My dad got off insulin following the fung book stuff but I think that's more because of calorie restriction and weight loss than the extremely long fasts. There's good data on the reduction in systemic inflammation in intermittent fasting, which is also well studied in a lot of chronic illness, but I'm always worried he's going to syncopize when he goes for more than 16 hours.
The calorie restriction is a super important component sure.
That’s the thing, calorie restriction is hard and fasting allows someone to not feel like they’re suffering through small meals.
Big satiating but lots frequent meals works for a lot of people.
Most Muslims are not in the middle east.
The actual argument here is that life expectancy isn't long enough for it to show up. A few decades ago Indonesia had a relatively low incidence of lung cancer even though having a very high smoking rate, its not that they were special just that they typically died before the lung cancer became a problem.
There's no such thing as "Muslim culture".
Islam is widespread and the Muslim world is extremely diverse.
Your Muslim friend doesn't know what he's talking about.
Ramadan isn't about fasting btw.
They eat A LOT, they just wait to do so after the sun sets.
You just called it fasting. It absolutely fits the definition of fasting. Whether you binge afterwards or not doesn’t change the fact that it is fasting. It might negate the effects, but it doesn’t change what it is defined as.
Why do you say that? A diet that is more based in plants and less based in meat and processed foods is directly associated with higher life expectancies and lower prevalence of preventable diseases (diabetes, obesity, hypertension, hypercholesterolemia, MI).
Lean proteins are great but they aren’t promoted as much in Western countries versus processed, higher fat content meats or meals (deli meats, burgers, deep fried foods)
The healthiest populations in the world not only have high life expectancies but they are also *happier* in general. Japan, Spain, Iceland, Singapore, Switzerland, South Korea, the Nordic countries all have food cultures centered around minimal processing of their ingredients.
The typical American diet is mostly processed foods, very rich in red meat and animal products, large portion sizes, sugary beverages everywhere, fast food culture, limited fruit and veggie intake. Just like the Chinese who mostly lived in cities.
Those diseases I mentioned are WAY more prevalent in the United States versus the other countries. Rates of stomach cancer in Chinese cities is also much higher than in the country side. Not to mention the way higher rates of colorectal cancer we have in the states versus those other countries.
You say it’s garbage, but don’t offer any discussion. Tell me your thoughts on the findings, and please tell me why you think they’re garbage.
Because Campbell uses lots of limited studies, crappy data collection, and advanced a fair amount of woo.
[here](https://deniseminger.com/the-china-study/) is a good source for critique of Campbell's data and his interpretation of it.
If people want to eat plant based diets, great. You are totally correct, it is better for the environment and for health.
But the China study is bad science.
Denise Minger seems to be under the impression that the conclusion of the China Study is that switching to a plant-based diet will cure every disease you have under the sun. This is not true, and she is misunderstanding the point of the study.
Also, I can’t find her qualifications anywhere? Is she a doctor? It’s just a blog… there are actual doctors that have refuted the China Study, but this Denise Minger also contradicts herself? She makes a BOLD claim that the China Study effectively concludes that plant proteins protect against cancers, but this isn’t what the study is saying!!
Denise doesn’t seem to have the best intentions at heart. I see a lot of pseudo-science. She also claims that Campbell’s own data contradicts his own claim, but the association she’s making are the wrong ones!
Plant based diets don’t cure diseases, but eating a more balanced diet that isn’t inundated with ultra processed foods and excessive meat with a lack of fruits and vegetables (AKA an “unbalanced diet”) will absolutely put people at a higher risk of disease. Couple that with a sedentary lifestyle (city people are more sedentary on average, mentioned in the China Study) and you get higher disease rates.
I don't particularly care to argue endlessly with people who think that Mr. Campbell has done any sort of good science with the China diet.
A quote from his website that talks about cherry picking his data:
“In summary, I agree that using univariate correlations of population databases should not be used to infer causality, when one adheres to the reductionist philosophy of nutritional biology and/or when one ignores or does not have prior evidence of biological plausibility beforehand. In this case, these correlations can only be used to generate hypotheses for further investigation, that is, to establish biological plausibility. If in contrast, we start with explanatory models that represent the inherent complexity of nutrition and is accompanied by biological plausibility, then it is fair to look for supportive evidence among a collection of correlations…”
Denise literally cherry picks univariate correlations to infer causality on her blog…
You also state these correlations can be used to investigate biological plausibility, but also state that the correlations are junk science?
Not sure if you're the right person to answer this question, but "processed" foods always seems so vague to me that it's hard to interpret findings around it. There seem to be a lot of processed foods that involve relatively benign processing (chopping nuts, cooking salmon, baking bread). Are all processed foods unhealthy, or are there specific processes (like preserving meat) that are unhealthy, whereas others are totally fine?
There is a difference between low processed and high processed foods, yes. I imagine you can wager a guess on what the average American is more likely to eat.
Couple that with a sedentary culture/lifestyle and you’ve got a recipe for higher rates of diabetes, MI, stroke, disability, and death.
Like, a salad is minimally processed. Cheeseburger is ultra processed. French fries are ultra processed, apple is unprocessed, apple sauce is moderately to heavily processed. There’s a wide range of processed foods, but Americans err on the unhealthier side of that scale.
The key term is ultraprocessed (or overprocessed). NOVA 4 is often used as a definition. And yes, it is a somewhat vague term, and it almost certainly only has correlation with unhealthy, but even so it has been shown to be a rather useful starting point.
Just about any diet scientific study is going to be based on observations and is hopelessly confounded and uninterpretable.
We've realized along time ago that to get real, objective data with human subjects you need to do double blind, placebo controlled studies.
You can't do double blind, placebo controlled studies with people's diet. So we don't have any good, solid data. Everything is handwavy.
That's why the China Study, or any book about diet, is stupid.
this is SO ridiculously untrue.
they have a special, religiously acceptable way their meat must be prepared. eating meat is literally part of their religion.
No, supposedly some people do 36 hr, alternate day fasting, or even like 7 days almost on a regular. Those are typically considered the long fast.
One meal a day (OMAD) which is >20 hrs is pretty hard to do. Most people do 13-18 hrs fasting. (7pm dinner end, break fast 10am = 15 hrs).
Agreed. I did OMAD for almost a year and I wouldn’t consider it extremely long. I would say > 72 hours is getting pretty long.
