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Old 09-10-2019, 11:08 AM   #1
shikataganai
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OMGHi2U Intermittent and extended fasting thread

A thread to reduce chapstein's aggrievement about the "Ask the doctors of OT" thread.

Envisioned topics:
  • intermittent fasting
  • extended fasting
  • intersection of dietary habits when feeding with fasting
  • sorting out the wheat from the chaff in the various and sundry claims about fasting, both good and bad

Teaser, noting that I didn't create this image and don't vouch for it personally:



chapstein, in addition to inspiring the spinoff, makes the good point to list some reasons to NOT fast:
  • Pregnancy
  • Breast feeding (at least for extended fasts)
  • Diabetic AND on medication for it (if diet controlled/"controlled" should be free and clear)
  • Body dysmorphic disorder as a baseline or without significant body fat to begin with (for extended fasts)
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Last edited by shikataganai; 09-10-2019 at 05:00 PM.
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Old 09-10-2019, 11:11 AM   #2
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To start things off.

What protocol should I follow for a monthly or maybe even just quarterly fast? I am thinking of doing this not for weight loss but more for the autophagic benefits, basically everything but the yellow line in that chart above. I've done a bit of podcast listening on the subject, just Ben Greenfield and Rhonda Patrick at the moment.

How long should I go?
How much mineral and electrolyte replenishment should I include?
How to structure the meal coming off fasting?
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Old 09-10-2019, 11:14 AM   #3
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I've been doing random intermittent fasting while doing Keto diet. Generally, dinner/last meal of the night is 6-7PM and I'll skip breakfast and have lunch at noon, so it's roughly 15-16 hours of fasting. I tend to this 3 days during the week and one of the weekend days.
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Old 09-10-2019, 11:18 AM   #4
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[migrated from other thread]

Quote:
Originally Posted by Compressed View Post
Since we are talking about it...

What protocol should I follow for a monthly or maybe even just quarterly fast? I am thinking of doing this not for weight loss but more for the autophagic benefits, basically everything but the yellow line in that chart above. I've done a bit of podcast listening on the subject, just Ben Greenfield and Rhonda Patrick at the moment.

How long should I go?
How much mineral and electrolyte replenishment should I include?
How to structure the meal coming off fasting?
There are some resources out there that might be useful beyond the crap that anyone can post:

Quote:
1) There's a closed Facebook group (for those who do such things) that has very helpful educational units. PM me if you want details.

2) Dr. Fung, a nephrologist from Toronto, has a website that has lots of info (paralleling his books) but which is kind of unorganized. If you have patience you can wade through it: https://idmprogram.com/fasting-a-history-part-i/ . Lots of the units in the FB group are from this site, more or less--the group follows his teaching, if you will.

3) YouTube has some good content and a lot of marginal content, IMO. I've been impressed by content from Jason Fung (of course), High Intensity Health, and Thomas DeLauer.
To answer more directly instead of punting you, to the best of my knowledge:

How long for autophagy? It seems like autophagosomes in mice are upregulated most at about 48 hours. This effect persists for some time (unknown to me exactly how long) after refeeding. So going 48-72 hours for an extended fast for autophagy-maximization seems reasonable.

The units on the FB group suggest that one should take in about 3 tsp of Himalayan sea salt + potassium (e.g. Nu-salt) + magnesium (Epsom salt bath or oral magnesium). This is per day, and I don't know amounts for the latter two. Pro tip: mixing in a bit of apple cider vinegar with the water and sea salt makes it much less nasty, and shouldn't break the fast.

I got lots of advice for coming off the fast, with most people recommending taking it slow. Thomas DeLauer now suggests a small lean protein meal and then taking a break for a few hours, whereas some others recommend small amounts of varying crap that has no internal consistency (like from bone broth to fruits and nuts).

When I came off my 98 hour fast I ate a normal sized low carb meal and had no GI distress or the like, FWIW.
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Old 09-10-2019, 11:25 AM   #5
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Back in college when I was a personal trainer, I had a couple clients we put on intermittent fasting to lean out. It was purely a trial to see what would happen and if the outcome resulted in leaner build or more fat, it was done over 3 months. They would consume all their daily calories in a 3-4 hour window (12-3/4). Results were pretty damn amazing. They leaned out incredibly well and changes were noticed in the first 3-4 weeks. Weight loss was minimal as we were trying to keep weight within -5lbs for the women -10 for the men over the 3 months.

