Fasting Compilation: Leading Experts On Water-Only Fasts, Fasting Mimicking Diets & The Optimal Fasting Window For Longevity

Eat for 11 hours or 12 and fast for 13 hours or 12. The fact is it can be done safely, it can be done effectively, and when it's needed there's nothing else that does exactly what water-only fasting does. Some studies show it's great for you, other studies show it's terrible for you, it has all these negative metabolic consequences. People are oftentimes medicated for their diet, and then after we're done, most of the time there's no need for medication. Intermittent fasting, water-only fasting, you know, 5'2", 25'5", time-restricted feeding, what is going on here? Fasting has become quite the popular thing lately, but what is fasting? It can mean many different things. There's intermittent fasting, there is time-restricted eating, there is alternate day fasting, twice weekly fasting, there's the fasting-mimicking diet, minimally supplemented fasting. So what is fasting, what are we talking about when we're discussing this topic? We're going to get right into it in a sec, but first. 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Now you might know this guy as the founder and CEO of Rivian. He's certainly that, but he's really so much more. He's one of those rare people who actually walks the walk. I've watched him over many years, and I know him to be this incredibly deeply committed person, committed to preserving wild spaces, while also inspiring people to explore responsibly. And that's basically Rivian in a nutshell. Their mission, Keep the World Adventurous Forever, comes from this understanding that adventure and a healthy planet, these are not separate things. They're the same thing. Here's what gets me. Every generation deserves wild places to roam, to climb higher, to run farther, to be changed by the journey. But obviously, that's only possible if we're not destroying those places in the process of getting there. So, yeah, Rivian builds electric vehicles, but really, they're building something bigger. Momentum toward a future where exploration does not come at the expense of nature, but actually inspires us to protect it. It's like, why create the ultimate adventure vehicle if we're not protecting the adventures themselves? And that's why I'm so proud to align forces in partnership with Rivian. This isn't just about transportation. It's about building a world worth exploring for our kids, for their kids, and for generations to come. For over four decades, Dr. Goldhammer has been at the forefront of using fasting as a powerful tool for healing and longevity. And our conversation dove deep into the science behind fasting and its potential to revolutionize our approach to chronic disease. Well, the type of fasting that we do is the complete abstinence of all substances except water in an environment of complete rest. So it's therapeutic, medically supervised, water-only fasting. There's a lot of fasting-mimicking programs out there, and they all have potential benefits and uses. Some of them have many advantages over the prolonged water-only fasting in that they don't require the level of supervision. They don't require aggressive withdrawal of medications. They don't have the risk profile that medically supervised water-only fasting could have if it's not done properly. So particularly, Volter Longo has popularized a program where it's limited nutrition intake. It can be done by most people at home. It can be very helpful to the degree that it's used, but it's not long-term water-only fasting. And as beneficial as these intermittent fasting programs can be in helping with weight loss and in helping people make behavioral changes, they're not necessarily the same thing you'll see in patients, for example, that have specific illnesses and need to reverse those diseases that you would see with long-term water-only fasting. So is that a way of saying that in your experience, prolonged water-only fasting is a superior protocol when it comes to helping people with acute or chronic lifestyle diseases? Why is it that you've chosen to focus on this rather than these other protocols that are seeming to be much more a part of the mainstream discourse around fasting? I think that when you can accomplish your goals with intermittent fasting or these other programs, that has advantages. As I said, safer profile, simple, doesn't require going to a place and requiring medical supervision. But many conditions won't respond to those protocols. And when they don't respond, that's oftentimes when we see people. When they've done their best, they've made diet and lifestyle changes, they've done what they can do to resolve the problem, but the blood pressure still persists. I know my colleague, John McDougal, calls us the punishment that if he has a patient, for example, that doesn't resolve their hypertension, which most do. But for those that don't, he'll... You get the hard cases. He'll send us over with apologies. Because what we do is a more intense process. It's not something that you necessarily look forward to if you're ill. But the fact is it can be done safely, it can be done effectively. And when it's needed, there's nothing else that does exactly what water-only fasting does. Right. So at true north, the typical hard case that finds his or her way to your doorstep is somebody that you're going to supervise over a period of how long as they undergo this protocol. Fasting ranges from five to 40 days on water-only, and there's a period of half the length of the fast recovery in the supervised setting. Typical patient might fast for two or three weeks, they might be with us a month. And those patients will oftentimes come in with specific complaints, high blood pressure, type 2 diabetes, autoimmune diseases, or some forms of cancer, particularly things like lymphoma. Right. And how do you decide then how long this fasting protocol is going to be on a case-by-case basis? Like who are the people that you recommend a 40-day fast versus just a handful of days? So you don't know with certainty before the fast exactly how the fast is going to go. And so what we do is we try to estimate long, and then if we can get it done quicker, that's great. I've had enough experience in fasted enough people. I can usually, by looking at their medical history, reviewing their lab, get a pretty good idea of what that range is likely to be. But there are patients that we expect to go a long time, but they get well really quickly, and so we just don't need to do it. Other people we're hoping are going to be a shorter fast, but it ends up being, it takes longer to get the job done. In some cases, it's pretty simple in the sense that like, for example, if you have high blood pressure, we want to fast you till you have normal blood pressure so that when you eat well, you don't have to be dealing with medications and the risk profile. And we know based on how high your blood pressure is, what your medical history is in terms of kidney disease and other things, how long that's likely to take. We can do the same thing with type 2 diabetics. We can look at your hemoglobin A1c, get an idea of how much insulin resistance there is. And the big factor is how much extra weight and extra visceral fat do you have? Because it's the obesity, the extra weight and the visceral fat that's responsible producing the inflammation that causes these problems. And so we want to bring people as close as possible down to their optimum weight. Now in some cases, people are not overweight, but they're over fat. And so those individuals, you have to stay within the reserves. Other people might have plenty of fat reserves, but they may not have electrolyte reserves. They may have other issues that become a limiting factor. And that's why we're carefully monitoring patients, examining them twice a day, monitoring their lab, their urinalysis, the variables that we can monitor so that we can get a good indication. And we know we do that safely because we've published a safety study where we have actually shown that if you follow this protocol, everybody that walks in gets to walk out. What do we know and not know about the causal or highly correlative relationship between visceral fat and the cascade of