Water Fasting Scientist: Surprising Link Between Fasting & Cancer! Fasting Completely Resets Your Gut Microbiome!

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Host (Steven Bartlett): This is the most effective treatment that's ever been shown in treating the leading cause of death and disability, which is high blood pressure. It also reduces insulin resistance. It can enhance cognitive capacities, and you also see it affecting things like depression and anxiety. It's called fasting, and there's more. Fasting introduces not just a chance to lose weight. It also mobilizes visceral fat, which is the fat around the belly and the organs, which is giving off inflammatory products that's causing heart disease, cancer, diabetes. And many people are maintaining higher visceral fat than what they should be. So I've spent 40 years helping people get healthy and I can tell you that I think you should be fasting every day.

Guest (Dr. Alan Goldhamer): So tell me about that then. But also, isn't the game here just to not eat as much?

Host (Steven Bartlett): Well, here's the problem. Dr. Alan Goldhammer is a pioneering physician who has spent his life helping thousands of people reverse chronic disease, eliminate medication and reclaim their health using one of the most ancient healing tools known to humanity. Today, we live in a world designed to make you fat, sick, and miserable, where 76% of people are overweight or obese, and where people think that health comes from pills, potions, and powders. And yet most of us are ignorant of the proven health benefits of fasting. In fact, if you look at all the chemical changes that happen with exercise, they also happen with fasting. Things like increasing BDNF, a neurochemical protecting the brain from Alzheimer's disease. And what about water fasting? So people that have not been successful resolving their conditions with medications including patients with polycystic ovarian syndrome have been profoundly affected by water fasting and we'll go through fabulous research but one thing you want to realize is that all human beings have the capacity to fast.

Guest (Dr. Alan Goldhamer): Okay, so let's run through the unique selling points versus any other diet or intervention.

Host (Steven Bartlett): Let's do it. Just give me 30 seconds of your time. Two things I wanted to say. The first thing is a huge thank you for listening and tuning into the show week after week. It means the world to all of us, and this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here, please join the 24% of people that listen to this podcast regularly and follow us on this app. Here's a promise I'm going to make to you: I'm going to do everything in my power to make this show as good as I can now and into the future. We're going to deliver the guests that you want me to speak to and we're going to continue to keep doing all of the things you love about this show. Thank you.

Host (Steven Bartlett): Dr. Alan Goldhammer. My first question is who are you and what have you spent the last four decades of your life doing and why?

Guest (Dr. Alan Goldhamer): I've spent my entire life really focused on one topic, and that's this idea that health results from healthful living. I got interested really young. I was in elementary school, and I had decided that I wanted to pursue this as a career. And when I finished training in the United States, I had an opportunity to go to Australia, and I studied with a guy named Alec Burton, who was the world's leading expert in the use of medically supervised water-only fasting. And I saw things there that weren't supposed to be happening. People were getting better. I saw people with chronic diseases like high blood pressure resolving their hypertension, getting off the medications. And so we began to carefully evaluate patients with hypertension. In this study, 174 consecutive patients with high blood pressure and 174 people normalized their blood pressure without the need for medication. After we published that paper, we went on and we've published a couple dozen papers now on the use of diet and fasting in the literature. And we've written a book, it's called *Can Fasting Save Your Life?* Which summarizes our work and other people's work on this use of fasting to help the body do what it really does best, and which is heal itself if you get out of the way.

Host (Steven Bartlett): So fasting, the word has become incredibly popular, but there's a variety of different types of fasting. So what is the type of fasting that you spend most of your time doing, working on, administering to patients?

Guest (Dr. Alan Goldhamer): Well, fasting is the complete abstinence of all substances in an environment of complete rest. So what does that mean? That means that you're actually resting while you're fasting in order to get therapeutic fasting to be most effective. And the reason is, if you're very active when you're fasting, your body has to produce more glucose in order to carry on the extra muscular and brain activity. And the only way that it does that after glycogen reserves are depleted is through a process called gluconeogenesis where the body breaks down lean tissue. So when you're fasting, if your goal is to maximize fat loss and minimize lean tissue loss, it's important that resting be a part of the protocol. It's true, if people are more active when they're fasting, they'll lose more weight, but that extra weight won't be fat, it'll be lean tissue.

Host (Steven Bartlett): So what happens to the body when someone fasts? And can you give me like an hour by hour or a play by play in terms of what actually is the sort of physiological sequence of events that are beneficial for one's health?

Guest (Dr. Alan Goldhamer): So it's a really interesting, fairly well studied and complex physiological adaptation that human beings make to fasting. Normally, your brain burns glucose.

Host (Steven Bartlett): Which is what I get if I have a piece of bread or a bar of chocolate.

Guest (Dr. Alan Goldhamer): Or if you break down protein, which can also break down into glucose, which is what happens after 24 hours of fasting. You've depleted your glycogen stores, the sugar stores in your muscles. And so then the body, in order to get the glucose it needs, has to either convert to burning fat or break down muscle in order to form glucose. What the human being does is it converts its main burner of glucose, which is the brain, from burning sugar to burning fat. Now, if it didn't do that, you could fast about a week. You'd enter starvation, deplete your protein stores, and you'd starve to death. Because you can convert your brain to burning fat instead of sugar, a 70-kilogram male can fast about 70 days. Now, that doesn't mean they should fast 70 days, but they could fast up to 70 days because your main burner of glucose, your brain, will convert to burning a completely different fuel, which is fat.

Host (Steven Bartlett): So let me see if I've got this correct. So if I'm on a typical American diet, I'm going to be eating lots of things, and my body's going to be breaking that down into this fuel source called glucose. If I stop eating the glucose, my body has this sort of evolutionary switch where it's going to start burning my fat and turning that into this thing called ketones, which my brain can run on as well.

Guest (Dr. Alan Goldhamer): That's correct. And you have about 24 hours of glycogen stores or sugar stores in your muscles, in your liver. So when you stop eating, for the first 24 hours, you're still able to produce glucose from your glycogen stores. But once you've depleted your glycogen stores, now you're stuck. You either burn fat or you break down lean tissue. Now, because the human brain is so ridiculously large—I mean, it's two and a half times a chimp's burn. It's a huge glucose-burning machine. You had to have a way of being able to use some kind of other fuel for that brain. Otherwise, the first time spring comes late, all the human beings would have died. And so this biological adaptation was clearly important for our survival in large part because we have disproportionately large brains that burn ridiculous amounts of glucose.

Host (Steven Bartlett): Just because the body does it as a survival mechanism doesn't posit that it's necessarily healthy though, right?

Guest (Dr. Alan Goldhamer): Absolutely. And what we've done, though, is we've taken this biological adaptation, which by definition would be something the body's capable of doing safely and efficiently, and utilizing it in a very unusual situation. And that's where people have consistently been exposed to dietary excess. In the world of our ancient ancestors, getting enough to eat and not getting eaten was the biological imperative of life. It was difficult to get enough to eat. In fact, most human beings that were born, modern humans, probably didn't live to reproduce. They didn't pass on their DNA. We're the results of the winners. Most people, starvation, predation, had all kinds of challenges that would prevent people from reaching reproductive age. Taking a biological adaptation, something that's natural to the body, and applying it in a situation where people had consistent exposure to dietary excess.

Host (Steven Bartlett): When you say dietary excess, you mean too much calories?

