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Insulin Resistance Doctor: Stop 16:8 Fasting Now (Do This Fasting Instead) — Transcript

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0:00reproducibly.
0:0136 hours, once a week for up to 6 weeks
0:04as a protocol. Reduction in total body
0:07fat mass of 50% reduction in visceral
0:09fat mass of 60% impact on skeletal
0:13muscle mass minus 2%. In other words,
0:15most clients gain 1 to 2 lb of skeletal
0:18muscle in that period of time. That
0:20should sound absurd, right? But if we
0:23understand the mechanism, what's
0:26happening with sustained fasting, it
0:29actually makes total sense.
0:30>> Dr. John chef, fasting for insulin
0:33resistance, fasting for visceral fat,
0:34fasting for metabolic health.
0:36What is your strategy? You have a unique
0:39approach.
0:41>> What I'd start by saying is
0:4316:8
0:45is not fasting. Period.
0:48That's where it begins. Understanding
0:51that
0:52the idea that the intermittent fasting
0:54fasting windows less than 24 hours is
0:58simply not enough time. And we know this
1:00with very clear in my my clinical
1:02practice, the data is obvious when you
1:04look at it.
1:06Less than 24 hours of of of food fasting
1:11is simply not enough to impact on the
1:14relationship between glucose, insulin,
1:16and lipolysis or fat burn.
1:19And you have to understand strategically
1:22that insulin is the critical regulator.
1:27That it's the gatekeeper. If you have
1:30elevated insulin, insulin resistance,
1:32right? Which most of Americans do. Your
1:35body cannot burn fat. Period. Full stop.
1:39That is real. That is a real truth. And
1:42when you consider the relationship
1:43between insulin and visceral fat, that
1:47is really at the core of why
1:50intermittent fasting does nothing better
1:51than any other form of chronic calorie
1:54restriction, which ultimately leads to
1:56metabolic adaptation and failure.
1:59Period. You flip the script by extending
2:02fasting strategically. Now, my obsession
2:05is around having data to drive those
2:07decisions around strategic fasting.
2:09But once you extend out that fast,
2:12you deplete glycogen,
2:14which is ultimately the key
2:18uh piece of the puzzle that interacts
2:20with insulin,
2:22will allow insulin levels to actually
2:24normalize. All of a sudden, the body can
2:28re-engage the normal mechanism of
2:30lipolysis,
2:32free fatty acids to ketones into fuel.
2:36>> So, do you think that people should be,
2:38and just to clarify, like a 24-hour
2:40fast, what? Like once a week or cuz I
2:42don't want people to think like, "Oh,
2:43you should be doing like a 24-hour fast
2:44like three, four times per week." What's
2:45kind of the timeline there?
2:47>> So, the the the protocol I use in my
2:49practice is
2:51up to 36 hours weekly
2:54for periods of time.
2:56>> Got it.
2:57>> So, what we've seen the greatest
2:58success, and this is where the numbers
3:00are are really fascinating.
3:03Reproducibly,
3:0636 hours once a week for up to 6 weeks
3:09as a protocol,
3:11reduction in total body fat mass of 50%,
3:13reduction in visceral fat mass of 60%
3:18impact on skeletal muscle mass,
3:20minus 2%. In other words, most clients
3:23gain 1 to 2 lb of skeletal muscle in
3:26that period of time.
3:27That should sound absurd, right? But if
3:31we understand the mechanism, what's
3:34happening with sustained fasting, it
3:37actually makes total sense.
3:39Because if we really understand how, and
3:43it's really about insulin glucagon, that
3:45that that is that principal balance in
3:48the human body that drives lipolysis.
3:51>> Just for people that aren't unfamiliar
3:53with glucagon, what what do you mean by
3:54that?
3:55>> Well, yeah, so let's talk about it. So,
3:57I think most of us have heard about
3:58insulin and we have our own perceptions
4:00around what insulin is, but insulin, as
4:03it relates to fat
4:05use,
4:07insulin is a more of a storage hormone,
4:10we'll say.
4:11Glucagon is the antithesis or the the
4:15counteracting agent of insulin. I think
4:17it's really important to understand,
4:19too, how the human body works because
4:21everything in the human body is in in
4:23balance, right? There isn't like this
4:26pure insulin state or pure glucagon
4:29state. Everything is constantly
4:32shifting. The reality is most Americans
4:35who are insulin resistant live in a
4:37highly
4:39um insulin influenced state, much higher
4:43fasting levels of insulin. Normal human
4:45metabolism, constant fluctuation.
4:49Glucagon manages insulin and insulin
4:52manages glucagon. So, they they are
4:54counteractors. Fascinating or fun fact
4:57for all the people interested in GLP-3,
5:01retatrutide, retatrutide. What's so
5:04unique about it? Is it it is based off
5:07of the glucagon molecule. So, you want
5:09to really rebalance that relationship,
5:12throw some glucagon in the mix, right?
5:14We can talk about that in a few minutes,
5:15but
5:16>> I think that that that's good. That
5:17helps people understand it cuz like why
5:18like not getting into that tangent too
5:20much, but like why does
5:22um
5:22you know, semaglutide work not nearly as
5:24well as retatrutide? Because you're
5:26actually working on that glucagon,
5:28right?
5:28>> Yeah.
5:28>> So, it's a very Point is is that insulin
5:31glucagon relationship is, even without
5:33knowing mechanistically what that does
5:34for the audience,
5:36just trust me say that is a very
5:38important relationship for maintaining
5:40muscle and dropping fat.
5:41>> Exactly. Exactly. And you just you
5:44touched on something that a lot of
5:46people out there
5:47uh might throw a fit over, which is the
5:50impact of glucagon on muscle
5:52preservation. And we'll come to that,
5:54too. But, think of it Let's look
5:57strategically at
5:59fat cells cuz
6:01everybody comes to me and and talks
6:04typically first first meeting they they
6:06want to lose weight and they have a
6:07number in their mind, scale weight
6:09number, right? I I was best at 175 lb.
6:13What does that mean? I have no idea
6:14because I have no idea what their body
6:16composition looked like, their metabolic
6:17health, what have you.
6:19But, people have a number in their mind.
