Can Fasting Save Your Life? The Danger Of Visceral Fat & The Incredible Benefits Of Prolonged Water-Only Fasting With Dr. Alan Goldhamer

25:51And we notice people aren't getting infections or problems in fasting, but their counts will drop. And we believe it's because they're clearing out those non-functional cells. And so temporary counts drop. And then of course they normalize after fasting. And that might explain that observation that we see why counts dropping during fasting. Autophagy is a very popular word that gets thrown around quite a bit, usually without a full understanding of what it means or the adequate amount of nuance. There's a multiplicity of physiological processes and things that you can do that will instigate autophagy, exercise being one, of course.

26:29So I'm interested, A, there are parallels between what's happening physiologically as a result of exercise-induced stress and fasting. So I wanna hear about that. But also I'm curious around autophagy with respect to prolonged water-only fasting versus the autophagy that you would see in a different version of fasting, say in intermittent fasting or time-restricted eating, for example. Right. Well, as far as comparing and contrasting water fasting from fasting mimicking approaches, we don't know what the differences are because that research hasn't been done yet. We haven't done that comparison.

27:08That's one of the things we'd like to look at. hopefully sooner rather than later. And of course, that would be very interesting. So this is really fascinating because almost you'd find so much research on exercise and the benefits of exercise and that people that exercise have these biochemical changes. In fact, it's overwhelming how much benefit exercise seems to instill in people. But the biochemical changes that occur in exercise often parallel and mimic fasting. And that's not intuitively obvious because, you know, in exercise, you're out vigorously stressing the body and in fasting, you're resting, stressing the body maybe in a different way.

27:48But they both induce many of the same biochemical changes. For example, BDNF, brain-derived neurotrophic factor, which protects the brain from developing Alzheimer's and dementia, increases with exercise, increases with fasting. if you look at all the different biochemical changes that occur with fasting many of them also occur with fasting you might say why would that be why would something vigorous and something passive do the same thing but if you think about it they both have one thing in common is they undo the consequences of dietary excess and they're mobilizing fat and particularly visceral fat and i believe that excess fat and excess visceral fat is a fundamental contributing factor to many of these inflammation-related diseases.

28:32So it's not shocking to find out that people that exercise vigorously get these improved biochemical changes and people that use fasting, whether it's every day for 12 to 16 hours or occasionally for a longer period of time, are going to induce those changes. And they do. And they don't just happen while you're fasting. A lot of these biochemical changes, these enzymatic changes persist. It's just like when you become a trained athlete, you get better at mobilizing glycogen stores and it doesn't happen just while you're physically exercising there's a change in enzymatic function that persists that's part of what being a trained athlete is and the same thing happens with fasting in fact part of the justification for intermittent fasting like limiting your feeding window to say to eight hours and fasting for 16 hours is the thought is that the changes that occur a little bit in those 16 hours but cumulatively day after day after week after month may approximate some of the changes we see in long-term fasting And also we've noticed that people that do intermittent fasting and also people that exercise, interestingly enough, are much better fasters.

29:36Yeah, I was gonna ask that. Is there any understanding of the difference between the average person or the person who's suffering from some form of chronic ailment who's fasting versus say a highly trained athlete who's very accustomed to rigorous, consistent exercise? And does fasting have a different impact on that person versus the other person or do we not know? I believe it does. In fact, we've got some evidence now looking at the idea of does fasting help healthy people or does it just help sick people? And we did a study where we actually recruited eight metabolically healthy people, which as you know, is a little bit more difficult than you'd imagine because only 12 % of the population is metabolically healthy.

30:19Even quote, thin people aren't necessarily metabolically healthy. So we recruited healthy people. These happen to all be women. This was a women's study. And we looked at the changes. Now, remember, these people have normal blood pressure, normal weight, normal blood glucose levels. But we looked at the cardiometabolic measurements and we looked at their biochemical changes and the magnitude of change was actually higher in the healthy people even than the sick people. What do you make of that? What I think is that the people that get the most benefit from fasting are the healthy people that are doing it preventatively.

30:53Much like the people that get the most benefit from exercise tend to be healthy people that are doing it preventatively rather than trying to induce it in sick people. It doesn't mean sick people don't get benefit both from exercise and fasting. But in terms of the magnitude of proportional change, I think the real cure, for example, of cancer is prevention. And the real, you can't cure obesity. You can lose the weight and keep it off, but you can't go back to the changes without it coming back. Same thing with high blood pressure. Same thing with diabetes. Medicine is so busy looking for cures that they don't realize that these are all management strategies.

31:27And so all we're doing is using intermittent fasting or long-term fasting, diet, sleep, and exercise to manage people's health, to support the change associated with health rather than deteriorating into aging and disease. We're trying to slow the aging process. You can't stop it, but you can slow it. You can allow people to age normally rather than this facilitated aging that happens because of our conventional diets. You see it with smoking more apparently. People get premature wrinkling of their face. It's like smoker's face because wrinkles are nothing more than crossline collagen tissue that comes from the oxidative damage from the effect of smoking.

32:06So if you don't smoke, you still age. You're still getting wrinkles. You're still going to age out. But it's much slower than that facilitated hyperinflammation from smoking. Same thing with alcohol. The liver ages out. You get cirrhosis of the liver. It's nothing more than fatty scar tissue from the damaging effect of alcohol. And the same thing with the diet. If you include salt, oil, and sugar in your diet, you're going to age the body more quickly than you would if you could eat a whole plant-food diet.

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36:01That answers two questions that I had. The first being this interesting distinction between your interest in fasting, which is treating people with, you know, significant chronic lifestyle ailments versus the majority of the discourse that you see out there, which is around health span extension and longevity when it comes to fasting. Like you're treating very sick people. You're seeing great results. You've been doing this for a very long time, but everyone else is talking about telomeres and, you know, like sort of living forever on the other side, which on some level is a whole different conversation, but what you just said helps me understand where these two things meet and are actually of a piece.

36:47You know, there's been 100 million modern humans born on the planet. We have good evidence that approximately five have lived past 117. And one of them is questionable because they probably adopted the identity of their grandparent to avoid conscription in the military, but that's a different issue. So the point is - Is there evidence of that? Yeah, you have about 1 in 20 billion chance today of living past 117. Now, maybe they'll figure out a way to extend lifespan. What I'm more concerned about is healthy lifespan. How well are you going to live in the time you have left? Most people spend the last 10 or 20 years of their life unhealthy and compromised.

37:23I think that those years can be the best rather than the worst years of your life. And that's what we're interested in doing is avoiding the strokes and the heart attack, the debility, the arthritis that limits people's mobility, inability to exercise. and poor choices they make in terms of diet and lifestyle. And the price they pay is they find themselves unable to talk or move lying in nursing homes beds waiting for people to change their diaper rather than having a good life and then a good death where you live your life and you go to sleep one night and you don't wake up because you've reached your genetic potential.

37:50And I think that we can dramatically reduce the debility that happens at the end of the years. And we're interested in doing a long-term study to look at exactly that. We want to enroll a large number of people, track them the rest of their life, and then compare, you know, what level of dietary adherence is associated with the best outcome? Does fasting actually help augment that and kind of tease that all apart? Because right now there's a lot of speculation, but not a lot of data. The second question that you answered was, why would a healthy person go to True North or entertain undergoing one of these extended water fasts?

38:23You know, I just got my blood work done. It's like pretty good. Like, do I really need to go, you know, take a month off and hang out with you? and lay in a bed while it's just whatever it is, you know? You're not gonna need to take a month off because when we fast healthy people, it's usually very brief, five to 10 days. It doesn't take, again, the way we judge is we fast them until their symptoms resolve. So some people don't have any symptoms. Well, what if I don't have any symptoms? Well, then you're gonna fast a week and be done, okay? But what more often happens is, and particularly in athletes that believe they're healthy because they're thin and have good muscle tone, they aren't always as adherent on the diet and lifestyle.

38:58And so when you put them on a fast, It turns out they do have some toxicity. They do mobilize some accumulated enumerated products and metabolism. They do go through some symptomatic change. Now, if you don't, that's a good sign. I use it diagnostically as well as therapeutically. But if you think about that intermittent fasting we're doing, we're fasting for 16 hours to induce changes. When you do a week of fasting, it is dramatically more impacting than the smaller amount. And using that diagnostically and potentially therapeutically, I believe will be proved to be useful. I can't prove it yet because we haven't done the research, but that's literally next on the list.