Guest (Dr. Alan Goldhamer): Too much calories. In fact, the diseases that we suffer today, the heart disease, the diabetes, the autoimmune diseases, some of the cancer—these used to be rare conditions that were called the diseases of kings. It was the wealthy elite kings that could consistently overeat that would get the gout, that would get the heart disease. These weren't common conditions that were present for the peasants. These were rarefied conditions. They've become common conditions because now people are consistently being exposed to dietary excess. And more importantly, we're fooling our brain satiety mechanisms into overeating by putting chemicals in our food. And as a consequence, we have a situation today where 76% of people are overweight or obese. And the extra fat comes with something called visceral fat. It's the fat that tends to accumulate around the belly and the organs. And it's pro-inflammatory, hypermetabolic, hypertrophic. It acts like a tumor. You have people walking around, maybe they have 20 pounds of extra adipose tissue. They have two pounds of visceral fat. And that visceral fat is giving off inflammatory products that's causing heart disease, cancer, diabetes, autoimmune diseases. And what's weird is these conditions are treated as if they're completely independent, unrelated conditions. You have to go to a different kind of doctor to be even diagnosed and treated with these conditions. And yet they all seem to be associated with dietary excess, excess fat, excess visceral fat, and the inflammation that's associated with that visceral fat.

Host (Steven Bartlett): Let's run through what happens inside the body when I start fasting. And then I want to talk about fasting in a little bit more specifics, but what's going on in the body? So you said in the first sort of 24 hours, 48 hours, my body is going to switch from using glucose as a fuel source to ketones. It's going to predominantly shift the brain and liver muscles are going to begin shifting. It's a progression depending on your glycogen stores. So within 16 hours, 24 hours, up to 48 hours, in that transition, you'll be going from burning almost exclusively glucose in the brain to burning predominantly byproducts of fat metabolism, ketones, and specifically beta-hydroxybutyric acid.

Guest (Dr. Alan Goldhamer): Is that basically ketones?

Host (Steven Bartlett): Ketones break down into different components. Beta-hydroxybutyric acid becomes the predominant fuel of the brain. It's a byproduct of fat metabolism. And the higher your beta-hydroxybutyric acid is, the more BDNF is produced. BDNF, brain-derived neurotrophic factor, is a neurochemical that's thought to be protective in the brain from oxidative damage. So that can result in things like Alzheimer's disease and dementia. And they do rat studies. Rats in a cage, 30 rats, both cages, everything's identical. They give half the rats a wheel. The rats with the wheel will run on the wheel and they don't get Alzheimer's disease. And they said, why? What is it about the exercise that's preventing these rats from getting oxidative damage in their brain that results in dementia, or Alzheimer's type disease. And they found it was BDNF. It's dramatically higher with exercise. It also goes up with fasting. In fact, it's interesting. If you look at all the cardiometabolic improvements that happen with exercise, the chemical changes that they, they also happen with fasting. And that's not intuitively obvious because in fasting, you're resting and exercise, you're vigorous. You might say, what do these two seemingly unrelated phenomena have in common? And what I think is going on is that both exercise and fasting undo the consequences of dietary excess. They reduce the fat, specifically the visceral fat, and the inflammation that leads to all these different diseases. And so every time you look at the benefits of exercise, you oftentimes see these corollaries with fasting.

Host (Steven Bartlett): And at some point in this fasting process, your body moves into a state of autophagy. I've heard that word a few times. What is that?

Guest (Dr. Alan Goldhamer): So autophagy or autophagy is how the body gets rid of senescent cells and waste products and cancer cells. It kind of eats up that debris and does the housekeeping. And there's some things that increase autophagy. And one of those things is fasting. If you take rodents, for example, and you let them eat ad libitum, they live as much as they want. They will live to a certain amount of time. If you take those rats and you periodically fast them, you can increase their lifespan from 30% to 100%, even though the diet's the same, just with periodic fasting or with systematic underfeeding. If you limit instead of giving them as much to eat as they want, you feed them at 60% of what they would eat if they ate unlimited amounts, and you can dramatically increase their lifespan. It's an interesting way of looking at it. From my viewpoint though, they're looking at it wrong. It's not that fasting doubles your lifespan. It's overfeeding cuts it in half. By overfeeding the rodents, they're developing fat, visceral fat, they get the inflammation, and you cut their lifespan in half. So what fasting is doing is allowing them to live their full span by getting rid of the consequences of dietary excess.

Host (Steven Bartlett): So isn't the game here then just to not eat as much versus fasting?

Guest (Dr. Alan Goldhamer): Absolutely. The idea is to avoid excess intake that results in excess fat that results in excess visceral fat. The problem is it's very difficult to do that when they are putting chemicals in your feed that fool your satiety mechanisms and lead to overeating.

Host (Steven Bartlett): So, satiety mechanisms being mechanisms that tell you whether you're hungry or not.

Guest (Dr. Alan Goldhamer): Right, whether your brain signals you accurately that the amount of calories you have. If you, for example, just sit down and eat your fill of whole plant foods, you eat a certain amount and then you feel full. But if you put certain chemicals in the feed, you'll eat significantly more before you trigger those satiety mechanisms and feel full. Those chemicals that we put in our food are salt, oil, and sugar. Salt, oil, and sugar are not food. They're hyper-concentrated components derived from food that are put back into food. And we put them into food to make food taste better. And what tasting better actually means is it results in more stimulation of dopamine in your brain. Dopamine is the neurochemical associated with pleasure. The more dopamine, the more pleasure, the more you like it. And so it turns out that higher caloric density foods or foods that have chemicals like salt, oil, and sugar in the food will stimulate more dopamine in the brain. And that's because your brain evolved in an environment of scarcity. It evolved where it was difficult to get enough to eat and avoid being eaten. And so richer foods had more value. And so the people that recognize the value of more concentrated foods tend to live to reproduce and pass on their DNA. Today, we live in a world where we've corrupted the whole system. And so now we have unlimited amounts of hyper-concentrated foods with these chemicals like salt, oil, and sugar. So when you eat those foods, you will overeat. The only question is, how much and what are the consequences?

Host (Steven Bartlett): Should we be intermittent fasting or should we just be restricting our calories? Are they the same thing?

Guest (Dr. Alan Goldhamer): Well, there's different tools available to allow for us to eat ad libitum, but still meet optimum nutritional intake. One tool is intermittent fasting, that is, or time-restricted feeding, which we've practiced for 40 years, which is basically don't eat three to four hours before you go to bed at night. So instead of eating right up to the time you go to sleep, you withhold calories after the last meal so that you have three to four hours of fasting every day. That gives you a 12-hour fast every day. And if you're trying to lose weight, some people believe you could extend that fasting period another four hours in the morning, do some exercise in the morning, preferentially burning fat. And so that would give you a 16-hour fast and limit your feeding window to eight hours.

Host (Steven Bartlett): And what's the benefit?

Guest (Dr. Alan Goldhamer): Some people find by limiting the feeding window, they can limit some of the overeating. A lot of eating is being done for reasons other than being hungry. Sometimes people at night, they've had a big dinner and now they're eating additional food, not necessarily because they're hungry because they're bored, they're tired, or they're fatigued. And sometimes when they're fatigued and they eat and they feel stimulated, they think, oh, they must have been hungry, when in reality they were tired. Our suggestion is when you're tired, go to sleep. And when you're bored, engage in productive activities. And when you're hungry, then you eat. And if you limit your feeding window to eight hours, some people find that it's a helpful tool at minimizing some of the overeating. Now, it's not going to work for everybody. If you have very high caloric needs, you're a competitive athlete, eight hours feeding window, particularly on high nutrient density, low caloric density foods, may not give you enough feeding window in order to get the calories that you need. When you're trying to burn 3,500 or 4,000 calories a day on very low caloric density foods, you may need to have a 12-hour feeding window in order to be able to get the calorie density need. But for most of us that are trying to maintain or lose weight, having a narrow feeding window may prove to be of some benefit.

Host (Steven Bartlett): When I'm in a ketogenic diet or when I guess I'm fasted, which is very rare, why is it that my cognitive performance seems to be significantly better? Because when I, people have heard me say this so many times, but it's so true. When I'm eating a normal Western diet, my ability to articulate myself and think and be creative seems to be diminished. Whereas when I'm avoiding carbohydrates and sugar, I seem to be able to think and talk better.

