ketones every day... It's just that we don't make a lot of it.

57:59 Ketones come from the muscles. All of us make some ketones, but most of us make very little. And the ketones will usually kick in probably around 18, 19, 20 hours, tiny amounts of it. But as you fast longer, the ketone levels will go higher and higher and higher. So hopefully by 36 hours you're really into ketogenesis. Now the other change. Autophagy the change that's going to happen, autophagy. You should expect autophagy to happen around 36 hours in the average patient. Hoping that autophagy is going to happen in 24 hours is. There's always a little bit of autophagy also. - Everything happens in small amounts in everybody because you and I

58:45 are still having autophagy. All of us are having autophagy... It's just the extent of autophagy is very minor. So the average person -- that's eating three times a day, who's got metabolic disease, he's also having some autophagy. We all have to have some autophagy. But he's having very little autophagy as a result of that. His cellular mechanisms are not very efficient. Autophagy means that when the body senses... that there's a energy deficit, the chemical changes that occur include a decrease in your "mTOR," increase in your "AMP" and the ratios of certain chemicals in your body

59:31 and your "SIRT," S-I-R-T, which are certain chemicals, and your "FOXO3," which is a certain chemical. They start going up... in your fasting state and they send a signal... to your cells to say, hey, I am here now, my job is to take all these redundant chemicals... and redundant protein molecules that have been just sitting in the cytosol of your cells, break them up, package them into little lysosomes and export them out of the cell... so that the breakdown products can be used by the body, who at this time is in a fasting state and needs these... How does the body give the message to the cell? It gives it through all these chemicals.

1:00:18 The "AMP," the "SIRT," the "FOXO3." So these are the chemical changes that initiate the autophagy. The autophagy results in a more efficient -- cell. The cell's efficiency is in its ability... to then make proteins, the "RNA," the endoplasmic reticulum, all that also improves. But also... your... mitochondria improve... and your genetic material improves. So I'm going to explain what my mitophagy is. Mitophagy, that means your mitochondria... in a fasting state like this, under the influence of these chemicals, your mitochondria. It's funny that nature makes mitochondria and we think that all mitochondria are the same. They're not.

1:01:04 -- They have some human tendencies. Some get lazy, some get round, some get fat, some get long... And they become inefficient. So inefficient. Inefficient mitochondria are no good because those mitochondria make a lot of reactive oxygen species and less "ATP" in the electron chain. So... what happens here is that these mitochondria that are not efficient in producing "ATP" and they produce more reactive oxygen species instead. That means they kind of dirty mechanisms, these mitochondria get knocked off. And in return you get division...

1:01:50 of other mitochondria and production of new mitochondria... Because these chemicals go to the "DNA" of the mitochondria, turn on certain mechanisms and make new mitochondria... These new fresh mitochondria. They get poured into the cells. Why does a child's mitochondria is so different from an adult's mitochondria. So you're producing these new mitochondria which are much more efficient, much better... because the body is trying to renew itself to make a better specimen out of you... Fasting creates a better specimen out of you. It improves your cells, it proves your mitochondria,

1:02:37 it repairs your "DNA." Your "DNA" undergoes changes under these chemicals. Influences "FOXO3," for example. So you'll repair your "DNA," your histones. Oh wow. What are histones? Histones are chemicals that cover over your chromatin material and when they unfold, they release, they open up. And now certain genes get expressed. So now these genes can translate and make new proteins. So these chemicals, when they are there they... make your chromosomes... start making new things.

