Gut Microbiome Benefits of Intermittent Fasting

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Today I speak with Dr. David Jockers on fasting. He’s recently written a book called The Fasting Transformation, and he also is someone who uses fasting in terms of his clinical practice and personally. So he brings a very well-informed multi-vantage point perspective to the conversation. He also does a phenomenal job elaborating on some of the research findings and explaining the mechanism underneath why people improve not only gut health, but gut bacterial diversity when they fast. So I think you’ll find that insight particularly interesting. We also talk about some of the metabolic benefits, the best way to “load” pre- fasting, so to speak. How much is enough? How much is too much? How does this interface with things like exercise, female hormones, male hormones, recovery endurance training? So this is really a very rich and beneficial conversation today with David.

DrMR:

I do hope that you will check out the podcast and also his book, The Fasting Transformation. I’d also like to remind you that if you are someone who is struggling with how to apply fasting, one of the things that we do at the clinic is offer not only health coaching, but performance optimization tools and techniques for people so that they can use all these tools beyond just “I have IBS”, “I have rheumatoid arthritis”, or “I’m looking for symptom management or resolution. We also discuss how can we use these techniques to have optimum energy, optimum mental clarity, and really just have the most enjoyable experience as a person in the world as possible. So with that, we will now go to the conversation on fasting with Dr. David Jockers.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio today here with Dr. David Jockers and we are going to be talking about fasting. This is a topic we’ve discussed in the podcast before, I discuss in Healthy Gut, Healthy You. There’s probably many of you out there who, if you’ve had gut issues have said to yourself, I feel great if I don’t eat. This tells you in part anyway, the power of fasting. So David was nice enough to send me his book, The Fasting Transformation, and he’s here today to kind of illuminate the topic of fasting. David, welcome to the show.

DrDavidJockers:

Thanks so much, Michael, I’m big fan of your podcast here. You put out such great information, so I’m excited to be on.

DrMR:

I’m excited to have you on. One of the things I appreciate about you is, at least as far as I’m able to tell, you are a self tinkerer. You and I had a kind of back and forth via email about continuous glucose monitoring. I could tell from your answers, you were really kind of paying attention where you had tried different amounts of caffeine plus or minus MCT, and commented on how that impacted your blood sugar. I always appreciate when someone isn’t only working with clinical information, but they’re also tinkering themselves. That tends to give you another layer of experience when you go through these things yourself. Definitely excited to get your perspective, not only knowing what the published literature says on fasting, but also some of your personal experience.

DrDJ:

Yeah. For sure. I think in general, when you’re in this field, or when I got started with natural health, there were more dogmatic ideas on nutrition, on what you needed to do to be healthy. As I’ve developed over the last 15-20 years I’ve been studying this, I become more and more open to different things. Using biohacking tools and ways of self monitoring, like continuous blood glucose. I have an Oura Ring looking at my sleep, things like that. I have become more and more open-minded and I realize that ultimately there’s not just one way. And even if you find something that’s working for you right now, that doesn’t mean you need to do it every day. In fact, sometimes diet strategies, whether it’s intermittent fasting or things that we’re eating, actually work best when they’re intermittent, Doing a little bit here and then stopping it and then doing it again, things like that. All these kinds of things. Just modifying these can really make a big difference. Just keeping an open mind, I think is probably one of the most important things we can do as practitioners and health influencers.

DrMR:

Yeah. I love it. There’s a lot here I want to jump into potentially, but let’s start with something that you said before we began the recording. A study on how fasting impacts the microbiome. I think that’ll be not only reassuring, but also an insightful study to kind of open up the discussion with.

Dr. Jocker’s Personal Journey

DrDJ:

Yeah, for sure. Well, I actually want to start with my own personal journey because I actually had irritable bowel syndrome in my early twenties. This is back in the early 2000. I started struggling in the late nineties in high school, but it didn’t really hit until my early twenties and I had irritable bowel syndrome. So I would have intense intestinal cramping, bloating, constipation, diarrhea, all those types of symptoms. was a personal trainer. So I thought I knew more about health than everybody else around me and I was doing the things that I thought were right. Yet I was struggling. Ultimately it came to a head where I actually lost 30 pounds, 30 pounds of muscle. And I’m already a thin guy.

DrDJ:

I was about 165 pounds. I got down at one 35. I had orthostatic hypotension where I would go from sitting to standing and I’d be really dizzy. My blood pressure was very low, usually like 90/50. I just had poor circulation. I was cold all the time. All of these different symptoms and I obviously made some nutrition changes. I took out grains out of my diet that really made a big difference. But the biggest difference maker was when I stopped eating breakfast. I didn’t even know the term intermittent fasting back then. In 2005 nobody was talking about this and I just stopped eating breakfast. I was in graduate school and I would drink a lot of water in the morning and I would just go to my classes in the morning.

DrDJ:

So I would go to class, I would drink a ton of water and not eat until like two or three o’clock when I got hungry. Then I would eat for like a four or five hour eating window. I would eat a lot of food and I started gaining my weight back and I started feeling significantly better. Started getting muscle back. I was stronger than ever in the gym. It’s funny because back then I actually thought it was the water. I used to tell people, when they would ask “what are you doing?” when they saw this transformation in me and I was like, I’m drinking a gallon of water between the time I wake up and noon. I thought it was the water that was increasing my sarcomeres and creating better contractile tension for my muscles.

DrDJ:

Lo and behold later I found out about intermittent fasting and the science behind it and how powerful this is and really how it impacts the gut. That’s what we’re talking about here is actually intermittent fasting, believe it or not. Most people think that you’ve got to eat lots of prebiotic foods in order to increase your bacterial diversity, right? Your gut diversity. The amount of different types of species of bacteria, and a lot of different studies linked this with lower levels of inflammatory diseases, metabolic diseases and higher longevity. It’s kind of a consensus, although this is still an evolving field. I would say most microbiome researchers would say today that the better your gut diversity, the more broad range of species you have of different types of bacteria, the healthier you are. What’s actually been shown is that fasting, intermittent fasting, time restricted feeding actually increases your diversity and can go into exactly how that works and how it increases different keystone bacteria. I would love to get into that in more detail.