39:34Right. What else do we know about what is happening physiologically when somebody is undergoing one of these extended fasts? Well, there's a lot of information that's available on the detailed physiology of fasting, but essentially what's going on is the most important adaptation is the brain. The brain is the biggest burner of glucose for humans. We have a ridiculously large brain, two and a half times, for example, the comparative mass of a chimp. If we couldn't fast, we wouldn't be able to go more than a week or 10 days before gluconeogenesis would break down our protein mass and we'd end up into starvation and die.

40:10That would have been a problem for humans because they wandered away from the tropics, unlike chimps that don't fast and can only go maybe a week or so. Humans wandered all over the planet and all the humans that couldn't fast, they couldn't convert their brain from burning glucose to burning beta-hydroxybutyric acid, they died. And we know that because literally everybody on the planet that's a modern human has this automatic conversion that happens when they go on fasting. The brain changes to burning ketones or specifically beta - hydroxybutyric acid, the body conserves. And now a healthy lean male can fast up to 70 days.

40:47Not that we would recommend you do that, but you would likely survive in a restful state 70 days. You would not be able to do that if you weren't able to convert your brain to burning fat. And so this biological adaptation was so critical to humans that essentially anybody that didn't have it bit the dust. And all we've done is take that ancient biological adaptation and apply it in a very unusual situation that has only occurred recently in modern history. And that's where people consistently overeat. What is the longest documented fast? 368 days in the medical literature, but that was in a very obese patient.

41:30How long ago was that? That was in the 70s, I believe. That's unbelievable. So that was - It's unbelievable a human being could do that. Well, you can fast essentially as long as you have nutrient and fat stores. So we routinely fast people up to 40 days. So Moses, David, Elijah, Jesus, and our patients fast as long as 40 years. I tell them they're in good company. And what is the role of the liver in all of this? Well, the liver is one of the main detoxifying organs of the body. It's really important both for controlling glucose production in fasting as well as detoxification. And so liver plays an active and heavy load during fasting.

42:09And oftentimes you'll get a lot of bile and other symptoms that are associated with liver function that can be quite distressing. But the net effect on liver function is very powerful. In fact, we have a study here that shows that fatty liver index dramatically improves with fasting consistently and objectively. So this fatty liver disease that's now become very common as people are on excess sugar and alcohol, etc., is a condition that seems to be able to be responsive to this kind of approach. There's an interesting thing that you say in your book, which is that the data also indicates that the beneficial effects of fasting persist even after the fasting period ends.

42:49So elaborate on that a little bit. Basically, that means that the beneficial impact of this experience has like a long tail. It isn't restricted to the time period in which you're actually fasting. No, one of those, for example, detoxifying enzymes that are produced where the body is able to grab onto, mobilize and eliminate materials. Those enzymes don't just disappear because you're back in the feeding state. You maintain a higher circulating level of those. You're glycogen mobilizing enzyme systems. A lot of those systems are canalized and persist. And it seems to be cumulative. If you notice, patients that do periodic fasting, it gets easier and easier.

43:28Part of that may be because they're lowering their total load. Part of it may be the diet. they're improving their health. But just the ability to get into and stay in fasting seems to improve. You know how when people first start exercising, it's really painful. It's really tough. But if they can get through it and adapt and get the body to go through those acclimations, it gets easier and to the point where you like it. And the same thing happens with fasting. You get to the point where your blood glucose isn't being driven down by elevated insulin levels because you're eating some highly processed foods and your brain thinks you're starving and you get cravings and you get binging and you have all these challenges.

44:03Blood sugar levels tend to stabilize, insulin levels tend to normalize. People, if they have to skip a meal because they, you know, it's not this tragic problem because their ability to adapt is improved. And fasting, you know, that's not just a during fasting phenomena, it's an ongoing phenomena. I understand the exercise analogy, like it's something that I tell people all the time, like, yes, it's gonna be uncomfortable and challenging and difficult in the beginning, but you will come to enjoy it. And yet, I have a hard time believing that this could be the case with fasting. Like the idea that you're gonna go that long without eating any food just seems so unimaginable.

44:44So talk a little bit about, you mentioned cravings and the like, like what is the difference between appetite and hunger? I think there are people who would think what you're doing is putting people on a starvation protocol, but there's a difference between fasting and starvation, and there's a difference between your appetite impulse and actual hunger. Absolutely. So fasting is, by definition, means there's labor reserves available. If you deplete your labor reserves, then you enter starvation and then you die. So we don't do starvation because that would be really bad for our outcome data. So we only do fasting and we monitor people to make sure we don't transition from the fasting state to the starvation.

45:25Fortunately, it's very I used to monitor that. It's not a complex clinical challenge. And appetite and hunger is a very important consideration because both us and the intermittent fasting advocates suggest that people not eat three to four hours before they go to bed at night. I mean, that's basically how you get your 16 hour fasting. You eat an early dinner, don't eat till you wake up, maybe defer breakfast since you've done some vigorous exercise, you know, delay breakfast a little bit. Now you have an eight hour window that you eat in. that 16 hour period of time is essentially time restricted eating and is thought to be it's thought to be helpful people eat for a lot of reasons they eat because they're tired and if they eat they feel better so they assume they were hungry when really they were fatigued and they got stimulated by the food they eat because they're angry so they have emotional distress so they eat and then they feel the dopamine stimulation from eating so they interpret that as they must have been hungry they eat for all kinds of reasons but the only reason to really eat is because you need caloric intake and not because you're angry, tired, or fatigued.

46:28If you're tired, you should go to sleep. If you're angry, you should figure out a way to dissipate the effects of the anger or get rid of the source of it. If you're bored, you should engage in productive activity. And eating is not one of those things unless it's because you're hungry. And so not eating, say for example, three hours before you go to bed eliminates a lot of that late night boredom, tired eating stuff. And then people are more inclined to wanna go to sleep. And that's exactly what you should do when you're tired. I struggle with this. I have a hard time falling asleep unless my stomach feels full.

47:00So when I do intermittent fasting, I tend to eat late and not eat during the day. And I've discovered that that is very disruptive to my sleep cycle. I'll generally wake up at three o 'clock in the morning or my REM states, my deep states aren't adequate enough. I don't think it's a net positive. And so I've kind of stopped doing that. So I would challenge you that if you were to undergo prolonged fasting, during the fast, you may not have good sleep cycles and stuff. It can be quite disruptive. But as a consequence of fasting, you may find that the quality of your sleep may be better than it's ever been before.

47:38I can't tell you exactly what all the mechanisms are, but we see it very commonly. People that have trouble either getting to sleep or staying asleep, post-fasting oftentimes are then able to sleep, get to sleep and sleep through the night. Sometimes it's because people had by non-prostatic hypertrophy, they're waking up six times to pee. You don't eat before you go to bed. You get the prostate inflammation down. Now you're only waking up one time. So you have less sleep disruption, better quality of sleep. Sometimes it's because when people eat late at night, they experienced just what you did.

48:08Is the digestive process is a pretty active process. You don't necessarily want this active biological process going on when you're trying to be in a restful state. And so there may be other biochemical factors that we haven't really elucidated yet. But whatever, the net effect of fasting oftentimes is improving sleep cycles. And improving sleep cycles is really important. If you get the quality and quantity of sleep you need, that's where energy comes from. Right, that becomes a life-changing thing in and of itself, like independent of everything else. Exercise. You don't have to sell me on that.

48:39But people that exercise regularly tend to sleep better overall than people that don't. People that eat well tend to sleep better than those that don't. And people that have used fasting appropriately oftentimes are able to correct imbalances. I suspect there's a psychological piece at play here as well, because anybody who shows up at True North and does, let's say, 40 days of fasting, it's something that is so mind-boggling that so few people have any experience with that I can't help but think that person is going to think differently of their own capacity and capabilities as a result of that.

49:15And it reframes their sense of what's possible for themselves. It's very empowering, right? It's to like undergo something like that. And then on the other side of it, say I can do hard things or now I'm up for a different type of challenge or I'm finally ready to, now that I've proven to myself that I could do something like this, I now feel like I'm capable of handling other dietary and lifestyle changes that have historically eluded me. You know, it's natural to be afraid of starvation. You know, if people weren't very concerned. Why do you think I would come to True North? I'm terrified of you.

