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The Peter Attia Drive
#59 - Jason Fung, M.D.: Fasting as a potent antidote to obesity, insulin resistance, type 2 diabetes, and the many symptoms of metabolic illness
Jun 24, 2019
02:42:06
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Quick takeaways
- Insulin resistance is due to glucose overload, not lack of responsiveness, posing a new perspective in diabetes treatment.
- Conventional diabetes drugs focus on increasing insulin rather than addressing glucose overflow, leading to organ issues.
- Exercise can help manage insulin resistance by reducing overall body glucose levels and positively impacting organ health.
- Insulin levels play a crucial role in metabolic syndrome, contributing to hypertriglyceridemia and abdominal obesity.
- Fasting is a culturally adaptable solution for metabolic health, showing remarkable success in reversing Type 2 diabetes.
- Regulating insulin and nutrient sensors can prevent chronic diseases, with fasting being a key tool for metabolic improvements.
Deep dives
Understanding Insulin Resistance as an Overflow Problem
Insulin resistance is traditionally viewed as a lock-and-key paradigm where glucose can't enter cells despite normal insulin levels. However, a new perspective suggests insulin resistance is due to cells being overloaded with glucose rather than a lack of responsiveness. This overflow hypothesis explains paradoxes like increased fat production alongside insulin resistance.
The Impact of Drug Classes on Insulin Resistance
Conventional diabetes treatments include drugs that increase insulin levels, mirroring the approach of forcing more shirts into an already full suitcase. These drugs push glucose into cells without addressing the underlying overflow issue. In contrast, SGLT2 inhibitors offer a new approach by removing excess glucose from the body, leading to organ protection.
Challenges of Traditional Glucose Control in Diabetes
Efforts to lower blood glucose levels using insulin-boosting medications have shown limited benefits beyond glycemic control. Studies reflect a disconnect between improving glycemia and protecting organs, highlighting the inadequacy of simply transferring glucose from blood to cells.
Insights on Exercise as a Potential Treatment Approach
Exercise emerges as a potential solution to address insulin resistance by reducing overall body glucose levels. By increasing physical activity, individuals may effectively manage the overflow problem associated with insulin resistance, impacting organ health positively.
Impact of Exercise on Blood Glucose Levels in Type 2 Diabetes
Vigorous exercise benefits individuals with Type 2 diabetes by effectively clearing excess glucose from the system. Clinical observations indicate that regular exercise can have positive effects independent of dietary changes. Although less efficient than dietary alterations, exercise plays a significant role in reducing blood glucose levels and promoting overall health.
Metabolic Syndrome and Role of Insulin in Hypertriglyceridemia
Insulin not only affects blood glucose but also plays a critical role in metabolic syndrome. Increased insulin levels lead to hypertriglyceridemia by prompting the liver to export excessive fat. This phenomenon contributes to abdominal obesity, highlighting insulin's broad impact beyond blood glucose regulation.
Insulin Resistance and Beta Cell Failure in Type 2 Diabetes
The development of Type 2 diabetes involves insulin resistance and beta cell failure. Insulin levels remain high in the early stages, maintaining normal blood glucose levels at the expense of beta cell health. Over time, beta cell failure occurs, leading to increased blood glucose levels.
Longevity and Regulation of Growth Through Nutrient Sensors
Longevity and disease prevention are linked to growth regulation through nutrient sensors like insulin, mTOR, and AMPK. Excessive growth in adults contributes to chronic diseases like cardiovascular disease and cancer. Intermittent fasting, by influencing multiple pathways, shows promise for enhancing longevity and reducing disease risk.
Importance of Time-Restricted Feeding and Dietary Restriction
Time-restricted feeding and dietary restriction, including carbohydrate limitation, are effective strategies for metabolic health. Limiting the hours of food intake and restricting certain food categories can positively impact health, serving as essential components before considering more advanced interventions like fasting.
Addressing Cultural Dietary Challenges with Fasting
Fasting offers a culturally adaptable approach to dietary change, overcoming challenges in traditionally carb-heavy diets. Introducing fasting can provide a simpler and effective method to initiate metabolic improvements without necessitating immediate dietary adjustments. This approach aligns with various cultural traditions and simplifies the transition to healthier eating habits.
