Transcription
Reproducibly. 36 hours, once a week for up to 6 weeks as a protocol. Reduction in total body fat mass of 50%, reduction in visceral fat mass of 60%, impact on skeletal muscle mass minus 2%. In other words, most clients gain 1 to 2 lb of skeletal muscle in that period of time. That should sound absurd, right? But if we understand the mechanism, what's happening with sustained fasting, it actually makes total sense.
Dr. John Sheff, fasting for insulin resistance, fasting for visceral fat, fasting for metabolic health. What is your strategy? You have a unique approach.
What I'd start by saying is 16:8 is not fasting. Period. That's where it begins. Understanding that the idea that the intermittent fasting fasting windows less than 24 hours is simply not enough time. And we know this with very clear in my my clinical practice, the data is obvious when you look at it. Less than 24 hours of of of food fasting is simply not enough to impact on the relationship between glucose, insulin, and lipolysis or fat burn. And you have to understand strategically that insulin is the critical regulator. That it's the gatekeeper. If you have elevated insulin, insulin resistance, right? Which most of Americans do. Your body cannot burn fat. Period. Full stop. That is real. That is a real truth. And when you consider the relationship between insulin and visceral fat, that is really at the core of why intermittent fasting does nothing better than any other form of chronic calorie restriction, which ultimately leads to metabolic adaptation and failure. Period. You flip the script by extending fasting strategically. Now, my obsession is around having data to drive those decisions around strategic fasting. But once you extend out that fast, you deplete glycogen, which is ultimately the key uh piece of the puzzle that interacts with insulin, will allow insulin levels to actually normalize. All of a sudden, the body can re-engage the normal mechanism of lipolysis, free fatty acids to ketones into fuel.
So, do you think that people should be, and just to clarify, like a 24-hour fast, what? Like once a week or cuz I don't want people to think like, "Oh, you should be doing like a 24-hour fast like three, four times per week." What's kind of the timeline there?
So, the the the protocol I use in my practice is up to 36 hours weekly for periods of time.
Got it.
So, what we've seen the greatest success, and this is where the numbers are are really fascinating. Reproducibly, 36 hours once a week for up to 6 weeks as a protocol, reduction in total body fat mass of 50%, reduction in visceral fat mass of 60% impact on skeletal muscle mass, minus 2%. In other words, most clients gain 1 to 2 lb of skeletal muscle in that period of time. That should sound absurd, right? But if we understand the mechanism, what's happening with sustained fasting, it actually makes total sense. Because if we really understand how, and it's really about insulin glucagon, that that that is that principal balance in the human body that drives lipolysis.
Just for people that aren't unfamiliar with glucagon, what what do you mean by that?
Well, yeah, so let's talk about it. So, I think most of us have heard about insulin and we have our own perceptions around what insulin is, but insulin, as it relates to fat use, insulin is a more of a storage hormone, we'll say. Glucagon is the antithesis or the the counteracting agent of insulin. I think it's really important to understand, too, how the human body works because everything in the human body is in in balance, right? There isn't like this pure insulin state or pure glucagon state. Everything is constantly shifting. The reality is most Americans who are insulin resistant live in a highly um insulin influenced state, much higher fasting levels of insulin. Normal human metabolism, constant fluctuation. Glucagon manages insulin and insulin manages glucagon. So, they they are counteractors. Fascinating or fun fact for all the people interested in GLP-3, retatrutide, retatrutide. What's so unique about it? Is it it is based off of the glucagon molecule. So, you want to really rebalance that relationship, throw some glucagon in the mix, right? We can talk about that in a few minutes, but
I think that that that's good. That helps people understand it cuz like why like not getting into that tangent too much, but like why does um you know, semaglutide work not nearly as well as retatrutide? Because you're actually working on that glucagon, right?
Yeah.
So, it's a very Point is is that insulin glucagon relationship is, even without knowing mechanistically what that does for the audience, just trust me say that is a very important relationship for maintaining muscle and dropping fat.
Exactly. Exactly. And you just you touched on something that a lot of people out there uh might throw a fit over, which is the impact of glucagon on muscle preservation. And we'll come to that, too. But, think of it Let's look strategically at fat cells cuz everybody comes to me and and talks typically first first meeting they they want to lose weight and they have a number in their mind, scale weight number, right? I I was best at 175 lb. What does that mean? I have no idea because I have no idea what their body composition looked like, their metabolic health, what have you. But, people have a number in their mind. What we want to really shift to is not talking about scale weight, but actually body composition. What does healthy body composition look like? In in plain sight, it is the least amount of visceral fat. Subcutaneous fat has value and actually some longevity benefits. Visceral fat, to my knowledge, correct me if I'm wrong, there is no health benefit. Visceral fat is a byproduct of our current environment and lifestyles. I I would love to see data. I wish we had data from Americans in the 1920s. What were their visceral fat loads? I expect they were probably negligible.
