The Obesity Code, page 25
Can I exercise while fasting?
Absolutely. There is no reason to stop your exercise routine. All types of exercise, including resistance (weights) and cardio, are encouraged. There is a common misperception that eating is necessary to supply “energy” to the working body. That’s not true. The liver supplies energy via gluconeogenesis. During longer fasting periods, the muscles are able to use fatty acids directly for energy.
As your adrenalin levels will be higher, fasting is an ideal time to exercise. The rise in growth hormone that comes with fasting may also promote muscle growth. These advantages have led many, especially those within the bodybuilding community, to take a greater interest in deliberately exercising in the fasted state. Diabetics on medication, however, must take special precautions because they may experience low blood sugars during exercise and fasting. (See “What if I have diabetes?” for recommendations, on page 262.)
Will fasting make me tired?
In our experience at the Intensive Dietary Management Clinic, the opposite is true. Many people find that they have more energy during a fast—probably due to increased adrenalin. Basal metabolism does not fall during fasting, but rises instead. You’ll find you can perform all the normal activities of daily living. Persistent fatigue is not a normal part of fasting. If you experience excessive fatigue, you should stop fasting immediately and seek medical advice.
Will fasting make me confused or forgetful?
No. You should not experience any decrease in memory or concentration. On the contrary, the ancient Greeks believed that fasting significantly improved cognitive abilities, helping the great thinkers attain more clarity and mental acuity. Over the long term, fasting may actually help improve memory. One theory is that fasting activates a form of cellular cleansing called autophagy that may help prevent age-associated memory loss.
I get dizzy when I fast. What can I do?
Most likely, you’re becoming dehydrated. Preventing this requires both salt and water. Be sure to drink plenty of fluids. However, the low salt intake on fasting days may cause some dizziness. Extra sea salt in broth or mineral water often helps alleviate the dizziness.
Another possibility is that your blood pressure is too low—particularly if you’re taking medications for hypertension. Speak to your physician about adjusting your medications.
I get muscle cramps. What can I do?
Low magnesium levels, particularly common in diabetics, may cause muscle cramps. You may take an over-the-counter magnesium supplement. You may also soak in Epsom salts, which are magnesium salts. Add a cup to a warm bath and soak in it for half an hour. The magnesium will be absorbed through your skin.
I get headaches when I fast. What can I do?
As above, try increasing your salt intake. Headaches are quite common the first few times you try a fast. It is believed that they’re caused by the transition from a relatively high-salt diet to very low salt intake on fasting days. Headaches are usually temporary, and as you become accustomed to fasting, this problem often resolves itself. In the meantime, take some extra salt in the form of broth or mineral water.
My stomach is always growling. What can I do?
Try drinking some mineral water.
Since I’ve started fasting, I experience constipation. What can I do? Increasing your intake of fiber, fruits and vegetables during the non-fasting period may help with constipation. Metamucil can also be taken to increase fiber and stool bulk. If this problem continues, ask your doctor to consider prescribing a laxative.
I get heartburn. What can I do?
Avoid taking large meals. You may find you have a tendency to overeat once you finish a fast, but try to just eat normally. Breaking a fast is best done slowly. Avoid lying down immediately after a meal and try to stay in an upright position for at least half an hour after meals. Placing wooden blocks under the head of your bed to raise it may help with night-time symptoms. If none of these options work for you, consult your physician.
I take medications with food. What can I do during fasting?
Certain medications may cause problems on an empty stomach. Aspirin can cause stomach upset or even ulcers. Iron supplements may cause nausea and vomiting. Metformin, used for diabetes, may cause nausea or diarrhea. Please discuss whether or not these medications need to be continued with your physician. Also, you can try taking your medications with a small serving of leafy greens.
Blood pressure can sometimes become low during a fast. If you take blood-pressure medications, you may find your blood pressure becomes too low, which can cause light-headedness. Consult with your physician about adjusting your medications.
What if I have diabetes?
Special care must be taken if you are diabetic or are taking diabetic medications. (Certain diabetic medications, such as metformin, are used for other conditions such as polycystic ovarian syndrome.) Monitor your blood sugars closely and adjust your medications accordingly. Close medical follow-up by your physician is mandatory. If you cannot be followed closely, do not fast.
Fasting reduces blood sugars. If you are taking diabetic medications, or especially insulin, your blood sugars may become extremely low, which can be a life-threatening situation. You must take some sugar or juice to bring your sugars back to normal, even if it means you must stop your fast for that day. Close monitoring of your blood sugars is mandatory.
Low blood sugar is expected during fasting, so your dose of diabetic medication or insulin may need to be reduced. If you have repeated low blood sugars, it means that you are over-medicated, not that the fasting process is not working. In the Intensive Dietary Management Program, we often reduce medications before starting a fast in anticipation of lower blood sugars. Since the blood sugar response is unpredictable, close monitoring with a physician is essential.
Monitoring
Close monitoring is essential for all patients, but especially, for diabetics. You should also monitor your blood pressure regularly, preferably weekly. Be sure to discuss routine blood work, including electrolyte measurement, with your physician. Should you feel unwell for any reason, stop your fast immediately and seek medical advice. In addition, diabetics should monitor their blood sugars a minimum of twice daily and record this information.