Clinical Success of Fasting in Reversing Type 2 Diabetes
Fasting has shown remarkable success in reversing Type 2 diabetes, outperforming conventional dietary interventions. Case reports demonstrate significant reductions in insulin dependence and long-term disease remission through strategic fasting protocols. The effectiveness of fasting in restoring metabolic health underscores its potential as a primary tool in managing diabetes.
Insulin's Impact Beyond Glucose Regulation
Insulin plays a broader role in health beyond regulating blood glucose levels. Its influence encompasses aspects such as hypertriglyceridemia, metabolic syndrome, and metabolic health. Understanding insulin's systemic effects can reshape approaches to managing chronic conditions and promoting overall well-being.
Nutrient Sensor Signaling and Disease Prevention
Regulating nutrient sensors like insulin, mTOR, and AMPK offers a comprehensive approach to preventing chronic diseases linked with excessive growth. Balancing these signaling pathways through interventions like fasting can enhance longevity and reduce the risk of metabolic disorders and cancers.
Potential Benefits of Fasting for Disease Management
Fasting, particularly for patients with conditions like diabetes, can lead to impactful health improvements. By undergoing fasting, insulin resistance can be reduced, leading to positive outcomes like liver fat reduction and improved pancreatic function. The process involves tapping into fat reserves for energy once glycogen stores are depleted, resulting in significant metabolic changes that combat insulin resistance and fatty organ buildup.
The Role of Fasting in Weight Loss and Metabolic Health
Fasting can offer substantial benefits for weight loss and overall metabolic health. Patients undergoing fasting protocols, even for extended periods, have shown remarkable improvements in conditions like type 2 diabetes. The fasting process triggers metabolic shifts that target fat reserves, reducing fatty deposits in organs like the liver and pancreas, which are linked to insulin resistance and metabolic dysfunction.
Considerations for Fasting in Clinical Practice
In clinical settings, fasting has shown efficacy in treating various health conditions, especially for individuals with obesity, diabetes, and immune system disorders. Recommendations for intermittent fasting or extended fasts are tailored to each patient's specific health needs and goals. Monitoring electrolyte levels and addressing potential side effects like sleep disturbances are crucial aspects of managing fasting protocols.
Balancing Risk and Reward in Fasting Practices
While the concrete evidence supporting fasting benefits in healthy individuals may be limited, the low associated risks make periodic fasting a viable health strategy. Evaluating the risk-to-reward ratio in fasting interventions, especially for disease prevention and overall health enhancement, can guide individuals towards incorporating fasting regimens into their lifestyle choices for potential long-term health advantages.
32.
The Compliance With Beriatric Surgery Is Easier Than the Compliance With Fasting
4min
In this episode, Jason Fung, nephrologist and best-selling author, shares his experiences utilizing an individualized approach to fasting to successfully treat thousands of overweight, metabolically ill, and diabetic patients, and why being a doctor who specializes in kidney disease gives him a unique insight into early indications of metabolic disease. We also have a great discussion on insulin resistance where Jason makes the case that we should actually think of hyperinsulinemia as the underlying problem. We also discuss the difference between time-restricted feeding, intermittent fasting, and dietary restriction (e.g., low-carb) and how they can be used to attack the root cause of T2D, metabolic syndrome, and obesity. We also have a fascinating discussion about the limitations of evidence-based medicine which leads to a conversation where we compare and contrast the scientific disciplines of medicine and biology to theoretical physics. We discuss:
- Comparing scientific disciplines: Medicine and biology versus physics [7:25];
- The limitations of evidence-based medicine [12:30];
- Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50]
- Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30];
- Why the common treatments for type 2 diabetes seem to make things worse [42:30];
- How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15];
- Insulin and weight gain, and using fasting to empty the cells of glucose [59:30];
- The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15];
- NAFLD and hyperinsulinemia: A vicious cycle [1:08:30];
- Are the features and symptoms of diabetes actually protective? [1:12:15];
- Is obesity causing insulin resistance or is it the other way around? [1:17:30];
- What role does inflammation play in obesity? [1:21:45];
- CVD and cancer: Diseases of too much growth? [1:27:30];
- How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45];
- Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15];
- Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00];
- Why people think that fasting is bad for you [1:55:15];
- Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30];
- A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00];
- Keys to a successful fast [2:12:45];
- Muscle loss during fasting, and why Jason isn’t worried [2:24:45];
- Will fasting help a healthy person live longer? [2:31:30];
- Does fasting cause gallstones? [2:38:45]; and
- More.
Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.
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