1:03:22 And some of these new things are anti-inflammatory chemicals. So when your "FOXO3" is high, when your "SIRT1" is high, your "Nrf2" will be turned on. What is that "Nrf2?" All that is that these chemical changes change your mitochondria. But also change your genetic material. When your genetic material now changes, it's going to make anti-inflammatory molecules... These anti inflammatory molecules are going to benefit the patient. So who turned it on?.. It was these chemicals who turned on those chemicals. It was an energy deficit state. What made that energy deficit state? Fasting did. So fasting turns on an anti-inflammatory. Now you see, we're coming to anti-inflammation,

1:04:08 fasting is anti-inflammatory because it... produced the chemical changes that made... your chromatin material... now make... certain... new anti-inflammatory molecules. So you've got new mitochondria, you got new expression of materials from your genetic materials that are anti-inflammatory. And these pathways have all been worked out. And we know these pathways, they've all been worked out and thereby you have a cell that is going to be more efficient and more resilient. Resilient cell, resilient to what to everything. It's... a stronger cell. You basically become a stronger cell, a stronger human being. What does that mean? I'm going to explain what that means and what's my practical experience on that.

1:04:54 When your cells have undergone this type of change. -- We call it a hormetic change. Hormesis is a stress on that cell. So I stressed that cell through my fasting program... and it produced a cell. Now that is a new type of cell. It's more... resilient to disease, it's better functioning and all. How does that transfer to real life? Well, now that cell under stress is going to survive longer... And your body wants you to survive... because it wants you to survive till you get your next calorie intake that's going to come in. For me, what I've seen is that when people... fast and they undergo surgery

1:05:41 of any kind, they recover faster. When patients are fasting and they're undergoing chemotherapy at the same time, I've noticed... and I've seen it... and I've worked out the mechanisms... that they actually go through chemotherapy much more easily. They get less nausea, less vomiting, they feel better. -- The theory, and I haven't proven this in studies because I don't do those type of studies, but basically what happens that the chemotherapy is going to attack every cell in the body, don't think that it's only attacking your cancer cells... It doesn't happen that way. But you've made your whole body more resilient through this process. So the cells are less likely to succumb under chemotherapy.

1:06:27 And then, of course, the cancerous cells are going to die under this circumstance. In that context, you need to know about senescent cells. What are senescent cells? Senescent cells in your body are old... cells. And these cells have bad chemistry. They haven't died yet, they're just old... and they hang around and they produce a lot of inflammatory molecules. So you take a senescent cells and put it amongst normal cells. It'll secrete all these chemicals around them and make all the other cells also dysfunction. In a fasting state, the senescent cells become the target as well, and they die off.

1:07:13 So fasting... is a synolytic. Fasting gets rid of your old zombie cells around your body as well, and thereby reduces inflammation as well. See, because those zombie cells produce a lot of inflammatory molecules... You got to get rid of zombie cells. You got to get rid of these senescent cells. You have to. We all have zombie cells as we get older. But nature made it that intermittent fasting, you're going to fix that all. Eventually you'll die, but you'll have a longer healthful span, because our health span has dropped by 12 years... because of this modern living... So you may live to 86, but my health span is so low that I spent the last 15 years of my life

1:08:01 sick and dysfunctional and... just feeding the health care system... or whatever, or becoming bankruptcy. Number one cause of bankruptcy is medical bills. So -- I'm digressing there. But the point I'm trying to make is that it's our responsibility to understand more what fasting does and how it's going to impact your physiology. Because when you're empowered with that knowledge that my senescent cells are going away, my telomeres are probably getting a little bit longer, which means I'm going to live a little bit longer. And by the way, we know that this type of diet makes you live longer. We know that. We know that that's been done in humans and animals. The hormesis induced by fasting makes you live longer.

1:08:49 There are other hormetic things that we can also do. So I like those types of hacks, but we can talk about that some other time, which is heat, for example, and saunas and the likes. They are also hormetic stressors. But the king of all hormesis is fasting. That is the king of all hormesis. There is no bigger hormetic stress than fasting. None whatsoever. - Now... at 36 hours, because that's where we are stuck. 36 hours, autophagy is kicking in. Autophagy gets higher and higher and higher... You get maximum autophagy.

1:09:35 72 hours. So don't tell me that, I'm getting an autophagy on day two. No, no, you want maximum autophagy, you're going to get some. But you want maximum.

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