chronic lifestyle diseases that seem to proliferate across the world these days? Everybody's worried about obesity and being fat, and they think of it often as a cosmetic issue. And it's far from just a cosmetic issue. On your body, there's a type of fat called visceral fat, particularly accumulates around the abdomen and the organs that has hypermetabolic effects. It produces inflammatory products, IL-16, TNL, alpha, acute phase reactive proteins. And these inflammatory components are thought to be responsible for the heart disease, the diabetes, the autoimmune disease, and some forms of cancer. You can think of visceral fat like a tumor. So if you had a multi-pound tumor in your body, you would be appropriately alarmed because of its effects, and we go to inordinate effects to get rid of those types of tumors. And interestingly enough, let's say you went on a fast and lost 10% of your body weight. You might think, well, I lose 10% of my visceral fat, but that's not the case. You may be losing subcutaneous fat or muscle mass. You would lose all those things. You'd lose muscle, fiber, glycogen, water, and fat when you fast. When you come off the fast, you regain water, fiber, glycogen, and protein, but not fat. When you follow a whole plant food SOS-free protocol, you'll continue to lose fat. And what's interesting is you don't just lose equal amounts of fat and visceral fat. You will lose disproportionate preferential mobilization of visceral fat. For example, we used a DEXA scanner to do some studies, typical male fast for two weeks, loses 20% of their total fat, but 55% of their visceral fat. So the visceral fat is being mobilized much like tumors are. In other words, if you lose 10% of your body weight, you don't lose 10% of your breast tumor. You might lose 50% or all of the breast tumor. So how does the body know that it wants to get rid of the breast tumor versus anything else? Because there is mechanisms in the body that preferentially mobilize materials and inverse proportion to their need. And visceral fat shouldn't be there. And as a consequence, the body appears to go in and deal with that first, which is really great because it's one of the great benefits of fasting is the preferential mobilization of visceral fat. So people going in might think I'm here to lose my subcutaneous fat, but the sort of good news and bad news is maybe not more of the visceral fat, but that's actually in your best interest. And I suppose there are people who are relatively lean, who nonetheless, and unsuspecting to themselves also have high stores of visceral fat. Is a dexa scan the only or the best way to figure out whether visceral fat is a problem for you if you're not kind of overtly obese? Well, a dexa scan with specific software that's designed to measure body fat, which is what we used in our studies, we'll do that. I don't know that it's necessary for people to do that because what's great is if you adopt a whole plant food, SOS free diet, engage in exercise, get enough sleep, your body's going to take you down to optimum weight. And even if you're at optimum weight, it's going to start the conversion process of mobilizing fat and replacing it with muscle. Next we have Dr. Volter Longo. Volter is an expert in gerontology and biological science, as well as the author of an extraordinary book called The Longevity Diets, that he then combines with this periodic fasting protocol that he calls the fasting mimicking diet. Yeah, so I would say that at least in my opinion now, the more clear evidence for fasting is in the time rest of the eating domain, so the daily fasting. And I think we discussed it before, but I stick with the 12 hours of fasting and 12 hours of feeding per day. And there's new data indicating that, in fact, maybe the problem of skipping breakfast and doing 16 hours of fasting and skipping breakfast may not be about skipping breakfast, but maybe about the 16 hours, right? So we don't know, but certainly that's a possibility. And so I think 12 hours is a much safer way to go. And that is effective, of course, at 16 hours of fasting every day, but it's still effective. And so I think such impending I will agree on the same 11 to 12 hours daily time rest so eat for 11 hours or 12 and fast for 13 hours or 12. My understanding, correct me if I'm wrong, is that we still need more research to really drill down on the efficacy of these specific windows. But as of right now, it's sort of a safe bet. Like this 12 on 12 off seems to be the one that kind of works for all purposes, whereas others may have benefits or deleterious impacts that we're still trying to better understand. But as of right now, like this seems to be the window that is the safest and most predictable in terms of outcomes. Yeah, the easiest, safest, no physician will ever argue that that's a bad idea. And really not a single paper saying that this is not safe or that is not effective or at least partially effective in preventing and treating a number of diseases. So yeah, so I think it's a good compromise. And I think something that everybody should do. That's also consistent, not just with the epidemiological data, the clinical trials also consistent with what centenarians have been doing for 100 years or more. So yeah, so I think that the 12 hours is one. And then I've always argued against the alternate day fasting in the five to not because they're not effective, but again, they're very demanding, right? So not eating every other day. It's going to be something that very few people will ever be able to do. And then you get into the again, the territory of are there side effects caused by not eating every other day or not even for two days a week. So I would say in general, I just don't see a big future, at least now for the general population, right? Some people can do it. We'll see about the efficacy and the safety. But I think that in general, I will say that at least I'm not enthusiastic about either alternate day fasting or two days a week of fasting. Then of course, I'm enthusiastic about the fasting making diet. So in addition to the time we're sitting eating daily, then the cycles of the fasting making diet. And so this is a plan based, low calorie, low sugar, low protein, high plant based fats that the program that we've been testing, we and many universities have asked to test it have been using it for all kinds of diseases from diabetes, pre-diabetes, cancer, Alzheimer's, auto immunities, etc., etc. For people that didn't listen to our previous episode, the fasting mimicking diet is essentially a way of eating a calorie restricted diet with a very specific kind of menu that physiologically mimics what the body would experience had it been just fasting. Correct? Do I say that accurately? Yes, that's accurate. So then there was first developed in mice and so we used certain markers to make sure that there is a fasting response equivalent to that of water only fasting. And then the same was done in people. And again, we're looking for certain factors in the blood that would show that in fact that that person has responded as he would if it was not eating at all. Before we move on from time restricted eating in this 12 hour window, to restrict your eating to a 12 hour period isn't really fasting at all. It's sort of like if you get up at eight in the morning and you go to bed at nine or 10 at night, there's literally only an hour or two in which you're not meant to be eating. Right. Yeah. And this is very important because if you look at Europe, 60% of people are overweight or obese in the United States is 75%. So we're in a world I think, and this is not just Europe and the US, it's the whole world with few exceptions. So it's a very undisciplined world. And so that's very important to also say not just what would be most effective, but will be easiest for people, realistic for people. And so I think that 12 hours, a lot of people say that's not fasting at all. Well, it is fasting because now on average, and this is work by Panda, people were eating for about 15 hours a day. So yeah, so people all over the world like to eat for long periods every day. So then somebody may start at 6am and end at 11.30pm. And so that the three, four, five hour restriction can make a big difference and can