Guest (Dr. Alan Goldhamer): I think, again, it may not be that the ketones are helping you think better. It may be that the sugar vacillations are interfering with your cognitive function. For example, when people eat particularly refined carbohydrates, their insulin levels go up, drive the sugar down, they end up with low blood sugar levels, which can interfere with cognitive function as a consequence of this vacillation that's taking place with their blood sugar levels between insulin and glucose. When you go on a ketogenic type of an approach or you're in a fasting state, everything's very stable as far as glucose is concerned and insulin is concerned.

Host (Steven Bartlett): Okay, so you don't want to be on the sugar roller coaster if you're doing important work. Getting stable seems to help people in their cognitive function. People talk a lot about juice fasting. And I don't know, there's something about when people say that they're on a juice fast. I always think, God, you're going to be missing important nutrients. You're not going to be getting the same quantity of protein necessarily. Maybe, I don't know, your gut microbiome is going to pay the price if you're restricting yourself from having certain things. Is juice fasting advisable? Is it a healthy approach?

Guest (Dr. Alan Goldhamer): So juice fasting isn't technically fasting because fasting is the complete abstinence of all substances. It's a modified form of eating. So it's a diet that's high in sugar, very low in fiber, virtually no fiber on these juices. Where it can be helpful is people that are trying to make dietary changes and they're addicted to the artificial stimulation of dopamine in their brain that comes from the use of their highly refined diets. They're trying to make a change. They're trying to make a break. And because it's sweet and very appealing, they'll drink the juices. They'll get their 600 or 800 calories. They'll feel relatively satiated. And it allows them to avoid the greasy, fatty processed foods that sometimes they're trying to get away from. Personally, I think that water fasting has advantages over juice fasting in terms of the magnitude of the detoxifying effect, the impact that it has. But the advantages to juice fasting, or what they call juice fasting, is that it can be done without modifying medications. You're still in a feeding physiology. It can be done safely by people without having to be in a controlled setting like you would for water fasting. So there's advantages to the intermittent or modified fasting approaches. It's not the basis of the research that we've published, which is actually water-only fasting. We fasted people in water only from 5 to 40 days.

Host (Steven Bartlett): 5 to 40 days. So tell me about that then. So who exactly would you prescribe a 40-day water fast to? And presumably in those 40 days they have nothing but water?

Guest (Dr. Alan Goldhamer): Right, patients that are fasting in our facility are on fractionally steam distilled water only. That's the only thing they take. They're not taking supplements, medications.

Host (Steven Bartlett): What is that fractionally?

Guest (Dr. Alan Goldhamer): Well, distilled water. So it's purified water, highly purified water. So in our case, we're using a distillation. Some people use reverse osmosis, different ways of getting all the hydrogenated hydrocarbons and the chlorine and everything out of the water. So just essentially what rainwater would be if the environment wasn't polluted.

Host (Steven Bartlett): Okay. Now, in fairness, not everybody's a good candidate for that type of fasting. In order to determine if you're a good candidate, obviously you have to review the medical history and take a look at what people are doing in terms of their medical treatment, particularly in terms of medications. Basic laboratory testing to make sure kidney and liver function are intact or capable of adapting to fasting. And when people fast, they need to rest. If people are active, we've already mentioned, they'll increase their weight loss, but that weight will be derived from breaking down lean tissue. We want to minimize lean tissue, maximize fat, particularly visceral fat. It's also important that they be monitored because people do have issues that can be aggravated by fasting. Fasting presents a dehydration response. There's a physiological dehydration that occurs with fasting. There's changes in electrolytes. So you need to make sure that people are being monitored appropriately. And then the most important part probably is they need to be refed progressively.

Host (Steven Bartlett): Yeah.

Guest (Dr. Alan Goldhamer): So when they're eating after the fast, if they go back to too rapid refeeding, you can get into problem with post-fasting edema, you can get refeeding syndrome. That could be a very serious or even potentially fatal problem. That can be completely avoided by following a reasonable protocol of a realimentation after fasting, which is the reason why we encourage patients that are doing fasting to do it either in a controlled setting or under some supervision so that they don't make catastrophic errors in terms of how they do it.

Host (Steven Bartlett): When it's that length, when it's long?

Guest (Dr. Alan Goldhamer): Well, water fasting, we're doing fasting anywhere from five to 40 days. So anywhere in that range, you want to make sure the person's a good candidate, that they're fasting in a controlled setting, that they rest, and they refeed properly. So a person that has, say, a 20-day fast would have 10 days of controlled refeeding. It'll take about half the length of the fast to properly re-aliment after the fast so that you're ready to go back to, hopefully, a whole plant food SOS-free type diet.

Host (Steven Bartlett): And when you say SOS, you mean sugar, salt, and oil for context?

Guest (Dr. Alan Goldhamer): Yeah, SOS is the international symbol of danger, but it also stands for the chemicals added to food that make people fat, sick, and miserable, and those are salt, oil and sugar.

Host (Steven Bartlett): What kind of candidate would come to your clinic to do a 5 to 40 day water fast? What are the symptoms they have? What are the diseases, illnesses that they're suffering with?

Guest (Dr. Alan Goldhamer): Well, we get a variety of people and ages. The conditions we see are often the conditions that we've published papers on because that's what people know us for. So one of the most common conditions is high blood pressure. We did a study with our colleague T. Colin Campbell, as I mentioned, 174 people in a row were able to achieve normal blood pressure without medication. We also did a prospective study recently with a colleague from the Mayo Clinic that we did 27 people completed fasting with hypertension. 26 were able to achieve normal blood pressure without any medication. One required half their dose of medication. And we had six weeks follow-ups where they did well. And then we followed them at a year. And we found that 76% of those people a year later had maintained their weight loss and the majority were still normal blood pressure without medication.

Host (Steven Bartlett): Were they still fasting after a year?

Guest (Dr. Alan Goldhamer): No, of course, they were fasting while they were at the center. They were back eating a healthy diet, and they'd maintained a healthy enough diet for a year that they were able to maintain their blood pressure and their weight loss. And that's very unusual because you don't find good long-term follow-up showing that people are not only able to get well, but sustain those behavioral changes. So it's more of an intervention in that regard.

Host (Steven Bartlett): And how long were they fasted for, those people?

Guest (Dr. Alan Goldhamer): So the people in that study ranged, the average fasting was about two weeks. So they had two weeks of fasting that normalized their blood pressure, a week of refeeding. And then even a year later, the majority were able to sustain the behavioral changes such that they were able to keep their weight off and they were able to keep their blood pressure down without the need for medication.

Host (Steven Bartlett): And what's going on there? Because there's physiological changes that take place. If I went and did a 40-day water fast with you, there's some physiological things that can happen. And of course, I'm going to go into ketosis. My fat's going to start to become my primary fuel source. But there's also going to be a physiopsychological relationship. There's going to be something that happens in my psychology. I mean, you talked about dopamine. My brain is going to change in some respect. My relationship with food is going to shift in some respect.

Guest (Dr. Alan Goldhamer): Absolutely. If you look at the outcome data, for example, we've got studies we've done with DEXA scanners that look at body composition changes during fasting. And so people that would say fast for two weeks would lose 10% of their total body weight, 20% of their total fat, but 40% of their visceral fat.

Host (Steven Bartlett): Visceral fat being the bad fat inside the organs.

Guest (Dr. Alan Goldhamer): Yeah, the 10% of fat that produces the inflammation that's thought to contribute to disease. Those same people would have only lost 6% of their lean tissue.

Host (Steven Bartlett): Now what's interesting, like muscle, water, nonfat tissue.

Guest (Dr. Alan Goldhamer): Yeah. So the lean tissue mass at six weeks was fully recovered. So that the percentage of their lean mass was actually higher at six weeks than it was at baseline. But the fat loss continues. So even though they're gaining weight after fasting because they're putting their glycogen back in their muscles, which is about two pounds, they're rehydrating, they're putting fluid, and they're putting fiber back in the gut, so the scale's going up. But the fat loss, even with that weight gain, is continuing down. And so what you look at is their whole body composition begins to change. And also their brain composition too probably in terms of their functional relationship to themselves. For one thing, a lot of people feel that any kind of pain is a bad thing. Any kind of pain is a bad thing and pain must always be avoided. If they have a pain, they have to take a pill, they have to do something because pain is the evil issue there. Athletes learn that pain isn't always bad, that sometimes discomfort can be associated with a positive response. We find it's easier working sometimes with athletes in people that have not been athletic because they've learned to push their body a little bit. And fasting creates a hormetic effect as well, whereas there is some physiological stress that's introduced. That stress is associated with a healing response.

