so what I’m gonna talk about today isintermittent fasting but before I get to that I thought I loved dr. Davis’smessage about undoctored and unfortunately my journey was much likehis I went through medical school and then residency at UCLA and then I wentand did knee disease and did it for a lot of years like 10 years or so andthen realized that it really wasn’t helping a lot of people like theconventional medications so so I deal with kidney disease the big the biggestcause of that is type 2 diabetes and so we would spend so much money on dialysisand drugs and drugs and drugs and it became obvious that I’m just sort ofholding their hand until they get their heart attack until they get dialysisuntil they go blind until we chop their feet off and it’s really sad tounderstand that the profession that you chosen is actually not really helpingpeople and at the same time we actually understand how to help people becausethese are all nutritional diseases if people would lose weight the diabeteswould go away if you don’t get that BT’s type-2 diabetes then you don’t getdiabetic kidney disease well that’s pretty obvious but there’s no money init so nobody was promoting this stuff and it’s sad because you’re in thebusiness to help people and being a doctor unfortunately you get trained inthe system where you really just get taught what drugs to get and whatprocedures to do and what surgery to give so we went from the person that youwent to to keep you healthy to the person who tells you what drug to giveeven if that’s not the cause and it’s sort of a sad state of affairs andthat’s what you know that’s what led me to start talking and blogging andwriting books and so on about these sort of things and why weuse things like intermittent fasting which nobody makes money on and it sortof reminds me of a conversation I had with a friend of mine so we’re in our20s and this guy is like the smartest guy I know he worked at Google and thenyou know he quit after two years and retired at 40 rightso really really really smart guy and he says to me one time and I said hmm youknow how when you’re kids you think that adults you know they have their shittogether right and then you grow up and you realize nobody has their shittogether and it’s like yeah that’s true and it’s the same thing with being adoctor like you think that your doctor knows what the hell is going on and thenas a doctor you realize they have no bloody idea what they’re doing out hereand that’s the whole problem and that’s why you almost have to take you knowmatters into your own hands you have to take your health into your own handsbecause you’re not gonna hear it from the media you’re not gonna hear it fromthe doctors and sometimes you gotta you got to do that cuz this is just like dr.Davis I get I get emails from people they say oh thanks for writing the bookI listen to you I you know lost thirty pounds I got myself off of insulin mya1c is now normal so therefore by definition you’re not diabetic and Ithink okay that’s great and then I always think to myself which I don’t sayto them I always think to myself why did you have to do that despite your doctornot because of your doctor but despite your doctor and that’s a very very verysad you know statement on the affair ofthings I had a patient once who I saw in the IDM clinic they are doing great theylost weight they they were on insulin for 20 years and I got him off in likefour months is ridiculous and their a1c was normal so again non diabetic and shewas like oh I’m so happy she went to her endocrinologist who’s a diabetesspecialist and he says oh good job and then he/she told him he was fasting andhe screamed at her right it’s like oh my god like any fool can see thatthis lady was so much healthier and yet you go to your specialist and they tellyou now you should stop what you’re doing which is making you healthier andeverybody can see that and go back to your diet that’s gonna make you sick anddiabetic which is gonna lead to your amputation and your kidney disease it’slike you know sometimes medicine is just such a such a logic free zone it’s likeridiculous so what we’re gonna talk about is another of these things thathas been used it’s an intervention intermittent fasting that has been usedfor thousands of years and recently it’s gotten more popular but when I startedto use it about five years ago it was considered quackery right so it wasreally thought to be so dangerous that you know the people had to warn themagainst listening to me because obviously we know that you know you haveto put muffins in your mouth every three hours to survive so that’s the realproblem of things so this is what we’re gonna talk about sorry this is the ohsorry this is not okay so I’m going to talk about intermittent fasting and kindof a little bit of how we got here so it’s about obesity and this is sort ofwhere things came from right and you you all know this so in 1977 when they cameout with the Dietary Guidelines for Americans I don’t think they were tryingto kill people but they were trying to do the best that they could but theproblem is that they you know they said oh you should eat lots of carbs which isokay if you’re an op na when eating like 90% sweet potato but if you’re eatingall refined grains then maybe it’s not the best thingand you should decrease your fat and this is the real problem this is theoriginal food pyramid from the 1980s and you can see that bread pasta and riceare like the face of that food pyramid so every single day you’re supposed toeat like six or seven slices of bread and we this was 1980 and we all thoughthey this is fantastic so we all did it because we’re trying to be healthy andthe government was telling us that this is what we should do nobody reallythinks that white bread is all that slimmingso that’s the problem but that wasn’t their point the point was actually totry and combat heart disease which of course was probably the exact wrongthing to do but that’s what we thought at the time so everybody likes to blamethe people that is oh yeah we gave him great advice but they didn’t listen butreally they did listen so if you look at consumption of butter you know way downeggs animal protein and we ate grains and sugar sugar that was actually notsupposed to they didn’t recommend it but they in the sort of hysteria of anti fatthey’re like yeah sugar is not so bad so jelly beans and stuff were you knowthey’re fat-free right so they it’s 100% fat-free so this is the whole problemand you know we always try to blame people we say well you know the obesitycrisis is because people didn’t listen to us it’s like they did listen to usthe advice was not good but people can’t admit that and that’s the problemso sugar was a particular problem because you can see that the you can seethat the when the dietary guidelines came out this sort of like sugar was notso bad for you so they they they increase their consumption of sugar andso you can also see that grains increase the consumption as well so it had beendropping until the 1970s and then really started to take off and if you ever ifyou if you live through that period of the 1980s 1990s when there’s this realhysteria about five you understand you know big plates of past that oh greatthat’s fantastic right and they we learned that in school oh yeah youshould cut your fat cut out the butter cut out the cream sauce but have a bigplate of pasta so this was something that we are taught but the other thingthat we don’t often talk about is that we’re also eating a lot more frequentlyand I think it was sort of inadvertent because what happens is if you eat a lotof refined grains and a lot of people understand you eat a couple of slices ofbread well a couple hours later you’re actually really really hungry so thenyou want to go eat a muffin at ten thirty so we went from eating threetimes a day so if you look at 1977 you can see that this is the an hain surveyso it’s a big large nutritional survey in the marrow1977 you can see most people are eating three meals a dayso again if you live through the 1980s as you grow up you to eat breakfastlunch and dinner nobody was eating snacks nobody who’s eating bedtimesnacks nobody was chasing the kids around between