make a big difference not just in reducing calories because you have less opportunities, but also in metabolic switches that may make energy expenditure higher, let's say, right? And also help people sleep. So those are some of the things that are emerging in mouse and human stuff. If people are eating on average 15 hours a day, is there evidence or is anybody kind of looking at the co-founding factor of the impingement on sleep that would be impacting deleterious health outcomes? Because if you're eating for that many hours, you're probably staying up late and not getting, you know, this the eight hours that you should be getting or seven hours. Yeah, so Satchin Panda published on that and showed that in fact, when they reduce the eating window from 14 hours and above, if I remember correctly, to less than 11 hours, there was an improvement in sleeping quality. So yes, so that seems to be the case. And I've always been also preaching not eating for the last three hours before you go to sleep. So that's consistent. That's still the hardest thing for me. It's really difficult for me to go to sleep when I don't have a full stomach or I'm feeling hungry at night. It's just a mountain I still have not mastered. Yeah, and I think it's important, you know, the foundation clinics, we everybody's got a different method, right? So I think it's important. So for example, it's better to eat a light dinner, but I have a very big dinner, right? So because I would be unhappy having a big lunch and a small dinner. So to me, it works. For me, it works. And so I think it's okay. I sleep well and or pretty well, unless I'm traveling, like I just did. But yeah, if you eat late, then and that's a big deal to someone. But that doesn't really affect you negatively. I don't think there is too much data we're suggesting that you're going to leave 10 years shorter because of that, right? So if you're sleeping well, that's probably okay. And okay, compromise. I do notice though, if I overdo it in terms of volume and, you know, hour of the evening, I'll generally wake up around two or three in the morning. And when I was wearing a CGM, I would notice, you know, these spikes in these drops that would occur, you know, over the course of the evening that don't happen when I eat earlier or like reduce the volume. Right. And as you get older, they might get worse. Right. So yeah. So then, yes, the recommendation stays eat earlier and eat within 12 hours. And then, you know, if somebody is not affected by it, by eating later, it's probably okay until that becomes a problem. Right. So I think that's a good way to look at it. And of course, you have to know that it's a problem, but, you know, not sleeping well. Most people will not even without a bracelet. You'll know. Yeah, you don't need any kind of like data feedback to know whether you're sleeping well or not, honestly. Who's next? My friend, Dr. Michael Greger is next. That's who Dr. Greger, for those that don't know, he's the man behind the Nutrition Facts website, which is an incredibly robust resource for searching for the latest, most up to date information on a vast spectrum of medical, nutritional and lifestyle topics. He is an incredible communicator of nutritional information. I love him to death. So here is a clip between me and Dr. Michael Greger. In the morning, your body has to make glycogen stores for the rest of the day. And instead of just using the energy, if you take the little chains of sugars and starches and make them to glycogen in your muscles and liver, that's an energy intensive process. And then you break it back down to be used later on. And so the fact that you're using energy to basically get the energy right back is kind of energy intensive. That's one of the small reasons why eating in the morning when your body's, you know, knows it's got a whole day ahead of it, where you have that glycogen building signal earlier in the day. But, you know, a lot of the chronobiology stuff, we just don't know in terms of what exactly is going on. But everything from body temperature to, you know, testosterone to cortisol levels, everything, you know, goes on this this wild daily cycle. And then there's seasonal cycles, weight loss, you know, it's the weight you put on in the kind of winter months for the holidays. It may have a role to play. Depends upon how far the earth is from the sun. It's crazy, right? The rotation. So that was, I mean, that just blew me away. I shouldn't put people on 2000 calories. The exact same 2000 calories is one meal at breakfast or one meal at supper. The army did this. And the evening group, same calories, gains weight, and the breakfast group loses weight. That's such a trip. It's crazy. And so then that really opened my eye. Okay, well, now anything's possible. And so then really kind of dug deep and, you know, came up just, you know, what are the criteria for, for often weight loss? Like what would a, what would the often weight loss diet look like from kind of from the ground up just because, um, originally, how not to diet, it was going to be a chapter on each of the latest diet trends. And just, you know, going through what's the science behind each, but I realized the book's going to be out of date before it even comes out. You know, I'm part of the US News and World Report, you know, diet panel, you know, and so we get dozens of new diets I've never heard about every year that we have to go through. And I just realized, well, wait a second, that's not the, right, it's like whack-a-mole. So instead, let's just, here's the criteria against which you can look at any future diet and see kind of where it would fall among this range. And then, and then the second half of the book is regardless of what you eat, there are, you know, kind of tips and tricks that can, and tweaks that can get you to accept that. Right, like the water thing and focusing on nutritional density and caloric dilution, things like that. So, yeah, nutritional density, that's really the first part. I mean, that's part of a good weight loss diet. It's a weight loss technique, but like the water, right, water preloading. So if you drink two cups of water before eating a whopper, you'll gain less weight than, I mean, so it's regardless of what you eat. That's the whole second half. And the hope is people won't just kind of jump to the second half and actually do a safe, sustainable, nutritious, healthy diet. But in terms of the foods to eat though, I mean, it harkens back to the previous book and it kind of orients around the daily dozen. It ended up, I mean, it ended up that way, based on those criteria, like you want to be fiber rich and, you know, low in added sugars and low in added fat and, you know, you know, water rich and all they say, and the same, you know, vegetables and kind of on down the list. And that was the criticism we got from the Daily Diet, the Daily Desson app that we released, it's, you know, a million downloads. And there's two camps of criticism. One is, oh my God, it's too much food. I can't eat at all. And which gets too much food. Oh my God, I can't go through all this stuff. You got to make sure you get all of that. Well, I mean, but look, it's aspirational. Like, you know, it's just, and you can, you know, make a game and see how many you can get. And if you know, do good one day, you can try better the next day. And that was actually this, I mean, I'm hoping to, you know, after you checked off those boxes, there's only so much room for pepperoni pizza at the end of the day. I mean, it's this kind of, it's this kind of eat more approach, but it's really hoping to kind of push out some of the less healthy options. But the other group of criticisms came in, it says not enough calories. It's like, look, I'm training, there's no way I'm gonna get enough calories eating this kind of stuff. I was like, well, look, this is the minimum, you can eat more food. I'm not saying this is all you can eat. This is, I just want people to hit this. But then I realized, well, wait a second, oh, too much food, too few calories. That sounds like a good weight loss diet. And the fact that these are some of the healthiest foods on the planet is a good bonus as well. Right. Did you come across some interesting research on intermittent