No. Yeah, I mean
Visceral fat is an adaptive it's an adaptive tool in the human body and visceral fat, you have to understand, is biologically active, unlike subcutaneous fat, which is a storage facility, right? Visceral fat is a hormonal entity. It is a biological suborganism, if you will, right? And how does visceral fat relate to insulin? Well, it worsens insulin sensitivity. So, it promotes insulin resistance. They sort of cohabitate, if you will. So, more visceral fat drives more insulin resistance. More insulin resistance, higher levels of resting insulin drive more visceral fat accumulation. So, this is where if you were going to talk about calories in calories out, excess calories are driven specifically towards visceral fat accumulation in a hyperinsulinemic state, high levels of insulin. So, these processes go hand in hand. So, now reverse those processes to become increasingly metabolically flexible. The key is really that relationship between insulin and visceral fat. Why do I strongly believe that sustained fasting has the results I'm claiming we see every day, and I'll show you case study after case study to support it, in 6 weeks time? How can we do that? Because we're strategically targeting visceral fat. Eliminate that fundamental signal to derange global metabolism, and everything else is is a is fair game. Does that make sense?
Yeah, for sure.
And that's the fundamental difference. And when you look at the data, again, population-based data for intermittent fasting, which again, you and I agree, that's not fasting. It's like someone told me the other day that they um do a 12 12 fast. That's That's That's That's normal. That's eating normally, okay? That That's not fasting. Um so, these these fasting windows critically do not impact on insulin or lipolysis. They simply create a calorie deficit.
Yeah, agreed.
I'm totally with you. One of the things that I've been doing recently is actually starting my day with about 500 to 1,000 mg of sodium before I even have my coffee. Now, I've noticed that this has made a pretty significant difference in my mental acuity when I go to the gym about an hour later. And when I start looking at the research, it makes a lot of sense because most of the signaling that occurs that gives us that kind of energy is dependent on sodium, and you wake up dehydrated a lot of times. So, I put a link down below for what I've been using. It's called Element. Now, they have a variety of different flavors. They have ready-to-drink sparkling cans, which are kind of a nice treat if you like the taste of soda, but you don't really want to have that actual soda, or you don't want to have a bunch of artificial sweeteners. So, that link is down below, and with that link, any purchase is going to get you a free sample variety pack. So, that means you get a variety of their leading flavors in a free package that you can keep for yourself, you can stock away, or you can give to a friend. So, that link is drinklmnt.com/thomas, and they're called Element Electrolytes.
And that's why we have to understand, really change the whole conversation around what what fasting actually is, and what the potential health benefits and health ramifications are. Because strategic fasting, it eliminating circulating insulin levels. Uh uh uh not to oversimplify, we can geek out over the science, but call it what it is. If your insulin levels normalize, which I can prove to you doing a serum blood draw during your fasting period. Someone that comes in with high-grade insulin resistance, baseline fasting insulin above 20. I can normalize that insulin level during a strategic fast. I prove it. Draw the blood, send it to the lab, right? For that period of time, all of a sudden, we can actually access adipocytes, fat cells, but specifically visceral fat cells. So, we're actually targeting the hormonal environment of the human body. We're not targeting um again, [snorts] just in in energy equation, and that's the difference. Because understand, I mean, when you look at the correlative data over time between visceral fat, insulin resistance, the development of type 2 diabetes, and all-cause mortality. It's a straight line. It's call it one in the same. From my perspective, it is the same thing. If I have someone with a I told you before, I mean my criteria for sustained fasting are dependent on not just fasting insulin levels, but on visceral fat load. You could have say a modest elevation of fasting insulin and high grade visceral fat load. That just means your body's doing everything it possibly can to keep up. There's a concept called metabolically healthy versus metabolically unhealthy obesity, right? What's the difference? It's the failure of the human body over time.
Yes.
And we know that metabolically healthy obese patients do worse over time. I call it the tip off the cliff phenomenon. Their pancreas pumping out it's going a thousand percent pumping out insulin. Their body is holding on for dear life in this hyper inflamed environment, right? Those people come here and they fall off the cliff. Things just shut down.
Yeah.
