More than two centuries ago Thomas Malthus predicted that food
production growth would fail to keep up with population growth and that the
world would suffer from mass starvation. He couldn’t have been more
wrong. In his native Britain, and in her former colony across the
Atlantic, our major drivers of mortality are not starvation related but rather
obesity related. Malthus and his allies were an almost perfect contrarian
indicator, issuing their dire warnings at the very beginning of the great
hockey stick curve take-off, about a danger which was the exact opposite of the
health crisis that actually occurred.
The developed world, with a few exceptions, is not underfed: it
is overfed, and we are now looking at an epidemic of the diseases which come
from excess body weight especially among the poor.
Before you cue the calls for a new round of spending for another
government program to deal with our health care crisis consider this: what if
the most powerful solution doesn’t cost anything at all? What if implementing
this solution not only involves no new spending but even involves
anti-spending, the elimination of a cost center? What if the solution was not a
newfangled invention, but the oldest dietary intervention known? What if the
solution was not secret, but the most obvious answer?
Dr. Jason Fung is a Canadian nephrologist. who was seeing an
ever-growing number of patients suffering from a combination of diabetes and
obesity (which have become so closely associated that members of his profession
have invented the moniker ‘diabesity’). They came to him when they advanced to
the stage of severity which leads to kidney failure. So, Dr. Fung gave them the
usual meds and hooked them up to dialysis and held their hand through the long,
‘progressive’ disease of diabetes with its kidney failures, heart attacks,
blindness, and amputations – all the bitter fruit of metabolic syndrome. But he
began to call into question the general consensus of the food pyramid, the
inevitability of decline and the focus away from life style towards medication.
The result of that research comes in the form of his first
book, The Obesity Code, which just was published in paperback, and
his new book, The Complete Guide to Fasting. Dr. Fung argues quite persuasively that we
are thinking of public health in the wrong way, that we have a 19th century
mindset which we are bringing to a late 20th and early 21st century problem. In
the 1800s people (those who lived to adulthood) tended to die of infections.
The antibiotic revolution came to the rescue and enabled us to give patients
pills to heal their diseases. If one problem can be solved with a pill than
perhaps they can all be solved with pills. A business model emerged in which
large corporations developed new compounds, filed for patents in order to
create temporary monopolies in that particular intellectual property, monetized
the IP, and waited for the patent to lapse as they sought out the next pill.
But the current plague of metabolic disorder, which Dr. Fung
says accounts for something like half of our health treatment industry, is not
an infection; and so far, getting people to swallow pills has had little
success. Perhaps the solution is instead of telling people to put one more
thing into their mouths, we should be telling them (us) to stop putting things into our mouths. Perhaps the
solution is fasting.
Fasting does possess a certain prima facie plausibility:
eat less often… lose weight. But it’s more than just a surface plausibility;
there has been a wave of research findings lately about what is called
‘intermittent fasting’, and so far, the findings are promising (Dr. Fung’s
books serve up generous portions of footnotes for people like me that want to
read the studies). The most common form of intermittent fasting (IF) seems to
be overnight fasting: stop eating at, say, 5 pm and don’t eat again until 11 am
the next day. That’s an 18 hour fast. Another slightly less popular version is
to eat one day and fast the next day. Some go longer, the staff of the Silicon
Valley Nootropic (supplements for cognitive enhancement) start-up company
Nootrobox fast together each week. They’re by and large young and trim, and not
focused on fear of weight loss. They do it for the cognitive benefits (more on
that in a future column). Some fasters go longer, one or even two weeks at a
time. Dr. Fung’s co-author Jimmy Moore did a 21-day fast leading up to the
release of the book.
It sounds hard, doesn’t it? I’ve been doing it since February of
2016 (what better time to start than in the Lenten season?), and I won’t say
that it’s easy, but it’s easier than I thought it would be. My wife and I
started out with 36 hour fasts centered on Fridays (eat dinner on Thursday
evening, don’t eat again until Saturday morning), which was probably pushing
things a bit too much too early. We stuck with that until we threw in the towel
a week before Easter. Then we switched over to overnight 17 hour fasts and
occasional 24 hour ones. Gradually we worked our way back to 36, then 48, then
60, and the week before last we did 72 hours together.
In fact, I’m fasting right now as I write this (it’s been almost
exactly 24 hours since I’ve last eaten). It’s just part of our regular Saturday
routine. (Be sure and let me know if you think that ‘starvation mode’ has
compromised the quality of my writing.)
We’re data people, so we monitor our blood sugar, blood
pressure, and our weight (and keep our doctors in the loop on what we’re
doing). Blood sugar levels have dropped substantially for both of us. Neither
of us were diabetic or even pre-diabetic, but levels were a little on the high
side, so we were pleased to find that they dropped about ten percent for both
of us. Weight has improved a lot, too (but for me there’s still a long way to
go). Blood pressure is largely unchanged but we both had good numbers already
so there was no need for change on that metric.
Fung’s book recommends a ketogenic diet as being more
comfortable for someone with a fasting lifestyle and I agree: this would be
much tougher if we were eating high carb. Before you give me the lecture about
eating a lot of fats, we are getting most of our fats from coconut oil, olive oil,
avocados and nuts, and my lipid profile has improved markedly.
The more I study the public policy confusion which has tied our
health care system into knots, the more I want to stay away from it. No, we
can’t avoid the whole system entirely, and there are parts of health care which
work pretty well, but I just find myself wanting to do everything which can be
done to avoid that Byzantine-verging-on-Kafka-esque system until it is
absolutely needed. I don’t like the costs (perhaps that’s what comes of having
adopted a health savings account a decade ago), and I don’t like the
incentives. Good people in the system do their best to do their best for their
patients, but that gets harder and harder with each new bright idea to fix the
system from the top down.