fasting? Because that seems to be the thing that, that, you know, a lot of people are talking about and thinking about and practicing right now. And I've had a couple of people on the podcast speak to it. That's the biggest chapter is the fasting chapter. So much information. I remember looking at fasting because there's been a, you know, common interest for years people ask me about it. And anytime, I only want to say, I don't know once ever, even if it's the most esoteric question in the world, I want to, the next time someone asked me that, I'm gonna know an answer to it. And so people can ask me about fasting and there just was no data. And so that's why if there's, if there's, if there's a condition or food that you can't find in nutritionfacts.org, there's no one reason. It's probably because there's just no good data out there. I mean, it's not like, you know, I'm trying to annoy. It's just like we don't know. And so, but just in the last few years have been explosion of research into intermittent fasting, water only fasting, you know, five to 25, five time restricted feeding, all these. And so tremendous literature was interesting about the intermittent fasting literature. Well, so in terms of intermittent fasting, no benefit in terms of compliance or lean mass conservation or weight loss compared to continuous caloric restriction. And the longest largest studies today shows increase in cholesterol for people that have the same caloric restriction doing alternate day, modified fasting. And so I would encourage people not to do it or at least get their cholesterol checked. But the time restricted feeding, where you try to narrow your eating window to 12 hours or less. And so you're fasting at least half the day. This was one of the research areas where there was, diametrically opposed, some studies show it's great for you. Other studies show it's terrible for you. It has all these negative metabolic consequences. And so it was my job to like, what is going on here? And it turns out it's timing, early versus late. So when you break the fast. So your window, right. So if your window is late, you get the negative biological consequences of eating at night and shifting your calories towards later in the day. And so people that skip breakfast, I had these negative metabolic effects of time restricted feeding. Whereas people that did early time restricted feeding not only got the chronobiological benefits of shifting their calories towards the beginning of the day, they also got the time restricted feeding benefits. And so that is really the, that's one of the things in the book that actually changed the way my family eats. Yeah. You just rocked me with that because I do it where I eat at night. If you miss any meal, it should be, you suffer not breakfast. Right. Breakfast is called break fast for a reason. Yeah. I mean, that, and, and, and, and that actually may be one of the reasons that the seven day Adventist vegetarians live longest living population in the world, right? Okinawa, Japanese was the number two. And they're not, they now they're eating KFC. There's really only one blue zone that continues to this day. It's in Loma Linda, California, these seven day Adventist vegetarians longest living formerly stopped studied population in the world. But one of the reasons may be because they practice this early time of strict defeating often skipping supper. The teachings of the church are, you know, like two meals a day and, you know, make lunch the biggest meal of the day hasn't been put to the test, but given all this short term data, that may be, I don't know, that'll be the next book. How not to age? I'll look deep into that. Good Lord, the holiday season. I can't believe it. But once again, it's here a time of year that I tend to find overwhelming because I'm a creature of routines and I don't like my routines being disrupted. But that's just the deal with holidays, all the travel, the family gatherings, eating patterns that go sideways. I think it's okay to admit that it can all be a little bit too much at times. To combat the chaos, I try to double down on portable routines that work and don't demand that much time. And at the top of that list is AG1 Next Gen, who's sponsoring this episode. It is a daily health drink that combines your multivitamin superfoods and antioxidants into one simple green scoop that's clinically shown to fill in common nutrient gaps. In order to stick, routines need to be simple. So I keep it that way. Just cold water, a scoop of AG1, done, one solid health decision just locked in before the day gets away from me. 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What about somebody who's coming in and they're on a battery of medications? You would have to wean them off of that, I would presume on some level before they could undergo this. Most medications you do not water fast while you're taking medications. Those have to be weaned down beforehand, but we have physicians that are experts at helping people unwind the consequences of their medical treatment. And most medications, interestingly enough, the day you change the diet, you have to begin changing the medication profile. Because most medications are treating the diet. Most people are being treated that is medicated for their diet. When you change their diet, the need for medication dramatically responds. You have to reduce the blood pressure medication. You start crashing these patients because they're not going to be hypertensive once you eliminate the reasons why they're hypertensive. And they're not going to be needing the same level of medication once you normalize their dietary intake as far as their diabetes or getting them off their pain medication. Once they don't have the pain, they don't need to be on all that oxy because now the pain is being reduced because the inflammation is being reduced because of the dietary change and then ultimately the fasting. So that's one of the reasons why fasting does need to be done in a controlled medically supervised setting. It's not the kind of thing that you do long term fasting at home. So you do that in a controlled setting where there's been a proper history exam lab and daily monitoring. So we're seeing each of these patients twice a day. And that's how we're able to ensure that this is a safe and effective experience. So they may withdraw their medication with careful feeding, initiate the fasting, normalize the condition. And then after we're done, most of the time there's no need for medication because they've gone from 220 over 120 cap dot on five meds to being 120 20 over 70 off medication. And so there's no reason for anybody to want to put them back on drugs that cause chronic cough, fatigue, impotence and premature death if the condition is actually normalized. Now the side problem is you have to keep on the healthy diet and lifestyle because you're not curing anything. You're just managing it. But you've rebooted this operating system and wiped the slate clean so you can build a new foundation for those health. It's very much like treating a, you know, when your computer becomes corrupted and you don't know exactly what's wrong, but you turn the thing off, you're turning on, you can't explain, but now it's working. Right. And it seems to be that way. And we're trying to figure out exactly what those changes are that's occurring in fasting. I know the pharmaceutical industry is very interested in what's happening because they want to come up with what are called fasting mimicking drugs. They want drugs that'll do just what fasting does to you, but without that nasty fasting. Yeah. That's something that they can sell in a pill. Yeah. So a lot of the research that's of interest is trying to figure out what exactly is it that's happening in fasting that's allowing the body to get well so that we can try to reproduce that without having to go through the process. Right. I mean, that's my next series of questions. Like, does it have to be water only? What is it about that deprivation protocol that is so special, you know, physiologically, that is causing this cascade of positive impacts? Like what would happen if you were eating a little bit? I mean, I know what Longo has this fasting mimicking protocol where he