6:20What we want to really shift to is not
6:22talking about scale weight, but actually
6:24body composition. What does healthy body
6:25composition look like? In in plain
6:28sight, it is the least amount of
6:31visceral fat. Subcutaneous fat has value
6:35and actually some longevity benefits.
6:38Visceral fat, to my knowledge, correct
6:40me if I'm wrong, there is no health
6:42benefit. Visceral fat is a byproduct of
6:45our current
6:47environment and lifestyles.
6:50I I would love to see data. I wish we
6:51had data from Americans in the 1920s.
6:54What were their visceral fat loads? I
6:56expect they were probably negligible.
6:58>> No. Yeah, I mean
6:59>> Visceral fat is an adaptive it's an
7:01adaptive tool in the human body and
7:03visceral fat, you have to understand, is
7:06biologically active, unlike subcutaneous
7:08fat, which is a storage facility, right?
7:11Visceral fat is a hormonal entity. It is
7:14a biological suborganism, if you will,
7:17right? And how does visceral fat relate
7:19to insulin? Well,
7:22it worsens insulin sensitivity. So, it
7:24promotes insulin resistance. They sort
7:26of cohabitate, if you will. So, more
7:30visceral fat drives more insulin
7:33resistance. More insulin resistance,
7:34higher levels of resting insulin drive
7:37more visceral fat accumulation. So, this
7:40is where if you were going to talk about
7:42calories in calories out, excess
7:43calories are driven specifically towards
7:46visceral fat accumulation in a
7:49hyperinsulinemic
7:51state, high levels of insulin.
7:53So, these processes go hand in hand. So,
7:56now reverse those processes to become
7:59increasingly metabolically flexible. The
8:02key
8:03is really that relationship between
8:05insulin and visceral fat. Why do I
8:08strongly believe that sustained fasting
8:11has the results I'm claiming we see
8:14every day, and I'll show you case study
8:17after case study to support it, in 6
8:19weeks time? How can we do that? Because
8:21we're strategically targeting visceral
8:24fat. Eliminate that fundamental signal
8:28to derange global metabolism,
8:31and everything else
8:34is is a is fair game. Does that make
8:36sense?
8:36>> Yeah, for sure.
8:37>> And that's the fundamental difference.
8:39And when you look at the data, again,
8:40population-based data for intermittent
8:44fasting, which again, you and I agree,
8:46that's not fasting. It's like someone
8:47told me the other day that they um
8:50do a 12 12 fast.
8:52That's That's That's That's normal.
8:54That's eating normally, okay? That
8:57That's not fasting. Um so, these these
9:01fasting windows critically do not impact
9:05on insulin
9:07or lipolysis. They simply create a
9:11calorie deficit.
9:13>> Yeah, agreed.
9:14>> I'm totally with you. One of the things
9:15that I've been doing recently is
9:16actually starting my day with about 500
9:19to 1,000 mg of sodium before I even have
9:21my coffee. Now, I've noticed that this
9:23has made a pretty significant difference
9:25in my mental acuity when I go to the gym
9:27about an hour later. And when I start
9:29looking at the research, it makes a lot
9:31of sense because most of the signaling
9:33that occurs that gives us that kind of
9:35energy is dependent on sodium, and you
9:37wake up dehydrated a lot of times. So, I
9:39put a link down below for what I've been
9:41using. It's called Element. Now, they
9:43have a variety of different flavors.
9:44They have ready-to-drink sparkling cans,
9:46which are kind of a nice treat if you
9:47like the taste of soda, but you don't
9:49really want to have that actual soda, or
9:51you don't want to have a bunch of
9:52artificial sweeteners. So, that link is
9:54down below, and with that link, any
9:56purchase is going to get you a free
9:58sample variety pack. So, that means you
10:00get a variety of their leading flavors
10:03in a free package that you can keep for
10:05yourself, you can stock away, or you can
10:07give to a friend. So, that link is
10:08drinklmnt.com/thomas,
10:12and they're called Element Electrolytes.
10:14>> And that's why we have to understand,
10:16really change the whole conversation
10:18around what what fasting actually is,
10:23and what the potential health benefits
10:24and health ramifications are. Because
10:26strategic fasting,
10:28it eliminating circulating insulin
10:31levels. Uh uh uh not to oversimplify, we
10:34can geek out over the science, but call
10:37it what it is. If your insulin levels
10:39normalize, which I can prove to you
10:42doing a serum blood draw during your
10:44fasting period. Someone that comes in
10:46with high-grade insulin resistance,
10:48baseline fasting insulin above 20.
10:51I can normalize that insulin level
10:53during a strategic fast. I prove it.
10:56Draw the blood, send it to the lab,
10:57right? For that period of time, all of a
11:01sudden, we can actually access
11:04adipocytes, fat cells, but specifically
11:06visceral fat cells. So, we're actually
11:09targeting
11:10the hormonal environment of the human
11:13body. We're not targeting
11:17um again, [snorts] just in in energy
11:19equation, and that's the difference.
11:22Because understand, I mean, when you
11:23look at the correlative data over time
11:25between visceral fat, insulin
11:27resistance, the development of type 2
11:29diabetes, and all-cause mortality.
11:32It's a straight line. It's call it one
11:35in the same. From my perspective, it is
11:37the same thing. If I have someone with a
11:40I told you before, I mean my criteria
11:42for sustained fasting are dependent on
11:45not just fasting insulin levels, but on
11:47visceral fat load. You could have say a
11:50modest elevation of fasting insulin and
11:52high grade visceral fat load. That just
11:55means your body's doing everything it
11:57possibly can to keep up. There's a
12:00concept called metabolically healthy
12:01versus metabolically unhealthy obesity,
12:04right? What's the difference? It's the
12:07failure of the human body over time.
12:09>> Yes.
12:10>> And we know that metabolically healthy
12:12obese patients do worse over time. I
12:16call it the tip off the cliff
12:17phenomenon.
12:18Their pancreas pumping out it's going a
12:21thousand percent pumping out insulin.
12:24Their body is holding on for dear life
12:26in this hyper inflamed environment,
12:28right?
12:30Those people come here and they fall off
12:32the cliff. Things just shut down.
12:34>> Yeah.
12:35>> Whereas the metabolically unhealthy,
12:37that is comorbidities associate with
12:39obesity. That's their body kind of
12:41screaming out saying, "Hey, we can't
12:43keep up." Then the doctors intervene. We
12:45throw some band-aids, you know, pill for
12:47every ill and kind of
12:49people limp along. But the root cause
12:52phenomenon is still the same.