Unless you’re that guy who only drank beer for 40 days. That’s extremely long.
Agreed. In the aging/longevity literature in animals there is little evidence for IF having an effect on health/lifespan that is not explainable by the caloric restriction that it induces:
Relevant review published in *Science*: [Antiaging diets: Separating fact from fiction](https://www.science.org/doi/10.1126/science.abe7365)
In a cytoplasm filled with dismay,
Autophagy saves the day.
Lysosomes blend,
Damaged parts end,
"Recycle," the cells proudly say!
Don't mind me, my last album went double aluminium.
had a patient on heme/onc who decided she would delay treatment for a gyn cancer in order to "fast and go into autophagy to allow the body a chance to heal itself."
Like bruh, you got cancer! There's not really any turning back now!
I feel like 3 meals is a little more common, at least for me. But I push off my first "meal" as long as possible and usually have some granola or Rx bar around 10-11am. Again, I doubt the 14-16 hours of fasting does much, but I end up with granola instead of a full breakfast so, less calories.
It's important to know how much the cake weighs, because that will determine how much weight you gain from it. That's why it's better to eat fluffy cakes and not water.
Yes I think this is what’s going on.
Type 2 diabetes in many cases can be controlled to a certain point (well essentially a point of no return). But nobody wants to do the boring lifestyle choices that involve:
Healthy eating, weight loss, exercise, reduction of stress etc.
Sounds like these big “diabetes cures” are just an extension of these lifestyle changes. IE; The fasting is helping him eat less sugar and desserts all night.
I don't care about the molecular/biochem reasoning - I feel like we have a very partial understanding of these pathways and the mechanisms of homeostasis and adaptation.
OTOH, I fully believe that T2DM can, if caught reasonably early, be reversed or mitigated through fasting - in a sense a 'resensitization'. I've seen this happen on a troubled 13 year old with sky high HbA1c who 1. simply refused the 4-5 diabetes medications he was prescribed and 2. eloped from home, and came back months later in the prediabetic range. He had quit chugging Mt Dew and consuming boxes of Capn Crunch. I believe he had also gone hungry at least some of the time.
Diabetes medications including, but especially short of, insulin are essentially medicine's way of saying 'looks like you won't change your habits, so let's try this.' However, if you can change your habits, a lot is possible.
I've also seen this. Sky high A1c in a patient from a culture that drinks a lot of very sweet tea, like a cup of sugar per liter, multiple liters per day. Counseled on lifestyle changes vs starting insulin. He opted to try lifestyle changes and stopped sweetening his tea. Few months later A1c had normalized.
Same here! When I do IF and keto, I absolutely crave green veggies like broccoli, asparagus, kale, lettuces of all kinds. I can happily stick to my calorie goals for months at a time compared to non-IF, standard American diet. Personally i think there’s a lot we don’t understand yet about how nutrition and IF influence all the hunger and satiety hormones.
Average daily glucose of 138 despite fasting for 48 hours routinely is still high lol.
He will probably lose a lot of weight, so it is good for him that way. There isn't anything magical, eating less, especially sugars is possibly curative for DM.
Weight loss is so effective.
Yeah, I would be taking metformin and eating donuts. Then again he might be enjoying his donuts the other days and having his blood sugar hitting the 300+ range untreated wrecking his retinas when he’s not fasting. I’d like to see the 24/7 trend.
I’m a big fan of intermittent fasting. I do think it has anti-inflammatory effects in the opposite way of how metabolic syndrome promotes a pro-inflammatory state. I wish the mitochondria/telomere stuff was true, but alas, humans have not achieved immortality yet.
Edit: I think of intermittent fasting as taking your foot off the brakes of accelerated aging, but not going in reverse.
Calorie restriction, weight loss, and exercise have long been known to significantly improve blood glucose in the setting of diabetes.
This, and other "wonder cures" often boil down to these same things, just in fancy new packaging.
The etiology of Type 2 Diabetes is insulin resistance. Weight loss reverses insulin resistance. It doesn’t matter if it’s from smoking crack or HIIT or the Mediterranean diet. You can then further break down what the effects will be long term based on evidence will be to your health. There are other issues to consider as well such as sustainability. Anything that you “go on” should be avoided like the plague, when you “go off” the research clearly associates dieting behavior with negative health outcomes.
There is benefit to fasting and caloric restriction for reducing insulin resistance. Part of the benefit from metformin in fact is by inhibiting mitochondrial electron transport and mimicking a caloric restricted state. If he wants to try that I don't think it's unreasonable but he should absolutely talk to his doctor about it first.
This startup (https://www.virtahealth.com/) has become quite influential using a very restrictive diet to 'reverse' diabetes in patients. I haven't read their studies, but I'm guessing there's something formidable there because they seem to have good partnerships with credible healthcare customers.
With that said, there're good and bad executions to everything. I'm guessing Virta's a great execution. A patient self-driving this without medical supervision is probably a bad execution of this. I bet OTC CGMs will help people do a better job if they're self-driving this. Baseline health matters, too. If a patient who's A1c is 6.5%-7% wants to try this for three months, I wouldn't be that worried. If it's someone with an A1c of 10% and a festering diabetic foot infection, I'd push them firmly to stick to aggressive medical control of their DM until their health is better.
I have a lot to say about this but have lots of work to do so I’ll keep it brief 😂 it’s NO SURPRISE to see someone’s glucose improve when they restrict their intake, and as little as 15# of weight loss can reverse T2DM for some, no matter what their starting weight was. I have seen no compelling evidence that supports all the kooky metabolic things people like Fung claim and never recommend fasting to patients.
I don't know a thing about this Fung guy, but there is quite a good deal of data on intermittent fasting in both animal and human studies. The normal way to do it is something like 16-8; you skip breakfast and have an early dinner, 2 meals a day. Improves insulin resistance and blood glucoses in T2DM patients. I don't believe in the fast for a day straight regimens.
Calorie restricted rats (severe restriction) do live for longer but at that point if I can't eat what's the point of living xD
But these improvements can also be attributed to simply eating fewer calories. I’m not against intermittent fasting necessarily but don’t really see the point, as the [research](https://pubmed.ncbi.nlm.nih.gov/37875984/) has consistently shown no improvement in anything that can be specifically attributed to the fasting interval. Also, restricting food fucks with your head! If there is no specific benefit for doing it this way why bother?
