Great new podcast - Peter Attia and Jason Fung

[mike]

This is an amazing podcast for anyone with Type 2 Diabetes, or anyone wanting to understand insulin resistance. IR is redefined from the lock being broken to an glucose overload situation. The problem is hyperinsulinemia, and not insulin resistance. This completely explains my T2D journey. Fung is also one of the experts on extended fasting, which is also discussed.

https://peterattiamd.com/jasonfung/

[thjj]

Thanks--I am going to listen to it!

[BrianR]

Even though I don't have T2D or even elevated glucose levels, I also thought it was a great podcast.

[mike]

Certainly puts a different spin on Insulin Resistance!

[cdamaden]

I found the first hour rather repetitive and I thought Peter Attia didn't challenge Dr. Fung very much since his work was based on clinical results. What I did like was that Dr. Fung said that his observations were limited to those very sick and said that fasting is low risk with potential high gain for those who aren't sick but may not be helpful in the end. This showed some humility in Dr. Fung's approach.

[aphorist]

review of the podcast.

[BrianR]

review of the podcast.

Interesting analysis, thanks. I think the conclusions from this Chris Masterjohn tweetstorm are worth saving here. Personally, I find his comments on fasting while lean very interesting. (Although I'm not sure what the definition of lean and healthy is.) Emphasis on the final conclusion point is mine.

• Overall, what I hear Fung saying is that fasting is a safe and highly practical intervention that can reduce metabolic dysfunction quickly in people who are very ill, and that this is superior to standard treatment.
  
  That makes complete sense to me.

• I disagree with the carb and insulin centricity of his explanatory model. In a defense of fasting over carbohydrate restriction, it’s a moot point.

• Ultimately what one clinician finds practical versus another probably depends on the patient population, but I comment him for pushing forward with fasting against the backdrop of paranoia or the assumption that because it’s hard patients won’t do it.

• Medicine tends to be paranoid about compliance, and that feeds into never having patients do tough things even when the payoff is high. I like that Fung is moving the needle there.

• Fung seemed skeptical that fasting is of benefit for healthy people to promote longevity. He said the data’s not there. I agree.
  
  He said that it’s probably not harmful either.
  
  I agree with some limited qualifiers.

• Almost no one is going to black out or have seizures. As he acknowledged, healthy lean people might lose muscle mass. I think some people fast too much and wind up in a higher stress, lower recovery state unnecessarily.

• My suspicion leans in that direction, that people who are lean and healthy should be wary of fasting too much because they are likely to tend toward too much stress and too little recovery on that end.

• Fung was clear that he’s targeting obese sick people with metabolic dysfunction.
  
  I think some lean healthy people use Fung’s work to use fasting themselves but I don’t hear him calling out for healthy lean people to do so.

• My quibbles are really with his theoretical model.
  
  Where does that become practical?
  
  In the recognition that insulin, acetylation, and other fed-state signals promote defense against ROS and glycation, and repair of damaged tissues.

• By missing that these processes are reciprocally regulated with fasting state autophagy, he places no emphasis on the need to restore a robust fed state.
  
  By not acknowledging these pathways as resistant in the overfed state, the need to return to a healthy fed state gets lost.

• Fasting may be an excellent way to quickly and forcefully correct an overfed state, but the healthy fed state has to be honored and given an equal place at the table for people to find the right carbohydrate intake and the right balance of fasting and feeding once they are lean.

[PBW]

Once again balance gets lost in frenzy of finding a process that breaks through to allow folks to heal. I agree with your last point. There is not enough information to make a decision on what is lean, what is a healthy fed state and how does one find the balance . Also is autophagy good for the very lean and how does one maintain healthy weight if they are fasting?

[NewRon]

There is not enough information to make a decision on what is lean, what is a healthy fed state and how does one find the balance . Also is autophagy good for the very lean and how does one maintain healthy weight if they are fasting?

Good summary Brian and good questions PBW.

Considering the volume of discussions about fasting on here, I'm surprised there isn't more debate.

Has anyone else any thoughts?

[PBW]

The next podcast I listened to on Drive was #18(Sep 10, 2018, Dr Richard Isaacson, M.D. Alzheimer's prevention Cornell). I am continually on the radar for anyone citing new research or theories on balancing/homeostasis with fasting, autophagy, ketosis and maintaining weight. Most seem to stop just short of going into these topics deeply. My takeaway from this listen: Dr. Isaacson referred to research that documented 16 hour fasting daily is better for Apoe4 than 12 hour fasting. And it stops there not mentioning other possible variations of plans(i.e. longer fasts and 2-3 day breaks, 24 hr daily fast for several months out of the year, etc.) Bredesen and Gundry have suggested 16 hour daily fast for ApoE4's also. This is the first I have heard of research documenting it. Oh course the question still hangs out there....how long and often should one stay in autophagy and ketosis? I also wonder if it matters what level of ketosis(using breath meter) one is maintaining. Generally I stay in the range of .05-1.5. When I have too manycarbs or not enough healthy fats and fall out of ketosis, it usually takes a couple of days with close attention to no fruits, dairy, grains, 3oz daily portions of seafood or shellfish, and eliminating resistant starches to get back to ketosis.