The numbers have become 1 so grave that diabetes deaths topped 100,000 in both 2020 and 2021— up from 87,000 in 2019, before the pandemic. Another 1 in 3 American adults are prediabetic, and most are unaware of this fact. Prediabetes is defined as an elevation in blood glucose over 100 milligrams per deciliter (mg/dl) but lower than 125 mg/dl, at which point it formally becomes Type 2 diabetes. However, any fasting blood sugar regularly over 90 mg/dl really suggests insulin resistance, and seminal work by the late Dr. Joseph Kraft, author of “Diabetes Epidemic and You: Should Everyone Be Tested?” suggests that 80% — 8 out of 10 — Americans are in fact insulin resistant, which means they're already on their way toward developing diabetes. That's the bad news. The good news is Type 2 diabetes is curable, and the cure is less than free. It actually saves you loads of time and money. In his book, “ The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally ,” Dr. Jason Fung details how to address this exceptionally common problem. Fung is a nephrologist (kidney specialist) with a practice in Toronto. A few years ago, I interviewed him about fasting, which is one of the most powerful interventions for Type 2 diabetes and insulin resistance. Fung was also one of the experts who peer reviewed my book, “ Fat for Fuel ,” which integrates some of his work.
Why Identifying Insulin Resistance Is so Important
There are two types of diabetes, Type 1, or insulin dependent diabetes, and Type 2 diabetes, which is lifestyle related. Type 2 diabetes accounts for 90 to 95% of all diabetes cases and is the topic of this particular discussion. Prevalence of Type 2 diabetes started to rise in the 1980s, at a time when obesity had yet to become a significant trend. However, as obesity became more prevalent, so did Type 2 diabetes.
“But the fundamental underlying problem of Type 2 diabetes, which is insulinresistance, is actually much more widespread than that,”
innovative thing Kraft did was that he took a standard glucose tolerance test,and measured blood insulin levels instead of blood glucose.Because if you think about what's happening, when you ingest 75 grams ofglucose [the amount administered prior to the test], your blood glucose maystay normal.But, your body may be producing a huge amount of insulin to really shove thatglucose into the cell. Because one of the functions of insulin is to move theglucose from the blood into the cell. Insulin resistance refers to the fact thatblood glucose is simply not getting in there.So, if your body needs to produce two, three, four, five times the amount ofnormal insulin to get that glucose in there, you have a problem, which is notdetectable if you just measure blood glucose.Because, yes, you are shoving all that glucose into the cell, but it took you ahuge amount of effort to do so. And by [using the] Kraft assay, which looks athow much the insulin goes up, you can detect [insulin resistance] at a muchearlier stage. This is important because there are things we can do aboutreversing … insulin resistance, and the sooner we get to it, the sooner we canget on the path to wellness.”
Ultimately, diabetes is just one symptom. Insulin resistance, which results in mitochondrial dysfunction, is also at the heart of cancer, heart disease, Alzheimer's and other degenerative diseases, and it all starts because your body is unable to burn fat as a primary fuel. When your body relies primarily on sugar instead, more reactive oxygen species (ROS) are generated, which damage the mitochondria in your cells.