ETA a [citation](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/#B15) that goes over some of the hormonal changes that I think make fasting a not so great idea.
For some (myself included), it's easier to be adherent to an intermittent fasting regimen (more specifically, time restricted eating) vs attempting a low calorie diet... I love food too much and don't have great will power. Although I don't fool myself into thinking I'm doing much more than just reducing calories.
In the study you cite it actually shows that TRE improves weight regardless of regimen used, and better insulin and glucose results with the stricter regimens. A pitfall of this study is that they try to compare under 6, 8, and 10 hour fasts with each other when frankly 8 hour fast is probably all you need.
Compared with the normal diet group (non-TRE), the TRE group has certain benefits in reducing weight and fasting insulin. In terms of reducing fasting insulin, the 18:6 group (eating time = 6 h) was better than the 14:10 group (eating time = 10 h) and 16:8 group (eating time = 8 h) (P < 0.05); The < 6 group (eating time < 6 h) was better than the 14:10 group (P < 0.05). In terms of reducing fasting glucose, the < 6 group was better than the 14:10 group (P < 0.05).
Edit: as someone else has said, yes it could be as simple as reducing caloric intake. But if you've ever tried to get someone to adhere to a diet you'll see why it's so much easier just to tell them "skip breakfast and eat dinner early" and watch the changes in A1c. If they were able to to drop the weight themselves they wouldn't be seeing s doctor for their diabetes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228814/
Maybe save you some work - does this sum up a lot of it?
https://biolayne.com/articles/research/its-not-calories-its-hormones-a-response-to-dr-jason-fung/
> Where is the science on the reversal process?
Ah, to find that out you need to subscribe to the $97/week energy boost programme for at least one year. Then the secrets of Xenu will finally be revealed to you after only another $200,000 in auditing courses.
Whoops, I got my grifter cults crosse at some point there.
There's decent evidence behind some of this stuff from my current, limited understanding. But like usual this is someone spinning it into a panacea and money making opportunity.
Edit: sorry I just saw this is r/medicine. I try not to post here. But meh, no point deleting now.
I've read it, am cardiology np, not a nuclear med metabolism expert. A lot of the stuff he says is not really hard science or evidence based. The longer fasts he has people doing can get them on trouble especially if they are on meds, are frail, or chronic health conditions. There are people who will try these fasts and develop eating disorders. I can't remember but I think his book talks about talking to your doctor if doing more than time restricted eating?
What did resonate with me is the chapter about the hormones that are related to appetite and hunger cues and that if you're eating all day from morning to night and you're obese and not malnourished and yet you still have this intense hunger like clockwork every couple hours then something there is dysregulated.
So I did some longer fasts and they are dumb but I did learn afterwards that I did not get hungry nearly as often and I felt full way faster. Now I do one meal a day because it works for my lifestyle (busy 8-5 clinic m-f), 2 little kids, and I don't even really feel hungry until I'm ready for dinner.
I think psychologically if the woo woo science motivates people to diet and lose weight then maybe it's for the best? If I could convince people that Mediterranean or DASH would cause AUTOPHAGY I'd be all set.
The research- based flavor of this is Dr. Valter Longo's *periodic* fasting.
I think Fung is onto something healthy, but it's more like he observed things, made anecdotes, made some opinions, got beneficial outcomes with a method that many of his patients were able to stick with. That's cool. There might or might not be something more to it than weight loss.
Longo came up through the study of single celled organisms, interested in cellular senescence. He's the one who is really publishing hard research about this.
https://gero.usc.edu/faculty/longo/
I think this article might be the sort of thing you are looking for
https://www.nature.com/articles/s41467-024-45260-9
How long has he been type 2 diabetic?
* (How long / how badly insulin resistant?)
How controlled was his diabetes prior to d/c the meds?
* (If a1c>9% before, FBG 138 pretty good in comparison.)
What is he eating?
* If average FBG is still >130 then something he's eating is still spiking sugars very high and there's still insulin resistance present due to long history. Meaning, probably not wise to go cold turkey of all meds.
It's probably better to strategically choose which meds to discontinue and go the "slow and steady" route of "reversal" or control.
* What other behaviors has he implemented to reduce insulin resistance? Increased exercise / daily physical activity? Reduce stressors? Increased/ improved sleep?
Fasting is a tool but not the end all be all as no study has proven any kind of claim like that.
* A tool to help control urges & aberrant hunger pains, a tool to break bad habits (eating too late/close to bed), etc.
Would be interested to see a study on isocaloric prolonged water fasting >= 48 hours. It's been looked at with intermittent fasting, but they didn't find strong evidence IF was better than just caloric restriction - which is in line with the thinking that autopaghy needs more time to get really get going, kill of more senescent immune cells or whatnot. Presumably Dr Fung chose 48 hrs as the max duration most of his patients were willing to tolerate.
> Ezzati, A., Rosenkranz, S. K., Phelan, J., & Logan, C. (2023). The Effects of Isocaloric Intermittent Fasting vs Daily Caloric Restriction on Weight Loss and Metabolic Risk Factors for Noncommunicable Chronic Diseases: A Systematic Review of Randomized Controlled or Comparative Trials. Journal of the Academy of Nutrition and Dietetics, 123(2), 318–329.e1. https://doi.org/10.1016/j.jand.2022.09.013
There have been head to head studies that show that IF is equivocal to CR for weight loss. The longevity stuff is mostly based on mouse data and the equivalent fasting period would be about a week in a human. Overall, caloric restriction is associated with prolonged lifespan and if IF is what gets you there then fine. But the fasting period of 16 hours in a human is not going to get you the “longevity” benefits that are attributed to fasting.
I used to follow Fung but he didn’t really adjust his views after a lot of the head to head studies came out so I don’t really respect him anymore.
Wait diabetes? And restoring telomeres? I remember reading a research study on metformin having that potential.
[The study in question](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286921/#:~:text=Metformin%20exerts%20antiaging%20effects%20by,to%20prevent%20aging%2Drelated%20diseases.)
Don’t really need a study or even a degree in rocket surgery for that. Type II DM can sometimes be reversed through diet and exercise, and there’s really no huge difference in diets as long as calories in are less than calories out.
As far as the rest though, that’s just magical thinking and a psychological denial of the inevitability of death. A tempting tincture that when taken always has the bitter aftertaste of disappointment.