Fasting and Improving Gut Health & Diversity

DrMR:

Yeah. A lot there to unpack it. I didn’t realize the extent to which fasting was part of your initial health journey. It’s awesome that you fell into that. I wish I had discovered fasting earlier. Unfortunately I was kind of entrenched in the old kind of athlete bodybuilding community of “eat every three to four hours”. Which, I think, was one of the reasons why my gut health took so long to fully come back online. A good illustration of how damaging dogma can be. When you’re willing to think outside the box and listen to your own experience, which you did, better than I did there, you can have fantastic results. Let’s go a little bit more into this piece. I know our audience is not new to this concept of it’s a false argument to say high diversity is good, therefore more prebiotics equates to better gut health because prebiotics feed gut bacteria. We’ve kind of debunked that and I think our audience understands that. Many of them have probably lived through that either seeing improvements in their gut health, by fasting or perhaps by going on a low prebiotic diet, like the low FODMAP diet. But I’m sure they’re keen to hear more about some of those findings regarding fasting and improving gut health and diversity.

DrDJ:

Yeah, for sure. I want to go through a couple different things that I found. The first one is Scientific American has a great article and this just came out in 2015 and they talked about this French gastroenterologist Harry Sokol. I don’t know if you saw this, but he actually did tissue samples of Crohn’s patients. I’m not sure if you’re familiar with that. When we think about Crohn’s, especially in Functional Medicine, we think there’s a parasite. There is some sort of bad bacteria, overgrowth, dysbiosis and sometimes that is the case, right. But typically we’re quick to think that. I know for me as a clinician, I’ve always tended to think that like, there’s some sort of really bad pathogen that’s in there. What he found was that was similar, and he looked at people in Europe and then he also looked at studies that were done in Japan and people in East Asia.

DrDJ:

And what they found was that there was a depletion of one specific bacteria, and this was kind of the similarity when they looked at all these different Crohn’s patients. It was this bacteria, Faecalibacterium prausnitzii, I’m not sure that I’m saying that correctly. I believe I am. It’s part of the Clostridial species. They call it a Clostridial cluster. Typically we think of Clostridium difficile. C. diff and how pathogenic and bad that can be. Clearly when that grows out of balance that can be very, very pathogenic and damaging to the body. However, what they found was that these Clostridial clusters actually created more protection for the intestinal membrane.

DrDJ:

The actual intestinal epithelium and the mucus membrane, they created more protection there. There’s been a few studies that have shown that intermittent fasting, there was a 2019 study in the Turkish Journal of Gastroenterology. They did Ramadan fasting. It’s easy to study people that follow the Islamic tradition of Ramadan because they’re not eating and they’re very compliant, right. It’s part of their religion. So they don’t eat or drink from sunrise to sunset. Oftentimes Ramadan is in the winter, so it’s like a 12 to 16 hour fast. A dry fast, for 12 to 16 hours. What they found was that doing this increases Akkermansia muciniphila. Mucniphila means mucus loving.

DrDJ:

That’s key because we’re going to talk a lot about the mucus membrane along the intestinal lining and how critical the integrity of that is. So it’s a mucus loving bacteria. It also increased Faecalibacterium prausnitzii and then also Bacteroides fragilis as well. All three of these microbiome researchers, many of them have called these Keystone bacteria. Meaning that in a large group of studies, when you have high amounts of these bacteria, they’re are associated with lower rates of inflammatory bowel disease and better metabolic health, meaning less body fat, better lean body tissue, better insulin sensitivity. So fasting has been shown to do that. I was interested in understanding the real mechanism of this. What I found was that Akkermansia and some of these other bacteria like our friend here, Faecalibacterium prausnitzii, what they actually do is they activate this MUC 2 gene in the goblet cells.

DrDJ:

We have goblet cells in our intestines. What they do is they produce mucus and the Akkermansia actually lives in the mucus. There are different types of bacteria that live in the mucus. Some degrade the mucus in a way that causes a net damaging effect. If those overgrow, we have a dysbiotic effect on the gut and we create more leaky gut, intestinal permeability. Whereas Akkermansia tends to have a very strengthening effect. So it eats the mucus, but it also stimulates the goblet cells to produce more mucus. The healthier mucus membrane, the better integrity there, the more intact the intestinal proteins, like the occludin proteins and the tight junctions are going to be. So there will be less damage that’s going to take place along that. The less intestinal permeability and the less overall inflammation that’s taking place. So it’s really interesting from that perspective.

DrDJ:

I was talking with Kiran Krishnan from Microbiome Labs. We had a good conversation about this. There are two different types of feeders in our gut. So there are primary feeders. When we eat something like broccoli or something, the primary feeders break down the cellulose. So they’re breaking down a lot of the hard fibers on there and they’re feasting off of that. Then you’ve got polyphenols. We’ve heard about how great polyphenols are for the gut. One of the reasons why they’re so good is that’s actually what Akkermansia as well as Faecalibacterium prausnitzii utilize. They eat those polyphenols and then they produce something called urolithins. These urolithins increase intestinal cell mitophagy. Mitophagy is a term for breaking down old, damaged and dysfunctional mitochondria. This is something that fasting helps to do as well. We know the mitochondria within all of our cells produce the energy. The healthier the mitochondria are, and the more of them you have in a cell, the more stress resilient it becomes. It’s able to handle stress better. It has less oxidative stress within the cell, and it has a greater life span and greater productivity.

