This is the second blog looking at reversal of Type 2 Diabetes. As I said in the first one, looking at Low Carb High Fat (LCHF) and Keto dietary changes, we can’t cure Diabetes – but we can reverse it and maintain lifetime control through dietary modifications. This blog will explore the next stage and discuss fasting as a therapeutic tool. Fasting is NOT recommended at all for Type 1 Diabetes.
History of Fasting
Fasting has been part of our life for many thousands of years. I can’t imagine stone age people sitting around having three good meals every day, separated by snacks and perhaps supper before bed, can you? No, these ancestors of ours probably feasted whenever they made a kill, or when fruits were in season and in between sometimes went hungry, probably for extended periods.
Fasting has been used as a health treatment as far back as our written history extends with Pythagoras from Ancient Greece being one of its exponents. A lot of religions (too many to mention) have fasting days and periods which help to cleanse the body and mind. These continue to this day still.
However, fasting as a therapy fell from favor many years ago and in fact has been decried as dangerous by our health systems across the world. Some studies from the 1950’s suggested that fasting was dangerous, even though these were for very extended periods of time and not well supervised. There have been shysters involved in prescribing fasting as well, some of whom have been prescribing very extended fasts, some of which have killed people from starvation.
Starvation vs Fasting
Starvation is a form of enforced fasting, most widely seen in times of war or sometimes when there have been disasters which have wiped out whole crops, leaving populations with no food, such as the Irish Potato Famine. Fasting is a voluntary act and should really be carried out under medical prevision, especially if the person is taking medication. Fasting can be especially problematic with anti-diabetic medication, because of the risk of hypoglycaemia (low blood sugar) if you decrease food intake without correspondingly decreasing blood sugar lowering medications at the same time.
Australian POW’s, WW2
The Theory behind Fasting
One of the main problems with the calories in and calories out model, is that it really makes no sense. 100 Calories worth of lollies or sweets does not behave the same as 100 Calories of Avocado. What happens as we Calorie restrict is that our body just gets used to surviving on a lower Calorie Diet and so adapts by lowering the basal metabolic Rate to suit. Then, of course as soon as we go back to “normal” Calories we don’t need this extra energy and so Insulin then stores it as fat! This leads to the so called “Yo-Yo” effect of losing weight with calorie restriction and then putting it all back on, plus extra when you relax your diet.
He suggests that we look at the two energy stores that we have, fat and glycogen as separate compartments. Glycogen is stored in the liver and muscles (limited storage capacity) and can be broken down quickly into glucose. Our glycogen stores are enough to last us for 24-36 hours with no food coming in. The fat is stored in Adipose Tissue (our body fat) and there is a huge potential to store energy here. Insulin controls these storage areas and directs excess ingested energy to be stored in one of these two forms. When insulin is high, we can store fat but not use it as an energy source. Therefore, we tend to get fatter over time on a high carbohydrate (low fat) diet
So how do we drop insulin? LCHF or ketogenic diets work, starvation that is enforced by others or by bariatric surgery works and fasting works. Once we can lower insulin, we can then access our fat that has been stored away for periods where we don’t have access to food (it’s original function is only as an energy storage device, its not there for looks alone!)
We are better off looking at a two chambered approach as per Dr Jason Fung – “Intensive Dietary Management”.
Types of Fasting
Disclaimer: Any attempt at fasting must be made with medical supervision, especially if you take any medications. This is particularly true with Diabetes Type 2. Fasting is not recommended at all for Type 1 Diabetes.
Obviously, the religious fasts have been with us for centuries and these are for religious purposes, but often have health benefits ascribed to them.
Michael Mosely popularised the 5:2 fasting method, in which we eat half the normal amount of calories (usually estimated at about 500 calories) for 2 days of the week and we eat normally for the other 5. This partial fast works well for weight loss, but as I said check with your GP before trying this if you are on any medications.
Fat fasting is a form of fasting where you only eat fatty foods for a period of time. This can involve different foods, but one popular one is avocado, olives, bacon and eggs only for a 3-4 day period. These foods have a limited insulin response and so can assist in weight loss. Again, always do any fast under medical supervision.
Time restricted eating is another form where you only allow yourself a limited window of time to eat each day, such as an 8 hour or 6-hour window, this then gives you a 16 or 18 hour fast each day.
One meal a day (OMAD) is like a 23 hour fast every day with one meal being eaten only
Intermittent fasting for 24, 36- or 48-hour fasts are the next stage and then longer fasts can be contemplated if required.
Most fasting is easier if you are already on a LCHF or keto diet already but can be done from a “normal” diet as well, although hunger can be more of an issue then.
Water is freely taken (2-3 litres a day) along with black tea and coffee along with some electrolytes if required (extra salt is often required during fasts longer than 24 hours), and even some bone broth.
So what happens?
When people fast, there is a period where some hunger kicks in within the first 24 hours. It usually is not dreadful and can be controlled with water, tea, coffee etc. Most people report a feeling of euphoria on longer fasts and this is a hormonal response and is completely normal. Once the insulin levels drop then we can start accessing our fat stores and we start to “feast” on our fat. This tends to happen at about the 24-hour mark with water fasts. Our basal metabolic rate appears to rise with fasting and we then require extra energy that we take from our fat storage areas. As insulin drops repeatedly, we also lose our insulin resistance to some degree (although this can take many years to reverse completely) and our hunger/satiety hormones start to work in sync again! Remember we have built our insulin resistance up over many years and it will take many years to fix it completely.
Benefits of Fasting
There are many benefits to fasting including:
1. It’s simple. Instructions are easily understood. Eat nothing, drink water black tea or coffee and bone broth. That’s it!
2. It’s Free. You don’t need to buy anything and in fact it saves you money on the groceries!
3. It’s Convenient. Less cooking, shopping etc. Do it when it suits you, there is no “correct” regime – You can mix it up depending on your lifestyle
4. You can enjoy some of life’s little pleasures. If it is someone’s birthday, Christmas etc, you can fast after the event and undo some of the poor choices you may have made. (This doesn’t apply to normal events, like every day ending in Y etc)
5. It’s Powerful. It works and you will see effects very quickly. Type 2 Diabetic patients will see an increase in insulin sensitivity and hopefully some weight loss with all the benefits that that confers (decrease diabetes complications such as vascular disease, heart disease, stroke, amputations, blindness)
6. It’s Flexible. You can adjust depending on what life throws at you. If you are not coping, just break the fast and seek some advice as to how to start again, when things are more conducive.
7. It works with any diet. That’s right, you can fast and see the benefits with any diet. As I said before the hunger is less of an issue if combined with a LCHF or keto diet, but this isn’t essential.
What could be simpler?
But remember, always fast under medical supervision – especially if taking any medications.
Dr Kevin Arlett
MBBS(QLD), FRACGP, FAICD
© Townsville & Suburban Medical Practice, 2019.