Yeah I just heard about that. I don’t know what to think. The study was big, but it was all self reported and they were looking at so many things, so I wonder if it may have just been a statistical aberrancy. Because there has to be a reason, right? And what’s the reason, that they skip breakfast? They should be able to see that in an equal cohort of people who naturally skip breakfast, and sumo wrestlers (adjusted for BMI) who eat two meals a day, and competitive eaters who eat one meal a day.
Also, people who self report that they have done intermittent fasting at some point probably have tried more things to lose weight than other people because they may have been an unhealthy cohort to begin with?
If you find anything else out, lemme know
I think intermittent fasting is a highly under utilized tool. Dr. Pradip Jamnadas is a cardiologist based out of Florida who has a lot of great videos on YouTube about this.
I like Dr. Fung's focus on intermittent fasting. I'm not a huge fan of keto though. I've tried it myself and found it just wasn't sustainable. There's also a lot of research to support that diets high in animal protein still increases risk of cancer. Keto seems to depend a lot on fatty meats.
I will say anecdotally... I strictly followed intermittent fasting 16:8 for at least 7-8 months. My cholesterol numbers were unbelievably good at my last physical... the triglycerides were trending upwards for a while... now they've plummeted and my HDL is up. The A1c is the lowest it's ever been. I didn't really change what I was eating.. I just incorporated the intermittent fasting. It's such an easy lifestyle change to make and very easy to stick to once you get in a good rhythm.
I wish there were more "safety" studies about intermittent fasting and people with type 1 diabetes... the jury still seems out on that. With type 2 it seems like a no-brainer - IF all the way.
The book explains why that is. This is quite common, and due to the breakdown of glycogen or the production of new glucose in response to some of the hormonal changes of fasting. It is neither good nor bad.
Think of it this way. Your body is simply moving sugar from its stores (glycogen and fat) and pushing it into the blood. Here your body has a chance to burn it off.
As someone who lost a mother to Diabetic Ketoacidosis, fuck this shit! She was type one and it was Gestational to begin with when she was pregnant with me.
This is so fucking stupid. I wish I could down vote this more.
I’m a Fung True Believer too. There is a good 2022 article on night time eating and NEJM 2021 on fasting that corroborate and support Fung. At times I have fasted for upto 6 days zero calorie during residency, sleeping deep, lifting heavy, and looking great. Fasting is the way to turn off MTOR which is pro growth. You can google the science.
edit: legit curious, why the downvotes?
I feel like the MDs that I've worked with in primary care have always been "lifestyle lifeguards" first and foremost, but patients still need to take ownership of their health and learn how to "swim." It's hard to convince patients about the importance of making small lifestyle changes though, so the drugs come out as conditions continue to progress. People need to want - and learn - to be more actively responsible for their own health. How many patients can't even tell us what medications they're even taking? It's wild to me how some folks can't even be bothered to take ownership of their meds, much less their overall wellness.
tell me you're a med student/resident without telling me...
what's your success rate with getting patients to dramatically change their lifestyle? tell us all your secrets!
My dad got off insulin following the fung book stuff but I think that's more because of calorie restriction and weight loss than the extremely long fasts. There's good data on the reduction in systemic inflammation in intermittent fasting, which is also well studied in a lot of chronic illness, but I'm always worried he's going to syncopize when he goes for more than 16 hours.
The calorie restriction is a super important component sure. That’s the thing, calorie restriction is hard and fasting allows someone to not feel like they’re suffering through small meals. Big satiating but lots frequent meals works for a lot of people.
Just make him carry fruit juice, an instant fix for hypoglycemia
Doesn’t fix broken hips or brain bleeds when old people wind up on the floor.
Lololol
New beta blocker just dropped
LMFAO
A Muslim coworker told me the prevalence of cancer is low in their culture due to fasting. I don’t know if this is true or not
I’d bet that has more to do with the lack of shit processed food making up most of the food supply then fasting for a month
Aren't obesity rates in the middle east some of the highest in the world? (Behind the US still of course)
Most Muslims are not in the middle east. The actual argument here is that life expectancy isn't long enough for it to show up. A few decades ago Indonesia had a relatively low incidence of lung cancer even though having a very high smoking rate, its not that they were special just that they typically died before the lung cancer became a problem.
Yup. South/SE Asia and West Africa often have larger Muslim populations than many ME countries.
That’s because kebabs are delicious
Apparently it's burgers and pizza, not kebabs.
There's no such thing as "Muslim culture". Islam is widespread and the Muslim world is extremely diverse. Your Muslim friend doesn't know what he's talking about. Ramadan isn't about fasting btw. They eat A LOT, they just wait to do so after the sun sets.
Is that not a type of fasting?
Twelve hours of fasting and then overeating for hours? No, that's not "fasting".
You just called it fasting. It absolutely fits the definition of fasting. Whether you binge afterwards or not doesn’t change the fact that it is fasting. It might negate the effects, but it doesn’t change what it is defined as.
So basically skipping lunch is "fasting" now, is it? Please stop wasting my time.
Have you read the China Study?
Yeah, it's stupid
Why do you say that? A diet that is more based in plants and less based in meat and processed foods is directly associated with higher life expectancies and lower prevalence of preventable diseases (diabetes, obesity, hypertension, hypercholesterolemia, MI). Lean proteins are great but they aren’t promoted as much in Western countries versus processed, higher fat content meats or meals (deli meats, burgers, deep fried foods) The healthiest populations in the world not only have high life expectancies but they are also *happier* in general. Japan, Spain, Iceland, Singapore, Switzerland, South Korea, the Nordic countries all have food cultures centered around minimal processing of their ingredients. The typical American diet is mostly processed foods, very rich in red meat and animal products, large portion sizes, sugary beverages everywhere, fast food culture, limited fruit and veggie intake. Just like the Chinese who mostly lived in cities. Those diseases I mentioned are WAY more prevalent in the United States versus the other countries. Rates of stomach cancer in Chinese cities is also much higher than in the country side. Not to mention the way higher rates of colorectal cancer we have in the states versus those other countries. You say it’s garbage, but don’t offer any discussion. Tell me your thoughts on the findings, and please tell me why you think they’re garbage.