is allowing people to eat something like, I don't know, 600 calories a day. And he's able to reap some of the benefits of what you're experiencing without having to go on a complete water fast. But what is happening to the body when you're depriving it of food in such a, you know, comprehensive way? Yeah. The intermittent fasting protocols are just that fasting mimicking diets or fasting mimicking programs, trying to reproduce some of the changes that we know occur with fasting without the risk profile or the complications of long term water only fasting. And I think they can be very effective as they've demonstrated. However, long term water only fasting has a much more profound impact on these mechanisms that are associated with fasting. For example, just the most obvious is weight loss, you know, when you're water fasting, you're going to lose an average of a pound a day. Now, some people say, well, you lose weight, but then you gain it back afterwards. Now, interesting, we've done a study. We have now recently acquired a Hologix Dexascanner with the new software that allows you to do a whole body detail composition that looks not just a percent body fat, but how much visceral fat there is. And we have a paper that'll be coming out that looks at the fact that, yes, you lose a bunch of weight fasting and you regain some weight after fasting, but it turns out the weight you regain after fasting when you're eating a whole plant food diet is exclusively water, fiber, glycogen and protein. There is no fat. In fact, the fat profile continues to drop during refeeding, even though the scale weight obviously goes up as you rehydrate, put some fiber back into the fat. Right. As long as you adopt the whole plant food, healthy, you know, dietary style. But the point that the old wives tell us, well, you lose fat and you just gain the fat right back. Well, that might be true if you go back to eating greasy, fatty, slimy, dead, decaying flesh processed foods. But that's not what's happening in these patients that we're refeeding appropriately. And so weight goes up. But what the weight that goes up is realimenting your glycogen stores and muscle storage, which is really exciting. So preferentially, not just do you lose fat, but you preferentially lose visceral fat, that the ratio of visceral fat to adipose tissue loss is 3.0. In other words, there's a significant preferential mobilization of this very type of fat that we think is most compromising to health. The fat, the abdominal fat, the fat that stores around the organs. So now we have what may turn out to be an effective strategy of specifically mobilizing visceral fat. Now, we've done some preliminary work. We're actually enrolling patients in a study starting in August, looking specifically at body composition changes long term with follow up. So, you know, we'll be able to speak more definitively about it by the end of the year. There's also a process that happens in water fasting that you don't see as profoundly influenced in juice diets or modified diets. And that's natural. There's a selective mobilization elimination of excess sodium from the body and water fasting that happens right away. It's very powerful, more powerful than say taking hydrochlorothiazide or a diuretic. And it's responsible for the big dump in fluids that happens initially on fasting that drops blood pressure so dramatically, gets rid of the congestive heart failure symptoms that eliminate some of the arthritic symptoms and joint swelling, and the non healing wounds. And this body is selectively getting rid of this excess sodium that's accumulated that the body's having to deal with because of the dietary choices. The traditional justification for fasting was the idea of detoxification. This idea that there's toxins in the body. And now we know that's true. They've actually been able to take that's controversial. Well, it's actually not controversial in the sense that you can take a fat box, you have a human and break it down and you'll find there's hundreds of different chemicals that are at various concentrations, PCB, dioxin, pesticide, residues, mercury. And the only thing that's controversial is they say, Oh, well, it doesn't matter. Well, it turns out it does matter. It just matters at different thresholds to different people. And so this, this idea of rapidly mobilizing toxins during fasting has been so well accepted by some that they say that's the reason not to fast is the body would rapidly mobilize these fat soluble nutrients too quickly and your body wouldn't know what it's doing. And it would overload your system unless you take their proprietary products. That apparently it's okay. But what our experience has been that there is a rapid detoxification. We know that there's some studies looking at they've even done total body load measurements before and after fasting and showed that PCB levels would drop clinically. Well, you're not taking any chemicals into your body and you're allowing the liver and the kidneys to just do what they do, right? But it's more than just what you would calculate through burning 2000 calories of internal fluids. There's a selective and rapid mobilization. For example, with tumors, let's say you have a breast tumor and you lose 10% of your body weight, you would assume that you'd probably lose 10% of your tumor weight. But what happens in the for example, in lymphoma, you lose 100% of the tumor. So the body's preferentially mobilizing some nutrient stores versus others. And it seems to be able to do that in inverse proportion to the value of those tissues to the body. So it's getting the visceral fat, which we think isn't probably healthful fat before it's mobilizing adipose fat or and certainly before it's getting to critical nerve tissues and other things that are preserved. The body has an intelligence where it's unwinding this self. And what we're suggesting is it appears that both endogenous and exogenous toxins are preferentially mobilized in water only fasting at a much more powerful rate than they are say when you're going on a healthy diet and lifestyle. And that may be a way justification for trying to facilitate and speed this process. There's also the effect on enzymatic induction. Think about athletes. One of the things of being a trained athlete is you induce, for example, glycogen, a genetic enzyme systems, you get better at mobilizing glycogen stores. And you know, this whole business of carb loading and trying to increase glycogen storage so you have more to pull on so that you don't hit the wall so quickly when you're running that marathon or whatever, you get through that process. Though that is induced with persistent exercise, the same enzymatic production for glycogen for what, ballistic enzymes for protein for gluconeogenesis enzyme systems is induced during fasting. Because you have to mobilize all your right in stores, you're in the chamber, you're taking that battery and draining it all the way down. And it suggested that not only do you induce improved efficiency of enzyme systems, but they persist after fasting, which is just like you get better and better at exercising every time you do it, you get better and better at fasting every time you do it, which is perhaps one of the justifications for intermittent fasting. If you fast 16 hours every day and you limit your feeding window to an eight hour window, you may be inducing some changes in that, even that limited fast, that 16 hour fast, day after day, after a week, after a month, cumulatively, that may have a very profound effect on body physiology. And that's one of the suggestions that's being made by those advocating intermittent fasting or short period of fasting that cumulatively it may be. Well, when you do a long term fast, this is a huge impact. And now this is some of the stuff we're working with people like Alugia Fontana from Washington University, where they're looking at changes in microbiome, changes in whole body composition, changes in these, these various exotic biomarkers. And what happens in short term and long term fasting, nobody knows yet, because we're really the only people doing and monitoring long term, modernly fasting and its physiological effects. So this is all virgin data and very exciting. Once