the halves of soccergiving him juice and cookies that was what we did if you were hungry afterschool you’d ask your mom for a snack you’d say no you’re gonna ruin yourdinner and that was that if you’re hungry after dinner he said you she saidyou should ate more that dinner and that was itright there is no snacks and that was the whole point so you went from eatingthree times a day to eating six times a day right so if you look at my son’sschedule and I don’t have that much control over it is because it’sbreakfast in that school you get a snack and then at lunch and then after schoolyou go to program you get a snack and you have dinner and then you knowbetween soccer somebody gives them a snack six times a day it’s like that’sbefore you know it and we teach these kids we ingrained this indoctrinatethese kids into thinking that you must eat all the time so it doesn’t feel sowrong because everybody’s doing it and my teacher told me and you think theyhave to shit together right so it’s like yeah that must be correct so then you goto the modern eating pattern and this is data from a couple years ago so theygave people a smartphone app and then they said you know check every time youeat and the the dot is when they eat and if you look at where it is you can seethat people start eating in the morning and they really just don’t stop untillike 11 p.m.And this is the whole problem of the modern eating pattern isthat we’re eating very very often so you can see that we’re in 1977 everybody’seating three times a day the lowest 10% of people are eating three times a daythe highest 10% of people are eating 11 times a day and that’s not becausepeople didn’t listen to us it’s because we tell them you should eat six times aday should eat small frequent meals all the time but we never did that beforeno Society in human history has ever done that before because we have work todo we’re not like oh yeah you know goingout in the field and it’s like yeah I could really use a little cookie rightthere’s no reason to do that because it’s very very difficult but that’s whatit is now because when we make these convenience foods which are highlyprocessed and usually with a lot of grains and sugars so that we can eatthis frequently and then we tell them they should and we’re eating later somost of the calories are consumed before noon and you can see that you know we’reeating all the time as well so the median daily eating duration is 14 hoursand 45 minutes that’s the average right that’s the median I should say ofeverybody so if you started eating at 8 a.m.You wouldn’t stop until 10:45 p.m.that’s the 50th percentile right slot people are eating more than that they’restarting at 7 a.m. and not in stalking until 11 p.m. so the only time we’re noteating is when we’re sleeping and that’s one of the big problems because you knowthat every time you eat your insulin is going to go up assuming you’re eating amixed meal and the insulin is actually a hormone that tells your body to storefood energy right I mean the whole problem of ecity is not really all thatdifficult if insulin goes up your body is supposed to store that food energywhen you don’t eat when you fast then your body is supposed to take that foodenergy back out and burn it and that’s the reason that you don’t die in yoursleep every single night it’s because you store it and then use it right andthis is the problem if you eat instant goes up you store it if insulin goesdown you burn it but you can only do one or the other if you spend all your timeeating then you’re gonna spend all your time putting food in it’s like a one-wayvalve the food is going in it never comes back out so what’s gonna happenover time you’re going to gain weight so that’s not really so difficult in factthe the English language itself provides the clue because it says you should eatbreakfast break fast that’s the meal that breaks your fast so you have tofast healthy living is balanced right so youhave to balance the which is the Fed state and you knowdigestion or the fasted state if you spent eat three meals a day over 12hours you have 12 hours of feeding 12 hours of fasting good 12 hours a dayyou’re putting food in 12 hours a day you’re taking food out now you’reputting food in sort of 13 15 16 hours of the day and not taking it out becauseeven after a meal it takes a few hours before your insulin goes back down soyou know and on the other side of course as soon as you eat your insulin goes upright away so it’s a there’s a bit of an imbalance so you’re spending not just1415 hours with your insulin high because it takes 3 or 4 hours for yourinsulin to come back down to get into the fasted State you’re really talking17 18 19 hours in the fed state and now instead of 12 and 12 you’re talkingabout sort of 18 and 6 or something like that so you’re eating all the timeyou’re putting food energy in all the timeand what was the problem the problem was that now we have this big obesity crisisbut there’s two main issues other than the carbohydrates that and the sugarthat we were told to eat it’s also the frequency we’re eating just toofrequently so the whole problem of weight loss it is very clear so theBiggest Loser is just in a show where people compete to lose weight and theynever do a reunion show because they all gain their weight back and this is theproblem everybody knows it so anybody who’s tried to lose weightknows that it’s really really hard to get that off and this sort of calorierestriction diet which has cut a few calories off of each meal 500 calories aday but eat six times a day that sort of advice is the sort of standard advice soif you look at the Biggest Loser diet for example you reduce your caloriesyour increase your exercise and it ranks really well in these sort of rankings ofdiets number three for weight loss ketogenic diets on the other hand weredead last so that’s what people think this is what the the sort of nutritionalauthorities think about weight loss this is what you should doand we pretend we’re living in this era ofevidence-based medicine that is okay if you think it works well show me thestudy to show that it works well we’ve done those studies so this is thetoday’s study for example published in the New England Journal Medicine whichis actually the probably the most prestigious medical journal in the worldand what they did is they took this approach which is calorie deficitapproach which is decreasing energy intake you know cutting doubt the fatcutting out the sugar the sugar probably a good thing and then they compared sortof lifestyle everybody got metformin which is adiabetic drug because these were type 2 diabetics everybody got metformin andthen you either got rosy glitter zone which actually caused a bit of weightgain on the right and on the red but then you also have this the thelifestyle versus no lifestyle treatment so cutting your calories increasing yourenergy because this is what they’re trying to do you can see that this greenline they started out a body mass index of 34 and after you know five years ofhard work he ended with a body mass index of 34 so it didn’t really work atall he only got back to baseline through a lot of hard work at the fifth year ifbefore that you’re actually gaining weight so this is this is the approachit doesn’t work and this is the diabetes prevention program which is the samething so if you look at lifestyle which is the the circle you can see that inthe first six months you do really great you lose a lot of weight six sevenkilograms 15 pounds but by the end of that four or five years again yourweight loss is no different thing if you did nothing at all so if you got nodietary advice you didn’t cut your calories it didn’t make any differenceright so there’s the evidence though so we have this intervention and cuttingcalories little few calories every day it doesn’t really work this is theWomen’s Health Initiative which is a huge randomized control trial almost50,000 women again here it is these women are cutting almost 360calories every single day and they’re doing it year after year and theyincrease our exercise so this is metabolicequivalency went from ten to eleven point one about a 10% increase in theirphysical activity