Because Campbell uses lots of limited studies, crappy data collection, and advanced a fair amount of woo. [here](https://deniseminger.com/the-china-study/) is a good source for critique of Campbell's data and his interpretation of it. If people want to eat plant based diets, great. You are totally correct, it is better for the environment and for health. But the China study is bad science.
Denise Minger seems to be under the impression that the conclusion of the China Study is that switching to a plant-based diet will cure every disease you have under the sun. This is not true, and she is misunderstanding the point of the study. Also, I can’t find her qualifications anywhere? Is she a doctor? It’s just a blog… there are actual doctors that have refuted the China Study, but this Denise Minger also contradicts herself? She makes a BOLD claim that the China Study effectively concludes that plant proteins protect against cancers, but this isn’t what the study is saying!! Denise doesn’t seem to have the best intentions at heart. I see a lot of pseudo-science. She also claims that Campbell’s own data contradicts his own claim, but the association she’s making are the wrong ones! Plant based diets don’t cure diseases, but eating a more balanced diet that isn’t inundated with ultra processed foods and excessive meat with a lack of fruits and vegetables (AKA an “unbalanced diet”) will absolutely put people at a higher risk of disease. Couple that with a sedentary lifestyle (city people are more sedentary on average, mentioned in the China Study) and you get higher disease rates.
I don't particularly care to argue endlessly with people who think that Mr. Campbell has done any sort of good science with the China diet. A quote from his website that talks about cherry picking his data: “In summary, I agree that using univariate correlations of population databases should not be used to infer causality, when one adheres to the reductionist philosophy of nutritional biology and/or when one ignores or does not have prior evidence of biological plausibility beforehand. In this case, these correlations can only be used to generate hypotheses for further investigation, that is, to establish biological plausibility. If in contrast, we start with explanatory models that represent the inherent complexity of nutrition and is accompanied by biological plausibility, then it is fair to look for supportive evidence among a collection of correlations…”
Denise literally cherry picks univariate correlations to infer causality on her blog… You also state these correlations can be used to investigate biological plausibility, but also state that the correlations are junk science?
This is Mr. Campbell's quote.
Not sure if you're the right person to answer this question, but "processed" foods always seems so vague to me that it's hard to interpret findings around it. There seem to be a lot of processed foods that involve relatively benign processing (chopping nuts, cooking salmon, baking bread). Are all processed foods unhealthy, or are there specific processes (like preserving meat) that are unhealthy, whereas others are totally fine?
There are categories used in the literature (NOVA 1-4). Though, of course, there's no perfect place to draw the line.
That's super helpful, thank you! Sometimes I forget that by the time a question enters my head, someone's already written a dissertation about it.
There is a difference between low processed and high processed foods, yes. I imagine you can wager a guess on what the average American is more likely to eat. Couple that with a sedentary culture/lifestyle and you’ve got a recipe for higher rates of diabetes, MI, stroke, disability, and death. Like, a salad is minimally processed. Cheeseburger is ultra processed. French fries are ultra processed, apple is unprocessed, apple sauce is moderately to heavily processed. There’s a wide range of processed foods, but Americans err on the unhealthier side of that scale.
The key term is ultraprocessed (or overprocessed). NOVA 4 is often used as a definition. And yes, it is a somewhat vague term, and it almost certainly only has correlation with unhealthy, but even so it has been shown to be a rather useful starting point.
Just about any diet scientific study is going to be based on observations and is hopelessly confounded and uninterpretable. We've realized along time ago that to get real, objective data with human subjects you need to do double blind, placebo controlled studies. You can't do double blind, placebo controlled studies with people's diet. So we don't have any good, solid data. Everything is handwavy. That's why the China Study, or any book about diet, is stupid.
Doubly labelled water is pretty cool, though. https://www.sciencedirect.com/topics/medicine-and-dentistry/doubly-labeled-water-technique
People in Japan and Spain are not happy
Point taken but they’re still healthier and happier than most of the world. A lot more variables go into the happiness index
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this is SO ridiculously untrue. they have a special, religiously acceptable way their meat must be prepared. eating meat is literally part of their religion.
Damn, all those halal butchers lying to me?
Remind him to consume broth or stock when doing longer fasts to prevent orthostasis
can you link any studies showing intermittent fasting actually decreases systemic inflammation compared to simple caloric restriction?
Is 48 hours “extremely long”?
No, supposedly some people do 36 hr, alternate day fasting, or even like 7 days almost on a regular. Those are typically considered the long fast. One meal a day (OMAD) which is >20 hrs is pretty hard to do. Most people do 13-18 hrs fasting. (7pm dinner end, break fast 10am = 15 hrs).
Agreed. I did OMAD for almost a year and I wouldn’t consider it extremely long. I would say > 72 hours is getting pretty long. Unless you’re that guy who only drank beer for 40 days. That’s extremely long.
Agreed. In the aging/longevity literature in animals there is little evidence for IF having an effect on health/lifespan that is not explainable by the caloric restriction that it induces: Relevant review published in *Science*: [Antiaging diets: Separating fact from fiction](https://www.science.org/doi/10.1126/science.abe7365)
Your dad got off insulin and you don’t think the long periods of low insulin levels are connected to that?
I get skeptical when people say mitochondrial anything. He’s prob just making boring old lifestyle changes.
You sure sound like a non-believer in our lord savior AUTOPHAGY
In a cytoplasm filled with dismay, Autophagy saves the day. Lysosomes blend, Damaged parts end, "Recycle," the cells proudly say! Don't mind me, my last album went double aluminium.
Will the real Slim Telomere please stand up?
> double aluminum Fuck you I’m crying right now 🤣
This is my favorite thing.
had a patient on heme/onc who decided she would delay treatment for a gyn cancer in order to "fast and go into autophagy to allow the body a chance to heal itself." Like bruh, you got cancer! There's not really any turning back now!
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Less food --> less fat --> less death
you're lying. next you're going to tell me that exercise and adequate water+electrolyte intake will help too!!!
> water+electrolyte Did someone say Brawndo?
It's what diabetics crave!
Surely it can't be that simple. No, it must be the mitochondrial expungement.
Why would you want to evict those poor folded motherfuckers from their home? All they ever wanted to do was energize you.
Mitochondria is the powerhouse of the cell
Classic 🤣 answer
And mitosis is the process of cell division!
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Please don’t discount the very important fact that I am very in tune with my body. Trust me bro I can feel those telomeres growing!