Host (Steven Bartlett): Would it not just be healthier if it were simple to take those people and remove all the processed food from their diet and then keep them on like a Mediterranean diet with like high protein, high fiber? Would that not be a more healthy intervention?

Guest (Dr. Alan Goldhamer): Because at least then I'm not going to lose, you mentioned I'd lose 6% of my lean tissue. At least then I wouldn't lose any muscle necessarily.

Host (Steven Bartlett): Well, I would agree that if your only goal is weight loss, diet and exercise are the key. Fasting introduces not just a chance to lose weight, but specifically to mobilize visceral fat. You will eventually mobilize that visceral fat with exercise alone. There's an advantage to getting rid of that sooner rather than later, particularly for people that have high blood pressure, diabetes, autoimmune disease, because the sooner you get rid of the visceral fat and the inflammation, the sooner you can get them off the medications. The medications themselves present their own problems. And people don't understand, if you have high blood pressure, you're being medicated not for your high blood pressure, but for the diet that causes the high blood pressure. Literally, the day you change the diet to a health-promoting diet, the need for medication begins to reduce. And if you don't reduce the medication adequately, you can actually shut people down from consequences of excess medication.

Guest (Dr. Alan Goldhamer): Is there a different advantage between me doing the fast, the water fast, versus just going on the ketogenic diet if I was trying to reduce my visceral fat, which is that sort of stubborn fat around your organs?

Host (Steven Bartlett): Yes, water fasting is a more efficient method of mobilizing specifically visceral fat. And the other problem with that, when we talk about a ketogenic diet, remember there's a lot of different ways of getting into ketosis. You can do it with a high-fat, high-protein diet, which is commonly advocated. You know, the dead Dr. Atkins diet, mits, filet, acyl, rest, and peas, or those kind of programs. Those have some disadvantages. High protein, particularly high animal protein, is actually thought to be one of the major contributing factors to many of these health compromises, including cardiovascular disease and cancer and inflammation and the rest of it. So we need protein. It's an essential nutrient. You need about 10% of your calories from protein. When you get excess protein, you put yourself at risk for kidney disease, cardiovascular disease, and other problems. We need fat. Essential fatty acids are a critical part of our ability to be healthy. And you also need carbohydrates. You're designed as a carbohydrate-burning machine. But you get all the fat, all the protein, and all the carbohydrates you need from a whole plant food diet. You don't need to eat large amounts of animal foods. You don't need to eat oils. You don't need to eat refined carbohydrates to get the foods you need. And in fact, a whole plant food SOS-free diet gives you the quantity and quality of nutrients you need without some of the negative consequences or the risks of dietary excess that come from these more processed modern diets.

Guest (Dr. Alan Goldhamer): So if you were to pitch to me the unique selling points of a water fast at your clinic versus any other intervention, medical or lifestyle, it would be the speed in which you're able to burn visceral fat and the speed in which you're able to lower blood pressure is unlike anything else.

Host (Steven Bartlett): It also reduces insulin resistance. There is no drug that reduces insulin resistance, but fasting does. And a significant percentage of our type 2 diabetics will achieve normal blood sugar levels without the need for medication with fasting. Again, if you do diet and exercise consistently enough, long enough, you're likely to get many of the same benefits. There are some things, though, that seem to change in fasting that don't change as well with these modified feeding regimes. For example, fasting, you know when you have a computer and it gets corrupted and you turn it off and you turn it back on and you don't know why, but now it works. You've kind of rebooted or flashed the memory, whatever it is. Fasting does a similar thing in humans, it appears, and particularly when it comes to the gut microbiome. So you've got trillions of creatures living just in your intestinal tract, particularly bacteria, but all kinds of organisms that are an important part of your digestive mechanisms, your immune response. And they're different depending on what you eat. So if you're eating an animal-based diet, you have different organisms than if you're on a plant-based diet. If you're on a high-sugar diet, even fruit sugars, you get different organisms flourishing than you would if you're in a fasting state. In a fasting state, there's a big drop-off in total organisms. And then when you refeed, depending on how you refeed, you can actually regrow those organisms and repopulate that.

Guest (Dr. Alan Goldhamer): I'm right in thinking if you do a water fast, you're going to wipe out a lot of the bacteria in your gut, including the bad ones, but also some good ones.

Host (Steven Bartlett): Right. And then you can reintroduce certain foods that will bring back the good bacteria. That's why refeeding after fasting is so important. If you refeed carefully, you have a chance to reestablish that normal microfloral balance. And that may be why we see such good response in many of these GI related conditions like ulcerative colitis and Crohn's disease and chronic constipation irritable bowel syndrome. But you also see it affecting things like depression and anxiety. They say 90-95 percent of the dopamine and serotonin that's produced by the body is actually produced in the gut. So the balance in your gut microbiome may be critically involved in cognitive function as well as what's going on in the digestive system itself. So we're just now learning the impact that fasting has and the effect that microbiome has and the relationship that those two things have together. There was a 2024 study that found after a seven-day water-only fast, levels of harmful Fusobacteria dropped by more than 80% and the gut microbiome shifted to a healthier balance. So it's clearly doing some of the work to wipe out some of the bad, unhealthy gut microbiome bacteria, which gives you an opportunity to reset the gut microbiome. That is really interesting, especially if, as you say, you have some of those sort of gut-centric diseases.

Guest (Dr. Alan Goldhamer): Is there a gender component to this between men and women? Because obviously women have menstrual cycles and certain hormone fluctuations that men don't have. So do you have to think about gender when you're thinking about fasting?

Host (Steven Bartlett): Well, we know that women have complicated systems in different ways than men, and they have different diseases, too, that show up. Fibrocystic breast disease, dysmenorrhea, menorrhagia, polycystic ovarian syndrome, all of these conditions that males don't know anything about seem to be associated with excess estradiol hormones. When estradiol is high, there's a higher association with many of these conditions. Estradiol normally breaks down to something called estriol, and it's excreted in the urine. What breaks it down is the gut microbiome and liver function. And the gut microbiome and liver function are both profoundly affected by fasting. For example, in studies we've done looking at fatty liver disease, we show significant changes in reversal of fatty liver disease with fasting. And as I mentioned, the gut microbiome goes through a whole kind of rebooting. And that may be why patients that come in with those symptoms, the fibrocystic breast disease, the dysmenorrhea, the menorrhagia, etc., often get profound short-term improvement and long-term benefit post-fasting. Now, all of these things I'd have to say, fasting is great, but unless it's a motivating factor to make the diet and lifestyle changes, I wouldn't be optimistic about long-term outcomes. When we use fasting, we're also providing intense education to try to get people motivated to adopt healthy diet and lifestyle habits. And it's those diet and lifestyle habits that are going to be necessary to sustain the benefits. I'll give you an example. In lymphoma, which is a type of cancer, we published a paper in the British Medical Journal, case reports on a young woman who had follicular lymphoma, had progressed for a couple of years. Interestingly enough, her oncologist told her that diet didn't matter, that diet wasn't related to this particular type of cancer. She could eat whatever she wanted to. But nonetheless, she decided to come in rather than go through chemotherapy and underwent fasting. We did three weeks of fasting during which time you could literally feel these tumors disappearing. She had her follow-up CT scan. And at a year, we submitted this case report. It was interesting because BMJ said, well, maybe she got lucky. And yes, it progressed for two years. Yes, it went away in 21 days of fasting. But maybe it was just naturally the time for it to go into remission. A small percentage of lymphoma patients do go through spontaneous remission. So they said, why don't you follow her for three years and see whether she can sustain that? Because we can treat lymphoma with drugs and the tumors will go down, but they tend to come back. And that's the problem. It doesn't really reduce necessarily all-cause mortality because the condition isn't actually resolved. So we followed her for three years and I told her that she had to stick strictly to the dietary protocol or it would be fatal because I'd track her down and kill her. And she did stick to the diet. And at three years, we have CT evidence that she was cancer-free. And we submitted that to BMJ. Interestingly enough, at first, they rejected the follow-up that they invited. And we kind of appealed that. And eventually, they did decide to publish the follow-up. And then we followed her for 10 years. And she continues to be cancer-free. And she continues to follow a whole plant-food SOS-free diet. And she went public with her story. She told some podcasts about what her experience was. And so we got a lot of lymphoma patients coming to True North Health. And now we've published a case series, which is a series of lymphoma patients, including one particular gentleman that was even more progressive. It was a stage four, already metastasized into the bones. He had failed chemotherapy. He also did well. And we did a three-week fast with him. Interestingly enough, his oncologist was kind of antagonistic because he was concerned the fasting would make him too weak for treatment. But he came in, he did the treatment, did well, went back to the oncologist who said, wow, that's really impressive. Why don't you go back and do some more of that? He came back, we did another 39-day fast, and he was able to get dramatic improvement. And again, those studies have been published in peer-reviewed journals.