12:54Which is severe metabolic When I say
12:57metabolic disease, what I'm talking
12:59about in effect is insulin resistance in
13:01that progression.
13:03Type 2 diabetes think of it as just end
13:05stage or terminal insulin resistance,
13:08right? So,
13:10the idea of
13:12strategic fasting. So, implementing a
13:15targeted fasting
13:17period
13:18greater than 24 hours. That is the
13:20threshold that we see. The more
13:22metabolically unhealthy or metabolically
13:24deranged, so higher levels of fasting
13:26insulin, higher levels of visceral fat.
13:29Typically, in general, it takes longer
13:32fasting periods
13:35over time,
13:36I would say, very simply put, to sort of
13:38break the system, to really reset it.
13:43Then, you can shift gears into more of
13:45that accelerator protocol.
13:47>> It's interesting because, like say you
13:49had someone do a 24-hour fast, they
13:51might end up in a
13:53if we're playing the deficit game, I
13:54mean, okay, maybe they end up in a let's
13:56say a 3,000 calorie deficit. Right? Like
13:59It's funny because, you know, it
14:00actually nets out over the course of the
14:02week. They're probably in less of an
14:04actual deficit doing that than if they
14:06were just to like restrict calories
14:07every day. They're literally in less of
14:09an actual deficit, yet they're having a
14:11stronger metabolic outcome.
14:13>> Right. Which again, it
14:16for the purists,
14:18that to me is the crux of the
14:20conversation. That the calories, the
14:23energy balance conversation, simply does
14:26not acknowledge the biologic nature of
14:29the human organism.
14:31It is
14:32that's simple math, and it exists in a
14:35lab in a controlled setting. First law
14:37of thermodynamics.
14:39Fasting, strategic fasting, takes into
14:41account the impact of a biological
14:43organism that adapts.
14:46But, this is another key principle that
14:48I that I've come to really stress, which
14:50is
14:51acute stress adaptation in the human
14:53body,
14:54I would argue is uniformly positive. In
14:56fact, it's profound.
14:58Chronic stress adaptation,
15:01so, in both cases we're adapting,
15:04is almost uniformly negative.
15:07Great example is chronic
15:10hypercortisolemia, elevated levels of
15:12cortisol, right?
15:14Cortisol's a very potent, powerful tool
15:17for survival
15:19in the acute setting.
15:21Elevated over time,
15:23it becomes a disaster. Great example,
15:25too, insulin. Insulin in controlled
15:28circumstances is the most really Well,
15:31I'd say it's the second most potent
15:32anabolic hormone in the human body. You
15:34want to build muscle, you need insulin.
15:37Put insulin up and keep it there for
15:39long periods of time, it's disastrous.
15:42So, that dynamic is really what we're
15:44trying to target and really shift. And I
15:47think it's fascinating when you do look
15:49from a cellular biology standpoint at
15:52how
15:53insulin and glucagon, again bringing
15:55glucagon back into the equation, how
15:56they interact at the cellular level for
15:59a fat cell, right?
16:02This is probably the most fascinating
16:04piece of the conversation, I think, to
16:06understand why indeed insulin is
16:10something we need to focus on and and
16:12try to control and regulate around
16:15global health optimization.
16:17Insulin interferes with something called
16:20HSL, hormone-sensitive lipase, right? It
16:22is step two
16:25in the process of a stored triglyceride
16:27in a fat cell
16:30being ultimately converted to ATP
16:33energy, right?
16:35All the processes that that glucose
16:38undergoes to convert to ATP are
16:40occurring within the same cell.
16:42With fat, fat has to be mobilized from a
16:45storage site, right? Delivered into the
16:47bloodstream, delivered remotely to a
16:50cell for use as fuel, convert to energy.
16:54But what's fascinating to me is
16:56insulin
16:57shuts off hormone-sensitive lipase, step
16:59two.
17:01Fat never can actually leave the fat
17:03cell in the in the setting of high
17:06levels of insulin because it inactivates
17:09HSL. That fundamental issue, which
17:12biologically is healthy under controlled
17:15circumstances, but
17:17the United States population is walking
17:18around with insulin just just pounding
17:21their system.
17:22It simply does not allow for lipolysis
17:25to take place.
17:27And again,
17:29I'm less concerned about the fat you
17:31have, you know, out here
17:34than I am on fat on the inside. And if
17:36it what's clear and we see this actually
17:39in the trend lines,
17:40we look at I use InBody as my primary
17:43body comp tool, um simply because it's
17:46it's repeatable, it's accessible.
17:48Um but when you look at the visceral fat
17:51and total fat mass curves during that
17:536-week protocol that I'm talking about,
17:56it's actually very interesting because
17:57the trend lines really kind of it's down
18:00trending over the course typically of
18:02the first three to four fasts,
18:05and then it quite literally almost falls
18:07off the cliff.
18:09In my strong belief, what's happening
18:11there
18:12is the direct impact on visceral fat.
18:15Eliminate visceral fat, you take
18:18really flip the the the whole hormone
18:20imbalance script on its head.
18:23Because visceral fat and its
18:24relationship with insulin is almost an
18:27exacerbating effect. Get rid of visceral
18:30fat, and all of a sudden
18:32everything else becomes accessible,
18:34right? Cuz now you've taken off
18:36exponentially reduced uh say the noise
18:39Yeah. that's preventing the net effect.
18:41You you do not see that with this this
18:44you know, so-called intermittent
18:45fasting.
18:46It's simply not And by the way, what do
18:49we accept? What what does the data say
18:52is acceptable weight loss in the context
18:55of calorie restriction, right? It's
18:57anywhere from 0.5 to 1% total body
19:00weight per week would be very high end
19:02with significant calorie restriction.
19:04But what do we also accept with that?
19:0740 to 50% loss of lean body mass.
19:09>> Yeah.
19:10>> So,
19:12that piece of the puzzle along with
19:14metabolic adaptation is what makes
19:16anything less than controlled fasting
19:20I I think highly ineffective. And
19:22unfortunately, people are sold on this
19:24idea that they're doing something for
19:26their health.
19:28And you and I both know
19:30the first month, maybe even 3 months of
19:33intermittent fasting, you do see a shift
19:36in scale.