Whereas the metabolically unhealthy, that is comorbidities associate with obesity. That's their body kind of screaming out saying, "Hey, we can't keep up." Then the doctors intervene. We throw some band-aids, you know, pill for every ill and kind of people limp along. But the root cause phenomenon is still the same. Which is severe metabolic When I say metabolic disease, what I'm talking about in effect is insulin resistance in that progression. Type 2 diabetes think of it as just end stage or terminal insulin resistance, right? So, the idea of strategic fasting. So, implementing a targeted fasting period greater than 24 hours. That is the threshold that we see. The more metabolically unhealthy or metabolically deranged, so higher levels of fasting insulin, higher levels of visceral fat. Typically, in general, it takes longer fasting periods over time, I would say, very simply put, to sort of break the system, to really reset it. Then, you can shift gears into more of that accelerator protocol.
It's interesting because, like say you had someone do a 24-hour fast, they might end up in a if we're playing the deficit game, I mean, okay, maybe they end up in a let's say a 3,000 calorie deficit. Right? Like It's funny because, you know, it actually nets out over the course of the week. They're probably in less of an actual deficit doing that than if they were just to like restrict calories every day. They're literally in less of an actual deficit, yet they're having a stronger metabolic outcome.
Right. Which again, it for the purists, that to me is the crux of the conversation. That the calories, the energy balance conversation, simply does not acknowledge the biologic nature of the human organism. It is that's simple math, and it exists in a lab in a controlled setting. First law of thermodynamics. Fasting, strategic fasting, takes into account the impact of a biological organism that adapts. But, this is another key principle that I that I've come to really stress, which is acute stress adaptation in the human body, I would argue is uniformly positive. In fact, it's profound. Chronic stress adaptation, so, in both cases we're adapting, is almost uniformly negative. Great example is chronic hypercortisolemia, elevated levels of cortisol, right? Cortisol's a very potent, powerful tool for survival in the acute setting. Elevated over time, it becomes a disaster. Great example, too, insulin. Insulin in controlled circumstances is the most really Well, I'd say it's the second most potent anabolic hormone in the human body. You want to build muscle, you need insulin. Put insulin up and keep it there for long periods of time, it's disastrous. So, that dynamic is really what we're trying to target and really shift. And I think it's fascinating when you do look from a cellular biology standpoint at how insulin and glucagon, again bringing glucagon back into the equation, how they interact at the cellular level for a fat cell, right? This is probably the most fascinating piece of the conversation, I think, to understand why indeed insulin is something we need to focus on and and try to control and regulate around global health optimization. Insulin interferes with something called HSL, hormone-sensitive lipase, right? It is step two in the process of a stored triglyceride in a fat cell being ultimately converted to ATP energy, right? All the processes that that glucose undergoes to convert to ATP are occurring within the same cell. With fat, fat has to be mobilized from a storage site, right? Delivered into the bloodstream, delivered remotely to a cell for use as fuel, convert to energy. But what's fascinating to me is insulin shuts off hormone-sensitive lipase, step two. Fat never can actually leave the fat cell in the in the setting of high levels of insulin because it inactivates HSL. That fundamental issue, which biologically is healthy under controlled circumstances, but the United States population is walking around with insulin just just pounding their system. It simply does not allow for lipolysis to take place. And again, I'm less concerned about the fat you have, you know, out here than I am on fat on the inside. And if it what's clear and we see this actually in the trend lines, we look at I use InBody as my primary body comp tool, um simply because it's it's repeatable, it's accessible. Um but when you look at the visceral fat and total fat mass curves during that 6-week protocol that I'm talking about, it's actually very interesting because the trend lines really kind of it's down trending over the course typically of the first three to four fasts, and then it quite literally almost falls off the cliff. In my strong belief, what's happening there is the direct impact on visceral fat. Eliminate visceral fat, you take really flip the the the whole hormone imbalance script on its head. Because visceral fat and its relationship with insulin is almost an exacerbating effect. Get rid of visceral fat, and all of a sudden everything else becomes accessible, right? Cuz now you've taken off exponentially reduced uh say the noise Yeah. that's preventing the net effect. You you do not see that with this this you know, so-called intermittent fasting. It's simply not And by the way, what do we accept? What what does the data say is acceptable weight loss in the context of calorie restriction, right? It's anywhere from 0.5 to 1% total body weight per week would be very high end with significant calorie restriction. But what do we also accept with that? 40 to 50% loss of lean body mass.
Yeah.