Guest (Dr. Alan Goldhamer): But he didn't go into remission?

Host (Steven Bartlett): With lymphoma, it would be considered remission, but it's not a cure. It's just like you can't cure lymphoma any more than you can cure obesity. You can lose the weight and keep it off, but if you go back to doing the things that cause it, it's coming back. You can't cure high blood pressure. You can normalize the pressure. I've got people who have been normal pressure for decades now. But if they go back to eating the greasy, fatty, slimy, salty processed food, it'll come back because you're managing it. You're not curing it. The whole concept of a cure is a little bit of a misnomer. In medicine, cure just means you're alive five years after treatment. It doesn't mean that you've actually resolved the underlying cause of the condition.

Guest (Dr. Alan Goldhamer): Interesting. And we have 120 plates here which is how much food someone would be passing up if they did a 40-day diet. So that's how many meals that they would miss on a 40-day water fast, which is a lot of food.

Host (Steven Bartlett): Staggering when you see it. And it's a lot of work for the body to digest that food. When you take that work away, those energies are able to be diverted to dealing with some of the accumulative problems that people have built up, whether it's excess fat and visceral fat, it's diabetes, it's autoimmune diseases where the body's actually attacking itself. I don't know if most people realize this, but in autoimmune diseases like rheumatoid arthritis or ulcerative colitis, ankylosing spondylitis, these conditions, it's actually your immune system that's attacking your tissues. The theory is that a lot of that is because you have the immune system being compromised by gut leakage, where people have leaky tight junctions in their intestinal tract, they're absorbing materials, and then genetically vulnerable people, the immune system becomes hyperreactive and begins to attack its own tissues. If it attacks your thyroid, we call it Hashimoto's thyroiditis. If it attacks your joints, you might call it rheumatoid or osteoarthritis. Different names for different inflammatory conditions, all triggered by leaking of materials into the intestinal tract. When you go on a fast, first of all, you're not eating. So there's not the inflammatory oxidative damage and free radicals that are causing the leaking to begin with. And second of all, the body's healing processes are able to be accentuated. So the gut leakage is able to heal. After you heal the gut and go back to eating a diet that's not full of free radicals, you're not smoking, you're not drinking alcohol with all of the free radicals from peroxidation of alcohol, you're not eating high-fat foods and particularly heated fat foods and fried foods, etc. There's not the onslaught of oxidative damage. And now you can manage those conditions with a whole plant-food SOS-free diet. That doesn't mean they're cured. If they go back to eating the other foods, they're going to flare up their condition. But to the degree they're willing to eat healthfully, they can manage their condition without the medications that oftentimes are very powerful and have long-term side effects.

Guest (Dr. Alan Goldhamer): When someone does a water fast with you, if they're doing a 40-day water fast, do you make sure that they get electrolytes and vitamins and other things? Are there other things that you have to give them?

Host (Steven Bartlett): No, we're just giving them water, but we are monitoring their electrolytes and their blood levels to make sure that their reserves are being recycled adequately and they're normal. If, for example, potassium gets below a certain point or sodium gets below a certain point, then we go back into a refeeding mode. We give them broths and juices and other materials in order to refeed them. We don't allow them to develop symptoms secondary to deficiency. What's interesting is potassium, for example, normally potassium might be 3.5. Fasting tolerances would be 3.0. If it goes below 3.0, then we're going to terminate the fast. But generally people are so efficient at recycling their nutrients during fasting that they stay within normal limits without us having to do premature termination.

Guest (Dr. Alan Goldhamer): And when you finish a long fast like a 40-day fast or even a shorter fast like a five-day fast, what is the protocol for refeeding them? What do you give them? What do you avoid? What's the speed in which you give them calories again?

Host (Steven Bartlett): They get a day of fresh fruit and vegetable juices for every week of fasting, more or less. So they're going to get about 600 calories of fresh fruit and vegetable juices if they had a three-week fast for about three days.

Guest (Dr. Alan Goldhamer): What's the thinking here? What's the underlying thought?

Host (Steven Bartlett): The idea is that we want to introduce initially food without fiber so if there's any digestive challenges that's short-lived. We want to introduce food starting in the morning rather than at night so if there's any challenges it doesn't disrupt their sleep. We want to make sure that they're rehydrating and getting some glucose without necessarily overloading their capacities. Once they've acclimated to the juices, which are relatively easy to absorb and bring up blood sugars relatively quickly, moving them out of the fasting phase into more of a feeding phase, then we'll introduce raw fruits and vegetables, which introduce some fiber. And then we'll introduce more concentrated foods like steamed and starchy vegetables until by the length, half the length of the fast refeeding, they're back to a whole plant food SOS free diet, the kind of diet that we want them to sustain forever.

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Guest (Dr. Alan Goldhamer): And what about healthy people? Healthy people come to you as well and do fasting. It's not just people that have these sort of severe health predicaments. I think I'm pretty healthy. Is there a reason or a benefit to someone like me fasting?

Host (Steven Bartlett): We did a study actually on this very question about what happens to healthy people that fast. And although there's tremendous improvements in sick people, it turns out when you look at the cardiometabolic risk factors, when you look at even things like weight and percent body fat and visceral fat on healthy people, people that are within healthy limits, there's additional improvement. Their blood cholesterol drops even lower. Their blood pressures drop lower. Their percent fat drops even lower. In fact, proportionally, the people that get the most benefit of fasting are healthy people that are doing it preventatively. But they tend to need short fasts, not long fasts. You're not necessarily taking a healthy person doing a 40-day fast. These are five to 10-day periods of time rather than the very longer fasts that are usually because there's a condition that takes that long to resolve. We want to fast as short as possible, but long enough to resolve the problem. If you come to me with blood pressure that's 210 over 100 capped on five medications, you're likely going to need a longer fast than a person that's 140 over 90 without medication.

Guest (Dr. Alan Goldhamer): But if I'm a healthy person, how frequently and for what length should I be thinking about fasting, if at all?

Host (Steven Bartlett): I think you should be fasting every day for 12 hours.

Guest (Dr. Alan Goldhamer): Okay.

Host (Steven Bartlett): And then, we don't know what the ideal is. That's one of the things we're going to be doing in this study is trying to figure that out. But what we do in practice is we have people fast once a year for a week. If they're clinically stable, they don't have any healing crisis, their numbers all are good, that's it. We move on. And even that week of fasting though has a profound effect on healthy people. I might mention though that most people that think they're healthy, when you actually objectively look at their biomarkers, aren't as healthy as they think. Many people are maintaining higher visceral fat, higher inflammatory markers, higher lipid levels than what they probably ideally should be, even though they're asymptomatic. They say somewhere around 2% to 2.5% of people are actually objectively measuring out as healthy. Some studies say as much as 12%, depending on the standards that you're using to define health.

