3 intermittent fasting mistakes that cancel fat loss and stop you seeing the benefits | Prof James Betts

23:30Prof James Betts:And in particular, you can have a problem if you're missing phosphate, magnesium, sodium, potassium. So when we do those studies, they were plain water only, but we give people some vitamin tablets to take during the time. Otherwise, when you eat afterwards, you can get something called refeeding syndrome if you've eaten the wrong thing after fasting. So it's worth mentioning that. But yes, short answer is for me, fasting is plain water only. Well, so first I'm definitely picking up that fasting from Monday to Friday is not something to try at home without some careful supervision. Is that what you're saying, James?

24:07Prof James Betts:Yes, I think so. I mean, many people actually, although we think that's awful, I mean, many of us have probably just been unwell for two or three days where you haven't been able to eat for two or three days. And some people say, I couldn't miss a meal. I couldn't skip breakfast. But actually, like we said at the very start, human physiology is actually quite well adapted to periods without food. So we do surprisingly well without that. When we talk about people fasting for their health, as opposed to for your studies, do you feel that coffee and tea needs to be excluded during these fasting periods to get the health benefits?

24:45Prof James Betts:No, I don't think so. It's really useful from a scientific perspective to control things. So we try and separate the fast from the weight loss, from the energy deficit, from caffeinated drinks. But actually, when we do come to talk about what you would actually recommend someone does, then I wouldn't see a reason to exclude those. Not least because some of those caffeinated beverages have some of the phosphate and so on that you wouldn't want to be missing. But caffeine, of course, can also help energize us without the calories. So if you were concerned that you might be a bit lethargic by fasting and reduce your physical activity, which we've seen in several of our studies, maybe the caffeine would help avoid that.

25:25Can I move on now to your answer about breakfast, which is, I've decided, highly divisive amongst scientists, including quite cutting-edge nutritional scientists. and that's because I think there's this message about it's the most important meal of the day and then other message about well it's almost sort of been invented by Kellogg's I've heard both of these things and that it kick-starts your metabolism is there any truth to any of this

25:53Prof James Betts:everyone's grandmother doctor everyone else has always told them breakfast is the most important meal of the day and it's just so common in the public psyche we all believe it and so we went ahead and did a series of experiments called the Bath Breakfast Project, where we really tried to take that apart and understand, is breakfast actually causally linked? So if you decided to start having breakfast, if you didn't already, or if you decided to stop, if you already had breakfast, is that going to change your body weight? Is that going to change your metabolic health? And so we did that using a method called a randomized control trial, where we recruited a load of people, we had them have breakfast every day for six weeks.

26:35Prof James Betts:And the other group had to skip breakfast every day for six weeks. And it was quite an extreme difference. Our fasting group couldn't have a single calorie until midday, every single day. And our breakfast group had to have 700 calories by lunchtime and 350 of that had to come within a couple of hours of waking up. So we had quite a clear difference between our breakfast consumers and non. So in terms of health, there wasn't a big difference. We saw some slight evidence using continuous glucose monitors that maybe glucose control was slightly better in the afternoon when people have breakfast.

27:14Prof James Betts:And we took some samples of fat from people's tummy, just a few fat cells, which we could then treat on the bench top and see how sensitive to insulin they were. And there was some evidence that the breakfast consumers had fat that responded to insulin better. But all the standard stuff that your GP would measure, your cholesterol, your glucose and insulin, and including with repeated meals. So we tested people with a breakfast and a lunch meal based on a follow-up, no difference between groups. And the big thing people are interested in is body weight then. They would wonder if you have breakfast, are you more likely to lose weight?

27:52Prof James Betts:And we repeated the experiment in lean people and obese people, and we found kind of opposite responses in a way. So with the lean people, if they started skipping breakfast, they lost weight. And with the obese people, skipping breakfast did nothing, but having breakfast caused a gain in weight. So there was some evidence for weight change there, but it certainly wasn't in favor of having breakfast. it wouldn't say that having breakfast is a good way to lose weight. So you're saying that people living with obesity, actually, if they skipped breakfast, they stayed pretty much the same. So what it shows there is that those people are more likely to compensate for that.