Fasting Resolves Insulin Resistance, the Cause of Diabetes
Fasting has been used for thousands of years to keep us well. Once you understand what insulin resistance actually is and what Type 2 diabetes is, then you'll understand why something so simple as abstaining from food for a period of time can be such a powerful intervention. Contrary to infectious diseases, you cannot treat metabolic disease with a pill, because metabolic diseases such as diabetes are predicated on lifestyle, primarily diet. As explained by Fung:
“You have to use metabolic treatments, which is why using fat for fuel is soimportant. It really gets to the point that you cannot follow this old paradigm [ofdrug treatment] because you're going to fail … Remember, the glucose goes intothe cell, and insulin resistance is when the glucose doesn't go out of the cell.So, for years we've used this paradigm of lock and key.That is, the cell is sort of gated off. Outside the cell there's blood, and wheninsulin comes around it turns the key, opens the gate and glucose goes in. So, ifinsulin is there, why is the glucose not going in? … You can measure the insulinand the insulin level is high. You can look at the insulin receptor, the gate iscompletely normal.So, [conventional medicine] said something like, 'Well, maybe there's somethinggumming up the mechanism. It's stuck in the lock so it doesn't open properly,therefore the glucose can't get into the cell.' There's a huge problem with thissort of paradigm, because if that is happening, the cell has no glucose andshould be starving.You should be losing lots of weight; you'd have a very thin liver. All your fatshould just melt away, because if you think about untreated Type 1 diabetes,where you don't have enough insulin, that's exactly what happens. The cellliterally starves and everything just wastes away … But that's not what'shappening here.In Type 2 diabetes you see that people are generally obese, they have largeabdomens … What's happening instead is that it's actually an overfiowsyndrome. The cell can't accept any more glucose because it's jam packed fullof glucose already. That's the reason you have insulin resistance. Insulin istrying to move glucose into the cell but the cell is full … So, it's really anoverfiow mechanism …That's also why your liver is full — it's a big fatty liver. The liver is busy trying toget rid of all this glucose by turning it into fat … Now, if Type 2 diabetes andinsulin resistance are the same sort of thing, it's really about too much sugar.That's the bottom line.And if you understand that the whole problem is too much sugar, then thesolution is not to use more insulin to jam more glucose into an already full cell.The key is to get rid of it all. So, what you want to do is: 1) Don't put more sugarinto your system, because you have too much sugar in already, and 2) Burn itoff.”
Why Exercise Cannot Replace Fasting
To avoid adding sugar into your body it is important to adopt a cyclical low-carb, high-fat diet, which I detail in “Fat for Fuel.” Then, to burn off the sugar already in your system, intermittent fasting or time-restricted eating is a powerful tool. Exercise is not the solution for diabetes, and cannot replace fasting. Remember, you can't out-exercise your mouth. The reason for this is because you not only have insulin resistance in your muscles, but in all your tissues and organs, and to eliminate the excess glucose in your organs you need to temporarily “starve” the cells. Clearly, you should exercise, but that will only burn the glycogen in your muscles. It's not going to address your fatty liver. As noted by Fung, fasting “gets rid of all the sort of excess nutrients. That's why, historically, people called it a cleanse or a detox, because that's really what it is.” In his practice, Fung has used fasting for many years and can attest to the dramatic turnarounds possible. “We have people coming in with the most severe diabetes; they're taking hundreds of units of insulin a day, and within three to four weeks we have them off everything.” Oftentimes, a severe diabetic can revert back to being nondiabetic within as little as two months.
Taking Insulin Worsens Type 2 Diabetes
This is not to say it's easy. Fasting can be dificult when you're used to eating multiple times a day. But it's a natural way that will allow your body to heal itself. Meanwhile, taking insulin for Type 2 diabetes is about the worst thing you can do. As explained by Fung:
“What happens when you give insulin is that insulin lets your body use all thatglucose, and when there's too much glucose, it's just going to [turn it into] fat.So, all these patients gain weight. And they always come back and say, ‘Whoadoc, you've told me I need to lose weight, then you give me insulin and I'vegained 20 pounds. How is that good?'And the answer is that it's not. As you gain more weight your diabetes getsworse, which means you need to take more insulin, which means you're going togain more weight. They can see themselves spiraling down the drain, and thedoctors do nothing but give them more insulin.It doesn't even make any sense because the underlying issue is thehyperinsulinemia and insulin resistance. That is, if you look at Type 2 diabetes,insulin levels are very high.So [why give] more insulin in a situation where you have too much insulinalready? If you have hyperthyroidism, if you have too much thyroid hormone,you don't give more thyroid hormone. If you have an alcoholic, you don't givemore alcohol. It's the exact wrong thing to do. In fact, if your levels of insulin aretoo high and that's your disease, you need to lower insulin. By giving insulin,you're actually making the fundamental problem much worse.”