So, that piece of the puzzle along with metabolic adaptation is what makes anything less than controlled fasting I I think highly ineffective. And unfortunately, people are sold on this idea that they're doing something for their health. And you and I both know the first month, maybe even 3 months of intermittent fasting, you do see a shift in scale.
Yeah, you're replacing a third of your Yeah.
I mean
Right? Yeah.
So, of course you're going to see something.
But the problem is what happens at that point?
Yeah.
It's the law of diminishing returns. Whereas, if we talk about strategic fasting, it's actually the law of accelerated returns. There's actually an ROI tied to it. Because in this process, too, that the other key concept I think here is by not allowing for negative metabolic adaptation, we are by definition preserving skeletal muscle mass, right? So, keep your muscle mass stable to increasing. The other thing I'm I'm extremely regimented about with this 6-week protocol I'm talking about is we base that entire protocol on your resistance training program. It's not the other way around. People think, "Oh, well, I'm going to need to modify what I do in the gym to account for my fasting." No, your fasting is predicated on the time in the gym. We can't lose performance. That's a net loss.
So, making sure that we can still maintain output in the gym while intervening with fasting. So, you're metabolically optimizing while maintaining strength output. That's That to me is the key. People have [snorts] in their eye in their mind, too, that fasting is some at least what I understand, fasting is somehow associated with less activity.
Yeah.
Fasting should be associated with more activity. And we actually to really get those high-level results, what I obsess over is intentional movement. You want to actually If you were going to strategically look at a week's time and hey, I'm fasting on Wednesday, I want you to be more active on Wednesday than any other day of the week. Create a baseline energy demand that the body has to respond to. It has to release fuel to support the energy demand.
Fasting and movement, I mean, dude, it's one in the same.
They absolutely and they should be done together. I mean, fasting and laying dormant, that that's that's freaking that's cachexia, [clears throat] man. That's like that's like diet. So, that's that's not what we're after and it's like there's When you look at the studies, it's so frustrating sometimes because it's almost as though a lot of these studies are set up to just confirm caloric restriction. Like they They frustrates me to how they set them up because you don't see studies where people are going eat in a eat in a surplus or eat ad libitum for 5 days a week and then do a 48-hour fast. Like they don't do that probably because it's hard to get the cohort for it. I understand why. I'm not saying it's necessarily like nefarious. But the only data we end up getting on fasting is like ETRF, TRF, like 16:8 and then they'll just say, "See, it's the same outcome as as caloric restriction." However, I will say even with that, even with like ETRF, these things, a lot of times there's enough to be a meaningful difference, but not statistically significant difference in metabolic health, but because they're only looking at the calories and the weight, they'll say, "See, it's the same." I'm like, "I actually look I actually see something different there. You might not say it's statistically significant, but based on this 5-day study that you did of having them simply skip breakfast, I see a noticeable change that if that was more extreme, if that was a longer fast, that would prove a very solid point." And it's like So, all of the fasting data, it's like people love to have a heyday saying it just is caloric restriction. It's just caloric restriction. But, it's like almost almost every single study I can't in good nature say I've ever seen one that doesn't show that like ETRF or some kind of like at least moderately I don't know alternate day fasting or something isn't showing at least a little bit better metabolic outcome.
Right.
Independent of weight loss.
Well, yes. And I think the other fatal flaw, the other fundamental limitation is what are your primary or secondary end points, right? [snorts] Because what do those all those studies are I don't think it's intentional, but I think they're designed to support one school of thought. But, what are we missing here is we're missing and it's hard to do at a large scale, we're missing the nuance to what's happening. Again, what's happening metabolically? What's happening to glucose curves? What's happening to whole body glycogen stores? What's happening to insulin glucagon ratio? That's a more nuanced study, right? It's not easy to do. It's not easy to churn out. But, the devil's in the details. What's cool about my world as a physician is I can look at all those data points. I can use MR to evaluate visceral fat volume. Can I do that at scale? Unfortunately, no. And that's where the gap exists, but the the beauty of being able to follow these curves is you can actually begin to dissect out those very nuanced details.
Yeah.
And then you can never never overlook the net impact on I said healthy body recomposition is the only language we should be using.
Yes.
And healthy rebody healthy body recompositioning is is really and I educate clients to this, it's about using fat to fuel muscle.
Yeah.