DrDJ:

So we’re stimulating more of that creating basically better mitochondria within all these intestinal cells. That’s one of the key factors here. If we’re constantly eating, we actually only feed the primary feeders. We actually need time between, time for those polyphenols to kind of drip into the mucosal membrane and allow the Akkermansia and these Keystone bacteria to really break those down and to thrive. If we’re constantly eating every few hours, like the bodybuilder diet that both you and I both followed for years, then we’re not allowing that to happen. We end up with a degradation of that intestinal mucosal epithelium. That’s going to lead to a greater tendency to have intestinal permeability and inflammation in our gut and inflammation throughout our body.

IBS and Fasting

DrMR:

Well, that is fascinating. Thank you so much because there are a few things there that I didn’t have quite a firm grip on. We had discussed some of this in Healthy Gut, Healthy You. Some of these species changing upon fasting or upon elemental dieting. I didn’t realize there was this kind of mitochondrial hormetic stressor, so to speak, but it makes a lot of sense in the capacity of fasting being a healthy stressor and tissues and cells needing healthy stressors for optimum function. I think that’s so important because this is a mechanism that verifies if we’re juxtaposing this conversation next to the evidence-based pyramid model of medical research, the pinnacle is outcome data. When we look at people who fast, they feel better than people who don’t. This isn’t an absolute rule, but there’s certainly this trend in the IBS literature. If we look at people who have IBS and fast, outcomes there, generally speaking, look pretty good.

DrMR:

When we put individuals with IBS on a high prebiotic diet, some are helped, yes. There is that data there. But there’s much more of a signal for people potentially being flared by either eating lots of food or eating lots of prebiotics. What you’re describing is the underlying mechanism for why we know that observation, which is fascinating. Hopefully that juxtaposition kind of helps our audience. It was maybe about five or six years ago when the fiber enthusiasts and the prebiotic diversity research was really coming into vogue. Why I was, and I’m assuming you were also David, I just wasn’t familiar with your work at that point in time so I don’t want to speak on your behalf. But I’m assuming that we were more in agreement with the thought that okay, this is interesting, but let’s not throw the baby out with the bath water. Meaning if we know that fasting helps this population, even if there’s this interesting mechanism, eat more prebiotics, prebiotics feed gut bacteria, therefore you should have a healthier gut. Even though that mechanism exists, we don’t want to throw out the higher quality observation of clinical interventions helping these populations, just because you don’t know the mechanism yet. You just outlined this contemporary mechanism underpinning why we see those observations.

DrDJ:

Yeah, it’s really fascinating. I’m right there along with you. Obviously in a natural health/paleo world resistant starch and prebiotic rich diets have been talked about for quite a while, but I never did well on those. And I still don’t. That sort of diet just does not work well for me or for a lot of the patients that I’ve worked with as well. I think it’s kind of like a bell curve. On one side of the bell curve, you have people that do a lot better with less prebiotic foods, more fasting, more of a protein, fat centric diet, less of these prebiotics. Then you get the middle where people do well with a certain amount. We all kind of have our certain threshold and then on the far right, you’ve got people that just do great on these high prebiotic foods.

DrDJ:

They’re the people that are, for example, whole food plant-based and thriving. There are people that do whole food plant-based diets that do very poorly. Or paleo diets with like lots of resistant starch and they do very poorly, but they think it’s the right diet. So they stay on it. Then you have people that do great. They’re thriving on these diets. Their genetic makeup and their microbiome is set up in such a way that they do great on that sort of diet. I think our health journey is really all about mastering our own body. So we have to figure out where we’re at on that. I think you do a great job of explaining that and helping people understand how to follow things like a low FODMAP diet.

DrDJ:

Some people need an elemental diet, for example, or fasting like I did in order to get to a certain point in their health and then they can start introducing more of these things back in. So I think this is really important to understand. Just in general, fasting, if you think about it, like if you have leaky gut or intestinal permeability, it’s kind of like having a broken or sprained ankle. If you were to go and walk or jog on your sprained ankle every day, it’s not going to heal.So it’s kind of like that with the gut lining, if the gut lining is really damaged, you need to rest.

DrMR:

I use that same analogy all the time. So we’re definitely on the same page there. Fully agreed.

DrDJ:

Yeah, totally. You need time to rest. The great thing about it is the intestinal membrane heals much faster than the tissues in your ankle, right? Typically you have to stay off of it for like six weeks for your ankle to heal. The intestinal membrane, there’s actually been studies on this, rat studies, but they have shown that within 24 hours of fasting, there is significant stimulation of intestinal STEM cells, these young embryonic cells. When we start to do intermittent fasting, we’re going to get this effect. Getting rid of the bad mitochondria, creating more stress, resilient mitochondria. We’re also going to stimulate the production of really young cells in general, to get rid of the older, bad cells that are just beyond repair. So there are certain cells that would just take so much energy to repair them. Why not just bring in some new young baby cells that have tremendous energy, and tremendous potential to handle stress. And so that’s what happens when we start to fast, we get this hormetic effect. We start to bring in these younger embryonic cells. They’re going to be more stress resilient. They’re going to be able to handle more stress. We’re also going to build up that mucus layer. So that way we’re going to have a better defense against pathogens and inflammation from degrading that intestinal membrane.

DrMR:

It’s such an important point.

SponsoredResources:

Is your gut not as healthy as it could be? Thankfully, there are many options out there that can help you. One that can lead to a rapid reduction of symptoms, inflammation, and imbalances is an elemental diet. I’m very proud to say that we’ve developed a line of elemental diets that are accessible and also do not require a doctor’s recommendation. We have our original, vanilla, and chocolate as well as the only low carb and the only whey-free versions that do not require a doctor’s note. We are about to release a low-carb vanilla, and a whey-free peach. If you head over to our store and use code, GetElementalHeal, all one word, you will receive 15% off your first order. Head over there and check it out. Hopefully you, like many others, will experience the quick resolution and improvement in your symptoms by using a simple intervention of elemental dieting.