49:51I'm terrified of this whole thing. Go ahead, sorry. So they're naturally afraid of, you know, starvation. And so sometimes when they feel hunger, you know, they interpret it as, you know, a serious problem. Once you've gone through fasting, first of all, you tend not to have quite as much vacillation in your blood sugar and insulin levels. So there's not as much biological input afterwards. It calms down. But also you realize I went for a week or I went for 10 days or I went for 40 days. You know, the idea of not eating on the plane isn't gonna be terrifying. And you're right, there's a huge empowering impact.

50:24And there's probably more people that have climbed Mount Everest than have done 40-day fast. And nobody would say, oh, I did this huge challenge. I ran this marathon, I climbed this mountain. Of course, it's gonna have an empowering effect on people. And laying around doing nothing has the same kind of impact on people. You mentioned earlier that only 12%, I don't know if it's of the US population or the global population is actually metabolically fit. It's not news that we're in a global health crisis, but the statistics are still nonetheless incredibly alarming, which you illustrate in the beginning of the book.

51:023 billion people globally have chronic diseases. In the US, 150 million people face chronic disease despite substantial healthcare expenditures. Six out of 10 US adults have some form of chronic disease. There's 40 million deaths annually as a result of these illnesses. US healthcare costs have exceeded 3.5 trillion in 2022. And in the US, over 70 % of adults are overweight with 40 % being obese. Like that is shocking. So help me understand how we got here. We got here because of the pleasure trap, the hidden force that undermines health and happiness. We fool the satiety mechanisms of the brains of humans by putting chemicals in our feed.

51:50If you put these same chemicals in the feed of rats or mice or birds, the rodents will gain 49 % of their body weight in 60 days. The birds will get so fat they can't even fly. There is no obesity in wild animals. You know, even whales are, what, 9 % body fat. They're lean, mean machines. They just wear it on the outside of their body. Unless those animals get exposed to our highly processed foods with these chemicals added to it. And then they'll get fat just like we do and they'll get the same diseases we do. The breast cancer, the colon cancer, the heart disease, the diabetes. These changes occur in animals the same way they do in us.

52:26And the chemicals that we put in our feed that fool the satiety mechanisms allow us to overeat and are responsible for the obesity and overweight that we see are salt, oil, and sugar, SOS. And that's why we advocate a whole plant food SOS-free diet. Because salt, oil, and sugar are not food. They're hyper-concentrated food byproducts. They're added to food to make food taste better. And that's what tasting better is, is the artificial stimulation of dopamine in the brain. And foods do taste better to us with those. In fact, they tastes so much better that will systematically overeat them. If you ask a person to eat their fill of say rice or anything, they'll eat a certain amount.

53:06Everything else being equal, if you salt that up, they'll eat more before they reach satiety, before they feel satisfied. And people say, yeah, because it tastes better. That's right. That's what it means, is that it will stimulate that dopamine production and you will have to eat more before you feel satisfied. If you just eat a whole plant food SOS free diet and you eat to your satisfaction, you will be able to maintain optimum weight. But to the degree that you add salt, oil, and sugar to the food, the only question is, how fat are you gonna get? I understand the implications of salt, oil, and sugar with respect to hyper-palatability in our ultra-processed food ecosystem, which is the kind of food that we're all overeating that we find very difficult to only have a little bit of.

53:56But is there a distinction or a difference between the salt, oil, and sugar that finds its way into those foods versus a little bit of salt on your whole food omnivorous diet or one tablespoon of olive oil and the sort of benefits that you can get from that type of oil in moderate amounts? Like why so severe to say it has to be SOS or nothing? Well, part of it may be biased by my patient population. So I'm seeing the person that has high blood pressure or diabetes or cancer. And so their ability to just eat a little bit obviously failed because, you know, and so has 72 % of the population in the United States who have achieved obesity or overweight and are now having excess visceral fat and they're dying prematurely and spending 20 years debilitated.

54:48So if a person in theory could eat small amounts, maintain optimum weight, optimum visceral fat, optimum blood pressure, and optimum glucose, you might be able to make the case that those people would get away with it. But that's not what my experience has been. It's very much analogous to saying, why do you tell alcoholics they can't drink at all? Can't they just have a little beer and wine on the weekend? Or couldn't they just control their quantity and then they would be okay? And it is true. Some people can have an occasional drink and not become a drunk, but if you're a drunk, it's not you.

55:19So I can tell you right off the bat, 72 % of the population don't have any business adding salt, oil, and sugar to their food any more than an alcoholic has business adding alcohol into their diet. Could alcoholics learn to control and have, you know, maybe there would be one. I just don't get to see those people. So I tell alcoholics, don't drink at all. Just stop it. And we tell people that are struggling with weight or health, stop putting the chemicals in your body that fool your brain and lead you into doing the things that are causing the problem. if you have a person that's able to maintain optimum weight and health and have a little variation you know so be it now in reality that's exactly what happens because if you look at the study we did one year follow-up on they weren't 100 vegan sos free but they had maintained enough adherence to the diet to maintain their weight loss and that resulted in them being normal blood pressure without medication so i'm more interested in the outcome than some philosophical argument about what can you get away with or what can't you get away with.

56:16So the easiest way, honestly, just like it is in alcoholics, just say don't drink and draw the line and be done with it rather than trying to figure out how much could you titrate in and still function. I think with salt, oil, and sugar, there's no natural relationship in my mind to adding those chemicals to the feed. I wouldn't do it in the animals. I wouldn't do it in humans if we want to get optimum health. Now, is it going to turn out that we'll be able to be more flexible for certain people? And they'll, yeah, it's very, very possible. but I don't get to see those people. Yeah, no, I understand.

56:45Listen, I'm on your page. You know, I'm a alcoholic in recovery and, you know, abstinence is easier than moderation. And as they say in a secret program, it's the great obsession of every alcoholic to like enjoy their drinking like a gentleman, you know, like, and this is what, you know, leads people to their grave. And I think there is an analogy that's apropos with prospective food. I think we could quibble over whether food addiction is a real thing, but when you look at the health statistics, it's pretty clear that there's a level of powerlessness with respect to our ability to modulate our intake.

57:26And abstinence, being binary about these kinds of things actually makes it easier. Like it seems harsher and more restrictive, but there's freedom in that. And I think it eliminates the decision fatigue around it and it drives behavior in a more kind of clear trajectory forward. So I get that, but I think it would be interesting. I'm trying to imagine the person who's listening to this right now, who's thinking, well, I'm down with Alan when it comes to this fast, but when I complete the fast, why do I have to do this SOS thing? What if I just did a really healthy Mediterranean diet and was very cautious about my salt, oil, and sugar intake as a result.

58:10And I'm wondering whether there are any studies on that or the difference between somebody who undergoes a prolonged water fast, does the SOS diet versus the person who does the prolonged water fast and has a sort of quote unquote, like healthy omnivorous diet in the wake of that. Yeah, no, I think your point is well taken and that is research we're actively and acutely interested in doing. Finding out how strict do you have to be to get the outcome and to avoid the pleasure trap. And maybe it's not an absolute thing like it appears to be with alcohol and some of these powerful drugs. But honestly, based on behavior, people don't wanna be fat and they don't wanna have visceral fat and they don't wanna be sick.

58:51And they're really trying, they're spending billions of dollars trying to solve this problem. We have a solution for it. If you adopt a whole plant food SOS-free diet, it becomes exceedingly difficult to maintain obesity or overweight. And when people neuroadapt to it, they get to the point where they'll like the diet as much or more than they did when they were on the traditional diet. Because there's an addictive component, it's hard for people to imagine how could they possibly stand to eat a diet without salt, without oil, and without sugar. And what's even more interesting is in the alternative health movement, many people will say, well, get rid of the oil, even olive oil.

59:27And they realize olive oil is less bad than the other oils, but being less bad, of course, doesn't make it good. It's still nine calories a gram of highly processed fat. where we can get all the essential fat we need from the diet, from the whole plant foods. That's not so much challenge now. There's lots of people that have written about that. Some people say, well, look, you got to get rid of the sugar. The refined carbohydrates cause the insulin to go crazy. They're empty calories. They suppress the immune system. They disrupt the gut microbiome. And a lot of people agree, okay, we got to get rid of the refined, the sugars, we've got to get rid of those.

59:57And some people say, get rid of the oil and the sugar. Okay, we'll get rid of those. now that food choices are narrowing, where I really pissed a lot of people off, including your viewers, was when I suggested that we get enough sodium from the diet. We don't need to add salt to the diet in order to get the sodium that we need, the gram a day that's needed, including by athletes that are sweating. And that if you want to increase your sodium intake, you could still do that from whole foods. You can eat more tomatoes and chard and other things that are naturally very high in sodium. You don't need to add salt.