19:37>> Yeah, you're replacing a third of your
19:38Yeah.
19:39>> I mean
19:39>> Right? Yeah.
19:40>> So, of course you're going to see
19:40something.
19:41>> But the problem is what happens at that
19:44point?
19:45>> Yeah.
19:45>> It's the law of diminishing returns.
19:47Whereas, if we talk about strategic
19:49fasting, it's actually the law of
19:52accelerated returns. There's actually an
19:54ROI tied to it. Because in this process,
19:57too, that the other key concept I think
19:59here is by not allowing for negative
20:02metabolic adaptation,
20:04we are by definition preserving skeletal
20:07muscle mass, right? So, keep your muscle
20:10mass stable to increasing. The other
20:13thing I'm I'm extremely regimented about
20:17with this 6-week protocol I'm talking
20:19about is
20:21we base that entire protocol on your
20:24resistance training program.
20:27It's not the other way around. People
20:29think, "Oh, well, I'm going to need to
20:30modify what I do in the gym to account
20:33for my fasting." No, your fasting is
20:35predicated on the time in the gym. We
20:38can't lose performance. That's a net
20:40loss.
20:41>> So,
20:42making sure that we can still maintain
20:44output in the gym
20:47while
20:48intervening with fasting. So, you're
20:50metabolically optimizing while
20:53maintaining strength output. That's That
20:56to me is the key.
20:57People have [snorts] in their eye in
20:59their mind, too, that fasting is some at
21:01least what I understand, fasting is
21:02somehow associated with less activity.
21:05>> Yeah.
21:06>> Fasting should be associated with more
21:08activity. And we actually to really get
21:11those high-level results,
21:13what I obsess over is intentional
21:16movement. You want to actually If you
21:17were going to strategically look at a
21:19week's time and hey, I'm fasting on
21:21Wednesday, I want you to be more active
21:23on Wednesday than any other day of the
21:24week. Create a baseline energy demand
21:29that the body has to respond to. It has
21:32to release fuel to support the energy
21:35demand.
21:35>> Fasting and movement, I mean, dude, it's
21:37one in the same.
21:38>> They absolutely and they should be done
21:40together. I mean, fasting and laying
21:42dormant, that that's that's freaking
21:44that's cachexia, [clears throat] man.
21:45That's like that's like
21:46diet.
21:48So, that's that's not what we're after
21:50and it's like there's
21:52When you look at the studies, it's so
21:54frustrating sometimes because it's
21:56almost as though a lot of these studies
21:57are set up to just confirm caloric
22:01restriction. Like they They frustrates
22:02me to how they set them up because you
22:04don't see studies where people are going
22:06eat in a eat in a surplus or eat ad
22:08libitum for 5 days a week and then do a
22:1148-hour fast. Like they don't do that
22:13probably because it's hard to get the
22:14cohort for it. I understand why. I'm not
22:15saying it's necessarily like nefarious.
22:18But the only data we end up getting on
22:20fasting is like ETRF, TRF, like 16:8 and
22:23then they'll just say, "See, it's the
22:24same outcome as as caloric restriction."
22:26However, I will say even with that, even
22:28with like ETRF, these things,
22:31a lot of times there's enough to be a
22:33meaningful difference, but not
22:34statistically significant difference in
22:36metabolic health, but because they're
22:38only looking at the calories and the
22:39weight, they'll say, "See, it's the
22:40same." I'm like, "I actually look I
22:41actually see something different there.
22:43You might not say it's statistically
22:44significant, but based on this 5-day
22:46study that you did of having them simply
22:48skip breakfast, I see a
22:51noticeable change that if that was more
22:53extreme, if that was a longer fast, that
22:55would prove a very solid point." And
22:58it's like
23:00So, all of the fasting data, it's like
23:02people love to have a heyday saying it
23:04just is caloric restriction. It's just
23:06caloric restriction. But, it's like
23:08almost almost every single study I can't
23:10in good nature say I've ever seen one
23:12that doesn't show that like ETRF or some
23:15kind of like at least moderately I don't
23:19know alternate day fasting or something
23:20isn't showing at least a little bit
23:22better metabolic outcome.
23:25>> Right.
23:25>> Independent of weight loss.
23:26>> Well, yes. And I think the other fatal
23:30flaw, the other fundamental limitation
23:32is what are your primary or secondary
23:34end points, right? [snorts] Because what
23:37do those all those studies are
23:41I don't think it's intentional, but I
23:44think they're designed to support one
23:47school of thought. But, what are we
23:49missing here is we're missing and it's
23:51hard to do at a large scale, we're
23:54missing the nuance to what's happening.
23:57Again, what's happening metabolically?
23:59What's happening to glucose curves?
24:01What's happening to whole body glycogen
24:03stores? What's happening to insulin
24:05glucagon ratio?
24:06That's a more nuanced study, right? It's
24:09not easy to do. It's not easy to churn
24:11out. But, the devil's in the details.
24:13What's cool about my world as a
24:17physician is I can look at all those
24:19data points. I can use MR to evaluate
24:22visceral fat volume. Can I do that at
24:24scale? Unfortunately, no. And that's
24:27where the gap exists, but
24:29the the beauty of being able to
24:33follow these curves is you can actually
24:35begin to dissect out those very nuanced
24:39details.
24:40>> Yeah.
24:41>> And then you can never never overlook
24:43the net impact on I said healthy body
24:48recomposition is the only language we
24:50should be using.
24:51>> Yes.
24:51>> And healthy rebody healthy body
24:53recompositioning is is really and I
24:56educate clients to this, it's about
24:58using fat to fuel muscle.
25:00>> Yeah.
25:00>> That's it. It's super simple. So, at the
25:03end of some given period of time, we
25:06should see a net market reduction. I
25:09mean, think about
25:10I I I have client after client that it
25:14almost baffles me when I look at the end
25:17at the entire at their own data, right?
25:20I'm like,
25:21"Holy crap." I had a client the other
25:23day come in that had lost 32 lb of total
25:27fat mass, reduced visceral fat, again,
25:31um by 65%
25:34and added 2 lb of skeletal muscle in
25:37that time frame.