How We Eat

DrDJ:

There’s published evidence showing that those who have IBS have a higher predilection towards anxiety. Because of that, there seems to be this tendency for people not to believe that their gut can heal. People oftentimes will think that an ankle sprain is easier to heal than the gut. Not to take anything away from how complex it can be to find the right combination of factors to heal someone’s gut, but I also don’t think people give their gut enough credit. How adept it is at being able to heal. So I’m glad you raised that point.

DrDJ:

Yeah. It’s really a catch 22 because the intestines can heal faster, but they’re also a lot more fragile. It takes more tension, more friction, more of an insult to damage your ankle than it does your gut, because your gut is only one cell. That mucous membrane that protects it is so critically important and it’s not talked about enough. You want to do everything you can to help protect that mucus membrane. Because again, when you only have one cell, connected by these tight junctions, it’s fragile. Probably most of the listeners that are tuning in here are on what would be considered a healthy diet.

DrDJ:

However, if we eat too quickly, we’re not producing enough stomach acid. Maybe it’s because we’re under stress. Regardless of the reason, low stomach acid is a major issue. We are just not producing enough. We’re not getting good bile flow, good pancreatic enzyme production. As a result food is not going to be digested as optimally as it should be. It’s going to put more stress on the gut lining. Again, if the mucus membrane is worn down, then there’s greater chance of really damaging that intestinal membrane and having large undigested food particles and pathogens from, into the bloodstream and creating more inflammation in the body.

DrMR:

Yeah. It’s such an important point. Just to throw out some perspective here that may motivate people to slow down their eating pace. I often need a reminder as well. My friend, Anthony Gustin who’s over at Perfect Keto was just with, I believe it was the Hadza. I may be incorrect in the tribe he was with, but he was in Africa with a group of Hunter/Gatherers. I don’t mean that the touristy driving by in a Savannah truck. He was living with them and he kind of gave me a download. This obviously really shifted my perspective. One of the things he remarked was needing to slow down the pace with which you eat. In kind of eating around a fire with this tribe of Hunter/Gatherers, where there is community and conversation and the pace of eating was much slower. I found myself that night listening to a podcast and eating really fast. It was a good reminder to kind of catch myself, sit back in my chair, relax and slow down my pace. I think there’s this perpetuation to do things fast in our society but it is important to have that mooring to prevent you from going too fast.

DrDJ:

Yeah. I have that same struggle. I grew up in a family. I was one of six kids. So my parents put down the food and then it was like a race for who could get the food. It was kind of ingrained, you know? So I have to unlearn that and slow down as well. Just trying to be more intentional with our eating is so important. I think that’s also one of the powerful things of the elemental diet or a semi elemental diet. I know I typically tend to feel better when I do a protein shake with an avocado in it as my lunch meal. Then dinner is solid foods. Meat, vegetables, healthy fats, things like that. But I tend to feel better having one of my meals being more of a liquid meal because the blender has done the job right.

DrMR:

Are you doing the heavier meal when you’re doing less? Like in the evening? Is that more relaxed? That makes sense.

DrDJ:

Totally. A big thing that I teach is to eat your largest meal when you’re in your most relaxed state. Right now I have young kids. So sometimes it can be stressful, but in general, that’s supposed to be the most relaxed state.

DrMR:

Relaxed is a relative term here.

DrDJ:

Yeah.

Eating & Bed Time

DrMR:

So here’s a question on that for you. It’s something I’ve been recently struggling with, I guess you could say. I tend to Swork all day and then I go from working to the gym and then from the gym to the sauna. And so by the time I get around to eating, it’s been a stretch. It wouldn’t be abnormal for me to eat at 8:30 or 9 o’clock at night going to bed, maybe around 11. It wasn’t until I got a stern paternalistic talking to about my Oura Ring data and that I really needed to be eating by 6 or 7pm. For a long time I’ve been kind of a C-minus sleeper. So for our audience, you get the sleep score from the Oura Ring . It’s simple, you get an A,B,C, or D grading and it correlates. I mean, if I”m out with friends and we’ve had some wine or some drinks and I’m up late, then I’ll have a D sleep score. But even when doing “everything” right, for me, the right may have been partially wrong. I would be about a C minus sleep score sleeper. So I changed two things. I started mouth taping, which I think can be significant especially with my risk profile of having braces and things like this. I also started eating earlier and that did bump me up to a mid B, B plus student after only about a week or week and a half. So it was a pretty remarkable change. One of the things that I’m wondering about from your clinical experience or personal experience, fasting can push the meal later and later in the day. If we don’t have that window for when we really slow down and relax till later in the evening, and that’s when we’re eating, what is the best balance for not eating too close to bed? Or maybe you don’t think that’s a big deal at all. How are you handling this potential challenge?

DrDJ:

That’s a great question. I definitely think it does matter, especially for certain individuals. It matters more than others. There’s a guy who’s popular on YouTube. I can’t remember his name. I heard about him a few years ago, but he eats one meal a day. The guy has lost like a hundred pounds. He looks great. He’s eating junk food a lot of the time. Sometimes he eats healthy meals, but a lot of times it’s junk food. He eats at like midnight because of his work schedule and everything. He films every single meal eats. It’s just like this one huge meal that he eats once a day. He is on this OMAD diet. He really popularized the one meal a day diet, cause his videos started going viral because he was eating junk and he was losing weight.

DrDJ:

So I think there are certain individuals that can somehow do that. It doesn’t affect them as much, but I would say the vast majority are going to be affected. I think it’s definitely important to eat at least three hours before you go to bed to really be able to digest that meal as well as you can. Also optimally trying to get at least one hour of sleep before midnight. I think that every hour of sleep you get before midnight is equivalent, I’ve heard this statement, it’s equivalent to three hours of the regenerative capacity of the sleep after midnight. And I

DrDJ:

When I tend to go to bed earlier, I have much better Oura scores. So I think that that is important. A couple of things you could do with intermittent fasting and trying to accomplish that. One is that you could, depending on how your schedule works, maybe take a little bit longer lunch break. Maybe just fast through the evening and eat breakfast and lunch. Have your eating window earlier in the day, and then fast through dinner. One day a week, I do somewhere between a 22 to 24 hour fast. So it’s usually Wednesday cause I don’t exercise intensely on Wednesday. I eat lunch and then I just fast through dinner. And then I fast until lunch on Thursday.