they’re moving more they’re walking more and all that wellwhat happened well here’s the difference overall at the end of seven eight nineyears there’s barely any difference at all if you measure waist circumferenceand so on you might think oh well they’re actually gaining more muscle itturns out they’re not there’s actually no difference at all so here we havethree randomized control trials of this calorie restricted diet and it doesn’twork we’ve proved it and yet if you go to talk to your doctor he’ll say wellwhat you need to do is just cut your calories and exercise more calories incalories out there you go it’s like but it’s not trueyou know it doesn’t work we’ve proved it doesn’t work and the hardest part – forpeople to understand is this is when people stay on their diet because thisis this is a study so you measure the people who stay on their diet thesepeople are not failing because they fail to follow the diet they’re failingbecause the diet doesn’t work and this is what’s really important because wetend to ascribe a lot of blame on to the victims we play this game calledblame-the-victim which is that as we gave you this advice to lose weight youdidn’t lose weight because you didn’t follow the advice so we’re blaming thembut they’re the ones who are suffering they’re the ones we’re getting sickthey’re the ones taking the diabetes and that’s like the most unfair thing we dobecause the evidence shows that this approach actually just doesn’t work andwe know this doesn’t work really if you look at the UK general practice databasewhat you can do is look at people who have tried to lose weight using thissort of advice and the probability of achieving a normal weight if you’remorbidly obese is 0.1% in other words this diet that we recommend as doctorsis has a 99.9 percent failure rate but when you fail we’re gonna blame youhundred percent of the time like that’s that’s the reality of modernmedicine everybody knows this everybody says this so you take these sort ofbible of diabetes say Jocelyn’s diabetes it says well you know restriction ofcalories is the cornerstone yet none of these approaches has any proven merit soas in we know it doesn’t work but we’re gonna recommend it right hand becauobesity dietary therapy reduction of energy results of such diets are knownto be poor and not long-lasting so we know it doesn’t work but we’re gonnarecommend it anyway and you know that’s so illogical like seriously seriouslybad so we actually know why it doesn’t work because we’ve studied this over ahundred years we know why this sort of cut 500 calories a day every single dayjust doesn’t work because of slowing metabolism that is there’s two mainproblems one is the slowing metabolism if you cut somebody’s calories downtheir daily energy expenditure is also going to go down so this study fromnineteen seventeen so as in a hundred years ago we knew this if you cut theircalorie its intake by about thirty percent what they see is a 30% reductionin basal metabolism you see it in Ancel keys –is biology of human starvationwhich was actually not a starvation study it was a fifteen hundred calorie aday diet so not very different than anything that we recommend now so wethink people take say 2,000 calories you should cut it to 1500 that’s what thisstudy is so when you cut their calories by about 40% guess what their metabolicrate drops by about 40% their heart volume shrank by 20% the heart rateslowed the body temperature goes down because it’s it takes a lot of energy toto burn to burn those calories to generate body heat so if your your bodydoesn’t want to burn so much because it’s not getting in so much and we’veproven this and in the in the lab – so Rudy Leibel he did this fantasticexperiment where he took people and he he gave them their at their initialweight he made them gain weight by force-feeding them they had us you knowthis milkshake that they had to take so they gain 10%weight then they went to back to their initial weight then they went to 10%weight loss and at all points they measured their basal metabolic rate soyou see that 10% body weight gain your body actually ramps up its metabolismit’s burning about 500 calories per day more it’s trying to burn it off right asyou go back to your initial weight it goes back to his baseline and as youlose weight you’re burning about 300 calories a day less so you can’t justsay oh I’m gonna cut you know this is the big fallacy of these calories andcalories out people because if you simply cut your calories by eating lessyour body will respond by earning less and then you’re gonna plateau and thenyou’re gonna regain that weight and then somebody you’re gonna face that sort ofmassive wall of condensation of oh you let yourself go it doesn’t work likecome on we’ve already proven that and you hope that this this sort of thinggoes away after a while but it never does so if you overfeed people the TEwhich is total energy expenditure goes up if you under feed people the totalexpenditure goes down and it persists over time and persists over a year sogetting back to the Biggest Loser this is really what happens here is that ifyou measure these contestants and say when you know 6 weeks and 30 weeks whatyou find is that they’ve lost a lot of weight so it’s great so they’ve lostthey went from 329 pounds to 202 pounds body fat went from 49 percent to 28percent over six weeks so you see the results on the TV they look fantastic sothat’s great but what happened to their metabolism and this is what happens yousee before they started they were the dark circle after they at 30 weeks so 6months roughly they that’s the open circle and what you can see is thateverybody’s basal metabolism the amount of calories are burning every day andthis is not exercise this is to keep your brain working to keep your liverworking to keep your lungs working it’s going way down so this poor guy overhere for example starts off at 3500 calories and hewent all the way down to here which is like 1800 calories a dayso almost 1,700 calories per day he’s burning less than he did before andyou wonder why his calorie restricted diet is stopping working because yourmetabolic rates going way way way down so this is what you see in the BiggestLoser so if you look at the the shaded area that’s the that’s your basalmetabolism that’s not including exercise the white bar on top is the exercise sowhat you do is in the show of course they try and make up for it with insaneamounts of exercise so you can boost that up but then as you go your yourbasal metabolic rate is still going down and this is the problem right so theygot off the show they’re not doing eight hours a day of whatever it is they’redoing and that white bar is goes back to sort of normal and then that’s itthey’re not burning the calories so even after they reduce their calories theirweight goes back up so you see this when when you look at the Biggest Loserexcept for this guy who had the stomach surgery their basal metabolic theirtheir weight goes all back off you know some people of 50 pounds more than theydid at the beginning and then but it’s because their basal metabolic rate isslowing so much and this is the whole problem is that we assume that energyout stays stable right so it’s a two compartment problem that’s the wholething so if you have a a factorize for example you know energy producing coalburning factory you have energy in which is the coal and then when it goes inyour body actually has two ways to use it you can either burn it for energy oryou can store it as fat right so the energy comes in and say the coal comesin you can either burn it or you can store it when you eat calories you havethe same option you can burn it or you can store it as body fat right so if youreduce the amount of energy in so say you reduce the amount of coal that comesin what we hope is that you keep burning the same amount of energy and then thefat stores will come down right that would be fantastic so if you’re themanager of a coal burning factory for exampleyou know you get a little less call you still burn the same and then you justdecrease the amount of stores well that would be good except that’s not whathappens what actually happens is that the fat