1:00:27that got, I think, a hundred and some angry comments. People were very upset. Yeah, about how completely crazy I am. Well, answer them now, you know? So here's your opportunity to address that. The data is coming out more and more that sodium is a problem, not just for high blood pressure, but I mean, just think about the gut microbiome in general. You've got a bacterial rich environment. You're putting a high sodium concentration. Do you think that that sodium could have an effect on bacterial population in the gut? Of course it can. I mean, we use salt as a preservative, for goodness sake. The data is not conclusive, but it's definitely coming out more in the favor that limiting sodium seems to be a highly beneficial health-promoting component.

1:01:13Now, the argument might be, well, how much? I don't know. Do you have to be completely free of added sodium and just rely on the sodium that comes in the food? Or can you get away with a little bit and still be healthy? I don't know. I do know, though, that in my experience in managing, for example, hypertensive patients, salt restriction becomes one of the critical components of maintaining long-term success.

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1:03:15I wanna double click on the SOS whole plant food diet. for somebody who's never heard those terms before, what are we talking about specifically? What does that look like? And perhaps even share some examples of what like a daily series of meals might look like. So a whole plant food diet is just that. The diet is made up of whole plant food. So in other words, we're talking about brown rice, grains, not necessarily, we don't use the glutinous grains, the wheat, rye, and the barley. We certainly don't use, encourage the breads. And, you know, bread is a great example. They call it the staff of life, right?

1:03:48People really like bread. But if you take away the salt, the oil, and the sugar from bread, then they call it matzah, and it's punishment on Passover. Nobody's getting too crazy about the wheat and the water. It's the additives that are added. And if you take wheat berries and you boil them and eat them, it's 500 calories a pound. You take bread, it's 1 ,500 calories a pound before you turn it into a butter boat and spread coagulated cow pus all over it. So the bottom line is how you process these foods can make a big difference in terms of whether they're helpful or not helpful. So we're talking about grains and legumes, so beans, lentils, peas, this kind of thing, but cooked like soup and whole grains rather than necessarily processed all the way down.

1:04:31We're talking about fresh fruit, but not necessarily fruit juices and dried fruits and highly processed fruits. We're talking about vegetables both raw and cooked. And we're talking about all kinds of vegetables, starchy vegetables like hubbard squash and butternut squash and potatoes and sweet potatoes. We're talking about the variety of green vegetables, particularly, and getting these, you know, high mineral content foods into us. And again, I'd rather see people eating more whole foods necessarily than relying entirely on juices and processed foods where you remove the soluble fiber, which is so critical to maintaining a healthy gut microbiome.

1:05:03And then we're not, and we're using small quantities of nuts and seeds and more concentrated, higher fat plant foods. What we're not using though are animal foods. So meat, fish, fowl, eggs, and dairy products, oil, salt, and sugar. So basically what I tell people is they should go inside themselves, look at a food. If they wanna know if they should eat it, just say, do I really, really, really want it? And if the answer is truly yes, you know. You can't have it. Because you get nothing. If you really, really, really want it, it's likely banging on the pleasure trap. Yeah, that begs the question of cravings and how powerful they can be.

1:05:40And back to the point about the psychological piece to all of this and the kind of extended metaphor of alcoholism or addiction versus the landscape in which you operate. I went to a treatment center to get sober and I was there for a hundred days. And part of that was a re-education. Part of that was abstinence, the physiological response to removing myself from this substance. But there's also, and the empowerment piece, of course, but in the course of that extended period of time, you're pattern interrupting. You're not doing the thing that you've always been doing and you feel all the cravings and all of the emotions come up and the resistance and you have an opportunity in a controlled environment to sit with that discomfort.

1:06:34And what you realize is that if you sit with it long enough, it dissipates. And with that comes a dawning realization that you can choose a different behavior and that those cravings over time will decrease in their intensity. And that in and of itself set aside physiological changes, all of it, just the idea that cravings are not static, that they are modulated and that the more time and distance you put between yourself and that food or that substance or that behavior that the cravings will recede into the background and so and that doesn't mean that they don't crop up from time to time and you have to confront them but you have enough experience knowing that you can kind of sit with that discomfort and it will change.

1:07:23And I think that is a huge dawning realization that in and of itself becomes a very empowering thing when people go off into their lives and they find themselves at a bar and somebody says, what do you want to drink? Or they're at a dinner party and they say, what do you want to eat? Or they're at a buffet in Las Vegas and they have a choice about what's going to end up on their plate. Yeah, I think that's absolutely the truth. It's just why you don't tell newly recovered alcoholics to become a bartender. You know, it's probably not the best choice. And we kind of know that's intuitively obvious.

1:07:58You wouldn't want to tell an alcoholic that they should go out and get a job as a bartender, that that's going to help them. Now it's true. I have a lot of patients that are recovered alcoholics and they're working as bartenders and they do okay in that environment. It doesn't impact their ability to maintain sobriety, but it wouldn't be a first choice. And you don't want to tell people that are struggling with these eating issues. You should go to work where there's big piles of candy all around and everybody's gonna put social pressure on you to engage in short-term pleasure-seeking, self-indulgent behavior.

1:08:29It's not, it doesn't make it easier. And that's exactly what happens to people when they leave True North Health. They're going out into a world where everything, convenience, practical, social pressures are all gonna be, everybody's gonna be trying to undermine their success. Do you have any experience with people with prolonged sobriety or people that have kind of undergone 12-step or something like that coming to true north, do they tend to be more or less successful than the average person because they're already inured to this type of behavior modification? Long-term recovered addicts are the best patients.

1:09:09That was my instinct. They're the most adherent. Because they already know. They totally got the model. They already know. You don't even have to say anything to me. They got it. I kicked heroin. Like how hard is this gonna be, right? You know, in some ways though, the feedback I've gotten is that it's actually in some ways even more difficult, not physiologically short-term, but long-term. Because socially, if you go to a party and they try to push alcohol and you say, oh, I can't drink, I'm a recovered. They might tolerate that and let you go by. But you started to do that with diet, forget about it.

1:09:42Where are you gonna get your protein from? This is good for you. or this is, you know, blah, blah, blah. There's no letting up. How do you counsel people on the social piece? Because I think that is, you know, an underestimated limiter in all of this. There's our capacity to make these behavioral changes, but when pressed and in the context of friends or loved ones, there's a whole matrix of confusing signaling and emotions that come into play that ultimately lead people to, you know, lapse even against their best judgment? My first advice is usually make new friends, but that's probably not the most practical solution for most people.

1:10:22The reality is that Dr. Lyle, our psychologist, explained to me how cognitive behavioral therapy works. And as I understood it or what I got out of it is it's a way of helping people manipulate other people's behavior so they don't annoy them as much. And so that's why I got interested in it. So the idea is that you can change your response to other people's behavior if you understand really where they're coming from and what the limitations are. You don't have to be angry. For example, he uses an example. If you're in an elevator and somebody's poking you in the back with a sharp stick, you don't like being poked in the back with a sharp stick.

1:10:55You might get angry. You see it's a blind person just trying to figure out where they are in reality. You're still going to step out of the way, but you don't have to be angry about it because you realize they're doing the best they can. And the reality is if you understand the limitations that that some of the people you're interacting with are working under. You don't have to be angry about the fact that they're not only not supportive, but actively trying to undermine your success. And you can communicate sometimes with people and help them modulate their behavior so they leave you alone or at least be not antagonistic.

1:11:21And if you can't, make new friends. When people leave True North after they've had this experience and you set them on their way with a whole protocol around the SOS diet, is there a caloric restriction piece to this? Are they allowed to eat as much as they want? Is that a case-by-case basis? Well, the people that are successful are the ones that avoid under eating. Under eating is a bigger problem on this approach than over eating is because when you're eating a whole plant food SOS free diet, you have to eat a lot. There's a lot of eating going on because you're eating a pound or two of salad and vegetables.

1:11:56You're eating fresh fruits. This is stuff you have to chew and you have to chop and it's a bigger volume of food. Sometimes people are not used to eating a large volume of food or they think, oh, I'll gain weight if I eat that much. They aren't thinking caloric density. And as a consequence, they'll under-eat and then they have trouble maintaining energy. You can't get them doing their exercise. They're not gonna be successful. So I'd rather see people eating a little more of low-density foods. And maybe they only lose a pound a week instead of two pounds a week, but they're more likely to be successful long run than the one that's under-consuming what their body actual needs are.