Metabolic Flexibility & Fasting

DrDJ:

I noticed that my heart rate variability scores are typically at their highest. I feel so regenerated on Thursday when I wake up. I feel like I got two extra hours of sleep. This is something I’ve been doing now for a long time. So I get that really great full day. This is just another tangent, but this is actually a goal that I have for individuals is to increase their metabolic flexibility. Their ability to go from burning sugar for fuel to burning their own body fat for fuel to the point where they’re metabolically fit enough to do something like a 20 to 24 hour fast and be comfortable during it. Where it’s not hard for them, but it’s something they’re actually comfortable. It’s actually something they, to some degree, look forward to because they feel better during that phase. This is something I do every week and I noticed that I feel better. It helps regenerate me. I do it midweek because, you know, being an entrepreneur and somebody that is a high performer, I’m charging hard during the week. Trying to really get a lot done, study a lot of things, creating a lot of content. It really helps regenerate me and set me up for the second half of the week.

DrMR:

It’s funny you say that because when I’m doing everything right, and there are times when I got kind of knocked off cadence, but I try to do one day per week, one meal per day. That seems to be enough of a stretch where, I feel a little bit of discomfort, but not so much where it crashes me. I haven’t really been able to do more than one day fast yet without it really feeling like it takes a toll and it isn’t worth it. For me, someone who works a lot in a very cognitively demanding field plus exercises a lot, I don’t think it’s worth the gain to go for the two day fast. I do, however, like the idea and it seems to be a within reach for most people to do an intermittent fast during the week.

DrMR:

Find your window. Maybe you skip breakfast, kind of like we’ve been talking about, but then have that one day per week that is kind of a stretch. I do feel my metabolism change. The main thing I noticed, and I haven’t looked at an HRV corollary and I’m going to start looking at that based on what you said, but I noticed my cravings afterward get totally reset. That’s one of the things that I’ve really found to be helpful, especially when you go home and see family. You have the chance, especially around the holidays to get pulled into all the junk food. For the past two years that I’ve been doing this kind of one meal per day, one day per week, I noticed that all the cannolis and the Italian cookies from my big Italian family, it’s not that I am trying not to eat them. I just don’t even have the desire for them. It’s really been remarkable where that fasting has had a profound impact on my cravings.

DrDJ:

Yeah. That’s a positive sign of metabolic flexibility. Your metabolic flexibility is very high. A lot of people will end up with cravings after they eat meals or just throughout the day. Of course there can be some emotional issues that go into that. So I don’t want to discount that. When we eat, we secrete dopamine, which makes us feel good. For some people they may not get a lot of dopamine release from their job or from their relationships. Food is a release for them. Outside of that, when we’re having a lot of these strong cravings, that is a sign that we’re more insulin resistant and we’re not as good at burning our own body fats. Our body feels like it needs some sort of quick energy.

DrDJ:

If you notice after you have a good meal and then you’re like, Oh, I need to have something with sugar or some sort of carbs. That’s a sign that again, your body has pumped out all this insulin, cause you just had this meal, yet you’re still struggling to get the energy within the cells. That can definitely be correlated. So the fact that those cravings have gone down is a really positive sign of your metabolic flexibility. I’m right along those lines as well. I think also doing the one day one meal a day fast, again, basically fasting somewhere between 20 to 24 hours in that range, depending on when you time your meals. The cool thing about it too, is it actually gives you more tolerance. This is nuanced because if you’re very insulin resistant and very overweight, you probably don’t have as much carbohydrate tolerance, but over time, as you get more metabolically flexible, you have more tolerance for having a larger carbohydrate meal and it having minimal effects on inflammation and insulin resistance.

DrMR:

That’s what Mike Nelson calls the Pop-Tart test. He wants to see if people can buffer the glucose from two Pop-Tarts. I haven’t run yet, but I’m hoping I’ll pass it if I do. There’s another thing here that we should just maybe state more plainly for people. II can’t claim have gone through an exhaustive review on the literature here, but I believe you mentioned this in your book also. In looking at low calorie diets for diabetes and obesity, as compared to implementing a fasting protocol, the fasting protocols show better outcomes for blood sugar regulation or dampening down higher blood sugar levels and also body composition. So all these things kind of seem to tie together. I think the important take-home for people, at least my read, is you’re better off not going lower calorie in perpetuity, but having these episodic periods that you go without any food so that your body can shift from the fed state, into the fasting state, rather being in this kind of limbo where you’re never fully fasted and you’re never fully fed.

DrDJ:

I mean, so true. We really need to be well fed at times in order to produce optimal hormones. There are some individuals that are morbidly obese that have done very long fasts and have seen amazing results with that. But that’s an outlier. In general, most of us really need to go through what we call feast/famine cycling. We actually need to bump our insulin up at times strategically. This is really important for menstruating females, but also for men for good testosterone production. So basically, you know, what we want to do is we want to fast for periods of time. Like on a regular basis for the average person, somewhere around 16 to 18 hour fast on a daily basis can be really helpful.

Hormones and Fasting

DrDJ:

Now, young menstruating females who are also very active and very stressed, I wouldn’t recommend doing a 16- 18 hour fast every day. I recommend doing it like two or three times a week on non-consecutive days. Ideally, in the beginning, when you first get started with that on non-exercise days. Now, as you feel better, you can start to implement fasted exercise. Which is an amazing hormetic stress on the body. But I find that young menstruating females tend to have the most trouble, particularly when they’re very lean with this. We want to be delicate with that process and also be doing it around their menstrual cycle. For example, the week right before the menstrual cycle, they really need a big bump in estrogen and insulin helps give that bump. So usually the week before the menstrual cycle, most women have cravings and those cravings are important to consider.