Guest (Dr. Alan Goldhamer): So speaking directly to the viewer now who sat at home, and there's a reason why they clicked on this conversation. They found the subject matter in the title or the thumbnail somewhat compelling. If you were speaking directly to the different personas of people listening. So you've got maybe someone who is healthy, someone who has maybe got a little bit of weight on that they might want to shift, someone that's got specific diseases and has been given diagnosis and maybe has given pills. Going through these different personas one at a time, how would you prescribe water fasting to them? And what would you tell them the benefits for them would be if we're thinking about these different personas? So starting with the person on the left side of the spectrum who is largely healthy, but is interested in maybe how it will make them feel.

Host (Steven Bartlett): For the healthy person, the main benefit that I see of fasting is it's a forced period of rest and introspection. You get a certain clearing of the palate. We've actually done a study like this. It's on our site where we looked at the sensitivity to sugar, the sensitivity to salt. It's actually enhanced during fasting. And so by fasting once a year, people kind of recalibrate their palate. And it makes it easier for them to make better choices. Sometimes there's been some slipping and sliding along the dietary regime as people go along during the course of the year. It reboots the gut microbiome. It tends to enhance cognitive capacities as well as probably brain serotonin and dopamine levels. It can affect people's mood states and just how they feel about themselves and the world around them. It's obviously not as dramatic as when you take a person that's in agonizing pain or debility and you see those dramatic changes.

Guest (Dr. Alan Goldhamer): What about then if I want to just lose some weight? What protocol should I use for water fasting? And what kind of results would I expect to see in what time frame?

Host (Steven Bartlett): We never know exactly how long a patient's going to fast until we see how they respond to fasting. Because fasting itself is as much diagnostic as it is therapeutic. But usually we can get a pretty good idea. I always like to try to get people as close to their optimum weight as possible. Whether it's with diet and exercise or with fasting. We don't think maintaining extra fat is a good thing. We think for every pound of excess fat you have on your body, there's all kinds of downstream consequences. So if a person, say, for example, 20 pounds overweight, they feel best at, say, 150 pounds, but they're 170 pounds. We know that it will take them about three weeks to lose that weight because people lose an average of about a pound a day. So I wouldn't have any concern, assuming everything else looks okay, fasting that person for three weeks. I'd be concerned about fasting them into an emaciated state. I don't want to get them very weak. I don't want to have them debilitated. I don't want to get them depleted. And so we're going to monitor them carefully to make sure that we're well within their reserves. But a person that's a bit overweight, that has maybe their blood pressure is a little bit higher, their blood sugar is a little bit higher, maybe they have some joint pain, maybe they have some various symptoms, we want those things to resolve. So we're going to estimate how long do we think this person is going to need to fast to get to the point when they feed, they'll keep getting healthier rather than sicker.

Guest (Dr. Alan Goldhamer): Can you explain these four graphs to me here? There's four graphs that come from work you've done.

Host (Steven Bartlett): Okay, well, this is outcome data that comes from studies that we've published. This basically is looking at the percent body weight change. And if you look at the bottom graph, you'll notice it's over time.

Guest (Dr. Alan Goldhamer): Okay.

Host (Steven Bartlett): So we're looking at the percentage body weight change during fasting. And you notice during refeeding, it actually comes down a little bit more, even though people are re-alimenting, they're losing fat, they're regaining water and muscle, and then they're able to maintain that percent body change. This is 65-day follow-up.

Guest (Dr. Alan Goldhamer): For people that aren't watching the video right now and are just listening to audio, what is it essentially saying happens? And in what period of time? With what protocol?

Host (Steven Bartlett): In this particular study, these people lost about 10% of their body weight over an average of two weeks of fasting. They refed for a week at the facility, and then they were followed up 65 days later. And at 65 days later, you'll notice they'd maintained their total body weight change, and then just a little bit more. And now they'd been back to eating and exercising. In the next graph, the percent body weight, this is the visceral fat mass.

Guest (Dr. Alan Goldhamer): And visceral fat again.

Host (Steven Bartlett): Visceral fat is the 10% of the fat that makes up the fat that typically accumulates around the belly and the organs. It's the fat that's hypertrophic, hypermetabolic. It produces inflammation. It acts like a tumor. So there's two types of fats. It shouldn't be there. There's subcutaneous, which is on the outside. And then there's visceral, which is on the inside. And the stuff in the inside is the worst. It's fat that wouldn't normally be there. Here's the problem. You evolve in an environment of scarcity. Storing fat is so critical to survival in a world of deficiency or of depletion that the body does everything it can to store fat because the people that store fat in a natural setting, they live to reproduce. In the modern world, it's become a disadvantage because we live in this very unnatural environment where you can get dietary excess. And so even though the body is designed for an environment of deficiency, it's responding with that genetic programming. And so it stores fat, even though it's not healthful for you. As far as the body's concerned, spring might come late. The more fat you store, the better. And as a consequence, that visceral fat is associated with these diseases of dietary excess. In fasting, the body preferentially mobilizes that visceral fat. It gets rid of it. Just like if you go on a fast and have a breast tumor, you lose 10% of your body fat. You don't necessarily lose 10% of the tumor. You might lose 50% of the tumor. You might lose the entire tumor because the body has some intelligence to it in terms of how it's mobilizing these tissues. You can take an animal, for example, and starve it to death. And if you measure its nervous system, you'll find the nervous system isn't depleted. Even when it's starved to death, it will preserve those tissues in preference to the visceral fat or the fat tissues. So this graph is showing that visceral fat not only comes down during fasting, but it keeps coming down, and it continues to come down with refeeding. And this particular graph here, this is blood pressure. So again, blood pressure comes down during fasting. It comes down even lower with refeeding. And people that are following diet and lifestyle changes are able to maintain that pressure without medication. So if you look at our study, people that started with stage 3 hypertension, so they're 180 or higher systolic blood pressure, they lost an average of 60 points on systolic blood pressure, not counting the fact that the baselines were often taken on medication. And the final graph here that you've got is percent in lean mass. So lean mass also went down in fasting because your lean mass is your fluids, your muscle. Lean mass goes down but then it recovers during refeeding and re-alimentation. And the percentage of lean mass which includes your muscle mass at six week follow-up was actually higher in those patients than it was at baseline.

Guest (Dr. Alan Goldhamer): Are they exercising there during recovery?

Host (Steven Bartlett): They are not during fasting.

Guest (Dr. Alan Goldhamer): Okay. And you mentioned PCOS earlier on when we're talking about the implications for women. Have you ever done any studies or had patients come to your fasting clinic that have symptoms of PCOS?

Guest (Dr. Alan Goldhamer): Yes, we treat, we've had dozens and dozens of patients with polycystic ovarian syndrome. It's a condition that responds consistently to fasting. It also responds to diet and lifestyle change. But understand, many of the people that have made the diet changes but have not been successful are then referred to us for fasting. We always want to try the diet first because a lot of things resolve just by getting a person on a good diet and exercise program.

Host (Steven Bartlett): And PCOS, for people that don't know—I'm sure a lot of men don't know about PCOS, but some of them will because they might have fertility problems with their partner. My partner's been very public that she has PCOS. She's found that the ketogenic diet, removing sugar from her diet, has had a profound impact on recalibrating her menstrual cycle. Her cycle was very inconsistent, irregular—could be up to 60 days or longer, or not at all. When she removed sugar and carbohydrates from her diet, it's now perfect, every 28 days. I was wondering if there are women suffering with hormonal challenges or PCOS, if you have any case studies from your clinic of that resetting their menstrual cycles or reversing the symptoms.