In particular, persistent nausea, vomiting, dizziness, fatigue, high or low blood sugars, or lethargy are not normal with intermittent or continuous fasting. Hunger and constipation are normal symptoms and can be managed.
Intermittent fasting tips
1Drink water: Start each morning with a full eight-ounce glass of water.
2Stay busy: It’ll keep your mind off food. It often helps to choose a busy day at work for a fast day.
3Drink coffee: Coffee is a mild appetite suppressant. Green tea, black tea and bone broth may also help.
4Ride the waves: Hunger comes in waves; it is not continuous. When it hits, slowly drink a glass of water or a hot cup of coffee. Often by the time you’ve finished, your hunger will have passed.
5Don’t tell everybody you are fasting: Most people will try to discourage you, as they do not understand the benefits. A close-knit support group is beneficial, but telling everybody you know is not a good idea.
6Give yourself one month: It takes time for your body to get used to fasting. The first few times you fast may be difficult, so be prepared. Don’t be discouraged. It will get easier.
7Follow a nutritious diet on non-fast days: Intermittent fasting is not an excuse to eat whatever you like. During non-fasting days, stick to a nutritious diet low in sugars and refined carbohydrates.
8Don’t binge: After fasting, pretend it never happened. Eat normally, as if you had never fasted.
The last and most important tip is to fit fasting into your own life! Do not limit yourself socially because you’re fasting. Arrange your fasting schedule so that it fits in with your lifestyle. There will be times during which it’s impossible to fast: vacation, holidays, weddings. Do not try to force fasting into these celebrations. These occasions are times to relax and enjoy. Afterwards, however, you can simply increase your fasting to compensate. Or just resume your regular fasting schedule. Adjust your fasting schedule to what makes sense for your lifestyle.
What to expect
The amount of weight lost varies tremendously from person to person. The longer that you have struggled with obesity, the more difficult you’ll find it to lose weight. Certain medications may make it hard to lose weight. You must simply persist and be patient.
You’ll probably eventually experience a weight-loss plateau. Changing either your fasting or dietary regimen, or both, may help. Some patients increase fasting from twenty-four-hour periods to thirty-six-hour periods, or try a forty-eight-hour fast. Some may try eating only once a day, every day. Others may try a continuous fast for an entire week. Changing the fasting protocol is often what’s required to break through a plateau.
Fasting is no different than any other skill in life. Practice and support are essential to performing it well. Although it has been a part of human culture forever, many people in North America have never fasted in their lives. Therefore, fasting has been feared and rejected by mainstream nutritional authorities as difficult and dangerous. The truth, in fact, is radically different.
Bone Broth Recipe
Vegetables
Chicken, pork or beef bones
1 tbsp of vinegar
Sea salt, to taste
Pepper, to taste
Ginger root, to taste
1Add water to cover
2Simmer for two to three hours until ready
3Strain and de-fat
APPENDIX C
MEDITATION AND SLEEP HYGIENE TO REDUCE CORTISOL
AS DISCUSSED IN detail in chapter 8, cortisol raises insulin levels and is a major pathway of weight gain. Therefore, reducing your cortisol levels is an integral part of your overall weight-loss effort. Reducing stress levels, practicing meditation and getting good sleep are all effective methods for achieving lower cortisol levels. Some useful tips follow.
Stress reduction
If excessive stress and the cortisol response are causing obesity, then the treatment is to reduce stress, but that’s easier said than done. Removing yourself from stressful situations is important, but not always possible. Work and family demands won’t go away by themselves. Luckily, there are some time-tested methods of stress relief that can help us cope.
It’s a popular misconception that stress relief involves sitting in front of the television and doing nothing. In fact, you can’t relieve stress by doing nothing. Stress relief is an active process. Meditation, tai chi, yoga, religious practice and massage are all good choices.
Regular exercise is an excellent way to relieve stress and lower cortisol levels. The original intent of the fight-or-flight response was to mobilize the body for physical exertion. Exercise can also release endorphins and improve mood. This benefit far exceeds the relatively modest caloric reduction achieved by exercise.
Social connectivity is another great stress reliever. Everybody remembers how hard it was to be singled out in high school; that’s no different at any age. Being part of a group or community is part of our human heritage. For some, religion and churches can provide this feeling of belonging. The power of human touch also cannot be underestimated. Massage can be beneficial for this reason.
Mindfulness meditation
Through mindfulness meditation, we can become more aware of our thoughts. The objective in meditation is to take a step outside of our thoughts and, as an observer, become aware of them. From this perspective, we can pay precise, nonjudgmental attention to the details of our experiences. Mindfulness meditation alleviates stress by helping us practice being present. It also involves reminding us of pleasant experiences from our past, when we have been able to overcome struggle and achieve personal success. There are many forms of meditation, but all have the same general goals. (Tai chi and yoga are forms of moving meditation with long traditions.)
We don’t want to get rid of our thoughts, only become aware of them. We aren’t trying to change ourselves, but instead become aware of ourselves as we presently are and objectively observe our thoughts, good or bad.