28:30Prof James Betts:So if you take away the breakfast, they would eat more later in the day and become less active to maintain their balance. Whereas if they were having the breakfast, then they would gain weight. And so that link to physical activity was actually one of the really interesting findings that we had was that skipping breakfast for both groups causes people to become spontaneously less active in the morning. So one of the benefits, if you like, of having breakfast could be that it just makes you naturally slightly more active during that period. So we've seen that in a few studies now that prolonged fasting periods do tend to make people just lose a bit of the movement, a bit of the physical activity in their lifestyle.

29:11Prof James Betts:And I think people could use that information to say, well, therefore I'll have breakfast because it will make me more active. If you're trying to help your dog lose weight, you could just do it that way. But of course, we're more intelligent than that. So if a person is saying, well, I'd like to skip breakfast because it might help me lose weight, but my concern is I'd be less active, we'll just make the simultaneous decision to try and be more active. decide to park that bit further away from the building and to take the stairs rather than the elevator and so on at the same time as fasting I think would be the combination.

29:43Could we start to talk about what's happening in the body when we fast because I think that's tied into like this theory about like the health benefits could you help us to understand this?

29:55Prof James Betts:So I think a good place to start is to recognize that you know anyone sat here now listening to this to think about what fuels you're using for your metabolism. Now, although there's several places in our diets where we can derive energy, including protein, we don't actually get a lot of energy in our diets from protein. All of us are sitting here now pretty much using a mixture of carbohydrates and fats. If you've been fasting a while, you might be more using fats. If you've been very reactive and eaten lots of carbs recently, you might be using pure carbohydrates, but most of us are somewhere in the middle using say half fat and half carbohydrate.

30:37Prof James Betts:If we then start a day and start to fast, so we miss breakfast, even by lunchtime, that would have shifted more towards the fats and you're using fewer carbohydrates for your energy. And then certainly if you miss lunch too, and you're getting in, so now you've been fasting for not quite double figures of hours yet, but maybe kind of seven, eight hours without food, you're going right towards the fat end of things. And we can actually understand why that is from the availability of them. So on your body stored right now, you probably have one or 2 ,000 calories worth of carbohydrate. If we add together, and this would be in a full state, so adds up to less than a day's worth of energy.

31:17Prof James Betts:Whereas we have vastly more calories stored as fat on our bodies. Even for a lean person, this could be 75 to 100 ,000 calories worth of fat available. So I think that's the first step to say then is within that first day when it's coming through to bedtime without eating, you have certainly shifted to using a different fuel. So I'd say that's day one. You've increased your use of fats rather than carbohydrates. If you continue to fast then, now as your body's becoming depleted a little of its limited store of carbohydrate, you start to see some other responses. As you go into that second day, you then need to metabolize your fatty acids a bit differently.

32:02Prof James Betts:So instead of just using them as a fuel, some of them are converted at your liver into ketone bodies. And this is what people may have heard of ketogenic diets or keto diets. It simply means that your bodily carbohydrates are running out. And because key tissues like your brain need glucose, the one other thing that they could run on there is ketones. So you could turn some of your fat into ketones and you start to see those elevate just a little on the second day. So now you're seeing that you haven't just shifted from carbohydrates to fats, but this third fuel source kind of comes into play on day two or three.

32:39Why does anyone think that any of this would be good for you? Because these all sound like clever ways to deal with like our ancestors, you know, facing famine, but I've got a fridge. So why would I want to do any of this?

32:54Prof James Betts:We know that a lot of the poor metabolic health conditions that we see in society today are really due to excess, right? This, not just this permanently postprandial state, but a lot of people have got excess body fat, they've got fat deposition in their muscles. And so there's an excess in the body that can cause some problems. What the proposed mechanism is for part of the benefits of fasting is that you actually remove some of your stored carbohydrate. So you know, you don't have certainly a liver, but also muscles that are just brimming with carbohydrate. And because that's depleted, you've shifted to using fats, even to the point where you're using fats to undergo ketogenesis and make these ketone bodies.

33:39Prof James Betts:And that's the signal that you've managed to persist with a long enough fast for that shift. And so that then by degrading those fuels means that it's proposed that you get greater benefits for insulin sensitivity so you can control your blood sugars better. There has also been some suggestions that that would mean that you lose more weight. And in particular, not so many nowadays, but there was always some suggestion that maybe not only do people lose more weight, but they lose it more from body fat and less from losses in lean mass, like reductions in muscle availability. And what about inflammation, which I think has come up a lot on this podcast over the last couple of years?