That's it. It's super simple. So, at the end of some given period of time, we should see a net market reduction. I mean, think about I I I have client after client that it almost baffles me when I look at the end at the entire at their own data, right? I'm like, "Holy crap." I had a client the other day come in that had lost 32 lb of total fat mass, reduced visceral fat, again, um by 65% and added 2 lb of skeletal muscle in that time frame. And that's that is reproducible. How we educate people to understand not only how, but but why. I think why is important and to get out of that mindset where they've been conditioned to believe somehow I'm skipping breakfast, I'm I'm doing something healthy. You're really not. And the beauty, too, by the way, of structured fasting like that is you want to talk about a perfect way to totally not care about energy balance. There's no way you can overcome the hormonal impact of weekly fasting by overeating. You simply can't consume that much. So, those other 5 and 1/2 days of the week, go nuts. As long as you're eating whole food, you're focusing on, again, carbs calories early, you're you're really prioritizing protein as as a primary macronutrient that we really anchor dietary goals around. Fat is a principal fuel source. You you take those as rules, I would challenge someone to to find a way to overeat to out-eat that not just calorie deficit, but again, the entire change in hormone makeup that occurs in that fasting period.
Yeah, I mean the net contrast between like probably a lifetime of never taking a day off of food.
Mhm.
And then all of a sudden like 6 weeks of structured like that is that is such a stark contrast the hormonal input that you get from that or the signal for hormonal change is so starkly different from a lifetime of never doing that.
Right.
That I would agree with you would be very hard to disrupt the benefit that you just achieved. Could you overeat enough calories to compensate for that? Absolutely. And like and that's part of the problem we see I think with even consistent intermittent fasting is like a lot of times like that does rebound. At least we we see it reproduced in rodent studies. I haven't really seen it heavily reproduced in human model, but either way point is is that you're not talking about just the calorie piece here. It's like this is a fundamental shift at a metabolic and hormonal level that isn't going to fix it overnight. It isn't going to fix it in 1 week, but it's setting the framework so that their diet can actually do the work for them. Right? Rather than just constantly like budding up against resistance all the time.
Well, and I think let's let's talk about kind of human nature here too. The the there are so many layers to um how we perceive ourselves, how we view ourselves that we're living in a society of fat phobia with with body positivity. It's all over the map.
Yeah.
Where I come from is very simply health optimization will translate to the best outward appearance you could have. My primary goal is not aesthetic, it's performance. And I think people also get into these kind of weird we talk about disordered eating, for example, right? Calorie restriction disordered eating, carb being carb restricted, all these things. Well, believe it or not, overeating is also a form of disordered eating as well, last time I checked, right? We talk all about oh, well, you're going to crash and burn, restrict this and do that, and it gets so confusing for people. Let's simplify it down to what's really happening. But again, pull the levers in a way that actually has transformative impact. Restricting calories over time doesn't work, period. That's just in the data actually supports that. We just skew it to to make any number of conversations. There's a guy on social media. I wish I knew his name. I'm embarrassed I don't. But you may know this guy. He wears this like Spock Spock um I think he's an anesthesiologist.
Yeah, I don't think I've seen him.
But he's always has the Spock shirt on, and then people are critical of his Star Trek um affirmations, but he talks all about fasting and the impact on visceral fat, and just gets lit up left and right on social media, right? Intermittent fast you know, then they say, well, fasting, here's the data, it's calorie That's because we're talking about two radically different ideas. What he's talking about is exactly what we're talking about. Sustained fasting, it's very very Yes, calories go along with that. I understand that. But like I said, we agree. I can create a strong calorie deficit over time with daily restriction that leads to dramatically less impact on biomarkers and global health outcomes, right?
Yeah.
Whereas strategically fasting changes the script altogether. I wish I had the capacity or the bandwidth. I wish I had a lab. Because these are really the questions that we should be asking and answering on a scientific level. We know the reality. But what to do it at scale, yeah, it requires Yeah, it requires more effort than your conventional hop on a scale, see how you do.
Yeah, no, dude. And I'm I'm I mean I'm done with the academic bullying that happens with it.
Yeah.
Like it's it's that's Let's call a spade a spade. That's what it is. And you know, people say they'll have these things that say like data over feelings or this and that. Okay, what about outcomes over data?
Yes.
Okay? Because like I know people lose weight with and I know people improve their metabolic health with caloric restriction. Okay. I get it. That doesn't mean that that is the way.
Right.
Like you're still trying to achieve the same thing that we're trying to achieve over here, but the a completely different avenue. And caloric restriction just happens to be perhaps a common denominator that is there.
Mhm. Mhm.
That doesn't mean that that's the cause of the fat loss, the weight loss, the metabolic improvement.
Right.