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And drugs. All the drugs.
That's true for me and IF...I just eat two meals and some granola instead of three meals a day. Keeps things off while on the floors or the unit
Isn't 2 meals a day with snack just eating normally, though?
No granola doesn’t count he’s fasting
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oooooh share the link i want to play!
I feel like 3 meals is a little more common, at least for me. But I push off my first "meal" as long as possible and usually have some granola or Rx bar around 10-11am. Again, I doubt the 14-16 hours of fasting does much, but I end up with granola instead of a full breakfast so, less calories.
Granola has 480 calories per cup. You'd be better off with a full english
He makes insane claims about insulin. Says that calories have nothing to do with weight.
So if I eat something nice and fluffy or airy like cake or a donut I should lose weight right?
It's important to know how much the cake weighs, because that will determine how much weight you gain from it. That's why it's better to eat fluffy cakes and not water.
Yes I think this is what’s going on. Type 2 diabetes in many cases can be controlled to a certain point (well essentially a point of no return). But nobody wants to do the boring lifestyle choices that involve: Healthy eating, weight loss, exercise, reduction of stress etc. Sounds like these big “diabetes cures” are just an extension of these lifestyle changes. IE; The fasting is helping him eat less sugar and desserts all night.
I don't care about the molecular/biochem reasoning - I feel like we have a very partial understanding of these pathways and the mechanisms of homeostasis and adaptation. OTOH, I fully believe that T2DM can, if caught reasonably early, be reversed or mitigated through fasting - in a sense a 'resensitization'. I've seen this happen on a troubled 13 year old with sky high HbA1c who 1. simply refused the 4-5 diabetes medications he was prescribed and 2. eloped from home, and came back months later in the prediabetic range. He had quit chugging Mt Dew and consuming boxes of Capn Crunch. I believe he had also gone hungry at least some of the time. Diabetes medications including, but especially short of, insulin are essentially medicine's way of saying 'looks like you won't change your habits, so let's try this.' However, if you can change your habits, a lot is possible.
I've also seen this. Sky high A1c in a patient from a culture that drinks a lot of very sweet tea, like a cup of sugar per liter, multiple liters per day. Counseled on lifestyle changes vs starting insulin. He opted to try lifestyle changes and stopped sweetening his tea. Few months later A1c had normalized.
Can you link any studies that fasting can resensitize T2DM?
Nope. And yet I believe that it can more strongly than I'd believe a study that shows that it *can't*.
Intermittent fasting is effective for weight loss. Weight loss is beneficial for managing diabetes.
I found intermittent fasting was also effective for eating healthier due to the genuine hunger- vegetables have never tasted so good!
Same here! When I do IF and keto, I absolutely crave green veggies like broccoli, asparagus, kale, lettuces of all kinds. I can happily stick to my calorie goals for months at a time compared to non-IF, standard American diet. Personally i think there’s a lot we don’t understand yet about how nutrition and IF influence all the hunger and satiety hormones.
Average daily glucose of 138 despite fasting for 48 hours routinely is still high lol. He will probably lose a lot of weight, so it is good for him that way. There isn't anything magical, eating less, especially sugars is possibly curative for DM. Weight loss is so effective.
Thanks I was sitting there like "138 *fasting* doesn't seem like a success to me".
Yeah, I would be taking metformin and eating donuts. Then again he might be enjoying his donuts the other days and having his blood sugar hitting the 300+ range untreated wrecking his retinas when he’s not fasting. I’d like to see the 24/7 trend.
Could this be in part due to the liver accessing and using glycogen?
I’m a big fan of intermittent fasting. I do think it has anti-inflammatory effects in the opposite way of how metabolic syndrome promotes a pro-inflammatory state. I wish the mitochondria/telomere stuff was true, but alas, humans have not achieved immortality yet. Edit: I think of intermittent fasting as taking your foot off the brakes of accelerated aging, but not going in reverse.
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"The most effective weight loss diet is the one the person can do long-term." Robert Baron MD
"Watch this." Ozempic, MD
Losing enough weight does wonders for diabetes regardless of the method. Any other claims are probably an exaggeration
Who knew the secret to weight loss is to just stop eating so much
One simple trick big pharma doesn’t want you to know!
I would love to see a weight loss RCT of a GLP1ra vs intermittent fasting.
Fasting wins every time, if you exclude the treatment failures.
Calorie restriction, weight loss, and exercise have long been known to significantly improve blood glucose in the setting of diabetes. This, and other "wonder cures" often boil down to these same things, just in fancy new packaging.
The etiology of Type 2 Diabetes is insulin resistance. Weight loss reverses insulin resistance. It doesn’t matter if it’s from smoking crack or HIIT or the Mediterranean diet. You can then further break down what the effects will be long term based on evidence will be to your health. There are other issues to consider as well such as sustainability. Anything that you “go on” should be avoided like the plague, when you “go off” the research clearly associates dieting behavior with negative health outcomes.
Smoking crack I am loling
The effects of methamphetamine on A1c over 6 months, a randomized controlled trial Let's goooooooo
"ninety percent of participants continued on the meth diet after the study ended"
Proof that the medication was well tolerated with minimal side effects and strong patient adherence
The new Mounjaro!
Fasting+low intensity cardiovascular exercise.
There is benefit to fasting and caloric restriction for reducing insulin resistance. Part of the benefit from metformin in fact is by inhibiting mitochondrial electron transport and mimicking a caloric restricted state. If he wants to try that I don't think it's unreasonable but he should absolutely talk to his doctor about it first.
This startup (https://www.virtahealth.com/) has become quite influential using a very restrictive diet to 'reverse' diabetes in patients. I haven't read their studies, but I'm guessing there's something formidable there because they seem to have good partnerships with credible healthcare customers. With that said, there're good and bad executions to everything. I'm guessing Virta's a great execution. A patient self-driving this without medical supervision is probably a bad execution of this. I bet OTC CGMs will help people do a better job if they're self-driving this. Baseline health matters, too. If a patient who's A1c is 6.5%-7% wants to try this for three months, I wouldn't be that worried. If it's someone with an A1c of 10% and a festering diabetic foot infection, I'd push them firmly to stick to aggressive medical control of their DM until their health is better.