Guest (Dr. Alan Goldhamer): Right. It's not uncommon for us to have women that, for example, have good plumbing in terms of their tubes and whatnot, but they're having difficulty initiating pregnancy. They fast, they reboot, and sure enough, within a cycle or two, they're able to achieve pregnancy. It's not unusual to have people with disrupted dysmenorrhea, menorrhagia, etc. Within usually not the very first cycle, but the second cycle, function will normalize. I think the reason is that the hormones for the next cycle are already kind of set up. Where you see the change is often at that six-week follow-up.

Host (Steven Bartlett): Let's be clear, because if you fast, it is a form of stress on the body. From everything I know about evolution, if you're fasting, your menstrual cycle is probably going to stop if you're doing an extended fast, because your body sends a signal to say, "We don't have the resources to give a kid life, so we're going to shut down."

Guest (Dr. Alan Goldhamer): If you take yourself below optimum weight or below optimum fat, yes, that's true. Disruption of menstrual cycle happens with excess weight loss of any kind or rapid weight loss. But for the patients that we're fasting, oftentimes it's quite the opposite. They're able to actually normalize their hormonal cycle. As I mentioned, it may be the conversion of estradiol to estriol because of improvement in the gut microbiome that's responsible for normalization of that and other hormonal issues that maybe we haven't even been able to measure yet.

Host (Steven Bartlett): Because your body needs energy to perform its menstrual cycle. Am I right in my thinking that if the body senses you don't have the energy to have a baby, it's going to shut down your cycle? Because having a baby would...

Guest (Dr. Alan Goldhamer): I think if it doesn't have the reserves. The thing is, many patients, even though they're fasting, they aren't in a depleted state. You don't see universal disruption of menstrual function because people are fasting. But athletes oftentimes see it when their percent body fat goes too low—they will become amenorrheic.

Host (Steven Bartlett): Do you see when someone comes to your clinic and does one of these extended fasts that there are other areas of their life that also improve that are completely unrelated to the benefits from the fast? I'm talking about willpower, their ability to motivate themselves, to be disciplined and persistent.

Guest (Dr. Alan Goldhamer): I don't think there's any question that those factors are involved. It's also just education and fear. People think if they get on a plane in New York and flew to California, they would die of starvation over Colorado. They think the pretzels that they ate saved their life. Once people have fasted for five days or 10 days or 40 days, the idea of having to skip a meal doesn't seem quite so terrifying. If there's not something healthful to eat, they just skip the meal until the next one. They're not afraid that they're going to die or enter starvation or have depletion. A lot of people have a lot of fear in their head that's completely illogical, unnecessary, and harmful.

Host (Steven Bartlett): It's so true. When you tell me that someone can actually fast, what's the longest a person could fast for without severe consequences?

Guest (Dr. Alan Goldhamer): They say that a 70-kilogram male could fast about 70 days, but the longest we fast people is 40 days. What happens is, you get beyond 40 days, everything gets a little bit more delicate. You have to be a lot more careful with electrolyte balance and other things. 40 days is only 1% of our patients. The vast majority are fasting between two weeks and four weeks—10 days, 14 days, or 20 days. That's where the big bell curve is. A small number of people need to fast longer than that.

Host (Steven Bartlett): You see this as a medical intervention. You don't see this as something that people should be doing on a frequent monthly basis. You see this as a medical intervention for people with specific issues predominantly?

Guest (Dr. Alan Goldhamer): I think that everybody should fast every day for 12 hours. I think that everybody, including healthy people, should at least consider fasting once a year for a week. Anybody that has a condition where it's appropriate to fast should fast however long it takes to resolve the condition, however frequently it takes to get well. We do have some patients that we're fasting two or three times during a year because they can't fast long enough the first fast to resolve the condition—they don't have enough reserves to do a longer fast. So we will do it periodically until the condition resolves.

Host (Steven Bartlett): What are the safety concerns with water fasts?

Guest (Dr. Alan Goldhamer): The biggest and most obvious concerns are orthostatic hypotension. When people are used to having high blood pressure and you lower their pressure, their brain is used to higher perfusion levels. When you drop the pressure, they can get dizzy at first until they get used to having normal blood pressure. You don't want people falling over and fainting and breaking something. Dehydration is a hermetic effect of fasting, and it's an important part of stimulating the healing crisis. But you also don't want to get somebody so depleted that they get into cardiac dysrhythmia or have problems. That's why we monitor people twice a day and make sure they maintain balance. One of the things we did in *Can Fasting Save Your Life* is we laid out all the protocols of fasting so a person could really understand what's going on. But we also wrote it so that their physicians would stop thinking they're crazy for being interested in doing something like that. At first blush, this sounds kind of crazy—that you're going to have a person take nothing but water for a prolonged period of time and somehow that's going to be a good thing. But when you really look at the science and the experience we've had, when it's done according to protocol, it is a safe and effective intervention at giving the body a chance to heal itself.

Host (Steven Bartlett): What are the big misconceptions about fasting that you encounter consistently?

Guest (Dr. Alan Goldhamer): One thing is people think you're going to become depleted because they don't understand the recycling capacity of the body when fasting is done properly. They think they're going to deplete their muscles and that the weight they lose in fasting is immediately regained after fasting, so there's no beneficial proportioning of body composition. They're driven by fear—an instinctive fear that we're designed to be intimately concerned about getting enough to eat. In a natural setting, that's a constant biological imperative. You're always struggling to get enough to eat. Because we live in a constant state of deprivation in a natural setting, the use of fasting was never anything other than a survival tool—an adaptation the body could make only under force, not by choice. But it is interesting that every major religion—the Jews, the Jains, the Hindus, the Muslims, the Christians, the Buddhists—all have a deep respect and tradition about fasting. There's a reason: it changes the way you feel about yourself and the world around you. It's so linked to spiritual traditions like meditation and clarity of mind and spiritual experiences. Because it is difficult to do, some of the benefits you mentioned earlier may be part of what's hard for us to quantify.

Host (Steven Bartlett): What is the most important thing we haven't talked about as it pertains to fasting that we should have talked about?

Guest (Dr. Alan Goldhamer): We haven't talked about the different kinds of mechanisms which might be going on in fasting. We've talked about weight loss—that's kind of an obvious one. If you don't eat, you're going to lose weight. But there's also a natriuretic effect. The body gets rid of the excess sodium accumulated in the body. That has a profound effect because literally people will lose several pounds of fluid a day early on in fasting, just because their body's been holding on to this in order to buffer the effect of sodium. Sodium—you think about it, you take a tablespoon of it, it's an emetic, it'll make you throw up. If you take enough of it, it'll kill you. There's an LD50 with it. Even though it's an essential nutrient in small amounts, an excess quantity is associated with hypertension, not to mention obesity. You might say, why would sodium, which has no calories, make people fat? It's because sodium stimulates what's called passive overeating. If you eat till you're full of anything—say brown rice—you just eat till you reach your satiety, you don't want anymore. Everything else being equal, salt that rice up and eat till you're full, you'll eat more before you feel satisfied. People say, "Yeah, because it tastes better." But that's what tasting better means—it results in more dopamine stimulation in the brain. Your brain gets fooled with salt. Take some foods, like bread, the staff of life—1,500 calories a pound before you turn it into a butter boat and spread coagulated cow pus all over it. Remove the salt, oil, sugar, and yeast, and what do you get? It's called matzah, and it's punishment on Passover. Nobody's getting fat eating matzah, but they're certainly having trouble with bread and bread-related products. It's because the wheat and the water become a carrier agent for these chemicals. Take beef, boil it, and gnaw on it. Do you like plain boiled beef? Not so much. It's a carrier agent for the sauces, the salt, the things it's carrying to the palate. We're using ultra-processed foods as carrier agents for these chemicals, and that's why we're in trouble. 70% of the calories of the average person come from ultra-processed foods. We haven't even talked about the chemicals—the emulsifiers and other things thought to affect the gut microbiome. So the natriuretic effect of fasting is a kind of rebooting effect that gets rid of the sodium. We haven't talked about detoxification. If you take a fat biopsy of human beings...

