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“One more time kid… Just because YOU made it work, it doesn’t mean it works in a van, down by the RI-VER!”

At last a medical professional with something to add to the intermittent fasting (IF) fuss has posted something helpful.

Dr Jack Kruse has this blog entry explaining why IF is a bad idea when you are leptin resistant. Leptin resistance needs to be addressed before taking the next step to IF.

For some reason, the low carb/Primal/Paleo folks have just lost their minds over this IF craze. It’s the “everyone is doing it and you should too” fad of the moment. If you don’t think so, you are not “with it.” If you see a problem or have questions, something must be wrong with you.

Martin’s Morons:

A lot of the blame for how this got out of control lies with a smart kid named Martin, who runs an IF site called leangains.com. Martin figured out how to make IF work for him to get his body fat down and his muscle % up. He got excited and did his site, answered questions, made claims, and he makes fun of people who don’t agree with him or have legitimate questions.

Leangains picked up a lot of followers, Martin’s Morons.

No Fine Print:

Medical products have to have a lot of fine print to disclose what something is, what it works for, what the risks are, who should use it, who should not, and what to watch for. Not so with web sites. This is the problem with leangains, and the IF craze in general. IF is a meme that spread quickly without the fine print. It’s a bad idea for people with a lot of weight to lose and hormone issues to fix first. Since Martin and many of his followers are not this type of person, they don’t see it and just spread what they consider “the good news.”

Months ago I was seeing people who have no business at all messing with IF first asking questions on the low carb/Primal/Paleo forums. I watched for a while and not a single person every mentioned the fine print, ever. There WAS no fine print. It was “hey, just do it, I did, so should you.” Morons. This is so wrong I don’t know where to start. It’s fine for the right people, but it’s not when people have real problems to solve first. I made some comments and asked people if they even know what reverse T3 thyroid was and how it goes up to slow metabolism when one stops eating, and with maybe one exception, no one ever even heard of it.

Leptin Resistance:

I did notice some people later on that knew the rT3 issue very well. It’s part of the explanation for leptin resistance (LR). Short version- if you have LR, you are most likely going to have high rT3 already, and you have some issues to fix before even thinking about IF. The IF folks simply failed to think about this, because it didn’t affect them, so they thought it didn’t affect anyone. Ignorance is bliss (except here).

Read This Slowly:

For a good, but very technical explanation, read Dr Kruse’s blog about how IF actually works, and why Martin’s approach is good, BUT only when it’s time. Dr Kruse is helping Martin straighten out the mess he and his moronic followers spread around the internet. I hope they pay attention.

Low-carb web forums and sites talk a lot about the benefits of intermittent fasting (IF). Some of the proponents are very passionate about it, but at the same time, some are short on facts or awareness of IF vs calorie restriction. When it crosses the line to excessive calorie restriction, which can kick in your body’s natural mechanism to slow metabolism, it’s gone too far.

The best approach gets hard to pin down, because IF is not defined in terms of the optimum interval and frequency, and neither is calorie restriction.

This entry will survey some of the on-line reading on it, point to some sites that are very pro-IF, and discuss the natural mechanism that kicks in when one goes into starvation mode. I don’t know of any sites that are dedicated to not doing IF, because if people don’t care to do it, they won’t write that much about it. It would be like starting a website about not collecting stamps.

“Fast way to better health,” 2006

Dr Michael Eades, author of “Protein Power” and a respected name in low-carb circles, may have kicked off the trend, or at least introduced the concept of IF to a lot of the low-carb folks in 2006.

Dr Eades wrote an entry in his blog that noted that calorie restriction has been well-researched and has many benefits (as long as it doesn’t get excessive-which we will get to below). Eades in 2006-

…There is a way to reduce blood sugar, improve insulin sensitivity, reduce blood pressure, increase HDL levels, get rid of diabetes, live a lot longer, and still be able to lose a little weight. All without giving up the foods you love. And without having to eat those foods in tiny amounts. Sounds like a late-night infomercial gimmick, but it isn’t.

Before I get to the real nitty gritty of how such a thing can be done, let’s look at a method that has been proven in countless research institutions to bring about all the above-mentioned good things. It’s called caloric restriction…

In other words, we eat too much and we can get by on less. No big controversy.

Eades then goes on to discuss IF as another way to do calorie restriction to get the same benefits. So, instead of eating less than everyone you know at each meal, do IF.

…Caloric restriction is a terrific way to lose weight and get healthy; problem is, it’s not much fun. When rats live out their little ratty lives calorically restricted in their cages they seem to show signs of depression and irritability. Primates do for sure. If primates don’t get enough cholesterol, they can actually become violent. But, if you’re willing to put up with a little irritability, hostility and depression, it might be worth cutting your calories by 30 percent for the rest of your long, healthy miserable life.

Doesn’t sound so cheery? You’re not ready to sign up yet?

Well, there is a better way.

A number of different research teams have studied a method by which rodents can get all the health and longevity benefits of caloric restriction without calorically restricting. And the method has been studied in humans and seems to achieve the same health benefits and, if an old Spanish study can be believed, maybe even an increase in lifespan.