How Fasting Benefits Your Mitochondria
Fasting is the most profoundly effective metabolic intervention I'm aware of. It's like getting a free stem cell transplant, and it massively upregulates autophagy and mitophagy. It also stimulates mitochondrial biosynthesis during the refeeding phase, which allows your body to naturally regenerate. For these reasons, fasting is not only beneficial for Type 2 diabetes and obesity but also for health in general, and likely even longevity. There's even evidence to suggest fasting can help prevent or even reverse dementia, as it helps your body clean out toxic debris. As noted by Fung, “It's fundamentally one of the keys of wellness.” By lowering insulin, you also increase other important hormones, including growth hormone (aka the fitness hormone), which is important for muscle development and general vitality. Other ailments that can benefit from fasting include polycystic ovaries, polycystic kidneys and fast growing cancer cells. The reason for this is because when autophagy increases, your body starts breaking down old protein, including fast growing cells. Then, during the refeeding phase, growth hormone increases, boosting the rebuilding of new proteins and cells. In other words, it reactivates and speeds up your body's natural renewal cycle.
Most people fear being hungry and avoid it like the plague. Here, intermittent fasting can make the process a lot easier. Before I tried my first five-day water fast, I increased my intermittent daily fasting to the point that I was fasting for 20 hours a day for a few months, but one month is likely suficient. At that point, going several days without food was easy, since my body had had gained metabolic fiexibility and was able to burn fat as my primary fuel. Most people get really hungry by Day 3 on a water fast, yet I had no hunger at all. Fung agrees, saying:
“That's a great point. If you are fueling yourself primarily with carbohydrates,then you can't use fat very well … So, when you transition from a predominantlycarbohydrate diet to a predominantly fat-based diet, your body can't storeglycogen, because those are chains of glucose, it needs to burn body fat (ordietary fat). To your body it's sort of the same thing, they're just triglycerides.When you biopsy muscle over a period of several weeks, you can actually seethe that the machinery necessary to burn triglycerides for fuel increase. You seeexpression of genes increasing that are able to use the fat. So, if you go from astandard 50 or 60 percent carbohydrate diet to fasting … your muscles aregoing to be weaker, because they're used to glucose. They're like, ‘Where's myglucose?'You have triglycerides [but] you can't use it at first. Some people call it keto fiu.But, over a period of about two weeks or so, your body gets used to it. So, aneasy transition is to switch over to a very low-carbohydrate, high-fat diet, so thatyour body is used to using fat.You're not fasting per se, but your body gets used to burning fat for fuel. Theother thing is you can start lengthening your period of fast. You should befasting every day … Whether it's 12 hours or 14 hours.There should be a period in there that you're fasting. Then you extend it, so thatyou gradually go to 16 hours, 18 hours, 20 hours and then 24 hours, and thenkind of go into it from there. Those are two ways to ease the transition andmake the fasting easier …Even shorter periods of fasting of 24 to 36 hours have a lot of benefits. Youstart to get into that period where you're depleting your glycogen and you'regetting into fat burning. You start to see autophagy start around 24 to 30 hoursas well. One of the other benefits people talk about nowadays is this sort of bio-hacking.People, especially in Silicon Valley, are fasting because it gives them moremental capacity. Their brain works better; they find they're clearer and they canthink better. So, this is a free way to boost your brain power. So yeah, there's alldifferent regimens, and there's all different ways to ease into it. But the key is tojust get started.”
How to Minimize Side Effects
Gradually easing into longer fasts will naturally minimize most side effects associated with fasting, as will transitioning over to a high-fat, low-carb diet, to help your body to adjust to using fat as a primary fuel. The so-called “keto fiu” is often related to sodium deficiency, so it's recommended to take a high-quality unprocessed salt each day. I typically pour salt in my hand and lick it throughout the day when fasting, as I obviously can't put it on food. This will also help reduce the likelihood of intractable muscle cramps at night. Headaches are also common when you first start water fasting. These too can often be minimized by taking salt. An alternative to eating salt straight, or putting it in water, is to add it to a bit of bone broth. Another important mineral is magnesium. It's particularly important if you are diabetic, as magnesium deficiency is very common among Type 2 diabetics. This is another possible culprit if you're getting muscle cramps. There are several types of magnesium, some of which are more poorly absorbed than others. During water fasting, your best bet is to use Epsom salt baths, as this allows your body to absorb the magnesium through your skin rather than your digestive tract. Magnesium has a laxative effect in high doses, and when you're not eating anything, oral magnesium can easily result in “disaster pants.” Multivitamins can also be useful during extended fasts, especially if you're doing them regularly. It is also important to understand that if you are on a multiday water fast you will liberate many toxins from your fat stores, so using an infrared sauna and taking effective binders, like chlorella, modified citrus pectin, cilantro or even activated charcoal can help eliminate these liberated toxins from your body and prevent their reabsorption.