stores stay the same your energygoes down your energy out goes data down and that’s the problem so the wholefallacy of calories and calories out is that that stays stable but it doesn’tyou’ve known that for a hundred years we have all the studies to prove that itdoesn’t work and the problem is not what you’re putting in the problem is thiscontrol right here this is the main problem not this so everybody points tothis but you actually have to control this because if this comes in and itgoes out as energy it’s okay if this comes in and goes over to fat storesthen you’re not okay so you’re really talking about thehormonal control of energy partitioning that’s the whole problem how do youcontrol it how do you control those hormones the second big problem ishunger so what we see is that if you lose weight then you get more hungry sothis is again published in the New England Journal of Medicine they tookpeople they lost weight and then they measured something called ghrelin whichis the hunger hormone and that’s here so black is baseline and then we 10-week 62what you find is that as you lose weight so you lose weight but the weight slowlycomes back on but at all points again you can see that the growlin level ishigher in other words you stay hungry with weight loss so you see this interms of it will translate the ghrelin which is the hormonal mediator is goingto translate into higher levels of hunger so this is the big problem so youknow that if you lose weight and you don’t control those sort of things thenyou’re going to not be able to control the hunger and you’re gonna eat andagain this is not just a lack of willpower this is realphysiology here it’s like if we did that to any one of you you would be hungrierand you would eat because that’s the physiology but we don’t do thatright we blame people and we say oh yeah you know you couldn’t stop yourself fromeating it’s like yeah because they’re ghrelin is higher you never controlledthe hormonal mediators and that’s the real issue of the body set weight whichis that the adaptation to weight loss is to reduce your energy expenditure andincrease your hunger what I’m gonna do is we’re just gonna move past this alittle bit so one of the problems is this right so you have to actuallycontrol insulin which is going to be the hormonal mediator of what’s going towhere this energy is going to go if you don’t control it then you’re gonna loseso if you cut 500 calories per day by cutting the fat off your meat forexample that dietary fat has almost no insulin effect it has 500 calories butno insulin effect your insulin is just as high so if insulin is highyou’re gonna direct all that energy towards your fat stores and this isthat’s where you’re gonna lose so how does fasting help this problem well ifyou look at the metabolic change as a fasting what you see is that the basalmetabolic rate is maintained so this is four days of fasting what you can see isthat the top is the weight the way it is steadily coming down but re E is theresting energy equivalent and what you see is that at the end of four days ofnot eating your major basal metabolic rate is actually 10% higher than whenyou started and the vo2 which is a measure of howmuch you know energy or burning is the same and it’s because there are otherhormonal changes that is as insulin goes down other hormones go up so insulin iscoming down but then your counter regulatory hormones goes up includingsomething called noradrenaline or norepinephrine as well as yoursympathetic tone and growth hormone those are the counter regulatoryhormones and they go up and that’s how you maintain your basal metabolic breakafter 22 days of alternate daily fasting for example what you see is that the RMRwhich is your resting metabolic rate goes from 66 70 63 to 6300 which is notsignificantly different this study compared CR which is calorie restrictionto to alternate daily fasting again you look at the adjusted resting metabolicrate the box on the right shows you that the caloric restriction reduces yourenergy output by 76 calories a day the fasting group only went down by 29 whichwere the p-values point 4 which means that’s not statistically significant soagain this is one of the big problems of weight loss long-term weight loss isthis metabolic rate and because the fasting improves the hormonal changesabout the energy partitioning it’s not actually it’s not actually giving youthe same problems because your body is not just ratcheting down its energyexpenditure what it’s done is it’s switched over its fuel sources from foodto body fat because that’s what body fat is for it’s for you to use when you havenothing to eat it’s not there for looks it’s for you to use so use it that’s allyou need to do don’t do something silly like eat six times a day cut your fatand cut a few calories the other problem is hunger and this is this is againghrelin we’re looking at fasting and ghrelin so they took people they fastedfor 24 hours and then they measured their ghrelin at all time points andthis is one of the things I always hear that if you don’t eat that muffin you’regonna be so hungry you know you’re gonna stuff your face afterwards so whatactually happens when you don’t eat for 24 hours so those are those things ontop that’s breakfast lunch and dinner you see that girl Ellen does spike soyou do get hungry at that time but what happens when you don’t eat lunch so sayyou skip lunch this is the first one al does go Ellen just keep going up and upand up no in fact when you get to 4 o’clock joerger Ellen has gone back downto baseline because this this line is here’s baseline that is you’re about ashungry eating lunch as not eating lunch and the same thing happens at dinnertime joerger Ellen goes off yes then you don’t eat in several hours it just goesright back down to baseline so the hunger doesn’t build and build and buildshe comes as a wave if you ride out that wave they’ll just go back to baselineand we’ve all done this right so you’ve been so busy you work right throughlunch I mean did this tons of times in medical school you’re too busy youdidn’t eat dinner yeah at 12 o’clock you’re hungry at 1 o’clock you’re hungryat 4 o’clock it’s as if nothing happened it’s as ifyou ate lunch and you just kept working and we know this happens because we’veall done this before and we know that it’s just yeah you might eat a littlebit more at dinner but you’re not like gravan ously starving and it’s okay tonot eat because what’s happened is that your body has taken that food energyfrom your body fat and that’s perfect that’s exactly what we wanted to do theinteresting part is when you go into the multiple-day fast what you see is thatover you know four or five days the gallon goes up and down but over theensuing days it actually goes lower and lower and lower and we see this with thewith the people who are doing sort of four or five days of fasting at a timethat the hunger actually starts to disappear because you’re fueling yourbody through your body fat so then you don’t have that hunger anymore andyou’re getting more efficient at using it so therefore it’s a great strategysome people say oh wow women it doesn’t help it turns out if you look at growlinwomen have a much bigger spike in growlin than men and so if you look atfood cravings and so on women tend to feel it more so they actually get morebenefit because some people say oh women should never fast it’s like why they gotmore benefit from that than anybody else and the weight loss is the same if youlook at food cravings for example you can compare a low calorie diet to a verylow calorie diet so it’s interesting because you can take any of thesecravings sweets or high fat whatever you put them on a twelve thirteen hundredcalorie a day diet those cravings don’t do anything so this is the measure ofthe cravings and this is how much they have cravings the low calorie diet doesnothing but if you eat practically nothing at allthe cravings just disappear because the cravings are like an itch so any parentknows that if your child is really itchy the last thing youreally want to do this Pratchett because it’s gonna get more itchy and cravingsare the same so by going into these instrument fasting where you’re