What is this magic method?

Intermittent fasting…

Dr Eades goes on to discuss his own experimenting with IF, which had about a 24-hr interval. Here’s the link to the above and the rest of his entry…

But, it seems that in 2008, he backs off.

Eades in 2008-

This appeared on another blog in 2008, which ran the above entry and a follow up from Eades that reported what happened after the first entry came out-

…I then wrote a blog post about IF that became the most commented post on my blog. It seems that the idea of IF had struck a chord with a lot of people, many of whom took up the torch and started IFing…

…Like many of my readers, the research community had jumped on the IF bandwagon as well. And, in a similar fashion, the results were not all positive. Papers appeared showing that subjects IFing, or even regularly skipping a couple of meals per day, were developing insulin resistance, impaired glucose tolerance, elevated blood pressure, and decreased thermogenesis. Even Mark Mattson published a couple of human studies, including a randomized crossover designed experiment that showing the above disorders in women who ate the same number of calories in one meal per day as opposed to three meals per day…

…It’s looking like the intermittent fast is another of those ideas in science that looks good in animal studies then not so good in human studies, proving once again that rats and mice aren’t simply furry little humans. And it appears – for humans, at least – that the intermittent fast is indeed beginning to look like the reality of a late-night gimmicky infomercial: long on promises, short on delivery. I suspect that it is also a cautionary tale about the applicability of caloric restriction studies to humans…

The last comment is a reference to how he got the idea in the beginning from studies on rodents.

But wait, there’s more..

Even though Dr Eades is clearly retracting what he wrote that started a trend in 2006, that’s not the end of it. People are still doing IF and claiming the benefits, and they even say the benefits go beyond calorie restriction for numerous reasons. They are claiming the benefits of calorie restriction are really due to the on-off eating, and not reducing calories in general-which contradicts what Dr Eades wrote about in the 2006 entry.  So which is it?

Possibly the best IF site-Leangains.com-Let’s see what it says-

Just about everyone that I see promoting IF links to this site- www.leangains.com. This is done by a bodybuilder that claims IF is the thing to do, and if you don’t think so…well how can you not think so, look at his muscles.  That must be due to IF!

I went there to look up the benefits of IF according to them, and guess what? They cite increased insulin sensitivity, less weight, and increased metabolism. This looks a lot like what Dr Eades says about calorie restriction. So, what is it about IF that makes it different?

I looked around leangains and didn’t really find a specific answer, and I didn’t want to read the whole site to find it. I did like reading the “Ten Fasting Myths Debunked” page, which gives you a really good summary of what it’s all about.

To finish the leangains side of the story, you want to read this primer. It links to the wiki page on IF and discusses the specifics of different IF approaches, plus it specifies 16/8 (16 hours without eating, 8 hrs where you can eat) as the leangains approach.

Moving on, the Three-Part Primer on Marksdailyapple.com Forum-

One of the sites where you will get shouted down if you are bold enough to question IF is the forum on marksdailyapple.com. There is some very good reading there, but I got a lot of people mad at me when I questioned all this IF in regards to excessive calorie restriction (more on this later).

The best reading is a three-part primer by pklopp.

Links: IF Part 1, IF Part 2, IF Part 3.

From the opening post in Part 1, we again see IF folks claiming the same benefits as calorie restriction-

Why would you fast intermittently? The Scientific / Metabolic Answer.

One interesting aspect of fasting during Ramadan is that people tend to compress their eating schedule as the same quantitiy of food is ingested, but this is done in what amounts to one large meal in the evening. So, an interesting question to ask would be whether a greater interval between meals had any metabolic effect. It turns out that if you fast during Ramadan, you can expect:
A decrease in LDL cholesterol, and a concomittant increase in HDL (as found in this study, as well as this one).
A decrease in serum triglycerides ( same source as above. )
No change in your plasma cortisol concentration.
A pronounced lowering of insulin during the daily fast portion “favor[ing] a predominant lipolytic state.”
No change in thyroid hormone levels (T3, T4).
Lowered levels of homocysteine and C-reactive protein ( indicators of inflamation ).
You may experience some changes in body composition, but the studies are contradictory, although you are unlikely to gain weight…

So what’s going on? I asked this on the forum, and pklopp, who is working on Part 4, explains (I think)-

This is actually preempting part IV of the primer, but, …. there is a vast difference between calorie restriction and intermittent fasting. This is inherent in the fact that calorie restriction focuses on how much you are eating whereas intermittent fasting focuses on how often you eat. The principal difference here is that every meal will cause an insulin response which will take about 5 – 6 hours to return to baseline (pre-meal) levels. While insulin levels are above baseline, adipose tissue release of non-esterified fatty acids ( ie fatty acids that are not part of a triglyceride and can be used as an energy substrate by tissues ) is suppressed. So, if you eat three calorie restricted meals roughly 5 hours apart, you are very effectively suppressing NEFA release throughout the day. Eating the exact same amount of calories in one single meal will also suppress NEFA, but only for 6 hours. This is not magic, it is just metabolism. Very interesting things happen when you work with your metabolism rather than against it.