1:12:29They need to eat enough to maintain optimum weight, just not current weight. That is a common retort with people who play around with adopting a plant-based diet. Like, oh, I felt lethargic. I didn't have enough energy. It's like, well, you're probably used to eating a certain amount of food and you don't understand that you actually can and should eat more now as a result. And that experience that you're having is most likely tied to caloric under consumption. And there's huge psychological overlay because people have all kinds of issues about volume. You know, if they're conscious about their weight, I tell them, if they put their meal down at work, people should come in and go, oh my gosh, you're not gonna eat all that, are you?

1:13:10Because if they don't react with shock and awe, they got the wrong size bowl. I mean, eating enough is my bigger concern. Now, the problem is you also have to avoid the highly processed foods. And that's really hard. I mean, 93 % of calories consumed in industrialized country come from either animal foods or highly processed foods. 70 % is fruits and vegetables. A third of that's potatoes served as French fries or potato chips. I mean, right now, the stuff we're asking people to eat is the decoration on the plate. You can go to restaurants where there's nothing that meets standards. It can be very challenging because so much of what people are doing is highly processed, fried, fractionated foods.

1:13:53That's what most of the calories people are eating. And that's how we've supersized the people. and it's a big ask to say, you need to eat this way, but you're probably not gonna have the ability to go to the restaurants you like to go to. It's gonna be challenging when you go out for dinner with friends. It's tricky socially to kind of navigate that. And a lot of restaurants have a hard time accommodating that. And if they do, it's a pretty dire, unpalatable situation. Actually, if you go to a place that actually has a cook, somebody that's cooking it rather than just reheating the practice materials that are so common in many of the restaurants nowadays, often if you call ahead and you say, look, we have somebody in our group, can you make a couple of baked potatoes or a sweet potato and some salad?

1:14:42You can get a beautiful dish. It can work out really nicely. If you plan ahead or you go to a restaurant you're used to going to and you have a relationship with the waiter or the waitress, they can oftentimes, if the restaurant has some kind of food in the kitchen and somebody that can put it together, that can work out really well. It's just not always the case. Yeah. Do you guys do some consulting or counseling around, okay, you're gonna go to Thanksgiving, you're gonna be with the family, here's how it's always gone down, but here's what you're gonna say. We spend a lot of time. So that you can, you know, still be in the good graces of your loved ones.

1:15:17We spend a lot of time teaching people little strategies, how to go along and get along and not piss people off and how to keep your mouth shut. And there are strategies that you can implement. The most important thing is, if you're dealing with people that love you and you explain to them that this is not a judgment on them, it's just an adaptation you're making, how much trouble are you if you ask them, could you put a couple of potatoes on for me? Or can I bring a salad for everybody? Because they don't wanna go through all the process of making that. What are they gonna say? Oh no, that putting a potato on?

1:15:50No, it's too much trouble. We don't want you here. You know, that's not gonna happen. If you explain to a person and you aren't judgmental about it, you don't wanna become a born again natural hygienist and walk in the room and say, oh, I can hear your vessels thickening from over here. You're not gonna eat that dead decaying flesh. I mean, you keep your mouth shut. You don't need to do that. It's just your issue for you, you know, and it is possible to navigate it. Yeah, I think top line, how can you be part of the solution rather than the problem? And if the family or the community of friends like already know that you've kind of jagged in terms of your diet, there's already a lot of judgment.

1:16:25Oh no, here comes so-and-so. It's gonna be a whole thing or whatever. But if you come open-hearted with a solution, like, hey, I'm bringing food for everybody as opposed to I'm gonna come and be a problem because I'm gonna make everybody change what they're doing to accommodate me. I think that's where the problems come in. I'm sure that you experienced some of the same issues, choosing not to drink in a setting where most people are drinking and they can be very uncomfortable sometimes. Initially, what you realize though is that you think everybody's thinking about you, but they're thinking about themselves.

1:17:00People don't care. They really don't. Food's a little bit different because there's a lot of emotion wrapped up in food and the sharing of food is how we share love. And that can be tricky and complicated, especially when there's historic patterns and a way of doing things over time. but go ahead, sorry. If people will just stop getting in other people's business, like stop worrying about what they're eating and just not, you know, because that's where the people get into trouble. It's not they're trying to eat well. You haven't been on Twitter lately then, have you? People seem to care a lot about what other people are eating.

1:17:38Well, they want other people to eat like they are so they can feel supported. They need to stop looking to other people for their support, get their internal support and let them be because you're not going to change them because you make snide comments about their dietary habits and try to prove that what you're doing is better. Just keep your mouth shut, set a good example, answer only questions that are asked, and maybe you'll figure out a way to survive it. What do you make of all the tribalism around diet? What is that about? I really don't know. I was hoping you would tell me. Yeah, it's very strange, but it's very passionate and heated.

1:18:14We're seeing it now with the carnivore diet. Like that's really grown way more than I would have suspected. And adherence of that lifestyle are very passionate in their views. What do you make of that diet? Well, you see variations on this diet throughout the last 40 years I've been in practice. And what's good for short-term weight loss, and there is a fasting mimicking effect of going on a carnivorial diet because you get into ketosis, there's a hunger blunting mechanism. and they were already eating meat three times a day. So, I mean, it's not like a fundamental necessarily difference, except they got rid of the carbohydrates.

1:18:49And short-term, they may lose some weight. Long-term, of course, we know what the consequences of high-fat, high-protein diets are and it's going to show up and it begins to manifest. Whether it be early on the gallbladder disease or later the cancer and other problems that come about. Now, I know they're vehement in defending it, but, you know, the data is the data, the facts are the facts. You can't go on that diet long-term as a broad recommendation to the population and expect that that's going to be an overall net improvement in health. Because the standard American diet is so crappy though, almost anything you do, like getting rid of refined carbohydrates, is going to induce some beneficial changes, including weight loss.

1:19:26So, you know, you can't argue short term. We've got to really look long term. You've got to look to the scientific literature. I mean, I have to say, I've been surprised myself watching fasting work, but not really understanding how well it worked until we got the database. and you really, and then look at, now I'm getting 30 year, 35 year follow-up on patients. And you're hearing the same stories. Everybody they know is dying. Some of them are outlived their kids. You know, it actually creates its own challenges and stress, just, you know, being so far outside the norm on health. That was, I mentioned last time when I was here, my mom, when she was 92, had outlived all her friends.

1:20:05And she told me, Alan, warn your patients. If they do this diet, make younger friends. And she said much younger because even 10 years younger when you're in the 90s isn't young enough. Yeah. We talked a little bit last time about the medical establishment's sort of lack of embrace of you to put it politely. I mean, you are a maverick and what you're doing and what you're advocating is somewhat radical and orthogonal to the protocols of the way our medical system and our healthcare system operate. I'm curious, has that changed at all in the interim period since we last spoke? What's going on there?

1:20:49Yeah, I think it has. I think I've gone from being a criminal quack to being a cutting edge researcher. And you can witness the 19 papers we've published in the literature, including British Medical Journal, Curious. Some major impact journals are accepting the case reports and the studies that we're publishing. and I think that that has been beneficial. I think that the work Walter Longo and others have done publishing major, you know, Journal of Metabolism 2015 did a fabulous piece is making it, at least you can discuss it without it being just immediately shut down as crazy. So I think it is starting to shift.

1:21:26I think that the diet clearly has changed. I mean, if you think 40 years ago, if you had people like John McDougal in 1986, you know, pioneer writing the McDougal program, looked on like he was, you know, nut job. Now, the idea of plant-based eating as being health promoting and reasonable, I think has, you know, at least general discussion. People aren't necessarily adopting it in mass, but they're at least tolerating it. I wouldn't think you'd have the same social impact, you know, because you're trying, you didn't happen to have animal foods or something on your plate. Nobody was going to think you're going to die that day from acute deficiency.

1:22:01Fasting, the intermittent fasting, I think has become pretty much accepted. You've got 10 ,000 medical offices selling pro-law. So, I mean, you know, there's definitely an acceptance. Long-term water-only fasting, it's gonna be up to us and the other people advocating it to prove that it can be done safely and effectively. We're starting to do that now with these publications. What is a study that you'd like to see conducted that has not yet been conducted that would put to rest some of the myths or misconceptions? Well, we are going to be doing a study with a major HMO. We've gotten excellent feedback from them.