reallyallowing nothing at all that’s gonna make more benefit for your cravings thanthe other and controlling hunger is the big issue it’s not about controllingcalories I mean that’s like grade school stuff right you have to control themetabolic rate and you have to control your hunger signaling that’s what’simportant and what’s really interesting is that if you go to very low caloriediets as you start to refeed what you can see is that the the the cravingsdon’t go back so they start up out here but even after six weeks of refeedingthe cravings have gone away so you’re sort of reprogramming your body for thatso this is the again the changes so when you compare see R which is calorierestriction to alternate daily fasting if you look at the box what you can seeis that the guerrilla is significantly different if you look at calorierestriction this one the ghrelin goes up by seventy one so you’re more hungryafter doing this calorie restriction the alternate daily fasting is only up by Ithink it’s 16 but the p-value is 0.5 which means it’s not significantlydifferent again the calorie restriction daily calorie restriction causing morehunger the alternate daily fasting causing less hunger and that’s a hugehuge huge part so if you look at long-term weight loss what you see isthat chronic calorie restriction cutting the fat cutting your calories eating sixtimes a day so you’re keeping your insulin high but dropping your calorieswhat you get is an increase in hunger and a decrease in metabolism and this iswhat happens your weight plateaus your weight starts to regain and you’re likeoh don’t even look at me right as you as you face that sort of you know all thatjudgmental people who are like oh yeah you shouldn’t have regained that way itwasn’t their fault because we know that this is all physiology as opposed tofasting where your hunger decreases your metabolic rate stays stable or goes upand you’re like yeah let’s go so that’s the wholewhy don’t we actually do this for people right it’s because there’s so many mythswith intermittent fasting people say well you shouldn’t do this you shouldn’tdo this you’re gonna burn muscle right that’s one of the more common things Ihear if you don’t eat you’re gonna burn muscle and it’s actually not true if youlook at studies for example this study where they compared fasting so it’s 70days of alternate daily fasting you can see that the fat mass has gone down fromforty three point five to thirty eight point one and the fat free master yourlean mass went from fifty one point nine sorry fifty one point four to fifty onepoint nine so in fact your lean muscle is being maintained again remember whatyou’re doing is you’re dropping insulin and raising growth hormones so that whenyou eat you’re gonna rebuild that protein so you’re maintaining that leanmass if you look at this study again from 2016 if you compare the the twogroups calorie restriction versus alternate daily fast and what you see isthat the truncal fat mass is much better with the alternate daily fasting so onepoint eight percent versus 0.3% and this is the really dangerous stuff right thefat that’s carried around your belly so that is like six times better but if youlook at lean mass it’s it’s so calorie restriction is up by 0.5 percent becauseyou’ve lost some fat but alternative daily fasting is up by two point twopercent in other words it’s like four times better at maintaining lean mass sothis whole idea oh you’re gonna burn muscle it’s just a minute and if youthink about it again do you think that our body is designed so stupidly that westore body food energy as body fat and when we need it we’re gonna burn proteinit’s like yeah that’s a good idea like you got to thinkthat mother nature is so stupid we think we’re so smart and humans are so smartand mother nature’s so stupid you know we’ve been here for millions of yearsyou you store body fat so that you can use it when there’s nothing to eatyou’re not gonna burn your protein it’s like you know storing all this firewoodand then the you need something for your wood-burningstove you chop up your sofa and throw it in the firelike honestly do you think that’s the human body like the human body is notthat stupid and the other thing that people say oh yeah you can’t do it rightyeah that’s great idea but nobody’s gonna do it right it’s like nobody likeall the Buddhists that don’t do it like all the Muslims you don’t do it all theCatholics who don’t do it all the Jews who don’t do it I mean literallybillions of people around the world follow this because of religion becauseof spirituality for whatever reason they do it millions of people have been doingthis for thousands of years like at least since the time of like zero or youknow aha Jesus when he said oh yeah you should fast like during Lent and so onlike it’s thousands of years we’re talking of a human history that peoplehave done it and Oh since 1970 it’s a really bad idea because modern man is sosmart and yet we got this obesity epidemic the type two diabetes epidemicand we still tell people you should never fast ever it’s like that’sridiculous so it doesn’t work is another refrain it’s like well if you don’t eatyou’ll probably lose weight and I put this in because some people say oh womenit doesn’t work in and it’s like well it does because when you put them on fastwomen lose weight at the same rate as men it’s it’s it if you don’t eat you’regonna lose weight and and the thing about fasting is that we’re talkingabout something we’re dealing with something completely different than dietokay so diet is something that tells you should I eat this or should I eat thisright if I think I’m talked about that at all fasting is dealing witheverything outside the period that you’re eating so it has nothing to dowith diet you can eat a high fat diet or you can do a vegetarian diet that hasnothing to do with fasting fasting is really dealing with a completelyseparate question of when you should eat that is you should eat within a certaintime or whether you should or shouldn’t eat it’s a completely different questiontherefore it’s a much more powerful because you can add it to sort of anydiet and that’s really a lot of the advantageso it’s flexible for example you could do it this week and not do it next weekyou could it’s convenient because you don’t if you don’t eat you don’t have toshop you don’t have to cook you don’t have to eat and you don’t have to cleanup and it’s like honestly that’s the reason I don’t eat breakfast because Iwake up at 7 I wanna be out by 7:15 so if I want a shower I’m not gonna eat andit’s it’s so much easier and my son does this and all the teenagers do thisbecause they wake up so I wake up 20 minutes before I get out my son wakes uptwo minutes before he gets out the door right so it’s convenient for peoplebecause you don’t have to do it and this is one of the things we all have busylives we all say oh you know you should eat a home-cooked meal every single timeit’s like that’s a great idea but it takes a lot of time this is not thatthis is gonna actually give you back time so when I get busy I tend to domore because I have work to do it’s free so this is a huge advantage like if youdeal with disadvantaged people’s if you’re dealing with native peoplespeople who just don’t have the resources to pie pastor fret you know pastor Ipastor fed you know organic produce it’s like that’s great stuff but it’sexpensive like these people are not shopping at Whole Foods they’re they gotthey got a budget and this is going to give them back money it’s not just freeactually gives you back money because you don’t have to buy all this stuff andit’s simple so again you can take these diets like ketogenic diets for exampleyou can say well you know they’re great but they’re complicated so I deal withthe 65 70 year old Filipino lady who doesn’t speak much English and you knowshe’s been eating this way her way for 65 70 years it’s very hard to change herbut it’s a lot easier to say well these meals don’t eat and just treat it like amedical therapeutic intervention you’re gonna let your body burn off the sugarthen you’re not going to need your insulin and they understand that andit’s simpler it is the easier it