I think that once the fat is gone, the visceral fat is reduced, the inflammatory load is less, it changes the environment altogether. Agreed. Net outcome when we're at that end outcome, we have we have maybe similar biomarkers when we have actually reached the outcome.
Okay.
The outcome we could talk about timelines. Like what it takes to get to that outcome. But let's say like if we forget time exists altogether and we end up at the same outcome, okay, yeah, we could agree that like a lot of these biomarkers might end up the same. But the thing that we're talking about is that the person that is calorically restricting may not even have enough time in their lifetime
Exactly.
to get to that point.
Right. Well, forget and and and also take into account compliance. It's Compliance and efficiency I think are interconnected, right? The less efficient the process, you're telling me, okay, if you restrict calories for, you know, X number of calories per day for the next 18 months, we're going to get you to this end point.
[snorts]
And I'm telling you, I'll get you to that end point in 6 weeks. Well, what do you think the more likely scenario is to happen? I ask my clients this all the time. If I told you you do exactly what I say for the next 6 weeks, you got a million dollars in your bank account. Or we'll target 18 months or so, and we may hit a million dollars in your bank account, but you may fall off around month four cuz you kind of get bored with the technique and all that stuff. Who is going to choose the 18-month route? No one will, right? And yet, that's what we're suggesting everybody do when you talk about chronic calorie restriction. And not only that, but like I said, it's not only the mental load and the and the the sort of the fatigue that goes into that process. I mean, go on social media. I mean, it's maddening to hear people talk about, you know, they had the two jars like, here's 100 calories of this, here's 100 calories of that. All
Yeah.
Your mind gets fried. Talk about disordered eating.
Right. That's my point. And and and so, like when you then then you have that other camp that's like, well, why does why does calorie restriction fail? Yeah, well, because it's so chronic. Not only is the body adapting, but the brain's going, you know what? This sucks, right? And so, unfortunately, you take some group of those people who are extremely well-intentioned, highly motivated, and who fail at month four or five. We see it. Right? You see it every January 1.
all the willpower in the world, man.
No. So, why don't we look at, again, goes back to strategy and efficiency point. We need to be talking about, okay, what is the mechanism to radically impact in the shortest period of who wants to drag it out?
Yeah.
If I can get a million dollars in the next 6 weeks, I will do just about anything. Because why on earth would I want to drag it out?
Yeah.
So, the I think the gap there that exists now is educating people, helping them understand that, you know, actually mechanistically, not only does this work, not only is it reproducible, but we can put it in your hands, protocolize it, and deliver results in a much And then I think the only other big gap or asterisks there is people hear fasting, like 24-hour fasting. And I told you this before, I see people almost have a visceral response to that, right? Oh my gosh, there's no way. How do we get over that hump and get people confident into that space where they can reproduce those results week over week for 6 weeks. This is where I think strategy around something like a GLP becomes incredibly valuable, incredibly potent. And I'm going to take it a whole step further, big leap. You want to get really, really, and this is what I think the future of metabolic medicine looks like, is when retatrutide hits the market.
Mhm.
You now have a mechanism, I mean, we're seeing it in the prelim phase three clinical data. You now have a mechanism to actually influence that glucagon to insulin balance real time. So, yes, you can powerfully impact that with movement and with muscle health and with with strategic fasting, but why wouldn't I engage another tool to accelerate the process, really flip that balance against insulin?
Yeah.
And I wish I had the study in front of me right now. I Maybe I'll to find it later but essentially like losing weight in a fast amount of time does not lead to more rebound. That's the thing. It's like so it's it's kind of funny because it's like we're led to believe that like it rapid weight loss is bad. There's nothing that shows that rapid weight loss is like regained any faster than like if you lose it at any other basic rate, right? I'm sure if you lose it over a ridiculously long period of time, there's a level of that adaptation that's maybe a little bit safer. But the point is is that when you model it out, the faster you can get that inflammatory load off of your body, the faster you can get this especially when you're like north of 40, north of 50 when every day that advanced glycation end products are forming, every day that visceral fat is leaking inflammatory side, every day that your HBA1C is high is taking minutes off of your life, right? The faster you get the weight off, the better. The trick is how do you do that without rebounding afterwards because you're going to rebound either way if you don't put the right tools in place, right? Like so forget it. So would you rather take I'm not trying to sound cynical but it's like would you rather take 6 months to lose 100 lb and rebound or would you rather take a month after you're literally going to do that a month and lose 100 lb and rebound? It's like okay, at least if I rebounded after losing that weight rapidly, I would have more time without that added stress impacting my body. Not condoning the people try to lose a crazy amount of weight and do extreme things. The point is is that you can lose weight fast as long as you are preserving the muscle because that's probably the biggest risk of rapid weight loss, right? And we fortunately now have data that makes that accessible to just about everybody at reasonable cost. And then [snorts] you say okay then the real work comes like after you've lost the weight then what's the lifestyle and that's I think where like my strategy is generally like, okay, then what's the fasting maintenance phase look like? Yeah. Like right, because that is
People think that I have this ridiculously regimented diet. My diet is not that strict. Everyone in this room has seen me eat before. And like I don't care. I mean, I try to 80% generally, right?