1:22:36What we're going to be doing is we're going to once again look at high blood pressure because it's just a common problem. And we're going to be doing the first RCT, randomized control trial, where they'll get their standard of care and in addition, 40 people standard of care, 40 people randomly assigned, will get a three-week stay at Truman Health Center and go fasting and get the additional education. And this is a practice already advocating a plant-based diet. So these are people that are already being encouraged to try to eat healthfully. In addition, they're going to get some fasting and then we're going to do some long-term trapping of those people.

1:23:09And then what's going to happen, we know what the results are going to be. We did a study with the Mayo Clinic. As I mentioned, we had excellent long-term results, including one-year follow-up. Once we've done that, we're going to approach the same HMO and try to do a prospective randomized control trial in the treatment of lymphoma, which will be much more controversial. And then our hope is that we'll have good enough success that they'll be forced to integrate fasting into their standard protocol, and we'll help them do that. And that's part of our foundation's mission is to get fasting to be more accepted in the mainstream.

1:23:40And it may only be for this one condition, but at least that'll be the start that we think we might be able to accomplish. And we've got some good relationships with this major group so that we're optimistic that we can pull it off. One of the things that opens you to criticism is the fact that these studies deal with small sample sizes. And I would suspect a part of that is because there's only so many people who are doing these extended water fasts. Is there a way to increase sample size with respect to these studies to kind of rebut that issue that recurs? Well, the analysis has been done. We know what size samples you have to have in order to get statistical significance.

1:24:19And it's deceptive because the effect sizes are so large, we don't need large ends in order to reach statistical significance and be clinically valid. And so we're meeting those. And that has not been a criticism in the studies that we've done to date, even though they are relatively small scale studies. Now, yes, would we like to see a large scale study? Well, what's the limiting factor? We only have 79 beds. So we can only process so many people. Well, we can process 1 ,200 people a year. So we can't take on studies more than that. But we don't need to in order to prove the points that we're trying to prove right now.

1:24:53Given all the success that you've had at True North and the fact that you've been doing it for 40 years, It's curious why there aren't versions of True North in major cities across the world. Like why hasn't this model been more readily replicated by other people who can see what you're doing and the success that you're getting? I think there will be. We have a residency training program. We train doctors that are interested in doing something worthwhile with their life, how to use diet and fasting to get people well. That program has been successful and the economics of it aren't successful. It's healthcare that's not covered by insurance.

1:25:27in terms of the stay at the center. We're a 501c3 nonprofit, so we have very modest fees. If you charged a lot of money, the problem is it takes time. You have people there 30 days sometimes, three weeks, six weeks. It would be a very costly process if you had to charge$2 ,000 a day like they do in the hospital. So we charge a couple hundred bucks a day. We can make it work, but you can't make it lucrative. Because we're a nonprofit organization, we got a lot of less pressure than most places would. We have modest facilities. We don't do advertising. We don't have to do promotion. We don't have any of the normal expenses that businesses would if you were to go out and do that.

1:26:04So I think it will become more acceptable, but it probably needs to become integrated into the conventional healthcare system because almost all healthcare is paid by these insurance modules or Medicare. That's why we're trying to get it into the HMO so that if they're able to offer it, it becomes acceptable part of the mainstream. I could see a situation much like, again, with the parallels with treatment centers and rehab and addiction, an entrepreneur coming along and replicating your model, but making it for profit, turning the place into like a high-end five-star spa situation and charging an unbelievable amount of money and catering to a high net worth person who's, you know, extremely unhealthy, who would just pay anything to be supervised to get to the other side.

1:26:52side. That's where all the other healthcare facilities are. They're all expensive, high-end, and they're even go further. They're not five-star though. Well, many of the resorts are. I mean, there's a lot of health resorts around. They just don't offer fasting. They're not doing prolonged. I'm talking about specific to prolonged water-only fasting. Oh, no, forget that. No, because the people that are gonna pay the big bucks don't wanna have to do anything uncomfortable. They wanna be told what they wanna hear. And if you look at most of the examples of resorts, they're pretty good about giving people what they want.

1:27:19I mean, even the Pritikin Center is now serving salmon and all kinds of stuff. So they're going to try to accommodate the people's needs, but it's a different model. We're essentially a human subjects laboratory that looks like a clinic. And the research is funded by the participants themselves that are participating in the program. That's not a good business model. It works well for our needs and we've managed to survive. But if you are an entrepreneur, you want to charge large amounts of money, but that means you have to give people what they want. This is not what they want. Yeah, that's a tricky one.

1:27:54They want the end result. They want fasting mimicking drugs. But maybe they don't want it, but they do want it. So they're gonna pay a lot of money as long as like the place is really nice and then they're locked up, you know, and they can't leave and they're gonna pay a lot of money to prevent them from being able to leave. I could see a certain clientele who might be up for that. Well, I hope that different versions of this do become available to meet everybody's needs. because obviously, you know, we can only handle so many people. The size of our facility wasn't based economically. It was based on the numbers we needed to be able to do our studies.

1:28:27And so we grew the facility to the size we needed so we could actually conduct what the goal was. Right, to fund the foundation, to fund the research. Exactly. So that's why it doesn't, like I get a lot of very successful people that come as patients and give me lots of advice about how, like for example. Business advice, yeah. You're running a terrible business here, Alan. They say you're ridiculous. Look at this. The way you set price in a business is you keep raising the rates until you don't have a three-month waiting list. And then, you know, that's the price point. When it drops down, it's only six-week waiting list.

1:28:58That's the right point. That's not our model. Our model is to get people to come in long enough, stay long enough, and come back as necessary so they can prove that we're right, that health is from healthful living, that fasting is a safe and effective tool. So if the goal was to make the most money, you don't do this business model. You do the business model where you give people what they want to hear. It's very funny. We talked about metabolic dysregulation. We talked about diabetes and obesity, but there's also some other very interesting kind of case studies that you talk about in the book.

1:29:36There's the person who has like the keratic growth on their face. There's psoriasis, rheumatoid arthritis, autoimmune conditions. Talk a little bit about some of these other success stories that you've had with very unlikely conditions that seem to be resolved through fasting, which seems like a crazy magic trick. It turns out that a lot of these conditions also were caused by dietary excess. Like for example, this is a paper we published just recently, 2023, in Integrative and Complementary Therapies called Prolonged Water-Only Fasting in the management of Hashimoto's thyroiditis, a case report.

1:30:17Hashimoto's thyroiditis is the most common cause of hypothyroidism. It's where the immune system attacks your own thyroid. And interesting, there's a theory that the, you notice the gene, the HLA-DQ gene that's common in these patients is the same gene associated with people that have gluten sensitivity. And so the theory is that people eat gluten, 1 % of the population gets celiac disease, where the immune system attacks the intestine. Very serious, you have to not eat gluten. on other people the immune system doesn't attack the intestinal system but attracts the thyroid and that's called Hashimoto's thyroiditis we've known that the immune system is taking out the thyroid it hasn't been clear about why is it doing that well it turns out that gluten and dairy products the diet you eat can dramatically affect your issue in this particular case we were able to use fasting to bring the symptoms that are associated with this with this condition under control.

1:31:09This was a 61-year-old and she had weight gain issues, edema, joint pain, constipation, cold sensitivity, brain fog, all the symptoms that go along with this condition. And she ended up undergoing fasting for 21 days, had 10 days refeeding, had fabulous outcome data. And obviously not just on terms of her thyroid function, but she lost weight issue to expect her blood pressure dropped from 134 down to 108. Her thyroid or TSH went from 61, which is very high down to 6.8. Okay. So CRP, which is a measure of inflammation went from 13 down to 1.2. So huge clinical impact on how she felt and how she funked.

1:31:52You wouldn't normally think Hashimoto's thyroiditis would be responsive to diet and fasting, but it is. And was it her follow-up long-term? Well, right now, this paper was just published in 2023. So she's continued to do well so far, but we don't have long-term effect. Some of these other cases where we've been tracking them for 10 years, it's obviously quite impressive. I wanted to point out though, that we have cases that we've published here where we just did the diet. So in other words, they didn't even involve prolonged water-only fasting. One was an 82-year-old gentleman who had atrial fibrillation, all kinds of cardiac-related symptoms, hypertension.