While smart policy advocates work on fixing the system and the
rest of us wait for them to succeed, we’ve decided to focus on fixing
ourselves. It costs nothing except saying ‘no’ to our desires from time to
time, and at least so far, it’s working.
I sat down across a Skype line with Dr. Fung recently to talk
about his new book, The Complete Guide to Fasting, and
his more academic work, The Obesity Code.
You can hear the entire interview here, and you can read a partial transcript
(edited for clarity) below:
Jerry Bowyer: The
United States transformed its healthcare system. Now it’s un-transforming it
back more in the direction of the way it was before, but with a lot of
uncertainty about where we’re going to end up. And Americans are
obviously very dependent on healthcare. It’s a system in which we tend to
run to the doctor for a lot of things. It’s a very expensive system.
And it occurs to me in talking to you, Dr. Jason Fung, about
your book, “The Complete Guide to Fasting”, which is just out now, and the
paperback edition of “The Obesity Code”, that the idea of entering into
intermittent fasting could be actually financially a very good decision because
treatment is very expensive, especially for a metabolic syndrome. So do
you have any thoughts on that?
Dr. Fung: Yeah,
I think the implications for the healthcare system in general, not just for the
United States, but really for the entire world, are enormous, because the
treatment, fasting, is free. And if you compare it to how we normally
treat these patients with medications and surgeries, the costs are huge.
And it’s not just one medication; it’s often multiple
medications. And if you look at the spectrum of disease that we’re
talking about, it runs virtually through everything. So the thing about
fasting, for example, is that it’s really targeted towards the healthcare
problems of today, because we’re stuck in a mindset of nineteenth century
medicine.
So if you look back at the diseases of the nineteenth century,
people were dying of tuberculosis, pneumonia, and infections. So the
treatment there is antibiotics. So when antibiotics came out then those
treatments were very, very effective. But we got into this mindset where
we have a disease and we take a pill to treat it.
So now we fast-forward into the twenty-first century, and we
still have that mindset. You have ‘diabesity’, let’s look for a drug to
give you so that you can take care of this problem.
But that’s not the problem. It’s the same thing with Type
2 diabetes, which is very closely related to the obesity epidemic. We
look for a pill or some drug that we can give you. But at their core, they’re
actually metabolic diseases, they’re actually dietary diseases. So giving
a drug to cure a dietary disease does not make any sense. And that’s
exactly what we see.
So for Type 2 diabetes and obese patients, we give them the
medications, but they don’t get better, because what happens is that they take
more and more pills year after year. So what happens of course, is that
the cost to the system keeps going up every year that these patients are there.
But instead, if you could make them lose weight — and we all
know this — those patients wouldn’t have these problems. They wouldn’t
have the Type 2 diabetes. They wouldn’t have the high blood
pressure. They wouldn’t have the cholesterol issues.
But the downstream problems of Type 2 diabetes cost a lot of
money. So keep in mind that Type 2 diabetes is the leading cause of
blindness; the leading cause of kidney failure and dialysis, which is very
expensive; one of the leading causes of strokes; cancers; heart attacks.
So practically a half of medicine — modern medicine — is related
to metabolic syndrome. So therefore, the implication is that you could
actually prevent all these diseases along with the human cost, but also the
financial cost, simply by spreading the knowledge that people can take care of
these problems, really, for free.
Jerry Bowyer: A
very interesting point you make. We’re still stuck in a — in an
antibiotic pill mindset. You take a pill for things. But in many
cases, the answer for metabolic syndrome might be not putting anything between
your — between your lips, but instead not swallowing anything for a while,
except for water and maybe a little bone broth or some tea.
Dr. Fung: Exactly.
And the thing is that if you don’t eat, then your blood sugars will come down
and you don’t need to take that pill. If you don’t eat, you’ll lose
weight; and if you lose weight, you’ll have less knee problems, you’ll have
less hip problems, you’ll have less back problems, for example. So all
those knee replacements, hip replacements, all those problems actually go down.
And the thing is that it’s a different mindset entirely, because
again, you got to keep in mind that nineteenth century medicine is how to cure
illness. So you get sick, you take a pill; whereas really what we need is
a treatment to keep people well. Right? It’s a wellness cure.
We want people to stay well rather than develop an illness and
get better. But we treat diabetes and obesity as illnesses rather than
kind of this failure to stay well. And that’s what fasting is
about. It’s kind of like a preventative sort of treatment to prevent all
these issues from becoming a problem down the line. It can be used in a higher
dose, to reverse these conditions; but really it’d a way of staying healthy
rather than a way of treating illness.
Jerry Bowyer: Sometimes
it seems to me as if there’s really one great modern mono-illness, and that is
this whole octopus of too much sugar, too much insulin resistance, too much
obesity, and then downstream from that, the diabetes, the heart disease, maybe
even the cancer.
Dr. Fung: Yeah.
Jerry Bowyer: There’s,
you know, increasingly evidence of a metabolic input to cancer. If we solved
this one, we could shut down, I don’t know, fifty percent of the hospital
capacity in this country because of all this downstream stuff. But I
hadn’t thought about the skeletal problems: hip replacement, knee
replacement. That’s also, in some sense, a metabolic disease, because of
all that stress on the joints from the extra weight.
Dr. Fung:
Yeah. If you’re carrying 50 pounds of extra weight or 100 pounds or 200
pounds, sometimes, every day, for ten years, that’s going to put a lot of wear
and tear on your knees, right? The knees take it all, the hips take it
all, the back takes it all, and those are big issues that have to be taken care
of, absolutely.
Comments
I like to
eat two small meals a day. They always include some protein. In addition to a multi-vitamin, I make sure I
also take my daily requirement of minerals.
This stuff works.
Norb
Leahy, Dunwoody GA Tea Party Leader
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