Sure.
But I maintenance with fasting.
Right.
Like it's that easy, right?
Totally agree. Totally agree. And it's it is actually easy when you put it in perspective, right? The and you know, the the one caveat I see is even even in the conversation around weight loss, losing 100 lb, let's talk about losing 30 lb of fat in the next 6 weeks versus the next 6 months versus the next 6 years, right? It's exponentially, I would argue, more accessible in the short term than it is the long term.
Yeah.
I'm a big believer, [clears throat] like I said, the acute stress phenomenon, hit the problem in the mouth versus tapping it on the shoulder.
Yeah.
If you really look strategically at the impact, and you make an excellent point, is every day that we exist, I mean, not to be too dramatic, but every day does count. So, you taking that 50-year-old right at that inflection point, they've spent 50 years getting to this point. That's limited the next 50 years to now 30 years or 20 years, right? So, it's not a one-to-one ratio. And you I I I think understanding we we've talked about this a lot, but people have to understand the the difference, the radical difference between visceral fat and everything else in the discussion. So, that's where it does become hard when you talk about weight loss because I want to know what your starting visceral fat load was and what we're able to accomplish in a short period of time. That will flip everything else around because we haven't even talked about it, but again, the release of inflammatory cytokines, the impact on systemic health that visceral fat has is so much broader reaching. We have to make I literally go so far as to say we have to really even when you talk healthy body recomposition, it has to really only be a visceral fat conversation. Get rid of visceral fat and literally everything else will come into balance because I mean, look at visceral fat and insulin resistance. Look at the impact on total testosterone in men. Right? There is a linear to exponential effect. As you reach a certain threshold, it becomes exponentially more impactful on baseline testosterone levels. People are running around looking for detergents, not wearing deodorant, right? Because their testosterone levels are low. Dude, get a fasting insulin level. I I I saw something recently a post about and it was showing an individual that had been struggling with issues related to hormone production and all this kind of stuff. I don't want to sound critical, but they were doing this whole and they're modifying detergents and deodorants and all this kind of stuff. And in fairness, the person's sitting on the couch and they're obese and they literally have a can of pop next to them. Like you're you're chasing uh the the 0.01% while ignoring the 99.9. Everything really in my mind it ties back to visceral fat load and that's something that starts accumulating. I mean, we're seeing insulin resistance being profound in adolescents. Someone asked me, "Well, when do you think insulin resistance starts?" I think it starts at birth.
Yeah.
I mean, feed a kid garbage from day one. No child is born insulin resistant and no child is born obese. True story. Right?
Yep.
And you're telling me by adolescence they're obese and insulin resistant or diabetic? Something happened between day one and adolescence. [clears throat] And now transform that and this is my By the way, this is my other issue. When we talk about the metabolic impactors on insulin resistance, what are the key drivers? When we look at the nutritional studies, Ward studies, right? Saturated fats are more of an accelerant to insulin resistance than glucose. Right? That's very clear.
Mhm.
So, we we say, "Well, the data says X." Well, the data is based off of 8 to 14-day diet interventions. Sometimes in obese, sometimes in healthy. Last I checked, the human lifespan is slightly longer than 14 days. So, I look at those Ward studies as wholly irrelevant. They're not even part of the conversation. What we can look at though is talk about insulin resistance reversal. There is a clear significant impact in reducing having a lower glycemic load in a lower glycemic model of diet. That does not mean under-eating carbohydrates. That means strategically consuming carbohydrates that are slower to digest, fewer simple sugars. The correlative data between added sugars, sugar-sweetened beverages, and diabetes.
Yeah.
It's very black and white. There's no secrets. We're not talking about the impact on saturated fats versus the impact on added sugars long term favors the glucose model 100% and it just makes more sense.
no one no one other than I mean a very small cohort is eating pure saturated fat. What are they how are they getting their saturated fat?
Right.