25:39And that's that is reproducible. How we
25:41educate people to understand not only
25:45how, but but why. I think why is
25:47important and to get out of that mindset
25:50where they've been conditioned to
25:51believe somehow I'm skipping breakfast,
25:53I'm I'm doing something healthy.
25:56You're really not. And the beauty, too,
25:58by the way, of structured fasting like
25:59that
26:00is you want to talk about a perfect way
26:02to totally not care about energy
26:05balance.
26:06There's no way you can overcome the
26:08hormonal impact of weekly fasting
26:12by overeating. You simply can't consume
26:15that much. So, those other 5 and 1/2
26:17days of the week,
26:19go nuts. As long as you're eating whole
26:21food, you're focusing on, again, carbs
26:23calories early, you're you're really
26:26prioritizing protein as as a as a
26:30primary macronutrient that we really
26:32anchor
26:33dietary goals around.
26:35Fat is a principal fuel source. You you
26:37take those as rules,
26:39I would challenge someone to to find a
26:41way to overeat to out-eat that not just
26:45calorie deficit, but again, the entire
26:49change in hormone makeup that occurs in
26:52that fasting period.
26:53>> Yeah, I mean the net contrast between
26:55like probably a lifetime of never taking
26:58a day off of food.
26:59>> Mhm.
27:00>> And then all of a sudden like 6 weeks of
27:02structured like that is that is such a
27:05stark contrast the hormonal
27:08input that you get from that or the
27:10signal for hormonal change is so starkly
27:14different from a lifetime of never doing
27:17that.
27:17>> Right.
27:17>> That I would agree with you would be
27:19very hard to disrupt the benefit that
27:22you just achieved. Could you
27:24overeat enough calories to compensate
27:26for that? Absolutely. And like and
27:29that's part of the problem we see I
27:30think with even consistent intermittent
27:31fasting is like a lot of times like that
27:34does rebound. At least we we see it
27:36reproduced in rodent studies. I haven't
27:38really seen it heavily reproduced in
27:39human model, but either way point is is
27:41that
27:42you're not talking about just the
27:43calorie piece here. It's like this is
27:46a fundamental shift at a metabolic and
27:48hormonal level
27:50that isn't going to fix it overnight. It
27:51isn't going to fix it in 1 week, but
27:53it's setting the framework so that their
27:56diet can actually do the work for them.
27:58Right? Rather than just constantly like
28:00budding up against resistance all the
28:02time.
28:02>> Well, and I think let's let's talk about
28:05kind of human nature here too. The
28:10the there are so many layers to
28:14um
28:15how we perceive ourselves, how we view
28:17ourselves that we're living in a society
28:19of
28:20fat phobia with with body positivity.
28:24It's all over the map.
28:25>> Yeah.
28:26>> Where I come from is very simply
28:30health optimization
28:32will
28:33translate to the best outward appearance
28:36you could have. My primary goal is not
28:39aesthetic, it's performance. And I think
28:42people also get into these kind of weird
28:47we talk about disordered eating, for
28:48example, right? Calorie restriction
28:50disordered eating, carb being carb
28:53restricted, all these things.
28:56Well, believe it or not, overeating is
28:58also a form of disordered eating as
29:00well, last time I checked, right? We
29:02talk all about oh, well, you're going to
29:04crash and burn, restrict this and do
29:06that, and it gets so confusing for
29:08people. Let's simplify it down to what's
29:10really happening.
29:12But again, pull the levers in a way that
29:14actually has transformative impact.
29:18Restricting calories over time doesn't
29:21work, period. That's just in the data
29:24actually supports that. We just skew it
29:27to to make any number of conversations.
29:30There's a guy on social media.
29:33I wish I knew his name. I'm embarrassed
29:34I don't.
29:35But you may know this guy. He wears this
29:38like Spock Spock um
29:41I think he's an anesthesiologist.
29:43>> Yeah, I don't think I've seen him.
29:44>> But he's always has the Spock shirt on,
29:46and then people are critical of his Star
29:49Trek um affirmations, but
29:52he talks all about fasting and the
29:54impact on visceral fat, and just gets
29:56lit up left and right on social media,
29:58right?
29:59Intermittent fast you know, then they
30:01say, well, fasting, here's the data,
30:02it's calorie That's because we're
30:04talking about two radically different
30:06ideas. What he's talking about is
30:08exactly what we're talking about.
30:10Sustained fasting, it's
30:13very very
30:15Yes, calories go along with that. I
30:18understand that. But like I said, we
30:20agree. I can create a strong calorie
30:23deficit over time with daily restriction
30:27that leads to dramatically less impact
30:30on biomarkers and global health
30:32outcomes, right?
30:34>> Yeah.
30:34>> Whereas
30:36strategically fasting changes the script
30:38altogether. I wish I had the capacity or
30:41the bandwidth. I wish I had a lab.
30:43Because these are really
30:45the questions that we should be asking
30:48and answering on a on a scientific
30:51level.
30:52We know the reality.
30:55But what to do it at scale, yeah, it
30:57requires Yeah, it requires more effort
31:00than your conventional hop on a scale,
31:03see how you do.
31:04>> Yeah, no, dude. And I'm I'm I mean I'm
31:05done with the academic bullying that
31:07happens with it.
31:08>> Yeah.
31:08>> Like it's it's that's Let's call a spade
31:10a spade. That's what it is. It is
31:12And you know, people say they'll have
31:13these things that say like data over
31:15feelings or this and that. Okay, what
31:17about outcomes over data?
31:18>> Yes.
31:20>> Okay? Because like
31:22I know people lose weight with and I
31:24know people improve their metabolic
31:25health with caloric restriction. Okay.
31:29I get it. That doesn't mean that that is
31:31the way.
31:32>> Right.
31:33>> Like you're still trying to achieve the
31:35same thing that we're trying to achieve
31:38over here, but the a completely
31:41different avenue. And caloric
31:43restriction just happens to be perhaps a
31:45common denominator that is there.
31:47>> Mhm. Mhm.
31:48>> That doesn't mean that that's the cause
31:49of the fat loss, the weight loss, the
31:51metabolic improvement.
31:52>> Right.
31:54>> I think that once the fat is
31:56gone, the visceral fat is reduced, the
31:58inflammatory load is less, it changes
32:01the environment altogether. Agreed. Net
32:03outcome when we're at that end outcome,
32:05we have
32:07we have maybe similar biomarkers when we
32:09have actually reached the outcome.