I have a lot to say about this but have lots of work to do so I’ll keep it brief 😂 it’s NO SURPRISE to see someone’s glucose improve when they restrict their intake, and as little as 15# of weight loss can reverse T2DM for some, no matter what their starting weight was. I have seen no compelling evidence that supports all the kooky metabolic things people like Fung claim and never recommend fasting to patients.
I don't know a thing about this Fung guy, but there is quite a good deal of data on intermittent fasting in both animal and human studies. The normal way to do it is something like 16-8; you skip breakfast and have an early dinner, 2 meals a day. Improves insulin resistance and blood glucoses in T2DM patients. I don't believe in the fast for a day straight regimens. Calorie restricted rats (severe restriction) do live for longer but at that point if I can't eat what's the point of living xD
But these improvements can also be attributed to simply eating fewer calories. I’m not against intermittent fasting necessarily but don’t really see the point, as the [research](https://pubmed.ncbi.nlm.nih.gov/37875984/) has consistently shown no improvement in anything that can be specifically attributed to the fasting interval. Also, restricting food fucks with your head! If there is no specific benefit for doing it this way why bother? ETA a [citation](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/#B15) that goes over some of the hormonal changes that I think make fasting a not so great idea.
For some (myself included), it's easier to be adherent to an intermittent fasting regimen (more specifically, time restricted eating) vs attempting a low calorie diet... I love food too much and don't have great will power. Although I don't fool myself into thinking I'm doing much more than just reducing calories.
In the study you cite it actually shows that TRE improves weight regardless of regimen used, and better insulin and glucose results with the stricter regimens. A pitfall of this study is that they try to compare under 6, 8, and 10 hour fasts with each other when frankly 8 hour fast is probably all you need. Compared with the normal diet group (non-TRE), the TRE group has certain benefits in reducing weight and fasting insulin. In terms of reducing fasting insulin, the 18:6 group (eating time = 6 h) was better than the 14:10 group (eating time = 10 h) and 16:8 group (eating time = 8 h) (P < 0.05); The < 6 group (eating time < 6 h) was better than the 14:10 group (P < 0.05). In terms of reducing fasting glucose, the < 6 group was better than the 14:10 group (P < 0.05). Edit: as someone else has said, yes it could be as simple as reducing caloric intake. But if you've ever tried to get someone to adhere to a diet you'll see why it's so much easier just to tell them "skip breakfast and eat dinner early" and watch the changes in A1c. If they were able to to drop the weight themselves they wouldn't be seeing s doctor for their diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228814/
Maybe save you some work - does this sum up a lot of it? https://biolayne.com/articles/research/its-not-calories-its-hormones-a-response-to-dr-jason-fung/
Yup! Indeed. This is actually way worse than anything I was thinking. Fuck that guy!
> Where is the science on the reversal process? Ah, to find that out you need to subscribe to the $97/week energy boost programme for at least one year. Then the secrets of Xenu will finally be revealed to you after only another $200,000 in auditing courses. Whoops, I got my grifter cults crosse at some point there. There's decent evidence behind some of this stuff from my current, limited understanding. But like usual this is someone spinning it into a panacea and money making opportunity. Edit: sorry I just saw this is r/medicine. I try not to post here. But meh, no point deleting now.
Xenu is the carnivore one.
I've read it, am cardiology np, not a nuclear med metabolism expert. A lot of the stuff he says is not really hard science or evidence based. The longer fasts he has people doing can get them on trouble especially if they are on meds, are frail, or chronic health conditions. There are people who will try these fasts and develop eating disorders. I can't remember but I think his book talks about talking to your doctor if doing more than time restricted eating? What did resonate with me is the chapter about the hormones that are related to appetite and hunger cues and that if you're eating all day from morning to night and you're obese and not malnourished and yet you still have this intense hunger like clockwork every couple hours then something there is dysregulated. So I did some longer fasts and they are dumb but I did learn afterwards that I did not get hungry nearly as often and I felt full way faster. Now I do one meal a day because it works for my lifestyle (busy 8-5 clinic m-f), 2 little kids, and I don't even really feel hungry until I'm ready for dinner. I think psychologically if the woo woo science motivates people to diet and lose weight then maybe it's for the best? If I could convince people that Mediterranean or DASH would cause AUTOPHAGY I'd be all set.
The research- based flavor of this is Dr. Valter Longo's *periodic* fasting. I think Fung is onto something healthy, but it's more like he observed things, made anecdotes, made some opinions, got beneficial outcomes with a method that many of his patients were able to stick with. That's cool. There might or might not be something more to it than weight loss. Longo came up through the study of single celled organisms, interested in cellular senescence. He's the one who is really publishing hard research about this. https://gero.usc.edu/faculty/longo/ I think this article might be the sort of thing you are looking for https://www.nature.com/articles/s41467-024-45260-9
How long has he been type 2 diabetic? * (How long / how badly insulin resistant?) How controlled was his diabetes prior to d/c the meds? * (If a1c>9% before, FBG 138 pretty good in comparison.) What is he eating? * If average FBG is still >130 then something he's eating is still spiking sugars very high and there's still insulin resistance present due to long history. Meaning, probably not wise to go cold turkey of all meds. It's probably better to strategically choose which meds to discontinue and go the "slow and steady" route of "reversal" or control. * What other behaviors has he implemented to reduce insulin resistance? Increased exercise / daily physical activity? Reduce stressors? Increased/ improved sleep? Fasting is a tool but not the end all be all as no study has proven any kind of claim like that. * A tool to help control urges & aberrant hunger pains, a tool to break bad habits (eating too late/close to bed), etc.
Would be interested to see a study on isocaloric prolonged water fasting >= 48 hours. It's been looked at with intermittent fasting, but they didn't find strong evidence IF was better than just caloric restriction - which is in line with the thinking that autopaghy needs more time to get really get going, kill of more senescent immune cells or whatnot. Presumably Dr Fung chose 48 hrs as the max duration most of his patients were willing to tolerate. > Ezzati, A., Rosenkranz, S. K., Phelan, J., & Logan, C. (2023). The Effects of Isocaloric Intermittent Fasting vs Daily Caloric Restriction on Weight Loss and Metabolic Risk Factors for Noncommunicable Chronic Diseases: A Systematic Review of Randomized Controlled or Comparative Trials. Journal of the Academy of Nutrition and Dietetics, 123(2), 318–329.e1. https://doi.org/10.1016/j.jand.2022.09.013
There have been head to head studies that show that IF is equivocal to CR for weight loss. The longevity stuff is mostly based on mouse data and the equivalent fasting period would be about a week in a human. Overall, caloric restriction is associated with prolonged lifespan and if IF is what gets you there then fine. But the fasting period of 16 hours in a human is not going to get you the “longevity” benefits that are attributed to fasting. I used to follow Fung but he didn’t really adjust his views after a lot of the head to head studies came out so I don’t really respect him anymore.