DrDJ:

That’s because the body is saying I need to build hormones. I need more insulin to help trigger and build more hormones. Insulin helps drive nutrients into cells. If you’re living healthy lifestyle outside of that week, if you’re getting regular exercise, you’re sleeping well, keeping your stress down, practicing intermittent fasting, you’re going to have good insulin sensitivity. When insulin does come up, it’s gonna be able to drive nutrients into cells and you’re gonna be able to produce. So it’s going to give you a bump in that estrogen that you need. I think that’s really important to remember. For men, they need it from time to time as well in order to help produce optimal testosterone. Depending on your baseline level of insulin sensitivity, that can help determine how often you want to bump up your carbs or feast in a sense.

DrDJ:

I’m very, very lean and I’m very active. I exercise five days a week and I’m 8% body fat. I want to maintain my muscle mass. If I don’t lift or exercise and lift heavy weights, I will lose 15 pounds. For me, when I eat, I typically feast. I eat a lot of protein, healthy fats. From time to time, probably two or three days a week, I’ll have a little bit more carbs. Usually I’m around 50 grams or less, but sometimes I’ll bump it up to about a 100-125. That seems to work great for me. I maintain my muscle mass, keep my energy high, keep my testosterone high, keep my drive really high. If I go to low carb for too long, I just notice my energy dropping my mental drive dropping. Those are signs of lower testosterone for a male.

DrMR:

There are a number of really important points there. One is that in addition to not always being low-calorie, we may not necessarily always have to be low carb. This is especially true if we’re getting these fast windows, cause then we’ll be able to buffer and hopefully get the positive anabolic effects, without any of the negative metabolic excess effects of prolonged high carbohydrate dieting. Super important point. Part of how that may be mediated is through not necessarily producing more hormones, just for the women who maybe are trying to be cognizant about this estrogen dominance. I think there are some challenges with the concept of estrogen dominance, but at least one mechanism may be that you’re not necessarily making more hormones, but you’re having more free hormone because insulin helps impact this sex hormone binding globulin.

DrMR:

This is part of the reason why insulin is anabolic. Because it helps these hormones not be stuck so tightly to the carrier protein sex hormone binding globulin. So that’s part of how you have these anabolic effects. If you go too far, then you have kind of the big puffy bloated bodybuilder look. Too anabolic. So there is this kind of sweet spot. I also just want to second your perspective on females. They probably should be doing some fasting, but there’s a middle ground. Pretty much exactly what you said is what I recommend people do in the clinic. About two days per week, intermittent fast for anywhere from a 14 to 18 hour window. So it gives you some of that fasting stimuli, but not enough to potentially crash someone. Also great point about fasted exercise.

DrMR:

This is something I found I had a condition my way up to, but some of the best cardio sessions I have not been front loaded with carbohydrates. Instead, the I don’t have much time, I don’t have time to eat, I got to squeeze in this cardio session, I’ve been fasting all day, let me go run. Then I felt like I had jets strapped to my back. Again, there is a point where you push too far and too hard, but if you’re fat adapted, and you haven’t been burning the candle at both ends, you’re going to have some good output while fasting. This also has ancestral plausibility in the sense that, well, when we were in a fasted state, we had to go out and procure food, which required more activity. We do have the ability to do this. People just they tend to think in extremes. If I’m doing this extreme fast, should I not do a killer workout? You’re not going to do this all the time, but you’re going to have these periods of stress that will help your body adapt and become stronger, but not excessive stress that kind of breaks you down faster than you can rebuild or recover.

DrDJ:

Yeah. I mean, it’s so true. You’ve got to really watch your body, but yeah, I love fasted exercise. At this point, I can’t even imagine exercising when I’m well fed because I only exercise when I’m fasted. The cool thing about when you’re exercising fasted is you already have growth hormone elevated. When you’re in a fasted state, your human growth hormone is increased. So insulin is kind of an antagonist growth hormone. Growth hormone is what they call the quintessential anti-aging hormone. It helps with lean body tissue development, f,at-burning good for the skin, collagen repair, joint repair. So you get a lot of great anti-aging type of benefits when you have elevated amounts of your own endogenous produce growth hormone. I’m not talking about some sort of injection or some sort of supplement with it.

DrDJ:

When you exercise, you’re really putting all of that together. You’re getting the growth hormone actually help you with your performance. Then on top of that, your body’s starting to utilize ketones as an energy source. They are a really, really clean fuel source. So when we burn glucose, which we will during exercise as well, glucose is a dirty fuel source. We can produce energy quickly from sugar, but we also produce a lot of oxidative stress and less energy overall, significantly less than when we’re burning fat for fuel. So burning fat, we produce a lot more ATP, lot more cellular energy and a lot less metabolic waste. However, we need oxygen in order to break it down in order to utilize it. And then ketones are a byproduct of fat metabolism that our liver produces for the brain because we can’t get fatty acids across the blood brain barrier.

DrDJ:

So we need some sort of fuel source outside of just glucose for the brain. That’s where we have ketones and ketones are an amazing fuel source for the brain. They also help down-regulate inflammation in the brain and they also actually activate their epigenetic influencers. So they actually activate healthy gene production. So good genes that help mitigate against neurodegeneration and things like that in your brain. So we want those ketones elevated and fasted exercise really helps with this. It gets you better at utilizing ketones as an energy source. It’s a great thing to do. Most people that start doing it, doing it appropriately, this is something you want to lean into. Like you were saying, you don’t want to just go aggressively with this. You want to lean into it gradually, maybe start with one day a week where you get your exercise in a fasted state, see how you do.