34:24Can fasting help there?

34:26Prof James Betts:The studies that have been done don't show such clear effects. I mean, that's part of the process too, that there's an idea that you need to fast for kind of 14 to 16 hours or more. But once you switch to those lipid-derived fuels, the sign there that you've achieved that is that you have this increase in ketones that actually a lot of processes like that that are arguably either something that if you've got low-grade inflammation that's believed to be bad for health, you could suppress that. And then a related process that I think I've mentioned the term already, autophagy, which means self-eating.

35:02Prof James Betts:cells seem to activate this process after a day or so without food so consistent with when the ketones start to increase and this is a way that cells kind of recycle and regenerate which is believed to be good for health so yeah there's a few processes like that in terms of systemic inflammation and autophagy in cells which are believed to be good for health and there's some evidence that they might increase with fasting but the studies that have been done using the kind of diets that people might be recommended. We can't clearly say yet whether the fasting is what does that because we know that a lot of those things will change favorably just with weight loss and fasting diets do tend to elicit weight loss.

35:47What are the reasons that someone listening to this might consider fasting? What are the benefits that might cause them to think about fasting in the first place?

35:57Prof James Betts:I think that would come down to their goals. If a person is trying to lose weight or improve their metabolic health, or usually both. If those are someone's objectives, then intermittent fasting in its various forms is broadly effective. You know, almost all studies that have used it do show that people lose weight and get some health improvements. The question in the scientific community is how much of that is specifically to do with fasting, or is it just that fasting is one good way to reduce overall energy intake? So James, if I'm listening to this and I would like to lose some weight, I guess my first question was going to be, well, how much weight do people lose with intermittent fasting?

36:42Prof James Betts:How much would they lose? This does seem to be a diet that people can adhere to for longer periods, but certainly the majority of studies have been done over, say, a month. Some of the longer ones up to six months, But in the first month or two, people can be losing, say, 4 % to 10 % of body weight, depending on how extreme the fast is. But even if people are only losing half a kilo to a kilo a week, this is sustainable. So you don't want to suddenly lose weight and then pile it back on again. I was going to say, James, could you describe to us actually what would be a good pattern if you wanted to do that intermittent fasting in a way that I can sustain for six months or six years?

37:24Prof James Betts:So if you want the more effective ones, it is the case that having a greater number of hours back to back without fasting have been more effective for weight loss and for health gain. So any of the different diets you're looking at, if it's 5-2, go for the two consecutive days. If it's time-restricted eating, having a bigger window without food in the day, they're going to be more effective. And then that's down to personal preference. the person would know that the longer the fast, the better, but there'll be a point where that would break them and they can't stick with that. So having the kind of longest intervals between meals that you can sustain over time.

38:00What is sort of like the longest eating window that I can have that could still be beneficial, bearing in mind the way you described that for a lot of people, basically they're never getting into this sort of sense of being fasted at all because they're eating at 9, 10, 11 p.m. and then eating again at 7 a.m.

38:21Prof James Betts:Having a window of 10 hours or more, whether it's early or later in the day, is probably where you need to be to start accumulating that benefit of missing calories day to day. You're saying that if you have a 10-hour eating window, which means sort of 14 hours that you're not eating on either side, that's probably the starting point of where you would expect to see benefits in terms of weight loss. Yeah, more or less. There's variability around that in the literature, but that's the kind of numbers. You see most of these studies ask people to stop eating at some point in early mid-afternoon time.

38:56I think up till now, as we're thinking about advice, you've been talking very much about weight loss. If someone is thinking about health and long-term health, what should they be thinking about this?

39:06Prof James Betts:there's a handful of studies now really showing that not being in this permanent delivery of nutrient state but having on-off times might theoretically be kind of more natural for us if we can use that word i mean it's highly variable outcomes but does seem to be that the diversity in the gut seems to benefit from having that kind of thing we know that a lot of things in our diet are not good for our gut so any diet which is going to restrict those things and have long periods without them, it could be that just having a break from processed food for periods of the day is really what your gut needed to recover.

39:41And so do you, in general, as you're looking beyond just the gut and into these other things, do you see improvements in metabolic health for people who didn't need to lose weight?