I wish I still had access to my photobucket as the progress pics are on there. I think I had 5 clients altogether do it, only 1 was on anabolics and the rest were natural. I didn't expect the outcomes we got but damn, it sure as hell worked. The men mostly complained about having to eat all the calories in such a short window and the first week or two was a struggle with fasting.

That's all I got to add
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Old 09-10-2019, 11:27 AM   #6
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For those who prefer physical books to web/YouTube resources Dr. Fung's book is good:

The Complete Guide to Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting

I bought a copy and read it, and thought it was worthwhile enough that I have gifted copies to my parents and two friends since then. It has marginal extra content as compared to what is discussed in various long interviews with Dr. Fung that are out there on YouTube, but it's nice to have everything presented in a more structured way.
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Old 09-10-2019, 11:36 AM   #7
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Quote:
Originally Posted by godfather2112 View Post
Back in college when I was a personal trainer, I had a couple clients we put on intermittent fasting to lean out. It was purely a trial to see what would happen and if the outcome resulted in leaner build or more fat, it was done over 3 months. They would consume all their daily calories in a 3-4 hour window (12-3/4). Results were pretty damn amazing. They leaned out incredibly well and changes were noticed in the first 3-4 weeks. Weight loss was minimal as we were trying to keep weight within -5lbs for the women -10 for the men over the 3 months.

I wish I still had access to my photobucket as the progress pics are on there. I think I had 5 clients altogether do it, only 1 was on anabolics and the rest were natural. I didn’t expect the outcomes we got but damn, it sure as hell worked. The men mostly complained about having to eat all the calories in such a short window and the first week or two was a struggle with fasting.

That’s all I got to add
It really is quite amazing.

Here's a tiny science dump on why it works:

1) It's different than calorie restriction with a normal eating schedule.

Implicit in this "normal eating schedule" statement is that we snack a ton more than we used to, as compared to, say, post-WWII habits. Correlation is not causation but there is a plausible mechanism for why this matters.

The other bit is that calorie restriction on a normal eating schedule leads to metabolic rate decreases, whether or not one increases physical activity as well. The Biggest Loser is the best example of this: very restricted calorie diet on a normal schedule, and tons of physical activity. They lost weight in the short term, sure, but legit papers (which I can provide if curious) show that their metabolic rate went down by an average of 600 calories/day at the end of the show. Moreover, 6 years out from the show's end their metabolic rate was down an additional 100 calories/day and they'd regained 2/3rds of the weight lost--no surprise with that metabolic rate.

Fasting doesn't lead to metabolic rate decreases, at least in the realm of intermittent fasting to probably about 2 weeks of continuous fasting. In the short-ish term of 16 hours onward metabolic rate actually increases, via increases in norepinephrine and cortisol. This is the magic bullet with regard to weight loss.

2) Fasting leads to a prolonged low insulin state, and that's what our bodies need as a signal to burn fat.

If you have any body fat you have energy reserves. The catch is that if we eat all the time we chronically have high insulin levels as the body seeks to move that sugar from the bloodstream and into cells. So if you're eating a conventionally timed low calorie diet with snacking all the time you'll be hungry (if high carb/quick burn) and you'll be constantly telling your body to store up energy by plumping up fat cells.

To break down fat implies going into ketosis. This can be for short periods of time near the end of your intermittent fast (how long it takes to get there depends on your diet as a baseline--eat ketogenic to begin with and you might already be there), or for days on end with extended fasting. To get into ketosis requires low insulin, and to get low insulin either requires super low carbs or periods of fasting.
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Old 09-10-2019, 11:36 AM   #8
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Anyone experience any GI discomfort as a result of not eating? (bloat/pain anything to that nature)
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Old 09-10-2019, 11:39 AM   #9
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Originally Posted by TheViking85 View Post
Anyone experience any GI discomfort as a result of not eating? (bloat/pain anything to that nature)
I personally haven't had such issues. You do experience a sensation of hunger, but this is periodic (for me about 4 times per day, meal times and around 10 PM) and goes away on its own in about 20 minutes.

It's like you have an alarm clock, not some gnawing sensation that persists and gets worse and worse. Indeed on day 3 and 4 of my extended fast the sensation of hunger was less than on day 2 (which is posited due to having higher ketone production once fully ramped up).