again, this is me and Dr. Volter Longo. With this understanding, the kind of basic tenets of what comprises a diet that, that promotes longevity based on this research, where does fasting coming come in? Like, what is the relationship between these dietary pillars and these protocols around fasting or fasting mimicking? So I think there are two, I always look first at the safety factor, right? So what is it that we don't know if it's safe or not? And then I just exclude them until we have many decades, I think, of evidence. But if you, if you look at safety and efficacy both, I think you come up with 12 hours every day as being very solid. I always say, I've never seen a study showing that if you do 12 hours of fasting a day, you're going to have a problem. When you get to 16, and as we, I think already discussed before, you get to 16 hours, you get to skip breakfast, skipping AC meta analysis, not just studies, but studies of all studies showing increased mortality, reduced lifespan. Now, what is the reason for it? We don't know. Probably there are double edged swords, right? So for example, ketone bodies, maybe fatty acids, ketone bodies are going both ways, right? They're helping you on one side and they're hurting you on the other side. But so 12 hours, very solid, and the work by Sachin Panda and everything else is supportive of it. And then I would say, probably people, we eat all the time. And so in the thousands of years ago, but as humans evolved, we evolved probably insulin resistance as a way to survive the winters, right? So you eat as much as you can during the summer or whenever food is available, you become diabetic, essentially, pre-diabetic or diabetic, you put everything away. And then the winter comes or some period where there is no food and then you become insulin sensitive again. So I think what happens now is everybody is insulin resistant all the time, or somewhat insulin resistant all the time, because the winter never comes. And that's where this prolonged, not just 16 hours of fasting, but say five days, that's what we've been working on. That's where they come in. There seems to be pretty clear now we have three more clinical trials that we are about to publish, very clear that they switch you into an insulin sensitive mode. So and also, and they switch you into a long-term anti-aging mode. So for example, leptin, and now this is about four clinical trials that we've done. Leptin stays low for a long time after you return to normal diet. IGF-1, the central growth factor pro-aging, it stays down for months. So in the first trial, we showed that after three months from the end, IGF-1 was still lowered. Yeah, so then I think that there is on one side, insulin sensitization. So the system now goes into a fat utilization mode versus building. And the system also goes into a maintenance mode. So now I'm just going to protect myself as much as possible, age as slowly as possible, waiting for the next wave of lots of food where maybe I can focus on reproducing. Right. So with this understanding that there is no winter, the winter is not coming, and everybody's kind of hurtling towards some degree of being pre-diabetic because of the western way of eating. How malleable is that? Like if somebody has been in that pre-diabetic state or in a situation where they lack insulin sensitivity for a prolonged period of time, what is your sense of how one can repair that? Like if obviously if you've just arrived in that situation, it's probably going to be easier for you through fasting and these other protocols to bounce back and create some insulin sensitivity. But if you've been in that state for a decade, does it become more difficult or can you still repair it? You can still repair it. We just finished trial and diabetes in Holland, 100 patients. And I cannot tell you the results, but I can tell you that even if you're diabetic, you're obese, you've been taking medicine for years and years and years. No problem. We can bring it back. We cannot bring it back to everybody, but I would say the great majority of people, you have the team, the physician, the dietician, and you have to have the method. So in that trial, it was just fasting, mimicking diet, no longevity diet. In the clinic, we do both. But again, we don't push you to 1500 calories if you had 2500 calories. We push you to keep the calories maybe just a little bit lower, maybe go from 2500 to 2300. And then we work on the nutrient tech, what I call nutrient technology. We work on making it easier for you to lose weight rather than starving you for a year or hoping that you stay like that for the rest of your life, which you're never going to do. So in the four years since we sat down, there's been quite a explosion of interest in fasting. It's gone from this kind of curious endeavor into something that has truly gotten mainstream attention. A lot of discussion about different ways of fasting and many different, as you mentioned, different types of thinking about fasting, intermittent fasting, alternate day fasting, time restricted eating, fasting, mimicking. Maybe it would be worth just talking about fasting in general and the validity of these various protocols and why you feel so strongly that the fasting mimicking approach is optimal. Yes. So alternate day fasting, it's an extension of the 16 hours, let's say. So there is no doubt that if you do 16 hours of fasting every day or you don't eat every other day, you're going to get a lot of metabolic effects. The problem and the question is, now that we have meta-analysis showing that if you skip breakfast, you live shorter and you have more cardiovascular disease and probably more cancer, etc., etc., is there some issue with these ketone bodies, with these fatty acids, etc., so no arguing with the metabolic effects, short term, but a big problem with long term. So I would say, don't do it. Certainly don't skip breakfast. Now what we're starting a trial is now what happens potentially if you skip lunch. So you keep the 12 hours and then skip lunch. That's what I've been doing for 20 years, but now we're going to finally get to test it. We don't know, but let's see. So that's alternate day fasting or let's say 16-8. Then you have, let's say, 5-2. That's another popular one. What happens if you do two days a week of fasting or semi-fasting? Well, we don't know because there is not very many studies. There are a few. It looks promising. The problem I see with that is most people have a difficult time, I say, going from four coffees a day or three coffees a day to two coffees a day. Half of the people that used to smoke are still smoking, even though we know that it kills you and it says that on the package. So is that going to really be more than a small, small percentage of the population? So even if we show that it was effective, who's going to do that? I mean, I don't know. Personally, I don't know anybody that would go two days a week without eating anything. I don't know a single person, but that doesn't mean it could not be effective. It doesn't mean there are people that could do it long term. So I'm not arguing that with the effectiveness and I'm not arguing that some people could do it. I will say the great majority of the people are not going to do it. And then I will say, we even don't know what will happen long term. So we got to go with things that are more realistic, less invasive, and that's where the fasting making that comes in. And this is again, 30 years of work since the Wallford years, right? So it's not an idea that I say, oh, I see a few patients in my clinic, they're doing so well with these five days, I'm just going to do that as it happened for many very popular diets in the past. So this was 30 years of building, building, building from all these pillars, right? And then you get to a point where you say, this looks very promising. Like, what if we made people do this three times a year for five days, four times maybe. And if you have diabetes in the diabetes trial, we did one cycle a month for 12 months. But most people did not do 12 cycles. Some people did two, some people did six, some people did eight, and some people did 12. So now we're going to analyze the data and we'll be able to tell, you know, who is doing well. But