Sunday, June 4, 2017

Type 2 Diabetes, a Dietary Disease #383: Fasting on 300kcal a day while keto-adapted

I have been eating Very Low Carb (VLC) for about 15 years. I lost 170 pounds, but inevitably gained some of it back. Losing it the 2nd time proved to be harder, so I decided to try Intermittent Fasting (IF).
I gave up my breakfast of eggs (I wasn’t hungry anyway) but kept a cup of coffee with heavy cream and stevia powder to take with my pills. I sometimes ate a light lunch (all protein and MY good fats) and then a supper of animal protein and one low-carb vegetable, with more fat (olive oil or butter). I did it for about a year, and it was easy. But, I didn’t lose weight! It was satisfying, but still too much food. I needed to try something else.
Then last fall Megan Ramos, director of Jason Fung’s Toronto IDM Program, suggested full-day fasts, i.e. the “other” kind of fasting. I told Megan that during a 2-month period during the winter I would do it, and I did. In 10 weeks I lost 30 pounds. With that success under my belt – why mess with success, right? – I decided to do it again, this time breaking new ground with the goal of reaching a weight I haven’t seen since my early teens.
How do I do it? What is the secret of my success? Full-day “fasting,” MY way. I put “fasting” in quotes because, on days when I fast, “my way” is not a strict water-only fast, although it is a basically a liquid-only fast. For Breakfast I drink a 12-oz coffee with 1½ oz of heavy cream and a smidgen (1g) of powdered stevia. If I feel dehydrated during the day, I will have just iced tea, sweetened with liquid stevia, and a pickle slice or just a little brine. Then, for Supper I drink 6-oz of red wine in a large glass filled with seltzer (with my evening pills ;-).
Macronutrients: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day total: 298kcal.
This is a departure from the usual “water-only” fast in three respects: 1) it includes dairy, 2) it includes a sweetener (pure stevia, not artificial), and 3) it includes alcohol. Total carbohydrates: Less than 6 grams/day.
The secret for the success of this “fasting” regimen is that on “feasting” days, I eat VLC. I am not hungry because I am “keto-adapted.” Keto-adapted means that my body is almost continuously in “nutritional ketosis.” On “feasting” days my body lives on what I eat, which is high-fat, moderate protein and Very Low Carb. For energy it burns the carbs first, then the unused glucogenic proteins stored in the liver as amino acids, then the dietary fat. Then, if my body needs more energy to maintain homeostasis, it simply transitions to breaking down body fat. My body fat is accessible because of my low blood insulin. That’s being keto-adapted!
At first, even though I’d read Jason Fung’s book, “The Obesity Code,” and another he wrote with Jimmy Moore, I had trepidations about not eating from one day’s supper to “breakfast” (my coffee) two days later. So, I started off with the idea of alternate day fasting (Tuesday and Thursday) every week. But I was surprised how easy it was (being keto-adapted to begin with), since I was not hungry at any time, day or night. In fact, I was not hungry at “breakfast” on the day after. So, I decided to try 2-consecutive-day and then 3-consecutive-day fasting. Again, easy. Absolutely no hunger. Lots of energy. I was alert, pumped, actually. Almost hyper!
I take Metformin twice a day: 750mg ER (extended release). It never occurred to me to reduce my meds, but then after a full day of fasting my FBG dropped into the mid 60s (3.6-3.7mmol/L). Once my FBG dropped to 60mg/dl (3.3mmol/L), but I felt fine. On a 3-consecutive-day fast, my FBG would be in the mid 60s all three days. I mentioned this to my doctor, and with a brush of his hand, he said, “Don’t worry about it. You can never get hypoglycemic on Metformin.” And I never did. The liver makes glucose, via gluconeogenesis, from both dietary protein (amino acids) and body fat (the glycerol molecule when a triglyceride breaks down). And when the lab report came back, my A1c had dropped a full half of a percentage point from 5.8% to 5.3%.

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