I did have some super loose stools on days 3 and 4, fwiw--this is supposedly due to autophagy causing some caked on feces to break loose from one's colon walls. I'm not sure if this is true or if autophagy per se has anything to do with it, but this is a known thing for whatever cause.
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Old 09-10-2019, 11:55 AM   #10
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Yeah it may be due to my ... relatively significant intake of craft coffee and the acidity that follows, but dang if my stomach doesn't hurt sometimes if I don't eat for extended periods.

I've been ...semi- fasting on and off for a bit, your process has sort of kicked me back onto it. Cutting snacking outside of meals is the number one thing of course, but right now I'm doing 1-2 meals per day (alternating, only dinner on day, lunch and dinner the next then back to only dinner) with some allowances on the weekend when I usually eat breakfast.

But yeah... them tummy cramps at times, lol
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Old 09-10-2019, 11:58 AM   #11
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I'd make sure to not have an ulcer or something along those lines, and definitely don't take NSAIDS (e.g. aspirin, ibuprofen) on an empty stomach.
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Old 09-10-2019, 12:01 PM   #12
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Quote:
Originally Posted by TheViking85 View Post
Yeah it may be due to my ... relatively significant intake of craft coffee and the acidity that follows, but dang if my stomach doesn't hurt sometimes if I don't eat for extended periods.

I've been ...semi- fasting on and off for a bit, your process has sort of kicked me back onto it. Cutting snacking outside of meals is the number one thing of course, but right now I'm doing 1-2 meals per day (alternating, only dinner on day, lunch and dinner the next then back to only dinner) with some allowances on the weekend when I usually eat breakfast.

But yeah... them tummy cramps at times, lol
Coffee in large amounts + fasting can cause GI discomfort. Maybe reduce coffee intake?
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Old 09-10-2019, 12:18 PM   #13
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Quote:
Originally Posted by shikataganai View Post
I'd make sure to not have an ulcer or something along those lines, and definitely don't take NSAIDS (e.g. aspirin, ibuprofen) on an empty stomach.
Genuinely doubt it's anything like that I can tell it's partially due to overall psychological state. Drinking more water instead of just the coffee seems to do the trick a lot of the time.

Quote:
Originally Posted by godfather2112 View Post
Coffee in large amounts + fasting can cause GI discomfort. Maybe reduce coffee intake?
I could do that, but I like my coffee

To be clear, this is not something that bothers me significantly or that is severe enough to be concerning, it's an annoyance.

Oh and Shik, I'm allergic to NSAIDS, so don't take those ever, cause beyond being hard on the stomach lining, they make it difficult for me to keep breathing, lol.

Edit: I might try 3-4 days of no coffee just to confirm that's the issue though.
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Old 09-10-2019, 12:21 PM   #14
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I've been interested in this as well. Worse thing you can do is just start eating again I figure.
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Old 09-10-2019, 12:24 PM   #15
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Man if I'm not looking forward to eating my sandwich in 45 minutes though. Homemade einkorn bread, nomnomnom.
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Old 09-10-2019, 12:30 PM   #16
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Things that fasting can help:

1) Type 2 diabetes.

If you're diabetic I'd strongly recommend getting Dr. Fung's book and reading through it. Tons of anecdotes from patients from his clinic who have gotten off insulin, gotten off all meds, and now are not diabetic (normal A1C). This is both through the weight loss itself but also through how prolonged periods of low insulin reduce insulin resistance.

This is huge (and not relevant to non-diabetic me) because diabetes has so many downstream problems with basically every organ.

2) Obesity.

I was turned onto this avenue because I'd gotten sufficiently fat that I was seriously contemplating having gastric bypass surgery. What changed my mind was a YouTube video by Dr. Fung (echoed in his book) where he notes that bariatric surgery is effective due to the same mechanisms that fasting is: low insulin state in particular. Surgery basically means you fast every day for the rest of your life because you can't absorb or pass enough calories (barring milkshakes and other cheats) to get out of that semi-fasted state.

Anyway, surgery aside, see the mini science dump post above for why it is effective. It allows for calorie restriction without downregulating metabolic rate. If weight loss is one's goal then eating ketogenic to start with is probably good, because it makes extended fasts easier (because switching into ketosis is not a big deal for the body once adapted), and because it increases the proportion of time one is in ketosis (i.e. at the beginning of the fasting period one burns off liver glycogen quicker if there's less of it to start).

3) Longevity/health.

See above posts re autophagy. Most studies thus far are with mice and the like, but fasting/intermittent switching between carb burning and ketosis has been shown to increase neuroplasticity. There are data that suggest that it helps stave off (mice-equivalents of) Alzheimer and Parkinson disease, and that it may increase telomere length (in other words slow aging).