32:11>> Okay.
32:12>> The outcome we could talk about
32:13timelines. Like what it takes to get to
32:14that outcome. But let's say like if we
32:16forget time exists altogether and we end
32:18up at the same outcome, okay, yeah, we
32:20could agree that like a lot of these
32:22biomarkers might end up the same. But
32:23the thing that we're talking about is
32:25that the person that is calorically
32:26restricting may not even have enough
32:28time in their lifetime
32:30>> Exactly.
32:30>> to get to that point.
32:31>> Right. Well, forget and and and also
32:34take into account compliance. It's
32:36Compliance and efficiency I think are
32:38interconnected, right? The less
32:41efficient the process, you're telling
32:43me, okay,
32:44if you restrict calories for, you know,
32:47X number of calories per day for the
32:49next 18 months, we're going to get you
32:52to this end point.
32:53>> [snorts]
32:53>> And I'm telling you, I'll get you to
32:55that end point in 6 weeks.
32:58Well, what do you think the more likely
33:00scenario is to happen? I ask my clients
33:02this all the time. If I told you you do
33:04exactly what I say for the next 6 weeks,
33:06you got a million dollars in your bank
33:07account. Or
33:09we'll target 18 months or so, and we may
33:13hit a million dollars in your bank
33:14account, but you may fall off around
33:16month four cuz you kind of get bored
33:19with the technique and all that stuff.
33:21Who is going to choose the 18-month
33:23route? No one will, right? And yet,
33:26that's what we're suggesting everybody
33:28do when you talk about chronic calorie
33:30restriction. And not only that, but like
33:32I said, it's not only the mental load
33:34and the and the the the sort of the
33:36fatigue that goes into that process. I
33:38mean,
33:39go on social media. I mean, it's
33:41maddening to hear people talk about, you
33:44know, they had the two jars like, here's
33:46100 calories of this, here's 100
33:48calories of that. All
33:49>> Yeah.
33:50>> Your mind gets fried. Talk about
33:52disordered eating.
33:53>> Right. That's my point. And and and so,
33:56like
33:56when you then then you have that other
33:58camp that's like, well, why does why
34:00does calorie restriction fail? Yeah,
34:01well, because it's so chronic. Not only
34:04is the body adapting, but the brain's
34:06going, you know what? This sucks, right?
34:09And so, unfortunately, you take some
34:11group of those people who are extremely
34:13well-intentioned, highly motivated,
34:17and who fail at month four or five. We
34:19see it. Right? You see it every January
34:211.
34:22>> all the willpower in the world, man.
34:23>> No. So, why don't we look at, again,
34:26goes back to strategy and efficiency
34:28point. We need to be talking about,
34:30okay, what is the mechanism to radically
34:33impact in the shortest period of who
34:35wants to drag it out?
34:37>> Yeah.
34:37>> If I can get a million dollars in the
34:38next 6 weeks, I will do just about
34:41anything.
34:42Because why on earth would I want to
34:44drag it out?
34:45>> Yeah.
34:46>> So,
34:47the I think the gap there that exists
34:49now is educating people, helping them
34:51understand that, you know, actually
34:53mechanistically, not only does this
34:56work, not only is it reproducible, but
34:58we can put it in your hands, protocolize
35:00it,
35:01and deliver results
35:05in a much
35:06And then I think the only other big gap
35:08or asterisks there is people hear
35:11fasting, like 24-hour fasting. And I
35:14told you this before,
35:16I see people almost have a visceral
35:18response to that, right? Oh my gosh,
35:20there's no way.
35:21How do we get over that hump and get
35:24people confident into that space where
35:27they can reproduce those results week
35:29over week for 6 weeks.
35:31This is where I think strategy around
35:34something like a GLP becomes incredibly
35:37valuable, incredibly potent. And I'm
35:40going to take it a whole step further,
35:42big leap.
35:43You want to get really, really, and this
35:46is what I think the future of metabolic
35:48medicine looks like, is when retatrutide
35:51hits the market.
35:52>> Mhm.
35:52>> You now have a mechanism, I mean, we're
35:54seeing it in the prelim phase three
35:56clinical data. You now have a mechanism
35:58to actually influence that glucagon to
36:01insulin balance real time.
36:03So,
36:04yes, you can powerfully impact that with
36:08movement and with muscle health and with
36:11with strategic fasting, but why wouldn't
36:15I engage another tool to accelerate the
36:19process, really flip that balance
36:22against insulin?
36:23>> Yeah.
36:23>> And I wish I had the study in front of
36:25me right now. I Maybe I'll to find it
36:27later but essentially like losing weight
36:29in a fast amount of time does not lead
36:32to more rebound. That's the thing. It's
36:35like so it's
36:37it's kind of funny because it's like
36:39we're led to believe that like it rapid
36:41weight loss is bad. There's nothing that
36:43shows that rapid weight loss is like
36:45regained any faster than like if you
36:47lose it at any other basic rate, right?
36:50I'm sure if you lose it over a
36:51ridiculously long period of time,
36:53there's a level of that adaptation
36:54that's maybe a little bit safer. But the
36:57point is is that when you model it out,
37:00the faster you can get that inflammatory
37:01load off of your body, the faster you
37:03can get this especially when you're like
37:05north of 40, north of 50 when every day
37:09that advanced glycation end products are
37:11forming, every day that visceral fat is
37:13leaking inflammatory side, every day
37:14that your HBA1C is high
37:16is taking minutes off of your life,
37:18right? The faster you get the weight
37:21off, the better. The trick is how do you
37:24do that without rebounding afterwards
37:28because you're going to rebound either
37:29way if you don't put the right tools in
37:31place, right? Like so forget it. So
37:32would you rather take I'm not trying to
37:34sound cynical but it's like would you
37:35rather take 6 months to lose 100 lb and
37:38rebound
37:39or would you rather take a month after
37:42you're literally going to do that a
37:42month and lose 100 lb and rebound? It's
37:44like okay, at least if I rebounded after
37:48losing that weight rapidly, I would have
37:50more time without that added stress
37:53impacting my body. Not condoning the
37:56people try to lose a crazy amount of
37:57weight and do extreme things. The point
37:59is is that
38:01you can lose weight fast
38:04as long as you are preserving the muscle
38:06because that's probably the biggest risk
38:07of rapid weight loss, right?