1:32:36We put him on the diet only and then took him off his medications. He was on a number of medications, weaned him off his cardiac medications. And not only did he completely normalize his blood pressure and his cardiac rhythm and get off all of his medications, but they thought he was having dementia, he actually woke up because he wasn't having dementia at all he was having polypharmacy he was having negative reactions to his host of medications that he was taking so there's here's a guy who ate carefully uh our medical doctors helped him wean his medication safely and what was fascinating we submitted this uh case report this is also the british medical journal and one of the reviewers said wow what an impressive case but what made you suspect it was the drugs wow because these are medications that uh people are commonly uh you know put on uh you mentioned you know uh carotid lesion on on a face that often these lesions just fall off during fasting again you know these products are more common in patients that have active inflammation fast intends to reduce it the body's able to stimulate the healing responses and so we'll get you know, impressive cases like plaque psoriasis, which is a disfiguring, really dramatic condition.

1:33:51Most doctors will tell you diet has nothing to do with it. Or maybe they might say, well, maybe you shouldn't eat too much dairy products or something. Where we have in the photos that are present on the study show within 10 days of fasting, you're starting to see changes. And then two month follow-up and just dramatic resolution of plaque psoriasis that sustained as long as people are willing to do a health promoting diet. That's very interesting. A lot of people suffer from that and it's very resistant to treatment. People spend years trying to figure out how to resolve it, many unsuccessfully.

1:34:26And we found that it responds consistently and it is difficult. It's not an easy condition to treat, but it does respond. And we've had significant clinical responses to it. And it's not like shocking to me Because autoimmune diseases, diseases where the body's attacking itself, are often associated with gut leakage. Where proteins get absorbed and in genetically vulnerable people, the immune system reacts inappropriately. And most of your itis conditions are essentially autoimmune conditions. Whether it's Hashimoto's thyroiditis or vasculitis or rheumatoid arthritis or asthma or eczema or plaque psoriasis.

1:35:02These all have this gut leakage that appears to be a part of the component. When you fast, the inflamed gut gets to heal. And then when you go on a whole plant food SOS-free diet, you don't have the oxidative damage that's coming from the highly processed foods and the animal foods. And so you're able to manage the condition. If you take those patients and put them back on conventional diets, so oftentimes their symptoms recur. So I don't think you're curing it, you're managing it. Just like you can't cure obesity. You can lose the weight and keep it off, but go back to the old diet, guess what?

1:35:32You're gonna get overweight again. Have you had success or experience with people that have other forms of bowel disorders like ulcerative colitis, other things that are related, leaky gut, et cetera? Irritable bowel, chronic constipation, ulcerative colitis are some of the conditions that we have the most experience with because these are conditions that typically don't respond well to conventional medical treatment. We tend to get the people that have tried everything and they're desperate. And that's traditionally been our - Yeah, I know people that have struggled for years trying to figure out a way to get it under control.

1:36:03Getting it under control is easier than keeping it under control because keeping it under control requires dietary control. That means things like gluten and wheat and sugar, keeping a whole plant food diet going. And then there's another problem is many of these conditions are also aggravated by the hormonal changes associated with chronic stress. So when people are under chronic stress, they have a different hormonal production and stuff that makes them vulnerable to lots of things. And so some patients have to actually change their life So they're not driving two hours a day to a job they hate and working in places they despise, doing things they don't wanna do.

1:36:40They have to actually find things that give them joy in life in order to be able to get well and stay well. Right, so fasting isn't this panacea that heals all. And one of the things you're always quick to say is that it's a practice, not a magic pill, basically. I mean, it's pretty dramatic, the results here, but I think it's important to place it in context of all the other kind of co-founding factors. It's dramatic because you're dramatically changing the diet and lifestyle. It's an environment to dramatically change the diet and lifestyle. And so if you don't change the diet and lifestyle, you won't see the sustained results.

1:37:20If you just change the diet and lifestyle, sometimes it'll take care of itself eventually. Fasting, as I see it, is a way to happen faster. It's sort of like psychedelics are to meditation. It's a super highway to the same destination. Is that a fair analogy? I don't know anything about psychedelics. I don't know from personal experience, but basically it allows you to access a certain state that you could achieve through, you know, a very devoted practice of meditation over a long period of time, but you can reliably and immediately achieve that instantaneously. Yeah, I don't know if it's instantaneous, but I do think that the fasting is a great facilitator.

1:38:01And like I say, I would always encourage people, and we do, to adopt the diet and lifestyle changes. And if you get to the point where you're frustrated because you're not making adequate progress, then we can talk about whether it's coming to the center in fasting or now we have the opportunity for people to fast remotely, which has also been helpful to people that maybe can't come to California or don't have the resources. And that's through our telemedicine practice, which since our conversation three years ago, we've had to dramatically expand. And so now we have doctors familiar with fasting that are able to help people where they are, go through, if they're appropriate candidates, go through fasting.

1:38:36Now they have to work with their local doctor. So it still requires the same protocol, history, exam, lab, monitoring, rest, proper refeeding. The problem with remote fasting isn't that there's any problem fasting, particularly if you have a supportive doctor, you can get the lab, you can do the stuff. It's getting people to rest. sometimes it's hard for them not to be too active it's and then most critically getting them to refeed properly after fasting too rapid a return to alamation can lead to refeeding syndrome and other problems that can be serious or even fatal so it's important if you're going too fast on your own that you use the same protocol that we use at true north house center which is why we've written this new book can fasting save your life and in that book as you saw we have detailed protocols that the patient's doctor can use to explain what kind of testing and monitoring needs to be done so that they can make sure that that gets done.

1:39:29It goes through the side effects, the concerns, adverse events. The data's all there. It summarizes all of this literature that we've done, literature other people have done on fasting, and it's brought together in a cohesive manner. And so people can read that book. They can share it with their physician. They can use our coaches through the telemedicine practice to provide them personalized support because their doctor may be able to help them monitor them medically. They're not going to know how to deal with the issues that come up in fasting. Sure. And it's not an inpatient situation. So they're not there monitoring them multiple times a day.

1:40:02Well, it means there are certain people that maybe wouldn't be good candidates for that. And we would encourage them to come inpatient. But there are many people that are relatively healthy that are not on medications. They might be a good candidate for a shorter fast at home. And we've done other things. We've made all of our daily lectures freely available to anybody through our website. We use live streaming. So we're live streaming our lectures so they can get the benefit. We have a Roku channel now, freely available, all of our recorded video so they can get the educational experience. They just have to have a home environment where they can rest.

1:40:33I mean, it's not, you can't take care of four kids and, you know, commute, drive to the store and do all that kind of stuff if you're fasting. You have to be able to rest. But if you can, and you have a supportive doctor and you utilize our telemedicine coach, that is a way that we've been able to successfully help people like we had a huge problem during the pandemic 15 of our patient come from foreign countries they couldn't come into the country and so we were working with remote doctors and we were able to successfully help people that you know really needed that now there are some limitations we don't do long you don't go over three weeks uh with remote fasting because it gets more complicated as you get deeper we don't do it with people that aren't stable off medications and we don't do it with people that are poor candidates for fasting.

1:41:15So, but for the right person, this is another way for them to get that experience. I would imagine an additional challenge is finding a supportive doctor. Like how many doctors are actually going to be supportive when the average person goes to their GP and says, I want to do this thing. The book hopefully will redress some of that, but I imagine that that patient is going to experience some resistance. We have a number of doctors that have trained with us through residency internship programs that are out there in the world. There's also the College of Lifestyle Medicine, whose many of their doctors are supportive of fasting.

1:41:50There's also some of the integrative medical doctors out there that have become more supportive of fasting. And remember, Walter Longo has 10 ,000 offices making Prolon available. Many of those doctors might be supportive. And then once a doctor has one patient and they have success, all of a sudden we're seeing all kinds of their patients. Now, again, some people are better candidates for inpatient care. Some people are fine for outpatient care. And one of the benefits of the free consult that I do with people is to help them. Are they a candidate for fasting? Are they a candidate for home fasting?

1:42:23If so, then we can hook them up with a doctor that provides those services. If they really need to do it inpatient, they can come to the center. They can go to the other places that do this kind of thing. Or maybe what they need to do is just adopt the diet and lifestyle principle long enough to where then they become a good candidate for those changes. So we're trying to make sure that whoever does it, does it intelligently and does it safely. Not everybody's going to follow our advice, but at least we can feel good that we've done our best to make the educational services available to everybody, to make the services available to people at home that are good candidates for that.