overall, they all did well. So I think that the three, two to four times a year, let's say some people may even last somebody like you probably, you know, a couple times a year, it'll be more than sufficient. But for most people, let's say three to four times a year, that seems to be very realistic. It's clearly showing this long term efficacy. It allows for FDA-like, it doesn't have to be FDA, but FDA-like procedures where you can say, hey, this was tested. That's exactly the way you should test it. And everybody can test it. Everybody can grab it. So now we have 30 clinical trials running. Some of them, you know, we help them with some of them, people just get it and they do their own trial. So that's the way it should be. Allow everybody to test it. And let's see, right? Eventually, we're going to see these millions of people and we're going to see the reports from it. And I really think that that's slowly moving in the toolkit of physicians on one side for lots of diseases. But it's also moving in the toolkit of the people that are paying attention and that want something that is being clinically tested. And just because we haven't defined it, essentially what you're saying is this is a five-day protocol where we provide you through Prolon this meal delivery, meal kit situation. And when you eat this way, you're mimicking your biological response to fasting without being overly calorically deprived. Yeah, I cannot talk about products because I'm prohibited from doing it. So in the FMD, for example, for cancer, it's four days. It's very different from the one for normal people, which is five days, as you just mentioned. And we have one for autoimmunities, it's seven days. We have one for Alzheimer's, we're testing now in Italy, which is five days, but then it has a daily supplement for the in-between. So it's really about nutrient technology. But yes, the fasting mimicking diet, let's say it goes from four to seven days in most cases, plus or minus what could be supplements. For example, in the Alzheimer's, we were worried about people losing weight. And some people did lose weight. And so that's why we give them a supplement between the 25 days between one cycle and the next of the fasting mimicking diet. We also, because they're so old, let's say 75, 80, 85 years old, we give them a higher calorie fasting mimicking diet. So we adjust based on the age, on the disease, and eventually, I think there may be adjustments also. For example, now we're developing a non-inflammatory one. So people with inflammatory bowel disease collide with gastrointestinal problems. We're developing something that is non-allergenic, non-inflammatory, which I think is going to be very important for... And we, I mean the university, I don't mean I'm not talking about company. So yeah, I think that's certainly... I'll be very surprised if this doesn't move into more of a mainstream and start competing with the drugs. Right? I mean, that's what we're trying to say. Let's start thinking about repairing systems based on all the things that we discussed and not just putting a bandaid on it. You have diabetes, drug number one, then you escalate to drug number two, then you get cardiovascular disease, you have two more drugs there. This is what happens. It's really criminal, I think, in the United States, in Europe, all over the world is... I call it unconspirited conspiracy. So everybody is going along with the system and you have a lot of bad food and a lot of drugs that people take and the whole system is profiting from it. But people, the average 45-year-old now has got two chronic conditions in the United States. And so by the time you get to 55, 60, you probably have three chronic conditions taking lots of drugs. So we're saying, what is the system not to just block that, but to bring you back to a healthy status? And it used to be ideas. Now we see it in the clinical trials, but we also see it in the foundation clinics where we follow lots of people. So we're very confident that this can work, but it's not going to work unless you have the team that I was discussing earlier, the doctor, the dietician, and the knowledge and probably also the molecular biologists. When you get to complex, so we get people at the clinic all the time, and they have very complicated problems. And so you have a very busy physician, even our own, and they have a very busy dietician. And I think that the molecular biologists specialized in whatever field, it could be the key person. So the strategies, like I am, so this person comes in, works with the physician and works with the dieticians to strategize, how do I solve the problem? This person has got three chronic conditions. Where do they come from? And how do I solve them with a clinic and another problem? I don't know about you, but I have this tendency to wake up overwhelmed before the day even begins, berating myself with all the things that I should have done better and should be doing now. But when the shoulds pile up, calm is the tool I reach for to release stress and find space to breathe, even on the busiest days. What keeps me coming back is the variety. Some days it's a meditation to clear my head, other days it's expert led talks, and I really love the sleep stories. They've become this essential for winding down. But basically every program on calm is this reset to ground me in the moment, remind me of what's most important, and let's face it, absolve me of the shoulds. Calm is the number one app for sleep and meditation, and it's here to help you feel better. Guided meditations to boost focus, sleep meditations to drift off naturally, grounding exercises to reset, and expert led talks to help with relationships and more. Calm has an exclusive offer just for listeners of our show. Get 40% off a calm premium subscription at calm.com slash richroll. Go to calm.com slash richroll for 40% off unlimited access to calm's entire library calm.com slash richroll. This podcast is brought to you by Squarespace. When it comes to the infinite scroll of our digital world, there's an important distinction I like to draw, which is that there is a difference between consuming content mindlessly, and on the other hand, using our computers with creativity and intention as a tool to build something meaningful, whether that's a coaching practice, for example, a store or a portfolio for your photography. What you need and deserve is a high quality, highly designed platform that reflects your personality without compromising functionality. 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Some people are fine for outpatient care. And one of the benefits of the free consult that I do with people is to help them, are they a candidate for fasting? Are they a candidate for home fasting? If so, then we can come up with a doctor that provides those services. If they really need to do it inpatient, they can come to the center, they can go to the other places that do this kind of thing. Or maybe what they need to do is just adopt the diet and lifestyle principle long enough to where then they become a good candidate for those changes. So we're trying to make sure that whoever does it, does it intelligently and does it safely. Not everybody's going to follow our advice, but at least we can feel good that we've done our best to make the educational services available to everybody, to make the services available to people at home that are good candidates for that. And we have a facility for people that are better candidates to come inpatient. Who isn't a good candidate for inpatient? So a person that's on medications that you can't safely withdraw. For example, if you've had a recent pulmonary embolism, cardiac arrest, you have atrial fibrillation and you're on an anticoagulant therapy medication, you don't just stop those drugs because it can induce a stroke. So it's very careful protocol to withdraw those meds and you don't fast on those medications because they can become like many medications, greatly potentiated during fasting. They will work differently in the physiology of fasting than they are in the physiology of feeding. And so fasting medications don't go together. There are a few exceptions. Sometimes we'll allow some hormone replacement therapies like thyroid replacement