is and that’s the whole point you can add thisto any diet because it’s not about the diet it’s about a completely separatequestion so whether it’s meat or wheat or nuts or you don’t have time you don’thave money you’re traveling all the time you don’t cook all of this stuff you canstill use the fasting and one of the things that always appeals to the sortof doctors is that you have it gives you sort of this unlimited power because thereason why people like it is because if you have a drug for example like insulinyou can prescribe you can give it and you know certain drugs have a maximumdose so you give metformin and there’s a maximum dose people like insulin becauseyou can just keep ramping the dose well fasting is the same like if you take adiet like a vegetarian diet and you don’t do well well you can’t get anymore vegetarian to get better results right it doesn’t work that way or ifyou’re doing heated genic diet it’s like you can’t get more ketogenic because ifthat didn’t work for you it didn’t work for you that’s the bottom line but withthe fasting it’s almost inconceivable that you can you can not lose weightbecause if you don’t eat you have to lose weight so nobody doubts that it’sjust the the reason people tell you not to do it is because they say it’s sounhealthy for you but it’s actually the opposite is true and again we get backto this idea that you know what’s so you know disconcerting about the whole thingis that these sort of ideas are not new they’re actually the oldest ideas thatever came about like I didn’t make this stuff up it came from Jesus Christ itcame from the Prophet Muhammad it came from Buddha yeah the three mostinfluential people in the history of the world like they only probably agreed onthat one thing so we’ve practiced this throughouthumanity throughout human history and yet as we get into the 21st century wethink that our old selves are so stupid that it’s not going to help you so youknow these are these are like the oldest ideas in the book and and and they’re sopowerful and they’re so and there’s so much physiology behind it we’ve studiedthis for hundreds of years and why can’t we do it right and theanswer always comes back to there’s no money in it there’s no money in it likethat’s it and this is why these sort of things are so important to get theseideas out there because the point is not to make money I don’t make money if youfast and do well I don’t make any money but I get paid in a different way rightsame as bill we get paid in a different way which is that we understand thatwe’re actually able to help move the needle for human health and we’reallowing people to take control of their own health because if you have obesityif you have type 2 diabetes you’re no longer have to say oh wow I have to gosee my doctor to see what pill I need I need to go see my doctor to see if heneeds to stick a stent in me no we’re giving you the power to take back yourown health because you’re not gonna get it from anywhere else thank you thank you so much for that presentationso we are going to start with some questions from the floor and even youhave a question that they’d like to ask dr.Fung Thank You dr. Fung that was wonderfulI wanted to clarify a little bit about the caloric load and some of thedifferent fasting approaches you talked about so let’s say in a calorierestriction model they would have someone eat 1,600 calories a day downfrom a 2,000 calorie a day diet in an intermittent fasting type program wouldyou still have them eat the 2,000 calories a day in a six-hour window eachday or in the alternate daily fasting are they eating 2,000 calories the daythey eat and zero the calorie the day they don’t eat or how does that workyeah so that’s a great question again the fasting only prescribes the amountof time that you’re not eating so whether you eat all your calories inthat time or you don’t eat that many calories in that time is really talkingabout the diet so in most times I actually don’t recommend people countcalories I don’t think it’s a useful thing to do because the body doesn’tcount calories it’s not a physiologic problem what you want to do is eat untilyou’re full I mean they did that in the 50s and it worked out fine for them butwhat you have to do is really cut out all of these refined foods so a lot ofthe refined grains specifically there a lot of the sugar specifically so ifyou’re eating things like meat and real food and vegetables and so on you’regonna get full at a certain point because again we think our bodies are sostupid but the truth is that we have multiple overlapping satiety mechanismsthat is to say if you eat protein you’re a whore moan called peptide why why goesup if you need fat cholecystokinin goes up if you eat a lot of fibrous foods youactivate stretch receptors in your stomach so we have multiple overlappingmechanisms that tell us not to eat and they’re very powerful because if youthink back to a time where you went to the Chinese buffet and you ate a lot offood and so on and you said whoa I can’t eat anymore like the sight of those porkchops might make you nauseated but half an hour ago you’re gobbling them downright and that’s because you’ve activated the satiety mechanism so youhave to get back to that but the the sort of processed foods evade that so ifyou’re eating you know you’ve had that big buffet and then youcan’t eat anymore steak but if somebody says well hey do you want this cookieyou’re like yeah sure because it doesn’t activate those same satiety mechanismsso the point is not to count your calories because that’s ultimatelyself-defeating you could take Diet Coke for example zero calories but it doesn’thave zero insulin effect and it’s gonna make you more hungry so the point isthat during that six hour period you could take as many calories as you why Idon’t recommend people but stick to real food Whole Foods and your body will tellyou when to stop if you decide that it’s not working then you simply extend andsay okay well that didn’t work so I’ll do a 24-hour fast and go from there butcounting calories in general is not something I recommend so you might begetting the full amount of calories but just in a concentrated period of timebut more likely you’re actually going to reduce the amount of calories becauseit’s hard to put all those calories so for example if you’re mobile if you’refasting three four days you’re not gonna be able to eat 15,000 calories and thatone sitting afterwards so most of the time you’re going to naturally restrictyour calories all day you’re gonna eat more so if you eat say one meal a daywhich is like a 24-hour fast for example chances are that meal you’re going toeat more than you normally do but not like three times as much to compensatefor the breakfast and lunch that you did didn’t do but again stick to the realfood stick to the full foods and you’re gonna do fine because your body actuallyhas the same mechanism that’s why in the 50s and 60s nobody counted calories andeverybody was thin because this is this is sort of a natural state you have tolet people go but if you try and circumvent all these mechanisms byeating a lot of processed foods by eating constantly then that’s why you’restarting gain weight because you’ve circumvented the satiety and that’s whyyou eat bread and jam in morning and then by 10:30 it’s like oh I’m hungryand then the dietician says well the bread and jam was great because it is solow fat but then at 10:30 it’s like go get a low-fat muffin so that’s theproblem you’ve circumvented those satiety mechanisms and now you’re hungryagain but if everybody knows if you eat steak and eggs in the morning oh I thinkthat thing just sits there right it just doesn’t move and thenyou’re like 10:30 well I’m not gonna go get that low fat muffin because it’slike what steak is still there because there are those natural satietymechanisms so don’t count your calories but you normally will when you cut thetime it will naturally sort of come down anyway I just want to take a textquestion here real quick which I have heard you talk about before if someonehas a history of eating disorders is there a risk that participating inintermittent fasting could trigger those behaviors would you approach