Work With a Knowledgeable Physician if You're on Medications
While fasting is a profoundly effective intervention for Type 2 diabetes, you do need to use caution if you're diabetic. If you are taking medication, especially for your blood sugar, you have to make sure you talk to your doctor, because there's a risk your blood sugar may end up dipping too low. If you're taking insulin, and keep taking insulin while fasting, you could get into trouble.
“Some people say that for that reason, Type 2 diabetics should never fast. Butthat's not true,” Fung says. “What's true is that you need to adjust the medicationin anticipation of [your blood] sugar going down … So, if you're on thesemedications for diabetes, you need to make sure you monitor very closely andmake sure that your blood sugar doesn't go too low.Remember, the fasting is going to drive your blood sugars down, and yourinsulin or your medications will drive your blood sugars down, so you've gotkind of two things driving your blood sugars down. All of a sudden you go low,you can have seizures, you can wind up in the emergency room and you couldabsolutely die.And that's one of the things you have to be very careful of. So yes, you can do it,but you have to make sure you do it in a supervised setting with somebody whoknows what they're doing.”
Why You Need Not Fear Starvation
Last but not least, one of the greatest fears people have about fasting is the concept of starvation and the loss of lean muscle mass. In his book, Fung explains why such fears are overblown. Your metabolic rate is the energy your body uses to generate body heat and keep your organs working. Your body basically needs a certain number of calories a day. People have a tendency to think that skipping a meal means your metabolic rate will decrease. In reality, the exact opposite occurs. In studies looking at basal metabolic rate, people's metabolic rate is actually 10% higher at the end of a four-day fast than at the beginning. So, your body is not shutting down, it's actually ramping itself up. The reason for this has to do with counterregulatory hormones. As insulin drops, counter-regulatory hormones go up. Some of these activate your sympathetic nervous system (the so-called fight or fiight response). “So, as you fast, all these hormones are going up, your sympathetic nervous system is going up, your adrenaline is going up, your growth hormone's going up,” Fung says.
“Obviously, if you're pumping your body full of adrenaline, your basal metabolicrate is not going down. In fact, it maintains itself, which is in distinction tocalorie restriction diets where, if you just try and cut a few calories a day, yourmetabolic rate will go down. The growth hormone is also important because of[its] protein sparing effect …When you study people fasting, you don't see an increase in burning of protein.There is a normal turnover. But at the end of it, because your growth hormone isso high, when you eat again, you will make up these new proteins. So, it'sactually much healthier for you because you're getting rid of all protein andyou're bringing new protein.”
If you're among the 80% of people who are insulin resistant, get yourself a copy of Fung's book, “ The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally .” Another of Fung's books, “ The Complete Guide to Fasting ,” is another excellent resource. As Fung says, we've known that fasting is beneficial for thousands of years. We just strayed away from it, and we need to re-embrace this foundational aspect of health.
“[A few years ago] somebody was telling me about fasting and I thought, ‘Wellthat's the dumbest thing I've ever heard of.' And then I thought, why? Why wasthis so silly? I dug into the research and then I just started doing it.I probably have more clinical experience, truthfully, than anybody in the world,and that's not hard because nobody was doing it a few years ago. And now itseems so obvious that [fasting is] the solution … You don't eat, then your bloodsugar comes down, you lose weight and your diabetes gets better. There's thesolution right there.”
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