Meditation can help us work through the thoughts, enabling us to cope with stress much more effectively. Mindfulness meditation can be particularly helpful in working through our feelings of hunger and cravings for foods. Meditation often only takes twenty to thirty minutes and can be done any time. Cultivate the habit of waking up in the morning, having a glass of cold water and beginning your meditation.
Three basic aspects are involved in mindfulness meditation: body, breath and thoughts.
Body
First, you want to connect with your body. Find a quiet location where you will not be disturbed for the next twenty minutes. Sit down either on the ground, on a cushion or in a chair. Cross your legs if you are sitting on the ground or on a cushion. If you are sitting on a chair, make sure your feet are placed comfortably on the ground, or on a pillow if your feet do not touch the ground below. It is important that you feel comfortable and relaxed in the position you chose.
Rest your hands on your thighs, palms facing down. Gaze down at the floor about six feet ahead of you and focus on the tip of your nose, and then gently close your eyes. Feel your chest becoming open and your back becoming strong.
Begin your meditation sitting in this position. For a couple of minutes, focus on how your body and your environment feel. If your thoughts wander away from your body, gently bring them back to your body and environment. Do this throughout your meditation every time your mind wanders away.
Breath
Once you have begun to relax, start to focus in gently on your breath. Breathe in through your nose to the count of six and exhale through your mouth slowly to the count of six. Pay attention to how your breath feels entering and exiting your body.
Thoughts
As you sit, you may become bombarded by thoughts. Pay attention to these thoughts. If they cause you to experience any negative emotions, try to think back to a time where you experienced similar challenges and remember how it felt to overcome those challenges. Work through these thoughts until your body begins to feel lighter.
If you notice that you have become so caught up in your thoughts that you have forgotten where you are, gently bring your thoughts back to your breath.
Sleep hygiene
There are several keys to good sleep hygiene, and none of these involve the use of medication. (Medications disturb the normal sleep architecture, the pattern of REM and non-REM sleep.) Simple but effective ways to improve sleep include the following:
•Sleep in complete darkness.
•Sleep in loose fitting clothes.
•Keep regular sleeping hours.
•Try to get seven to nine hours of sleep each night.
•See the light first thing in the morning.
•Keep your bedroom slightly cool.
•Do not keep a TV in your bedroom.
ENDNOTES
Introduction
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Chapter 1: How Obesity Became an Epidemic
1.Begley S. America’s hatred of fat hurts obesity fight. Reuters [Internet]. 2012 May 11. Available from: http://www.reuters.com/article/2012/05/11/us-obesity-stigma-idUSBRE84A0PA20120511. Accessed 2015 Apr 13.
2.Centers for Disease Control and Prevention [Internet]. Healthy weight: it’s a diet, not a lifestyle! (Updated 2014 Jan 24.) Available from: http://www.cdc.gov/healthyweight/calories/index.html. Accessed 2015 Apr 8.
3.National Heart, Lung, and Blood Institute [Internet]. Maintaining a healthy weight on the go. 2010 Apr. Available from: http://www.nhlbi.nih.gov/health/public/heart/obesity/aim_hwt.pdf. Accessed 2015 Apr 8.
4.Brillat-Savarin JA. The physiology of taste. Trans. Anne Drayton. Penguin Books; 1970. pp. 208–9.
5.William Banting. Letter on corpulence, addressed to the public. Available from: http://www.proteinpower.com/banting/index.php?page=1. Accessed 2015 Apr 12.
6.Data source for Figure 1.1: Jones DS, Podolsky SH, Greene JA. The burden of disease and the changing task of medicine. N Engl J Med. 2012 Jun 2; 366(25):2333–8.
7.Arias E. Centers for Disease Control and Prevention [Internet]. National Vital Statistics Reports. United States life tables 2009. 2014 Jan 6. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_07.pdf. Accessed 2015 Apr 12.
8.Heart attack. New York Times [Internet]. (Reviewed 2014 Jun 30.) Available from: http://www.nytimes.com/health/guides/disease/heart-attack/risk-factors.html.Accessed 2015 Apr 8.
9.Yudkin J. Diet and coronary thrombosis hypothesis and fact. Lancet. 1957 Jul 27; 273(6987):155–62.
10.Yudkin J. The causes and cure of obesity. Lancet. 19 Dec 1959; 274(7112):1135–8.
11.USDA Factbook. Chapter 2: Profiling food consumption in America. Available from: www.usda.gov/factbook/chapter2.pdf. Accessed 2015 Apr 26.
12.Data source for Figure 1.2: Centers for Disease Control [Internet], NCHS Health E-Stat. Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960–1962 through 2007–2008. Updated 2011 Jun 6. Available from: http://www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm. Accessed 2015 Apr 26.
Chapter 2: Inheriting Obesity
1.Bouchard C. Obesity in adulthood: the importance of childhood and parental obesity. N Engl J Med. 1997 Sep 25; 337(13):926–7.
2.Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr. 1994 Apr; 59(4):810–9.
3.Stunkard AJ et al. An adoption study of human obesity. N Engl J Med. 1986 Jan 23; 314(4):193–8.