therapy stuff to modify the dose and monitor it, but it's not an absolute barrier. But we discuss that in detail in Confasting, Save Your Life. We talk about who's a candidate, who's not a candidate, what has to happen in terms of medication. But it's basically you have to get people stable off meds. You have to have people that have a condition that we believe are likely to respond to fasting. We don't want to be doing experiments on people particularly remotely unless we kind of know what their condition is and what symptoms they're likely to experience. So we can educate them about that. You need to have a person that's willing to try to eat healthfully after fasting. It's no good to do a fast and then go on some crap diet and get terrible symptoms and then blame fasting. I'm not interested in that. We're trying to actually get a good net long-term result. And that means we have to limit working with people that are willing to try to do these things. Not everybody's going to be perfect. A lot of people are going to struggle, but if they aren't going to make a good faith effort, it's probably not the best thing to do. They should be doing some other kind of program that isn't going to put them at risk. How do you make that determination during the intake process to gauge willingness? Well, first of all, they've filled out a detailed medical questionnaire. So I have their medical history that I've reviewed before I've talked to them. And we asked those questions in the questionnaire to gauge where they are. And also, I've interviewed tens of thousands of people. I mean, essentially, that's what I do is I talk to people on the phone about their specific issues and try to direct them in the right place. And I've been doing it for 40 years. I got a pretty good idea of who's likely to behave and who's not going to behave and who's a good candidate and who's not. And witness that everybody that's walked into the center, 25,000 people now for fasting, probably close to 40,000 people overall, everybody that's walked in has walked out. So we're pretty good at making sure we don't bring in people that are not good candidates. Not everybody has an uneventful stay. There are patients that have serious side effects that we have to deal with. Occasionally, we'll have to hospitalize a patient. If they get into an issue, we'll have to get diagnostics done, whatever. But as the safety studies show, this is a comparatively safe process when it's done according to protocol. What is your personal fasting practice? I fast every day. So you never eat? I fast every day for 16 hours. Or as close to 16 hours as I can manage. You're on a 65 year fast. I fast every year. So you do a 16 hour fast every day. So you eat between the hours of what and what? Well, I usually have, depending on which morning it is, because I play basketball in the mornings. But so depending on how long the basketball goes, I'm eating between eight and nine in the morning. I'm not eating after five, five, 30, a night. So I have a window in there feeding. And then I don't have anything before or after. So I do that every day. I fast once a year. I fast for a week. If I'm doing okay, no symptoms, then I'll stop it. If I have symptoms, I'll go however long it takes to resolve the symptoms. I don't like fasting. You have to rest when you fast. You can't play basketball. It's really annoying. My wife is Dr. Morano, is really strict about it because she's my supervisor when I fast. And she won't let me on my computer. That's the hardest part of all. I let the patients have their computer. What do you do all day? Oh, I just lay around and meditate and rest. And it's awful. But I don't have symptoms, which is interesting because I've done this. I mean, I never smoked, never had a drink. I've been a vegetarian since I was 16 years old. So I've not had the exposure. So there's not a lot. I don't use medications. I don't use drugs. So the fast itself is boring. Nothing happens in terms of untoward symptoms, but you still have to rest. And for me, that's the big challenge is slowing down. And I do. I find that some of the most beneficial intervention I do is fasting, but it's not pleasurable. Sure. And your blood work is, yeah, it's going to be, my blood works good. My blood pressure is great. But again, I started as a kid. So you would expect it to be. You've been doing this a long time. It's so interesting. It seems so severe and radical to undergo these things, but so many people, thousands and thousands of people have benefited from what you're doing. You practice it yourself. What is radical though? Radical is radical. It means root or cause. That's the fundamental thing we're doing is we're actually getting to the reason people have these problems. We spend all of our time and money treating the leading causes of death, heart disease, cancer, stroke, diabetes. Instead of the leading cause of death, we don't deal with the actual cause of death, which is smoking, drinking, eating animal foods and highly processed refined carbohydrates. If we put our time and energy treating the actual causes of death instead of the leading causes of death, we'd probably be a lot better off. The reason isn't going away. We talked about the statistics earlier. They're quite dire, but I don't see an eradication of highly palatable ultra-processed foods disappearing from our food environment anytime soon. If anything, it just continues to metastasize and people are getting more and more sick and fatter and fatter. It doesn't appear to be headed in a great direction, which demands these types of interventions to save people's lives and get them on a different track. What is your prescription for the world? Like, how are we going to, as a collective, conquer this challenge that we have in terms of our food system to create something better? Honestly, for the sake of humanity. To me, if I look at humanity as a whole, it would be very stressful and I don't like stress. So what I do is instead, I look at the fact that I'm going to do everything I can do to influence the one or one and a half or two percent of the population that are hungry for information willing to make these changes and hope that if we can get those people optimizing their health, that they'll set a good example and the 100th monkey effect will kick in and maybe it'll have some downstream effect, maybe not in this generation, but in future generations. So I'm not going to try to take on the world as a whole. I only want to work with the highly motivated people that are willing to do what it takes to actually get and stay healthy and prove that this is an approach that can help them spend the last 20 years of their life healthy and happy. And to kind of end this, maybe look to camera and say, what is the message that you want the person who's listening to this or watching to understand? Maybe that person has their own health challenges. They're trying to figure out what to do about it. They're a little bit scared or intimidated by what you shared and aren't really sure-footed about how to take that first step or where to begin. Well, health results from healthful living. So if you want to be healthy, you've got to pay the price and live healthfully. That means diet. Our particular version is a whole plant food SOS, free diet. Other people have different opinions, but a healthy diet, hopefully, regular exercise within your capacity, abundant sleep. So developing the ability to get to sleep in a cool, dark and quiet place and maintain good sleep hygiene, fast every day for 12 to 16 hours, fast occasionally as appropriate, and try to figure out strategies to minimize stress, perhaps by only focusing on the things you can do something about and not worrying about the things that you have no potential to control. There you have it. I really hope you enjoyed these highlights. And in closing, I just want to say that I'm genuinely grateful for all the guests who share their wisdom. And also for you, our listeners, our viewers, without whom this show just wouldn't be possible. So thank you. If any of these snippets piqued your interest, I encourage you to watch the full episodes, links to which you can find in the show notes on the episode page of Ritual.com, as well as in the YouTube description.