39:52Prof James Betts:So if there are people with metabolic disease, diabetes, pre-diabetes, it does seem fairly clear that actually some of these intermittent fasting diets can improve those aspects of their metabolic health and make them slightly more insulin sensitive and so on. Then if we're thinking about people who don't have any metabolic disease as such but are concerned about their health, there are several studies showing improvements at a really mechanistic level when we've looked at things like insulin sensitivity where that seems to improve. But generally the actual profile of their metabolism as your GP might measure, the standard things, just looking at glucose control at a whole body level, don't seem to measurably improve.

40:35Prof James Betts:But that's mainly because you're dealing with people where there already wasn't a big problem there. So there might be a bit of a floor effect where it's either there's no potential to improve or the benefits are so small it's just difficult to detect them with a noisy intervention like this. None of these studies are perfect, but when you look overall, I think that's the pattern, that there are some specific parts of metabolism that can improve in otherwise healthy people. Generally bigger effects on those health outcomes if you're looking at people who are not metabolically so healthy, whereas the weight change side is as effective as any other form of caloric restriction.

41:13Prof James Betts:Even if you do a 24-hour fast, so fast for an entire day, the next day people only eat 10, 15, maybe 20 % more, not the 100 % more they'd need to eat to fully make that a waste of time. So people don't really make up for what they missed. That is, by the way, one of the issues with some of the studies that are out there is that it's really not clear whether participants in those studies were told to eat more or not on the Fed days. So I think that's something I'd like to see more of in future studies where we're actually told what the research participants were understood about what they were supposed to do on the Fed days.

41:52One of the things I've learned running a data-driven health science company is this. Small actions create compounding impact. Your hitting subscribe is one of those small actions. It tells the algorithm that this show matters. That helps us to reach more people. And it lets us bring you more science-backed advice. If this episode gave you value, subscribing is how you can give a little bit back. And we'll keep showing up every week to return the favor. Okay, let's get into it. Can I ask you this question about exercise and fasting? And you said that you've done some research and there's been this open question, like, is it a good idea to go and do exercise in the fasted state or actually is it a terrible idea and it's really important that you eat first?

42:39Prof James Betts:When you exercise, you use fuels, you deplete fuels, and that gives your body a signal to adapt and you can get benefits in terms of improved insulin sensitivity and fat oxidation and so on if you exercise to deplete fuels. If you then exercise in a fasted state, you start already without all those ingested fuels. If you and I went for a run in the morning and you've had breakfast and I haven't, we both run the same distance for the same time. The alarm bells at a cellular level in my body are going off earlier so that my liver, my muscles are sending out the signals like I've trained harder. And I might get more bang for my buck by doing the same amount of training.

43:22Prof James Betts:And so then the big debate is, but would I have trained as hard? So I think the way to look at that is if you're going to just be doing your kind of routine training, you're going to go for a run with a friend where you know how far you're going to go, where you're going to go and how fast, maybe do that in a fasted state and you'll get more benefit. But if you're doing your high quality training where you want to push yourself, maybe do that in a fed state or at least have some caffeine before because then you might actually push yourself harder and some of the benefits then will be greater because you push yourself harder and you did run further or faster.

43:56I've been trying this a bit and doing like one of my gym sessions first thing in the morning before I've had anything to eat. And the first time I did it, I was convinced that I would fall over. It would be impossible because obviously I'd need to have food before I was going to try and lift something heavy or the rest of it. And interestingly, as soon as I get into it, I do not notice any difference. And it's quite the opposite of what I sort of imagined.

44:23Prof James Betts:Yeah. These things kind of go hand in hand. There's a real synergy there that we're talking today about the benefits or effects of fasting and then layering on exercises. as well, maybe if you exercise it can facilitate the effects of fasting. The two go hand in hand because they're both aiming for the same thing, to deplete some fuel stores more rapidly so that then you get the benefits of having depleted them and turned over your glycogen. This is the stored form of carbohydrate in the body. So again, you could look at that philosophically that a sedentary person who eats all the time with this permanently fed state, their carbohydrate stores are just kind of stagnating.