1:42:55And we have a facility for people that are better candidates to come inpatient. Who isn't a good candidate for inpatient? so a person that's on medications that you can't safely withdraw for example if you've had a recent pulmonary embolism cardiac arrest you have atrial fibrillation and you're on an anticoagulant therapy medication you don't just stop those drugs because it can induce a stroke so it's very careful protocol to withdraw those meds and you don't fast on those medications because they can become like many medications greatly potentiated during fasting they will work differently in the physiology of fasting than they are in the physiology of feeding.

1:43:31And so fasting medications don't go together. There are a few exceptions. Sometimes we'll allow some hormone replacement therapies like thyroid replacement therapy stuff to modify the dose and monitor it. But it's not an absolute barrier. But we discuss that in detail in Can Fasting Save Your Life. We talk about who's a candidate, who's not a candidate, what has to happen in terms of medication. But it's basically you have to get people stable off meds. You have to have people that have a condition that we believe are likely to respond to fasting. We don't want to be doing experiments on people, particularly remotely, unless we kind of know what their condition is and what symptoms they're likely to experience so we can educate them about that.

1:44:12You need to have a person that's willing to try to eat healthfully after fasting. It's no good to do a fast and then go on some crap diet and get terrible symptoms and then blame fasting. You know, I'm not interested in that. We're trying to actually get a good net long-term result. And that means we have to limit working with people that are willing to try to do these things. Not everybody's gonna be perfect. A lot of people are gonna struggle, but if they aren't gonna make a good faith effort, it's probably not the best thing to do. They should be doing some other kind of program that isn't gonna put them at risk.

1:44:44How do you make that determination during the intake process to gauge willingness? Well, first of all, they filled out a detailed medical questionnaire. So I have their medical history that I've reviewed. before I've talked to them. And we ask those questions in the questionnaire to gauge where they are. And also I've interviewed tens of thousands of people. I mean, essentially that's what I do is I talk to people on the phone about their specific issues and try to direct them in the right place. And I've been doing it for 40 years. I got a pretty good idea who's likely to behave and who's not going to behave and who's a good candidate and who's not.

1:45:21And, you know, witness that everybody that's walked into the center 25 ,000 people now for fasting probably close to 40 ,000 people overall everybody that's walked in has walked out so we're pretty good at making sure we don't bring in people that are not good candidates not everybody has an uneventful stay there are patients that have serious side effects that we have to deal with occasionally we'll have to hospitalize a patient if they get into an issue we'll get you know have to get the diagnostics done, whatever. But as the safety studies show, this is a comparatively safe process when it's done according to protocol.

1:45:58What is your personal fasting practice? I fast every day. So you never eat. I fast every day for 16 hours, or as close to 16 hours as I can manage. You're on a 65 year fast. I fast every year. So you do a 16 hour fast every day. Every day. So you eat between the hours of what and what? Well, I usually have, depending on which morning it is, because I play basketball in the mornings, but so depending how long the basketball goes, I'm eating between eight and nine in the morning. I'm not eating after five, 5.30 at night. So I have a window in there, a feeding. And then I don't have anything before or after dinner.

1:46:42So I do that every day. I fast once a year. I fast for a week. If I'm doing okay, no symptoms, then I'll stop it. If I have symptoms, I'll go however long it takes to resolve the symptoms. I don't like fasting. You have to rest when you fast. You can't play basketball. It's really annoying. My wife, Dr. Morano, is really strict about it because I fast. She's my supervisor when I fast and she won't let me on my computer. That's the hardest part of all. I let the patients have their computer. What do you do all day? I just lay around and meditate and rest and it's awful. but you know i don't have symptoms which is interesting because i've done this i mean i've you know i never smoked never had a drink i never you know i've been a vegetarian since i was 16 years old so i i've not had the exposure so there's not a lot i don't use medications i don't use drugs so the fast itself is boring nothing happens in terms of untoward symptoms but you still have to rest and for me that's the big challenge is slowing down and and i and i do i I find it some of the most beneficial intervention I do is fasting, but it's not pleasurable.

1:47:46Sure. And your blood work is, yeah, it's gonna be. Yeah, my blood work's good. My blood work's great, my blood pressure's great. But again, I started as a kid, so you would expect it to be. You've been doing this a long time. It's so interesting. It seems so severe and radical to undergo these things, but so many people, thousands and thousands of people have benefited from what you're doing. You practice it yourself. What is radical though? Radical is radicus. It means root or cause. That's the fundamental thing we're doing is we're actually getting to the reason people have these problems. We spend all of our time and money treating the leading causes of death, heart disease, cancer, stroke, diabetes.

1:48:32Instead of the leading cause of death, we don't deal with the actual causes of death, which is smoking, drinking, eating animal foods and highly processed refined carbohydrates. If we put our time and energy treating the actual causes of death instead of the leading causes of death, we'd probably be a lot better off. The reason isn't going away. We talked about the statistics earlier. They're quite dire, but I don't see an eradication of highly palatable ultra-processed foods disappearing from our food environment anytime soon. If anything, it just continues to metastasize and people are getting more and more sick and fatter and fatter.

1:49:10It doesn't appear to be headed in a great direction, which demands these types of interventions to save people's lives and get them on a different track. what is your prescription for the world? Like, how are we going to, as a collective, conquer this challenge that we have in terms of our food system to create something better? I mean, honestly, for the sake of humanity. Yeah, you know, to me, if I look at humanity as a whole, it would be very stressful and I don't like stress. So what I do is instead, I look at the fact that I'm gonna do everything I can do to influence the one or one and a half for 2 % of the population that are hungry for information, willing to make these changes and hope that if we can get those people optimizing their health, that they'll set a good example and the 100th monkey effect will kick in and maybe it'll have some downstream effect, maybe not in this generation, but in future generations.

1:50:05So I'm not gonna try to take on the world as a whole. I only wanna work with the highly motivated people that are willing to do what it takes to actually get and stay healthy and prove that this is an approach that can help them, you know, spend the last 20 years of their life, healthy and happy. And to kind of end this, maybe look to camera and say, what is the message that you want the person who's listening to this or watching to understand? Maybe that person has their own health challenges. They're trying to figure out what to do about it. They're a little bit scared or intimidated by what you shared and aren't really sure-footed about how to take that first step or where to begin.

1:50:46Well, health results from healthful living. So if you want to be healthy, you've got to pay the price and live healthfully. That means diet. Our particular version is a whole plant food SOS free diet. Other people have different opinions, but a healthy diet, hopefully. Regular exercise within your capacity. Abundant sleep. So developing the ability to get to sleep in a cool, dark, and quiet place and maintain good sleep hygiene. Fast every day for 12 to 16 hours. Fast occasionally is appropriate. and try to figure out strategies to minimize stress, perhaps by only focusing on the things you can do something about and not worrying about the things that you have no potential to control.

1:51:25I think we covered it. Is there anything we didn't get to that you feel compelled to share or talk about? No, I think this book that we've written is a really good book. I hope people read it. I hope they like it. And I'll be interested to hear what feedback we'll get after this show. The book is great. It's called, Can Fasting Save Your Life? Everybody should pick it up. We'll link it up in the show notes and in the description below the video. You can go to the True North website to learn more about everything that Alan is doing and the center there. Maybe they can find the email on that website if they wanna get in touch with you.

1:52:04Yeah, if they wanna - What's the best way? What they go is they go to truenorthhealth.com. They fill out the registration forms, which gets me their medical history. and we offer them a no-cost screening call so that we can kind of give them, help them review their options and point them in the right direction. That's great. You're doing great work. You are truly a servant to humankind and I appreciate what you're doing and the gift that you're sharing and thank you for coming here today and getting into it with me. I think people are gonna really enjoy it. Thank you. Yeah, it's great. Thank you.

1:52:37Peace. Peace. Peace. Thank you.

1:53:11in the Plant Power way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and or comment. This show just wouldn't be possible without the help of our amazing sponsors who keep this podcast running wild and free. To check out all their amazing offers, head to richroll.com slash sponsors. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful. And finally, for podcast updates, special offers on books, the meal planner and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com.

1:54:00Today's show was produced and engineered by Jason Camiolo. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg, graphic and social media assets courtesy of Daniel Solis. And thank you, Georgia Whaley, for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants. Namaste.

1:54:37Thank you.