That’s an impressive answer, but it still doesn’t account for the fact, if we go back to the very beginning, of these things also attributed to calorie restriction-and this is well-researched. It could very well be that both IF and calorie restriction work and have these benefits, and they may not match exactly. But, to claim that IF is the only way to do it seems quite a stretch. The IF proponents have a lot of passion for IF, and it is understandable that they see IF as the reason for the benefits, and nothing else.

If I find some info that shows IF to work better than calorie restriction, I’ll write another entry or add it to this one… It’s time to move on to what happens if you overdo it-

The problems with overdoing it-

What concerns me about the near-religious fanaticism that people promoting IF have is that they either completely dismiss the possibilities of wrecking your metabolism by overdoing it, or they are just ignorant and get angry if you ask. The same applies to excessive calorie restriction, but no one talks about that-it’s not trendy enough.

A second concern is that anyone can say “IF,” but since there is no accepted specification, it can mean different things to different people. Someone may be into the leangains 16/8 interval, but I have seen people talking about 40-72 hours or even a week at a time. I haven’t seen one single forum where someone in the IF camp actually responded to these longer intervals and said “whoa, too much of a good thing, don’t go there.”

Similarly, we know there are problems with excessive calorie restriction, but just like with IF, we don’t know exactly what defines “excessive.”

How “going too far” actually works-

Our bodies have a natural mechanism for survival in times of famine. I wrote about this in March. That mechanism is reverse T3 (rT3). It’s a lot easier to find articles online about IF than it is to find details on rT3.

We don’t know for sure what a safe IF interval is to keep your starvation mode from kicking in (rT3 goes up), and we also don’t know for sure what “excessive” means on calorie restriction. We don’t know if what defines “safe” is much different for, say, a bodybuilder, or someone whose hormones are whack and they are huge and just trying to lose weight. I guess if you did these things and a blood test shows high rT3, then you know you overdid it!

I brought this up on the IF threads on a couple forums and never found any IF proponents that knew anything about it. They did get busy with google trying to prove that it didn’t matter, and there wasn’t much conclusive. After going back and forth with them on this and reading what was uncovered, I can only guess that a safe limit is something close to 24 hrs.

Leangains, which promotes 16/8 just laughs it off. They write-

Efficient adaptation to famine was important for survival during rough times in our evolution. Lowering metabolic rate during starvation allowed us to live longer, increasing the possibility that we might come across something to eat. Starvation literally means starvation. It doesn’t mean skipping a meal not eating for 24 hours. Or not eating for three days even. The belief that meal skipping or short-term fasting causes “starvation mode” is so completely ridiculous and absurd that it makes me want to jump out the window…

Oh really? Prove it. I can see that leangains is laughing this off because they stick to less than 24 hrs, but since IF can be anything, there are people going crazy with it. There has to be a limit. The IF folks just don’t know what it is. They don’t want to know, and that is what concerns me the most about them. It just makes me want to jump out the window…

It should also be noted that leangains is a bodybuilder’s site, written for bodybuilders and people that want to do what they do. They are not going to be that informed on the details of potential problems like a doctor would. Doctors see people that have problems, and it’s their job to understand problems.

I found a good discussion of rT3 that quotes the doctor that started the clinic I go to, Dr Kent Holtorf. It’s on Mary Shomon’s About.com thyroid page in a discussion about thyroid hormones and weigh loss-

It’s interesting to me that a doctor that deals with this every day knows about and talks about reverse T3, while IF proponents (some of them trainers or gurus) know zilch about it, and/or never mention it. It’s not on their radar at all. Note that Dr Holtorf says, “reverse T3 is produced in times of stress or starvation to reduce metabolism, and with chronic stress or dieting, RT3 can remain elevated, suppressing tissue thyroid activity and metabolism.”

So, a doctor that sees people that have been overdoing it on the diets sees elevated rT3 all the time. It’s not like it never happens like leangains says. They just don’t know what they don’t know.

It’s not like everyone has bought into IF, even though sometimes it seems like it. Jimmy Moore has a low-carb site where this came up too.  Moore organizes a “Low Carb cruise” each year that features fun and expert speakers. He wrote this on his forum the other day-

…ALL of the low-carb experts on this year’s Low-Carb Cruise universally condemned intermittent fasting.

Summary-

I don’t think it makes sense to tell people IF doesn’t work. I think it’s roughly equivalent to calorie restriction.

People promoting IF are mostly amateurs that are resisting discussion of what it means to go too far, so beware. If you do it, try not to go crazy and go past 24 hrs.

It’s very interesting that IF is strongly embraced by the low-carb crowd, while calorie restriction is not! They are roughly the same thing. Why is this?

I think it is because low-carbers are sick of the “low fat” and “calories in/calories out” conventional dogma, so much so that we just don’t want to hear this calorie restriction stuff. We are sick of it. We like to think that it doesn’t apply to us, because hey, we do low-carb, we don’t have to count like everyone else.

Then when it doesn’t work, instead of just saying “I think I will eat less,” we say “I’m cool, I don’t have to eat less, I eat less often!”