the processany differently yeah so it’s it’s definitely a question of context sofirst the studies don’t show that it does so we’re talking about anorexia andbulimia so anorexia was a big problem in the1970s people would actually die from anorexia and that was a big problem sothe whole thing is that that’s a it’s not a it’s a psychiatric disorder ofbody image that is people think they’re fat but they’re really skinny and thewhole thing is that it’s it’s a matter of context so if you’re 16 years oldgirl who’s like 35 pounds sort of thing then yeah you shouldn’t be fasting butthe risk for example of this 60 year old 300-pound man developing anorexianervosa is virtually zero so it’s like yeah I’m not gonna fast thissixteen-year-old stick thing girl but this 300-pound diabetic man I amgonna fast so it’s a matter of context so yeah if there is a history ofanorexia nervosa then yeah you have to be cautious and you might try insteadjust to adjust their diets and so on and I always say that fasting it’s it’s aweapon right it’s a weapon in the fight against obesity if you use it wrong it’sit can hurt like it can kill you the so those people in the 70s when Twiggy wasreally popular and stuff like a lot of a lot of girls died it’s like a seriousproblem but that doesn’t mean that you shouldn’t use it in the 60 year old manbecause he’s gonna die of his heart disease or he’s gonna die of type 2diabetes in dialysis perfect thanks Priscilla pleaseso excellent presentation could you speak to the data on intermittentfasting on the brain and cognitive functionyeah that’s really fascinating topic actually and there’s not a huge amountof data but the it appears that intermittent fasting or fasting ingeneral improves cognitive function which is you know a lot of people havethe opposite and this is one of the other big myths so you know I have towork so I’m not going to be able to concentrate when you don’t eat it turnsout that if you do studies of memory and so on its improved so there are storiesfrom you know antiquity so the Pythagoras the famous Greekmathematician for example would require his students to fast before coming intointo class because it would improve their cognitive function and that’sagain because you’re allowing your your you know instead of eating and all theblood sort of working on digestion you can you have that available forcognitive function and if you think about Thanksgiving for example if yousay oh you had this big meal it’s like do you feel like really really sharpafterwards it’s like most people just want to sit down and watch some footballbecause they’re sort of sluggish they call it food coma and stuff so thecognitive function is actually increase I always look back there had that foundI read this fascinating book called unbroken which is about prisoners of warin Japan and one of the passages they this this man who is who was literallystarving says that he observes his his you know the other prisoners and and hesays one is like reading a book a hundred percent from memory and anotherlearn Norwegian within a week he says this is the astonishing mental clarityof starvation I’m like whoa like they knew about this like why didn’t anybodytell us right so what’s what’s fascinating is that in Silicon Valleyintermittent fasting is taken off like crazy and it’s not because these youknow 20-somethings skinny computer geniuses need to lose weight they don’tbut it’s a very very competitive world and if you can increase your cognitivefunction it’s the difference between Facebook and MySpace right it could meanmillions of dollars so they’re fasting becausethey want an edge and you know even in in sports you see this as well so wework with some elite athletes some of whom are like fighters for example andthey’re like whoa I can’t believe it because I’m fasting and I can seeeverything right because their senses are heightened and why it’s because thesympathetic tone is increased noradrenaline is increased so this isnot because of some you know psychology it’s because of real physiology theyfeel better they feel sharper and it’s like yeah because think about it for asecond if you’re a fighter like an elite fighter like multiplemartial arts or whatever do you want to be the hungry wolf or do you want to bethat lion that just ate right because that line that just ate is just lyingthere in the Sun and the hungry wolf is sharp and so on so the cognitivefunction is actually increased significantly can it do things likeprevent Alzheimer’s that’s a really interesting question I don’t have ananswer but my my guess is yes because again you activate this sort of processcalled at otha G which is where you’re clearing out some of the old proteinsincluding perhaps some of the protein that’s clogging up the brain in the endyou’re increasing your mitochondrial health and all this stuff which itincreases your bioenergetics of the mitochondria those cells that provideenergy and you’re able to increase it you see increased mitochondrialbiogenesis with fasting for example increased turnover and so on so it’s avery powerful therapy that’s been used for many many years not because peoplethought it was unhealthy for you but because people thought it was extremelyhealthy we are running a little bit over so I want to ask you guys want to stayand do Q&A or do you want to go drink coffee yay okay I’m gonna go back to thetext iron real quick obvious studies that show decreased prevalence ofdiabetes in the populations who have been fasting for religious and spiritualreasons for thousands of years this is a good question because they’ve studiedRamadan and I was talking with some dr.Seif read about this Ramadan turns outnot to be very good so ramadan is the holy month of fasting you’re not allowedto eat from sunup to sundown so the original idea the ProphetMuhammad was a very great proponent of fasting you’re supposed to fast twice aweek and then Ramadan and you’re supposed to eat just a little bit tosustain you turns out what happens in real world sort of 2018 is that thepeople wake up at 4 a.m. gorge themselves and then they fast andthen when the Sun Goes Down their drinking tubs of coca-cola and gorgingthemselves again and that’s not really super healthy for you so unfortunatelyyou don’t have that data there is emerging data so it was just publishedactually last week I think where they use intermittent fasting strategies andwhat they found was that it could be just as effective as any of the otherdietary therapies we’ve published some cases where people and implement theseintrument fasting strategies and are able to get get off of insulin and so onbecause again it’s not difficult to understand you don’t eat your bloodSugar’s come down blood Sugar’s come down don’t take your medications andpretty soon if you do that consistently you’ll lose weight as you lose weightthe diabetes gets better so it’s it’s a it’s it works obviously and I don’tthink there’s much doubt perfect we’ll take a question from the floor sure thank you for the message I just wantedto share it’s more of a comment than a question I we have been doing theintermittent fasting program in our prevention program in conjunction withit with a CrossFit box happy to report that over the last year that we’ve beendoing doing this our patients have lost 1.25 tons of weight a fat and gained 478pounds of muscle or lean mass during that time so there’s a question from the text linewhat are your thoughts on carb cycling and fat loss meaning limiting carbs for3 to 4 days then having very high carb days in cycles there’s not really anygood data so does it work it’s possible you know I also tell people not to counttheir macros because again it’s it’s not your body doesn’t know what you’reeating it doesn’t have carbohydrate sensors for example has insulin which isa hormone so it’s but it’s not just the carbohydrate so there are populations inthe world like all kanawha for example in Kotova where they have studied thisand people eat very very high carbohydrate intake so I come you knowmy family’s from Hong Kong and China if you look at the 1980s they’re actuallyeating mostly white rice and vegetable so if you look at the inter map studythey’re eating like 350 grams of