These benefits are more pronounced with longer fasts than the 16-18 hour ones common with intermittent fasting, but there's probably benefit over a normal diet even with "short" fasts.
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Old 09-10-2019, 12:31 PM   #17
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Is it Ramadan already?
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Old 09-10-2019, 12:33 PM   #18
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This thread rocks. Jason Fung is a rock star.

My own experience is that keto makes IF and alternate-day fasting a lot easier. Carbs stimulate appetite.

My longest fast was 100 hours. Broke it with a starbucks breakfast sandwich and a latte. No issues. strength training while fasted was easier than you would think.
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Old 09-10-2019, 12:47 PM   #19
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Quote:
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Is it Ramadan already?
With my beard and all I've actually been asked this.



But it is relevant (and mentioned in Fung's book) in that most major religions and famous old(e) people of yore like Aristotle endorsed fasting...
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Old 09-10-2019, 12:50 PM   #20
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Quote:
Originally Posted by Keshav View Post
This thread rocks. Jason Fung is a rock star.

My own experience is that keto makes IF and alternate-day fasting a lot easier. Carbs stimulate appetite.

My longest fast was 100 hours. Broke it with a starbucks breakfast sandwich and a latte. No issues. strength training while fasted was easier than you would think.


I've got religion now, time to proselytize!

On my 98 hour fast I didn't lift (as I haven't in a long time--gaining muscle mass is not my problem) but I biked several times with no issues.

I rode in this morning at 36 hours fasted and felt no different than usual, and went downhilling with Compressed the other week while 18 or so hours fasted.

3 hours of downhilling with no water did get to me in the end, in full disclosure. Felt a little loopy.
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Old 09-10-2019, 01:11 PM   #21
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Old 09-10-2019, 01:15 PM   #22
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I keep planning on starting intermittent fasting but still haven't pulled the trigger. I absolutely think it would be the best bet for me to lose the last pesky pounds or bit of fat that hangs around. I'm in decent shape but I'm not going to follow a strict diet of what I can eat, so when I can eat sounds better.

I don't weigh myself but I'm probably low 150s, 5'10", age 35 and am in pretty good shape (can run a 26:something 5k, do strict deadhang pullups, etc). So I don't need to drop 30lbs or anything but would like to try to lean out a bit more where my moderate workouts and normal unrestricted diet fall short.

There's no reason for me not to do this, especially since I work from home. The wife (PhD in molecular nutrition) agrees it would be a good option for me. She wakes up and leaves around 6AM so I could skip breakfast, go to the gym late morning and then my first meal will be my post-gym smoothie and then lunch. We're going away this weekend so maybe I'll start Monday and track my results until the end of the year.
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Old 09-10-2019, 01:21 PM   #23
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So, I decided to give the intermittent thing a shot. 8 on 16 off. In the last week and a half I've lost 5 lbs. Keep in mind though that I have a pretty hefty base metabolic rate (I lift). So far it isn't really all that hard to maintain. Lifting was tougher on Sunday though.
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Old 09-10-2019, 01:54 PM   #24
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This thread should include a link to the longest supervised fast. 382 days.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/

Quote:
A 27-year-old male patient fasted under supervision for 382 days and has subsequently maintained his normal weight. Blood glucose concentrations around 30 mg/100 ml were recorded consistently during the last 8 months, although the patient was ambulant and attending as an out-patient. Responses to glucose and tolbutamide tolerance tests remained normal. The hyperglycaemic response to glucagon was reduced and latterly absent, but promptly returned to normal during carbohydrate refeeding. After an initial decrease was corrected, plasma potassium levels remained normal without supplementation. A temporary period of hypercalcaemia occurred towards the end of the fast. Decreased plasma magnesium concentrations were a consistent feature from the first month onwards. After 100 days of fasting there was a marked and persistent increase in the excretion of urinary cations and inorganic phosphate, which until then had been minimal. These increases may be due to dissolution of excessive soft tissue and skeletal mass. Prolonged fasting in this patient had no ill-effects.
https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast

He went from 465 lbs to 180 lbs.
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Old 09-10-2019, 01:59 PM   #25
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How accurate are the online BMR calculators? I tried one and it est a Basal metabolic rate for me of 2,360 calories, which to be honest sounds insane, would've expected it to be in the 1,6k range.

(Curr weight 225lbs, 6ft and a bit, sedentary.)
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