DrDJ:

If you do well with that, maybe the next week two fasted workouts, right? You just kind of gradually find where your sweet spot is there. You will see like a noticeable difference as you build your metabolic flexibility and start applying this. You’ll notice how you feel amazing during the workout and you get better benefits, but again, you don’t want to overtrain and hit the wall, so you don’t want to overstress your system. So you have to be really, really diligent with that. Even if you had planned a fasted workout, but let’s say you slept really poorly, or you had significant stress the night before, or the morning of probably a good idea not to do it that day and reschedule it for another day. Then just do a low-level activity. Like maybe taking a walk outside, going in nature or something along those lines would be a lot better idea.

DrMR:

So for people to keep in mind, as you’re pushing this envelope, one of the ways you find where the edge is is to overstep it. Keep in mind. I totally include myself in this and I’ve shared some of my collapses, so to speak where I’ve reached too far and had a setback. I just think it’s important to frame that appropriately and not think, Oh my God, I did some serious damage or something is wrong with me. I mean, when we’re reaching for optimum, sometimes we’re going to stumble and fall and that’s okay. Just have a little bit of patience with yourself, take notes and learn from it so that you don’t keep repeating the same mistakes. There are some tripwires out there that we’re all likely gonna step over or trip over at some point.

DrDJ:

Yeah, absolutely super, super important to understand. Also on top of that, going back to that conversation about feasting and hormones, another key hormone is thyroid hormone. When we are in an under eating state, for a prolonged period of time, our body says, well, we don’t want to waste energy. Thyroid hormone activates metabolism, activates the mitochondria and energy production within the cells. So the body’s trying to conserve that energy cause it’s like, okay, I don’t know where my next meal is and we’re not getting enough fuel here. So we don’t want to convert as much active thyroid hormones. Sometimes on labs you see this on your T4 to T3 conversion. T3 is the active thyroid hormone and it starts to go down. For some people, that’s actually a healthy adaptation, in the sense that their body’s being more efficient while for other individuals, they start to have a lot of thyroid symptoms. The hair starts falling out, they feel really, really cold, they can’t lose weight. They feel really tired. Those are signs that they’re not getting enough activation there. They may need a little bit more bump of insulin in some cases to, again, get that conversion of T4 to T3 to work better because insulin is important for that conversion process.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrMR:

So there’s this reoccurring, same of that Goldilocks zone, where any stressor carried too far can become detrimental rather than kind of this hermetically beneficial stimulus.

Fasting is a Natural Process

DrDJ:

Absolutely. Fasting is one of those things. Fasting is really, my opinion, it is the most ancient, inexpensive and powerful healing tool known to mankind. I say that because all of our ancestors did it, since the beginning of mankind. We’ve done it our whole life. When we sleep, we’re not eating, we are fasting. We just have to be a little bit more intentional. Our ancestors didn’t have pantries and refrigerators, so they may have a great harvest or a great hunt. When they did that, they feasted because food had a short shelf life. They would eat as much as they could, enjoying their meals. Then they may only be able to eat once a day or they may go days sometimes without meals.

DrDJ:

This is kind of built into our blueprint and there were even cultures, like, for example, I don’t know if you watched the movie 300 with the Spartans. That is such a great movie. The Spartans were renowned for their resilience. They were a small army, but they could take on significantly larger army. In the movie, they took on Persia, which had like a hundred times more soldiers. They were able to fend them off so they were just extremely resilient. One of the things the Spartans did was they trained and worked out all day and then they feasted it in the evening. So like five o’clock or so they would feast and they would eat in like a three or four hour eating window, go to sleep.

DrDJ:

Then wake up the next day and start doing their thing again. There’s even athletes like Herschel Walker. I live in Georgia, Herschel Walker is an NFL legend and he was a legend at the University of Georgia. He’s like this phenom and he was amazing running back. He only eats one meal a day and has been doing this most of his life. He eats a big meal with vegetables, bread, which I know you and I would love to help him reduce the amount of bread that he is consuming, but he likes bread and he eats fish. He’s consuming that meal and he’s like 5% body fat or something like that. Most running backs, when they get to their forties, these guys have been concussed so much, and they’ve just been hit so much, that they need multiple surgeries.

DrDJ:

They’re on a bunch of pain medications and life isn’t really as enjoyable later in life for running backs. Whereas with Herschel Walker in his fifties, he decided he felt so good he went to the MMA (mixed martial arts) and for like 10 -15 years, he was beating up 20 year olds in mixed martial arts. Why is that? I mean, genetically he’s a phenom. However, I believe that his regular pattern of eating one meal a day was creating this remarkable resiliency, this autophagy STEM cell development that he was getting. He was able to recover and repair. He had lower levels of inflammation, oxidative stress in his system. So really powerful. Now I don’t recommend for all of us to do one meal a day. For some individuals, it works great, particularly individuals that do have a lot of weight to lose.

DrDJ:

Those would be the types of individuals that can sometimes do well on that. For just about all of us, doing something like a 12 hour fast, this is typically where I start people. Is doing a 12 hour overnight fast. You finish dinner at 7:00 PM. You don’t eat anything with calories until 7:00 AM. Then, you start your day with water. You start hydrating your body. If you drank 8-16, up to maybe 32 ounces of water, you are going to suppress ghrelin, which is your hunger hormone. A lot of people will tell me that they’re really hungry when they first wake up and that’s typically a conditioned response. So if you’re used to eating, like I used to eat like a big bowl of oatmeal in the morning, going back many years ago.

DrDJ:

So I was used to eating in the morning. So I was hungry in the morning. Ghrelin is your hunger hormone. It is released by your stomach and it’s a conditioned hormone. So it will be released when you either don’t have anything in your stomach or at a time of day when you’re used to eating a large meal. So what you do is you hydrate. When we first wake up in the morning, we are dehydrated, because we’ve been breathing out water vapor all night. So you hydrate your body. You could put in some good quality sea salt, good electrolytes. And that really help hydrate. You can drink herbal tea if you want, black coffee. That can actually make it easy right there to push your fast out to about 14 hours, just that alone.