38:09And we fortunately now have data that
38:11makes that accessible to just about
38:13everybody at reasonable cost.
38:15And
38:17then [snorts] you say okay then the real
38:18work comes like after you've lost the
38:20weight then what's the lifestyle and
38:21that's I think where like my strategy is
38:23generally like, okay, then what's the
38:24fasting maintenance phase look like?
38:26Yeah. Like right, because that is
38:28>> People think that I have this
38:30ridiculously regimented diet. My diet is
38:31not that strict. Everyone in this room
38:33has seen me eat before. And like I don't
38:36care. I mean, I try to 80% generally,
38:39right?
38:39>> Sure.
38:39>> But I maintenance with fasting.
38:42>> Right.
38:42>> Like it's that easy, right?
38:44>> Totally agree. Totally agree. And it's
38:47it is
38:48actually easy when you put it in
38:50perspective, right? The and you know,
38:54the the one caveat I see is
38:57even even in the conversation around
39:00weight loss, losing 100 lb,
39:03let's talk about losing 30 lb of fat
39:07in the next 6 weeks versus the next 6
39:09months versus the next 6 years, right?
39:12It's exponentially, I would argue, more
39:16accessible in the short term than it is
39:18the long term.
39:19>> Yeah.
39:21>> I'm a big believer, [clears throat] like
39:22I said, the acute stress phenomenon, hit
39:25the problem in the mouth versus tapping
39:28it on the shoulder.
39:29>> Yeah.
39:29>> If you really look strategically at the
39:32impact, and you make an excellent point,
39:34is
39:36every day that we exist, I mean, not to
39:39be too dramatic, but every day does
39:42count. So, you taking that 50-year-old
39:45right at that inflection point, they've
39:47spent 50 years getting to this point.
39:51That's limited
39:53the next 50 years to now 30 years or 20
39:58years, right? So, it's not a one-to-one
40:00ratio. And you I I I think understanding
40:04we we've talked about this a lot, but
40:06people have to understand the the
40:08difference, the radical difference
40:10between visceral fat and everything else
40:14in the discussion. So, that's where it
40:16does become hard when you talk about
40:18weight loss because
40:20I want to know what your starting
40:22visceral fat load was and what we're
40:24able to accomplish in a short period of
40:26time. That will flip everything else
40:28around because
40:30we haven't even talked about it, but
40:32again, the release of inflammatory
40:33cytokines, the impact on systemic health
40:37that visceral fat has is so much broader
40:41reaching. We have to make I literally go
40:43so far as to say we have to really even
40:46when you talk healthy body
40:47recomposition, it has to really only be
40:49a visceral fat conversation.
40:51Get rid of visceral fat and literally
40:53everything else will come into balance
40:55because I mean, look at
40:58visceral fat and insulin resistance.
40:59Look at the impact on
41:01total testosterone in men.
41:03Right? There is a linear to exponential
41:07effect. As you reach a certain
41:09threshold, it becomes exponentially more
41:12impactful on baseline testosterone
41:15levels. People are running around
41:17looking for detergents, not wearing
41:19deodorant, right? Because their
41:21testosterone levels are low.
41:23Dude, get a fasting insulin level.
41:26I I I saw something recently a post
41:29about
41:30and it was showing an individual that
41:32had been struggling with issues related
41:34to hormone production and all this kind
41:36of stuff. I don't want to sound
41:37critical,
41:39but they were doing this whole and
41:41they're modifying detergents and
41:43deodorants and all this kind of stuff.
41:45And in fairness, the person's sitting on
41:47the couch and they're obese and they
41:49literally have a can of pop next to
41:51them.
41:52Like you're you're chasing uh the the
41:560.01%
41:58while ignoring the 99.9.
42:01Everything really in my mind it ties
42:05back to visceral fat load and that's
42:07something that starts accumulating. I
42:10mean, we're seeing insulin resistance
42:13being profound in adolescents. Someone
42:16asked me, "Well, when do you think
42:17insulin resistance starts?" I think it
42:18starts at birth.
42:19>> Yeah.
42:20>> I mean,
42:21feed a kid garbage from day one. No
42:25child is born insulin resistant and no
42:27child is born obese. True story. Right?
42:30>> Yep.
42:31>> And you're telling me by adolescence
42:32they're obese and insulin resistant or
42:34diabetic?
42:35Something happened between day one and
42:38adolescence. [clears throat]
42:39And now transform that and this is my By
42:42the way, this is my other issue. When we
42:44talk about the metabolic impactors on
42:47insulin resistance, what are the key
42:48drivers? When we look at the nutritional
42:50studies, Ward studies, right?
42:53Saturated fats are
42:56more of an accelerant
42:59to insulin resistance than glucose.
43:03Right? That's very clear.
43:04>> Mhm.
43:06>> So, we we say, "Well, the data says X."
43:09Well, the data is based off of 8 to
43:1114-day
43:13diet interventions.
43:15Sometimes in obese, sometimes in
43:17healthy. Last I checked, the human
43:19lifespan is slightly longer than 14
43:21days. So, I look at those Ward studies
43:24as wholly irrelevant. They're not even
43:26part of the conversation. What we can
43:28look at though is talk about insulin
43:30resistance reversal.
43:33There is a clear
43:35significant impact in reducing
43:38having a lower glycemic load in a lower
43:41glycemic model of diet. That does not
43:43mean under-eating carbohydrates. That
43:46means strategically consuming
43:48carbohydrates that are slower to digest,
43:52fewer simple sugars. The correlative
43:54data between added sugars,
43:55sugar-sweetened beverages, and diabetes.
43:58>> Yeah.
43:59>> It's very black and white. There's no
44:01secrets. We're not talking about the
44:03impact on saturated fats versus the
44:06impact on added sugars long term
44:09favors the glucose model 100% and it
44:12just makes more sense.
44:14>> no one no one other than I mean
44:16a very small cohort is eating pure
44:18saturated fat. What are they how are
44:20they getting their saturated fat?
44:22>> Right.