carbohydrates per day almost all whiterice then there’s almost no obesity and almost no no type-2 diabetes but thedifference is that they’re not eating all the time there’s no sugar intake andso on so you know I I think that cycling it is is possible as long as you’re notstill stimulating insulin and you know dr.Davis talked about the differencebetween say carbohydrates amylopectin a which is found in grains and beans whichhave amylopectin see it’s completely different the physiologic effect iscompletely different but there’s both still carbohydrate so you really can’tequate the two that is eating bread I think is relatively obesogenic whereaseating beans is probably not and there’s a lot of studies on eating beans and itseems to be fairly healthy so just to say carbs it’s very different eatingbread amylopectin a day and eating beans amylopectin C so that’s why I say wellit’s it’s it’s much more complicated than just carbs like it’s a good startbut at the end of the day it’s not the whole answer so if you’re gonna eat highlot of teens then you’re probably okay if you’re gonna eat a lot of bread andsugar then you’re probably not gonna be okaydoing that but they’re both still carbohydrates so it is a bit morecomplicated than that so sticking to again trying to make things simple whichis again going back to the 60s it’s like just a real food stay away from thesugar stay away from snacking don’t eat all the time like these are the thingslike your grandmother would have told you we’ve got a question here yeahthat’s a great question again not a lot of data on that because they justhaven’t been done so we know there’s clearly a link between obesity andcancer so the w-h-o classifies I think 11 or something two cancers as obesityrelated including breast and colorectal two of the most common cancer so we knowin the lab for example there’s a lot of insulin receptors on breast cancer forexample but does that mean lowering insulin through intermittent fastingthrough low carbohydrate diets is going to work I think it will but is there anyactual evidence not not a whole lot and the other thing is that my suspicion isthat if you try to take care of it after the cancer has developed especiallyafter it’s metastasized it’s it’s probably not gonna be enough it issomething that you want to use to prevent cancer more than you want to tryand treat cancer with because I don’t know that it’s going to be strong enoughto do anything by the time you get to that stage but there’s clearly a link Imean the link between diet and cancer is just a fascinating one because againthis whole focus of cancer medicine in the last sort of 3040 years cancer as agenetic disease I mean it’s so wrong and so stupid like honestly I don’t know howany intelligent person can look at the disease and look at the progress andthink that we’re doing well so you take a Japanese woman in Japan you move thatJapanese woman to San Francisco and her rate of breast cancer will triple whatand that tells you this is a genetic disease like nothing it’s not a geneticdisease right it’s stupid but we do things like the Cancer Genome Atlaswhich sucks out like so much research dollars looking at oh hey we found thisgene that’s associated with breast cancer and all these little ol women aregoing out on their walks with their pink ribbonsyou know earnestly earning money and we’re just pissing it away I’m lookingat the genetics of this thing and it was not a genetic disease so why don’t weinstead look at some of these therapies looking at it from a new paradigm from asort of metabolic mitochondrial disease State and one of the things I think toowhich is fascinating is the fasting it actually improves mitochondrial house sotherefore could that be a potentially useful therapy to prevent thedevelopment of cancer because Tom says if you have mitochondria you if you havehealthy mitochondria you don’t get cancer so that’s a fascinating thing butthat the amount of research that has gone into it is sort of minisculebecause we’ve you know found every single gene you know you know geneticmutation and it turns out there’s like a hundred of them and the patient next toher has 100 completely different genetic mutations so how are you gonna treatthat it’s like where has there been any useful therapy so I think that the it’sit’s a fascinating question but unfortunately I don’t have those answersyet and hopefully we can get some answers but we’d have to really startchanging the thinking of a lot of the cancer cancerous likeI mean of all the areas of Medicine like that’s the worst one right they make theleast progress of anybody we have one last question yeah so there is going tobe a period of adaptation when you go from you know high carb low carb whichis the keto flu and so on fasting is is sort of the same becauseif you’re adapted to eating or if you’re adapted to eat to fat metabolizing fatwhether your fat comes from the steak or whether your fat comes from your bodyfat makes a difference so if you’re on a sort of relatively low carbohydrate dietthen your body will get the energy it needs so if you do muscle biopsies forexample of people you can see up regulation of the genes that areinvolved in oxidation of fat so your muscle gets more adapted to fat burningbasically that’s all it is so during exercise your muscles shouldget whatever energy it takes I mean if you think about the any we for examplewho are eating all meat because there’s no vegetables in the High Arctic they’reable to do whatever they need to hunt those seals and hunt those whales and soon so your body will adapt to it but there is if you’re trying to transitionyou have to be aware of this sort of two to four week period where there’s anadaptation but after that again your body like you don’t have to you knowassuming that you have adequate fat stores and so again an average personhas 25% fat so if you’re talking about elite athletes even a marathoner is atabout 10% body fat so assuming you have that then your body’s gonna get whateverenergy it needs from from your stores of energy so there’s actually a bigmovement in a LEED athletics to do this so-called training in the fasted Stateso it’s a it’s a very very interesting idea because what you do is you fast for24 hours then you do your workout then you eat and sometimes they eat a lot sowe we work with some professional these who are eating sort of five or8,000 calories at a time like a lot so the the point of it is that if you fastfor the 24 hours what you’re gonna do is you’re in going to increase againsympathetic tone you’re going to increase noradrenaline and growthhormone so the increase in the noradrenaline means you can workoutharder than you did before because you’re the hungry wolf instead of thesort of stated lion then you eat and your growth hormone is high so you’reactually going to increase the the production of proteins because when youexercise you’re breaking down muscle protein so therefore the bottom line iswhen you’re talking about elite athletics what you’ve got is the abilityto train harder and recover faster and we are talking about those sort ofmillimeters or whatever it’s a huge advantage so we actually have a lot ofpeople talking about doing that so it was sort of professional and an Olympicoffice because again they know that the difference between that multi-milliondollar Nike contract and d-league sort of basketball is just a little bit sothis this whole idea is actually coming around there’s not a lot of data but thephysiology suggests that this this sort of training in the fasted State is goingto be a potentially useful adjunct to treatment like that is you know in whenyou treat people like there’s no absolute so some people will love it andsome people will hate it some people will respond well and somepeople won’t but what we always say is that it’s a therapeutic option so youeven try it and if you do better on it then great if you don’t do better honorthen just go back to what you used to do because these are these you know you canchange but yeah physiologically there’s nothing to to block you from usingfasting and some people are doing it deliberately to to increase performanceyou

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