45:01Prof James Betts:They're stuck in their muscle and their liver. Whereas what you really want to do is turn those over, use them up and replace them on a daily basis is a much healthier approach. One thing we haven't touched on is eating consistency, like eating your meals at the same time versus maybe moving them around. And we've been talking about eating windows. You said, you know, you're going to eat for 10 hours, you're going to eat for six hours. Do we know what happens if those eating windows aren't exactly the same. So let's say rather than saying I'm going to start eating at 11 in the morning and finish at 7 p.m., I like moving around because I'm going to do that the weekend, but maybe during the week I'll start eating at eight and I'll finish at four or whatever it is.

45:45Do we know anything about whether consistency matters?

45:48Prof James Betts:When you eat is important, not just in terms of time of day, but time relative to other meals, sleep, activity. it's most important that it's relative to when you usually do those things because your body your physiology becomes entrained to a certain pattern there's so many rhythms throughout tissues in your body and these are really helpful because it means that your body essentially learns your tissues learn they have these literal molecular clocks within tissues so that they know when light appears when the first meal tends to appear. So your cells across your different tissues in your body know if you're a breakfast consumer or not.

46:30Prof James Betts:They know if there's going to be a big wash of sugars and fatty acids at eight o 'clock, an hour after you woke up, or if that doesn't normally happen until lunchtime. So you can definitely condition your body to anticipate and expect nutrients to be there or not to be there at certain times of day. And then incidentally, that's one of the reasons that time-restricted eating might be favorable because if you're doing a 5-2 or alternate day fasting, you're kind of working against that physiology that your body wants to see repeating cycles day after day. Whereas if you did time-restricted eating where you say, well, this is every single day, I'm now going to eat at that time and not at that time.

47:11Prof James Betts:That's something that your body could become more accustomed to and then work more effectively with. So the consistency is likely to be better whether I've got a health goal or a weight loss goal than sort of moving it around every day. Yes. So that is the conventional wisdom. And you hear people all the time talk about kind of circadian rhythms and how we know there's rhythms in our body. And so being very regular with things and having a routine is really important. I've started to question that idea. yes you could do the exact same thing at the exact same time every day and then be very happy with yourself that you're aligning with your rhythms and you're all in synchrony and then real life gets in the way and you travel on a long-haul flight or just you go somewhere and can't eat at a certain time of day i'm also then wondering whether there could even be some value in occasionally doing things um irregularly um so that your your body yes has to be strained to adapt to the new feeding pattern, but maybe straining your body and training it to adapt to different things isn't the worst thing either.

48:18What do you make of olive oil during a fast? And I ask that because a lot of influencers on social media are saying it can boost this autophagy that you were describing as like killing of cells and also reduce inflammation.

48:32Prof James Betts:As we covered at the outset, I think the hard line as a scientist, as a physiologist is that fasting means no disruption of your metabolism by ingested fuels and olive oil is lipid is fat so you are taking calories in i think the rationale behind that would simply be that we know that there's a much more profound acute response to sugars so if you have sugars you get this episode of a load of hormones like insulin increasing and a really acute disruption of metabolism that's quite measurable and rapid whereas with lipids it's a more slow and steady response so there would be a change in metabolism, but not as clear.

49:11Prof James Betts:And maybe I think the reasoning behind having olive oil during the fast is that some of those processes that we were talking about as maybe important, like ketogenesis and autophagy, may not be as disrupted by that as having sugar. But it absolutely is breaking your fast. The question is just whether it's completely disrupting the objective of doing the fasting. And finally, is there a best meal to break a fast with? There wouldn't be a single best meal. There are certain considerations. One I alluded to earlier is if you fasted for a very long time, you could have some electrolyte imbalances.

49:57Prof James Betts:So if someone's fasted for multiple days, you do need to think much more specifically about what to eat. But I think here we're talking about the more routine 5-2 alternate day fast type meals, in which case we know that if you fasted for a shorter period, you'd be very insulin sensitive. So it wouldn't be like sugars are a huge problem there. If you've fasted for a couple of days, you get this a bit of a paradox where your insulin sensitivity goes, you become less insulin sensitive. So you wouldn't want a very high carbohydrate load at that point because your control of those sugars wouldn't be as good.

50:34Prof James Betts:Generally within a day though I think the main practical advice would be to acknowledge that you have banked this fast, you've got a period of calorie restriction which you're hoping for many people result in a deficit and elicit physiological responses that could be good for health. So I think the main thing is then just to recognize that you're probably feeling quite hungry by that point and maybe your dietary restraint won't be amazing so you would make not some of your best dietary choices and maybe eat quite a lot so I think while there's no one best meal I think the trick would be to have decided before you did the fast what you were going to eat and how much of it ideally then choosing something healthy because you're clearly motivated to do this fast you're probably feeling good about choosing making a good choice whereas Whereas the person you are by the end of an extended fast probably isn't best place to choose the foods.