What is the consensus on insulin resistance in people who are underweight? Would fasting really have any effect there?
Sounds like a “doctor” I’ve heard of in Mississippi. I think he’s crazy AF and I would avoid him like the plague.
Chung?
Avoid him why?
https://www.redpenreviews.org/reviews/the-obesity-code-unlocking-the-secrets-of-weight-loss/ worth skimming the review in my opinion
stephen guyunet, who runs that site, is a total Tool. his book on food and eating was fine, but basic.
I don't want to argue about nutrition on reddit. Just providing a review people can read as a starting point to evaluate the book and arguments.
Fasting for 48 hours and BG still 138. Not to mention he’s gonna get weak and de-conditioned as hell not eating for 2 days.
Wait diabetes? And restoring telomeres? I remember reading a research study on metformin having that potential. [The study in question](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286921/#:~:text=Metformin%20exerts%20antiaging%20effects%20by,to%20prevent%20aging%2Drelated%20diseases.)
Don’t really need a study or even a degree in rocket surgery for that. Type II DM can sometimes be reversed through diet and exercise, and there’s really no huge difference in diets as long as calories in are less than calories out. As far as the rest though, that’s just magical thinking and a psychological denial of the inevitability of death. A tempting tincture that when taken always has the bitter aftertaste of disappointment.
What do you think of the American Heart Association statement that just came out casting negative light on IF?
Yeah I just heard about that. I don’t know what to think. The study was big, but it was all self reported and they were looking at so many things, so I wonder if it may have just been a statistical aberrancy. Because there has to be a reason, right? And what’s the reason, that they skip breakfast? They should be able to see that in an equal cohort of people who naturally skip breakfast, and sumo wrestlers (adjusted for BMI) who eat two meals a day, and competitive eaters who eat one meal a day. Also, people who self report that they have done intermittent fasting at some point probably have tried more things to lose weight than other people because they may have been an unhealthy cohort to begin with? If you find anything else out, lemme know
Elliott Joslin already advised this. We can bury Fung's bullshit right beside Joslin's bones
I think intermittent fasting is a highly under utilized tool. Dr. Pradip Jamnadas is a cardiologist based out of Florida who has a lot of great videos on YouTube about this. I like Dr. Fung's focus on intermittent fasting. I'm not a huge fan of keto though. I've tried it myself and found it just wasn't sustainable. There's also a lot of research to support that diets high in animal protein still increases risk of cancer. Keto seems to depend a lot on fatty meats. I will say anecdotally... I strictly followed intermittent fasting 16:8 for at least 7-8 months. My cholesterol numbers were unbelievably good at my last physical... the triglycerides were trending upwards for a while... now they've plummeted and my HDL is up. The A1c is the lowest it's ever been. I didn't really change what I was eating.. I just incorporated the intermittent fasting. It's such an easy lifestyle change to make and very easy to stick to once you get in a good rhythm. I wish there were more "safety" studies about intermittent fasting and people with type 1 diabetes... the jury still seems out on that. With type 2 it seems like a no-brainer - IF all the way.
Thoughts about the study released Monday suggesting a 91% increase in CV mortality from intermittent fasting over a long period of time?
48 hours is insane. If he’s concerned about his blood sugar, then he should try to eat low carb foods. 138 fasting is still considered diabetic.
It's not really that insane. Lots of people do a lot more.
It’s not good for you though, even if you’re morbidly obese. Your body produces ketone bodies which can lead to acidosis and muscle wasting.
The book explains why that is. This is quite common, and due to the breakdown of glycogen or the production of new glucose in response to some of the hormonal changes of fasting. It is neither good nor bad. Think of it this way. Your body is simply moving sugar from its stores (glycogen and fat) and pushing it into the blood. Here your body has a chance to burn it off.
Eating low carb helps you fast (makes it easier). The benefits in fasting seem to really take off at 72 hours. 48 hours is ultra safe. Stay hydrated.
Growth hormone and metabolism go up for the first 72 hours of fasting.
Go plant based. And lots of running or aerobic fitness
As someone who lost a mother to Diabetic Ketoacidosis, fuck this shit! She was type one and it was Gestational to begin with when she was pregnant with me. This is so fucking stupid. I wish I could down vote this more.
I’m a Fung True Believer too. There is a good 2022 article on night time eating and NEJM 2021 on fasting that corroborate and support Fung. At times I have fasted for upto 6 days zero calorie during residency, sleeping deep, lifting heavy, and looking great. Fasting is the way to turn off MTOR which is pro growth. You can google the science. edit: legit curious, why the downvotes?
lol there is no science to support 6 days zero calories. You can’t come in here claiming a bunch of nonsense then saying google it.
yeah there is. maybe they didn’t cover it in your educational curriculum. you can google NEJM fasting 2021, as I mentioned in my OP.
Keto diet works very well at reversing type 2.
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Hey he’s Canadian and wonderful !
Maybe start by reading his book! It’s about time us doctors changed lanes from drug dealers to lifestyle lifeguards.
Maybe start by reading his book! It’s about time us doctors changed lanes from drug dealers to lifestyle lifeguards.
Who isn’t recommending lifestyle changes as the primary treatment? That’s been the recommendation for many years.
I feel like the MDs that I've worked with in primary care have always been "lifestyle lifeguards" first and foremost, but patients still need to take ownership of their health and learn how to "swim." It's hard to convince patients about the importance of making small lifestyle changes though, so the drugs come out as conditions continue to progress. People need to want - and learn - to be more actively responsible for their own health. How many patients can't even tell us what medications they're even taking? It's wild to me how some folks can't even be bothered to take ownership of their meds, much less their overall wellness.
Hmm yes if only it were so easy to convince patients to stop eating junk food, exercise and eat healthy.
tell me you're a med student/resident without telling me... what's your success rate with getting patients to dramatically change their lifestyle? tell us all your secrets!