44:22>> They're getting their They're not
44:23getting I I
44:24you know, they're not getting their
44:25saturated fat from a beautiful ribeye or
44:27ground beef. I'm sorry. They're getting
44:28it from some trans fat or some fat in
44:31their potato chip or or in their They're
44:33getting it some not their potato chip
44:35but they're you know, their fried food
44:36or whatever, right? They're getting it
44:37some other way. They're getting it so
44:41and it's combined. It's not just the
44:43saturated fat. It's just
44:45>> Correct.
44:45>> That is a very frustrating discussion to
44:47have because there's a very big
44:48difference between a high fat high
44:50saturated fat diet. If you look at like
44:52even in rodent models how they induce
44:53obesity, they induce it with high
44:55saturated fat, of course, but it's not
44:57that's high saturated fat in
45:00adjunct to their rodent chow.
45:02>> Right.
45:02>> Like if you were to put just a rat on
45:04pure saturated fat, I don't know what
45:06would happen. Maybe it's been done. Like
45:07they probably would have very low
45:09insulin. I mean they probably would
45:10cause some other issues.
45:11>> Right.
45:12>> Point is is that it's not like the
45:13saturated fat is not I mean I'm I mean
45:15let's anecdotal I just got my like
45:17an AI driven coronary artery calcium
45:20score everything all my plaque. I've
45:22been eating a high saturated fat
45:24zero zero across the board.
45:26>> Right.
45:27>> Fasting insulin less than two HBA1C like
45:304.8.
45:31>> Right.
45:31>> Like
45:32on a
45:34arguably high saturated fat diet. And
45:36I'm not all keto. So I also eat carbs.
45:39>> Right.
45:40>> So
45:41I think it's leading to your point of
45:42like this hormonal environment this
45:45other environment. I'm not saying that
45:47saturated fat isn't problematic.
45:48>> Right.
45:49>> It can absolutely be problematic.
45:51>> Right.
45:51>> It just depends on the environment in
45:53which it 100% is or is not problematic.
45:55>> Yep.
45:55>> So let's stop demonizing one thing
45:57because it's just confusing the hell out
45:59of people.
45:59>> Right.
46:00>> Totally agree and man
46:03I thought you were going to
46:04take it all the way down the cholesterol
46:06conversation path. But, I mean, there's
46:09there's clearly a relationship between
46:11saturated fat consumption and
46:12cholesterol. There is a relationship
46:14between cholesterol and coronary
46:16disease. But, what gets left out of the
46:19whole fat is bad conversation is what is
46:22the environmental factors that are
46:24contributing. Now, there's
46:27I I'm sure you're aware of this, but the
46:30you know, the CT keto study that, you
46:32know, that was done using clearly an AI
46:35algorithm.
46:36Um
46:37You know, the it it people that are in
46:41high-grade keto states using principally
46:45red meat and driving cholesterol levels
46:48to absurdly high levels
46:50can demonstrate an accelerated
46:53atherosclerotic plaque
46:55>> Yeah, even in a lean mass hyper
46:56responder. Like, you got crazy high
46:58levels, right?
46:59>> Correct.
47:00But, this is why when
47:02common sense dictates, and this is where
47:04we got to go back to just basic common
47:06sense.
47:07Anything at absurdly extreme
47:10levels probably isn't the best for the
47:13human body.
47:14Take it from the perspective, um why did
47:17visceral fat, I would argue, not exist?
47:19Especially if you talk and, you know,
47:21people that are big on the ancestral
47:22conversations. Why did visceral fat not
47:25exist? Well, think about just how we
47:27lived our lives ancestrally, right? We
47:30lived our lives very much driven by
47:34periodization.
47:35Right? You couldn't go to the grocery
47:37store and get
47:39red meat
47:41365 days a year. There was a season with
47:44which the the meat burden is high.
47:47There's a season with which the fruit
47:49burden is high, so on and so forth.
47:52We have to consider the environment we
47:54live in today is radically different. We
47:56have access to yes, ultra-processed
47:59foods, but we also have access to
48:01incredibly broad-based whole food
48:03sources. How does that all exist
48:06together?
48:08The simplest way I can put it is use
48:11human biology,
48:13restore natural mechanisms, which
48:16healthy mechanisms, metabolic
48:17flexibility as a core principle.
48:21Everything else will come into line. No,
48:24I'm not a big believer in the magic
48:26bullet theories and all this kind of
48:27crap. No, do I think you should eat
48:29three servings of red meat a day, even
48:32if you are
48:33hemoglobin A1C is 4.8? No, probably not
48:36a good idea, right? But in balance and
48:39in context, the the root cause still
48:42remains metabolic dysfunction. Yeah.
48:45That's that's really the summary
48:46statement. So,
48:48fasting
48:50as the most powerful potent mechanism we
48:53have to reverse metabolic dysfunction is
48:57indeed the most critical element I think
48:59to long-term health and performance. It
49:02has to be. And it simply does not have
49:06to be that hard.
49:09Because
49:11I mean, people have done it for for
49:13decades, for centuries. I've gotten
49:15obsessed with it simply because the data
49:17is very clear in what the long-term
49:20benefits are. And when you consider the
49:21root root cause at the the core of
49:26disease and death in Western
49:28civilization today. I mean, all you have
49:30to do is consider the impact. Use
49:33diabetes as end-stage insulin
49:34resistance. We'll use that as It's an
49:36easy population to study, type 2
49:38diabetes, right?
49:39Look at the
49:41exponentially higher risk of death and
49:45comorbidity in diabetics than any other
49:48single condition, including familial
49:51hypercholesterolemia,
49:52right? For sure. Okay? You want to talk
49:55I mean anyway we can digress into the
49:57cholesterol talk, but I mean just look
49:59at the diabetic cohort.
50:01Risk of all cause mortality 3.5 to 4.5 x
50:04higher than the general population. What
50:06other single
50:08contributor has that great an impact
50:11even considering genetic risk,
50:13right? It's that simple. Fix that
50:15problem
50:17and the way to fix it
50:19movement, muscle health
50:21fasting, true fasting and 16/8
50:25throw it out the door. It's It's
50:26meaningless.
50:27>> Well, Dr. Sheff, where can everyone find
50:29you, man?
50:30>> Instagram @johnsheff, YouTube
50:34@drjohnsheff.
50:36I love the conversations. I love the
50:38feedback and I love to learn from other
50:40people. That's the way to look me up.
50:42>> Thanks for having me.
50:43>> All right, brother.

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