They're getting their They're not getting I I you know, they're not getting their saturated fat from a beautiful ribeye or ground beef. I'm sorry. They're getting it from some trans fat or some fat in their potato chip or or in their They're getting it some not their potato chip but they're you know, their fried food or whatever, right? They're getting it some other way. They're getting it so and it's combined. It's not just the saturated fat. It's just
Correct.
That is a very frustrating discussion to have because there's a very big difference between a high fat high saturated fat diet. If you look at like even in rodent models how they induce obesity, they induce it with high saturated fat, of course, but it's not that's high saturated fat in adjunct to their rodent chow.
Right.
Like if you were to put just a rat on pure saturated fat, I don't know what would happen. Maybe it's been done. Like they probably would have very low insulin. I mean they probably would cause some other issues.
Right.
Point is is that it's not like the saturated fat is not I mean I'm I mean let's anecdotal I just got my like an AI driven coronary artery calcium score everything all my plaque. I've been eating a high saturated fat zero zero across the board.
Right.
Fasting insulin less than two HBA1C like 4.8.
Right.
Like on a arguably high saturated fat diet. And I'm not all keto. So I also eat carbs.
Right.
So I think it's leading to your point of like this hormonal environment this other environment. I'm not saying that saturated fat isn't problematic.
Right.
It can absolutely be problematic.
Right.
It just depends on the environment in which it 100% is or is not problematic.
Yep.
So let's stop demonizing one thing because it's just confusing the hell out of people.
Right.
Totally agree and man I thought you were going to take it all the way down the cholesterol conversation path. But, I mean, there's there's clearly a relationship between saturated fat consumption and cholesterol. There is a relationship between cholesterol and coronary disease. But, what gets left out of the whole fat is bad conversation is what is the environmental factors that are contributing. Now, there's I I'm sure you're aware of this, but the you know, the CT keto study that, you know, that was done using clearly an AI algorithm. Um You know, the it it people that are in high-grade keto states using principally red meat and driving cholesterol levels to absurdly high levels can demonstrate an accelerated atherosclerotic plaque
Yeah, even in a lean mass hyper responder. Like, you got crazy high levels, right?
Correct. But, this is why when common sense dictates, and this is where we got to go back to just basic common sense. Anything at absurdly extreme levels probably isn't the best for the human body. Take it from the perspective, um why did visceral fat, I would argue, not exist? Especially if you talk and, you know, people that are big on the ancestral conversations. Why did visceral fat not exist? Well, think about just how we lived our lives ancestrally, right? We lived our lives very much driven by periodization. Right? You couldn't go to the grocery store and get red meat 365 days a year. There was a season with which the the meat burden is high. There's a season with which the fruit burden is high, so on and so forth. We have to consider the environment we live in today is radically different. We have access to yes, ultra-processed foods, but we also have access to incredibly broad-based whole food sources. How does that all exist together? The simplest way I can put it is use human biology, restore natural mechanisms, which healthy mechanisms, metabolic flexibility as a core principle. Everything else will come into line. No, I'm not a big believer in the magic bullet theories and all this kind of crap. No, do I think you should eat three servings of red meat a day, even if you are hemoglobin A1C is 4.8? No, probably not a good idea, right? But in balance and in context, the the root cause still remains metabolic dysfunction. Yeah. That's that's really the summary statement. So, fasting as the most powerful potent mechanism we have to reverse metabolic dysfunction is indeed the most critical element I think to long-term health and performance. It has to be. And it simply does not have to be that hard. Because I mean, people have done it for for decades, for centuries. I've gotten obsessed with it simply because the data is very clear in what the long-term benefits are. And when you consider the root root cause at the the core of disease and death in Western civilization today. I mean, all you have to do is consider the impact. Use diabetes as end-stage insulin resistance. We'll use that as It's an easy population to study, type 2 diabetes, right? Look at the exponentially higher risk of death and comorbidity in diabetics than any other single condition, including familial hypercholesterolemia, right? For sure. Okay? You want to talk I mean anyway we can digress into the cholesterol talk, but I mean just look at the diabetic cohort. Risk of all cause mortality 3.5 to 4.5 x higher than the general population. What other single contributor has that great an impact even considering genetic risk, right? It's that simple. Fix that problem and the way to fix it movement, muscle health fasting, true fasting and 16/8 throw it out the door. It's It's meaningless.
Well, Dr. Sheff, where can everyone find you, man?
Instagram @johnsheff, YouTube @drjohnsheff. I love the conversations. I love the feedback and I love to learn from other people. That's the way to look me up.
Thanks for having me.
All right, brother.