Sunday, March 20, 2016

Type 2 Diabetes, a Dietary Disease #320: “Total Fasting Reduces or Eliminates Hunger”

As related in #319 here, to jump start weight loss I began a major change in my lifelong eating pattern. If successful, I am prepared to continue this new routine until I achieve my goal, then reassess. However, it is unlikely that I will transition at that point to “maintenance;” it is more likely that I will set a new goal and continue the weight loss. After all, why mess with success? I will still have a lot of weight to lose.
The modified plan basically incorporates a daily fast (7 days/week) from supper to lunch. That entails skipping my (our) traditional breakfast of eggs (mine was 3, any style). The plan also requires me to only eat when hungry, and only until I am sated. So, to work these parameters into my plan, I have prepared my lunch in advance: a covered container of hard boiled eggs in the refrigerator. That provides portion control and allows me to eat just enough to “satisfy.” As an alternate lunch, I also have a tin of Brisling sardines in EVOO, another portion controlled meal.
Here’s where it gets interesting. I decided to skip breakfast because I observed that after an overnight fast I was never hungry at breakfast. So from the standpoint of adhering to the new “plan” to incorporate a longer fast and eat only when hungry, skipping breakfast makes sense. But because I’m married and try to maintain an eating pattern compatible with a “family” lifestyle, I make a cup of coffee every day when I rise and then save some to “eat breakfast” (take my pills) with my wife. The coffee contains a little cream, but not enough to break my fast.
Then lunch time rolls around. My wife told me long ago (right after we retired) that she “married me for better or worse, but not for lunch.” So, not eating lunch with her was not a problem. Before my new eating pattern, lunch was usually a can of Brisling sardines packed in EVOO. (Omega 3s, MUFAs, portion control and no dishes.) This lunch, together with 2g of fish oil a day, has produced fabulous triglycerides for over a decade (all <50mg/dl).
Now, with the new dictum to “eat only when hungry,” around lunch time (1-3PM), I usually eat just 1, sometimes 2, hard-boiled eggs. Why? I am still not hungry at lunch, ‘cause I have become keto adapted. So, 1 or 2 eggs is a token, a “protein-sparing” offering to my body: 6 or 12 grams of protein, and some good fats to go along with it.
Naturally, I am now getting a little concerned about my total calorie intake. No conventional Registered Dietician (RD) or Certified Diabetes Educator (CDE), or clinician (MD), would counsel someone of my gender, age, weight and activity level to eat as little as 1,200kcal/day (which is how I achieved most of my 170 pound weight loss), much less as little as 800kcal/day. But that’s where it looks like I’m going. My “3-small-meals-a-day” plan had been 375 + 375 + 450 = 1,200kcal. My predicament was a bit of a conundrum, until I considered total energy expenditure. Fasting “reduces or eliminates hunger” because the body is happily feeding on its own fat reserves.
Total energy expenditure, at the cellular level, is what your body is oxidizing, or burning, to supply all your body’s energy needs. If you are eating a balanced diet that includes beaucoup carbs, it will burn the carbs (and protein and fat) you eat and then tell you that you are hungry for more. It does this because 1) it assumes you have access to more carbs and, therefore, 2) it does not (i.e. cannot) burn fat that it has conserved in your body, for this very purpose, because access to it is blocked. You are, in fact, quite literally starving. Your body does this “dirty trick” on you with hormone signaling between the gut and the brain. The hormone insulin is the switch.
But when you become ketoadapted, by abstaining from eating carbs for 1-3 days, your blood insulin level drops, opening the switch to your body’s fat reserves. From this point on, so long as you abstain from eating more than incidental carbs, your body burns whatever you eat first and then effortlessly (without hunger) switches over to burning fat, your body fat. Body fat breaks down into free fatty acids (FFAs) and ketone bodies, excellent sources of fuel for both brain and heart. You are in a blissful state called “ketosis.”
As the NIH’s Richard L. Veech told Gary Taubes here, “Doctors are scared of ketosis. They're always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue it is the normal state of man.” 

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