DrDJ:

Then over time as your body gets more metabolically flexible, by doing this regularly, you’ll notice that it’s easier to be able to push it out to 16 or 18 hours. Again, you don’t need to do that every day. It could be something you do two or three days a week. For some individual, especially if you’re really lean, doing it on non-consecutive days is a good strategy. Monday, Wednesday, Friday, something like that can be a really a great strategy for you. Doing that several times throughout the week can be so powerful. Ultimately over time as you’re doing this and you’re feeling good, make sure you’re feeling good. You’re building metabolic flexibility. Then it’s time to consider, Hey, I want to push it to one of those longer fasts.

DrDJ:

Like we were talking about earlier, 20 to 24 hour fast and do that one day a week. I think that’s really powerful. Now, the more extended fasts, I know you were talking about like going beyond one day, those would be for really good for times when you have less stress. Some people do amazing with that. I don’t think everybody needs that. Getting a regular fasting lifestyle can be so powerful. However, over time you may decide that you want to do a partial fast, like a bone broth fast is a popular one, fasting mimicking diet is another one. A lot of people like to do juice fasts. It is a great thing to do, you know, once or twice a year. If you’re working with a health coach or a doctor or something like that it could even be something you do once a month. Doing like a three to five day partial fast, where you’re consuming 40% or less of your calorie load.

DrDJ:

I talk all about that in the book. The benefits of that. That could be something that you do that can help you get amazing results. There’s also water fasting that many people have gotten amazing results with. The best place to start is really intermittent, fasting, and start with that 12 to 14 hour fast and kind of gradually build up and find a good strategy that you can be successful with. When you eat, make sure you’re eating well, eat until you’re satiated. You’re not trying to under eat when you’re doing your typical intermittent fasting. You’re trying to eat until you feel really well, satiated and eating nutrient dense high quality foods.

DrMR:

You have, in your book, various menu items, so to speak for fasting applications. Also some troubleshooting for people who may experience some of the traditional discomfort associated with fasting. It’s not an intimidating read, it’s about 175 pages. So I would encourage people to grab your book. I guess you want to tell us a little bit more about your book and/or website and where people can find out more about you and your work.

Episode Wrap-Up

DrDJ:

Yeah, for sure. Well, you know, again, I’m just such a huge advocate of fasting. It’s really given me my life back and it’s something that I do on a regular basis. I really believe that if everybody adopted some form of a fasting lifestyle, we could reduce metabolic degenerative, inflammatory diseases. I think by like 90%. Just by improving insulin sensitivity, improving the microbiome, like we talked about earlier, reducing overall inflammatory load in the body. I think we can have a significant impact. So that’s why I wrote this book and I think of it like the Bible for fasting. I mean, it goes through every type of fasting strategy, lots of troubleshooting. We talk about some of the challenges people have, whether it’s headaches, cravings, feeling cold while they fast, what’s actually causing that and things you can do to help mitigate it.

DrDJ:

We also talk about some of the things that take place like gut induced endotoxemia. So when you start to fast, especially if you’re doing a longer fast, bacteria are going to start to die and you might have an increase in the amount of endotoxin or lipopolysaccharides in your bloodstream. There are things you can do. Taking binders, for example, like an activated charcoal or clay, or zeolite or something like that that can help bind and pull some of these things out. For some people they get really high cortisol which is a stress hormone. So taking maybe some adaptogenic herbs or phosphatidylserine or something like that to help reduce that down can be really, really powerful. Magnesium actually works really good for helping mitigate that. Taking some salts and electrolytes can be really powerful. Also fat cell induced endotoxemia is another big issue. We store our toxins in our fat.

DrDJ:

A lot of people think you store toxins in your liver, but you don’t, unless you have fatty liver, you’re not actually storing toxins in your liver. You are deactivating toxins in your liver. You store them in either your bile or your fat. As you start to burn fat for fuel, you start to release toxins. If you have a heavy, toxic load that can cause more inflammation in your body. Some people will get rashes and different things like that, because it’s a higher amount of toxic load getting into the bloodstream, driving up inflammation in the system. Taking some systemic binders, possibly some antioxidants can be really helpful for helping reduce that as well. So I talk about all of those types of things in the book. Ultimately I really think that it’s important that when people start fasting, although it’s important to learn when you overstress your system, like you talked about earlier, especially in the beginning, I think it’s really important just for our psychology to have a good experience. I really want people to have a good experience with fasting to where it’s almost something that they look forward to, even though that’s counterintuitive. We get such a dopamine hit when we eat food. I want you to look forward to like a fasting window, almost like you would a great meal where you’re like, wow, this is going to be great. I’m going to feel so much better.

DrMR:

Yeah. Energy and mental clarity are things that I get. So I will, I will absolutely second that.

DrDJ:

Yup. That’s really my goal. That’s why I put the book together to really create a baseline because anybody can tell somebody to just stop eating. There are so many nuances with it and if somebody has a really bad experience with it, they may not go back to it. I think it’s something that we all need to be practicing at some level throughout the course of our lives to really live our best and healthiest life.

DrMR:

Yeah. I agree. It’s been helpful for me, even though I was a little bit late to the party. The book is The Fasting Transformation, assuming that’s available on Amazon? What’s your website for people?

DrDJ:

It’s DrJockers.com. We put out tons of great content. In fact, the article I sent you guys as well. It’s about time restricted feeding and how it improves the microbiome. I don’t know if you could include that in the show notes?

DrMR:

Yeah. We can definitely link to that. You have a great website and many great articles. So people check out the website in addition to the book. David, I feel like we could talk for a few more hours, but I guess we gotta cut it there. This has been an awesome conversation. Thank you so much for taking the time to chat with us.

DrDJ:

Thanks again, Michael. It’s really an honor. Appreciate you so much.

DrMR:

Absolutely. Thank you.

Outro:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 

• Elemental Heal Original
• Elemental Heal Low Carb
• Elemental Heal Whey Free
• Dr. Ruscio Resources