51:32James, thank you so much. I'd like to try and do a quick summary. So the first thing that I'm struck with is this idea that we do so much of our science based upon looking at what happens with like mice and rats and then infer it for ourselves. But actually mice eat constantly and humans are designed just to eat a few times with like these big gaps between them. and that as a result, there's some really important things we're only just starting to understand as we think about the way that we really eat these discrete meals. And we therefore don't have all the answers that we thought we had. What we also know is that most people today, you know, living in the Western world, eating modern food are in this sort of fed state all the time.

52:16In other words, they're still just trying to metabolize the food that they've eaten and they're not back to their sort of fasted state they would have been when they first woke up. And that's really very different from the environment that probably our ancestors were in and has a lot of implications probably for our health and what's going on. And that for you, the interest in fasting is like, how could you start to be spending a lot less of your day in this sort of fed state and more of the time in this unfed state because that has a bunch of benefits. Our ancestors didn't eat to fuel their day.

52:55They had to like go out and do a bunch of things to get the fuel and then they would eat it. So this idea that you have to get up and have to eat food before you do anything else because we just can't function otherwise is simply not true. And you gave this example with exercise where potentially doing this exercise in this fasted state might actually be good for you. Like that very strain is actually helping out. And that in the same way, one of the reasons that fasting might be good is we have these sort of stores of glucose or something that can be turned into blood sugar really fast. And if it's never used up, it's just sort of sitting there.

53:30But if we can from time to time sort of deplete that and replace it, again, it may be like helpful. And I think this analogy a bit of like, you know, going to the gym, lifting something heavy hurts at the time, but is good afterwards. Then I think we talked a bit about the specifics of the fast. I think the really big message I got is you can't eat on a fast. There's no cheating. You can't have a bit of olive oil or anything else. Like there's got to be a fast. Like it can't be anything that is actually going to be giving you any calories. in your experiments you go so far that you can't even have like tea and coffee but actually saying for normal people you know that's fine and maybe the caffeine can help a bit to counteract some of this sense of being tired that you say happens in a fasting period that you therefore potentially do less exercise and that for anyone doing the sort of time restricted eating which we see a lot of i think being aware that you might be less willing to do physical activity before you cut into your eating window is really interesting.

54:29And so you probably need to think a bit more about what am I doing to make sure that I am walking or I am going to be doing some physical activity in that period because otherwise potentially I just sort of do a bit less and I'm maybe counteracting the benefit of this window. In terms of what fast there is, I think there isn't one right fast is what I took away from this and that there are range. You have an ability to fast for four days, which sounds pretty amazing. I know that I can't do that. But if we're thinking about this sort of probably most sustainable end of something you're doing daily, then you would say, think about this window of what you're eating.

55:09Maybe the benefits probably start with about a 10 hour eating window. You were saying, I think for that could start to have an impact if you're thinking about weight loss. If you can get to six hour window, that's probably like the most effective. This is a short period of time, but sort of most effective for weight loss. And then finally, I would leave it with this is relevant for people who are not worrying about weight loss, but thinking about health benefits that I think probably doesn't push it as tight on the windows as my takeaway. and that all of this is still relatively early in terms of the amount of science and studying.

55:48We don't have this data going back 50 years, understanding people who restricted their window for 10 hours every day versus not else. But you're pretty bullish about the benefits of some sort of fasting even as we don't yet have all of that data?

56:09Prof James Betts:Yes, I'm bullish on the benefits of it relative to doing nothing. So if someone's saying, shall I do this? Yes or no? I'd say yes. But if they're saying, well, I'm choosing between this diet and any other one, it hasn't been shown to be more effective, certainly for weight loss and for generally healthy people for health gain, not hugely better than just cutting calories at every meal. So if someone's thinking, oh, I really struggle with fasting, as you've said, then there's no reason to try it. You could just say, well, I'll reduce my calories at every meal. But yeah, if it's relative to shall I fast or not fast, there are benefits to doing that for many people.

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