Host (Steven Bartlett): A what?

Guest (Dr. Alan Goldhamer): A fat biopsy. You take a piece of fat or a piece of tissue and you analyze it.

Host (Steven Bartlett): Yeah.

Guest (Dr. Alan Goldhamer): What you find is there are hundreds of different chemicals—PCB, dioxin, pesticide residues, heavy metals—in everybody to varying degrees. People have different degrees of vulnerability to that. In fasting, the body rapidly mobilizes those materials and eliminates them. Some people have said, "Oh, it does it so efficiently you shouldn't fast because the body doesn't know what it's doing and it would put it out too quickly and overload your system, so don't do it." But the reality is the body—this is a biological adaptation. It does a good job of mobilizing the materials and eliminating them. If you take that fat biopsy and ask where all those toxins came from, as much as 90% of some of those toxins came from eating animal foods, which biologically concentrate the pollution in their environment. You eat the animal food, you get its entire lifetime accumulation of toxins. When you fast, you kick in the system you use to get rid of that stuff. Every time you do it, it gets better. These are things that don't necessarily happen to the same degree with juice fasting or modified feeding regimes. We talked about the autonomic nervous system—the part of the nervous system that controls all the stuff you don't think about. If you were to go out running and your heart didn't speed up, you would be in big trouble and potentially die. But it doesn't happen because your heart automatically speeds up and pumps more blood. That's controlled by the autonomic nervous system. It has two parts: the sympathetic and the parasympathetic. They have to be in balance. We've invented hundreds of healing systems to try to rebalance the autonomic nervous system—massage, biofeedback, homeopathy, chiropractic manipulation, osteopathic manipulation, acupuncture, relaxation, biofeedback. How do you think all these things make people feel better? At least to some degree, it's to the degree they help rebalance the autonomic nervous system. The most powerful way to rebalance the autonomic nervous system, in my experience, is fasting. Fasting has a profound impact on this autonomic sympathetic-parasympathetic balance. I think one of the most profound effects is on taste neuroadaptation. We did a study on how you taste things. When you go on a fast, good foods start to taste good. When you first come off a conventional diet, this kind of food is disgusting, tasteless swill. People have no interest in it. They can't imagine how anybody could choke it down. What kind of food? Whole fruits, vegetables—simple foods without salt, oil, and sugar. They just can't imagine how anybody could eat that. But after fasting, whole plant foods start to taste good. The longer you eat them, the better they taste. You get to the point where you actually prefer to eat whole plant foods rather than the salty, greasy, fatty processed foods that everybody else is eating. These are big changes that occur in fasting that are not necessarily as easily objectified from a research standpoint, but have a profound difference on how people feel and how they live their lives.

Host (Steven Bartlett): I noticed that as well. When I was on the ketogenic diet, I noticed that the things I would usually get cravings for suddenly had no cravings at all. When you're talking about taste changing, when I was on a ketogenic diet, things tasted sweeter. I don't mean because I wasn't eating much sugar—some sugar-free drinks just tasted significantly sweeter. There were zero sugar drinks, but clearly because of some of the sweeteners, I almost couldn't drink them. When I came off the ketogenic diet and started having carbohydrates again, those drinks didn't taste so sweet anymore. It's your palate that changes.

Guest (Dr. Alan Goldhamer): The ketogenic diet is a fasting-mimicking diet. It mimics some of the effects of fasting, not the least of which is changes in taste—what's called taste neuroadaptive sensitivity. It's not carbohydrates that desensitize you, it's refined carbohydrates. If you get people on a whole plant food diet—fruits and vegetables, whole simple foods—they maintain that acuity of taste. But as soon as you put them back on refined carbohydrates, the processed carbohydrates, they begin to go back into the dietary pleasure trap.

Host (Steven Bartlett): Got you. [Ad break] I guess what is the next step if someone is curious? What would you recommend they do?

Guest (Dr. Alan Goldhamer): We have a really valuable free service for your viewers. If they go to our website and complete the registration forms at truenorthhealth.com, I offer a free phone conversation with them to tell them whether this might be something they should be considering and try to point them in the right direction. If they're really interested, they can read our book, *Can Fasting Save Your Life*, and it will tell you and your doctor everything you need to know about what it takes to safely get into a fast, through a fast, and what the benefits of fasting are thought to be.

Host (Steven Bartlett): I'll link all of that below for anybody that is curious and wants to learn more. As a sort of disclaimer, if people are doing water fasting, they should seek medical advice and medical support. They should seek a consultation from someone who knows what they're doing before just trying to do this at home. They want to make sure they're a good candidate with history, exam, and lab. They want to make sure if they do fast, they're fasting in a restful state, staying hydrated properly, and that they refeed carefully because it can be a serious problem if you don't do it properly. Is there a particular case study that comes to mind when you think about the power of fasting? I know you talked a little bit about the lady that had lymphoma, which I read about in the British Medical Journal—I think it was 2015 that it was published.

Guest (Dr. Alan Goldhamer): I think even more powerful than individual case reports are these studies that we've done involving dozens and in some cases almost 200 people and the consistency of the data. This works. It is the most effective treatment that's ever been shown in treating the leading cause of death and disability, which is high blood pressure and its consequences. If a person has essential hypertension and they fast long enough, they're going to normalize their blood pressure. If they're willing to do dangerous and radical things like eat well, exercise, and get to bed on time, they can sustain those results.

Host (Steven Bartlett): We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. The question left for you is quite a tricky one, but it's interesting. It is: "What is the biggest lie that you think is ruining most people's life?"

Guest (Dr. Alan Goldhamer): I think one of the biggest mistakes is that people think that health comes from pills, potions, powders, and treatments instead of healthful living. Health is the direct result of healthful living. That means diet, sleep, exercise. But they're hard. Especially in the world we live in where everything I see is trying to play with the neurotransmitters in my brain to get me to be addicted. People are trying to sell the pleasure trap. They're trying to tell you what you want to hear, not what you need to know. What you want to hear is that there's a way to not do hard things but still get good benefits. What you need to know is how to do hard things so you can be successful.

Host (Steven Bartlett): I think that's like the defining trait of the 21st century—your ability to do what you know you should for long-term benefits, not short-term benefits. Delayed gratification is maybe the defining trait of the 21st century. We've all heard of the cookie experiments they did on those kids to see which kids would take the cookie and which ones would wait for two cookies later. The further in my life I've gone, the more I've realized that every self-help book ever written could be one page and it could just say, "Delay gratification." Do the thing that is in the best interest of long-term you versus short-term you.

Guest (Dr. Alan Goldhamer): I think there are three characteristics that everybody should aspire for, whether it's a mate, an employee, or a friend. What you're really looking for is honesty, integrity, and intelligence. Honesty means they're going to tell the truth. Integrity means they're going to do the right thing. Intelligence means they're going to do things right.

Host (Steven Bartlett): That applies for ourselves as well, right? If we have high integrity and be intelligent with our own decisioning?

Guest (Dr. Alan Goldhamer): I think those are the characteristics that determine both success, but more importantly, happiness. The people that I meet that are happy have high degrees of all three of those things. Some people are very intelligent, but they don't necessarily do the right thing. Some people are honest, but they won't necessarily tell the whole truth. You have to have all three, I think, to have a high degree of probability of success.

Host (Steven Bartlett): What are you working on at the moment? What's keeping you busy at this moment in time?

Guest (Dr. Alan Goldhamer): We're in the process of getting ready to launch a major study. We're going to enroll between 2,000 and 3,000 people for the rest of their life, and we're going to track them and try to see if we can avoid the average 16 years of debility that greet people at the end of their life. We believe with diet, sleep, exercise, and periodic fasting, we can avoid the debility that's so common and make the last 20 years of people's lives the best years of their life instead of the worst.

Host (Steven Bartlett): You said at your clinic, 1% of patients do the 40-day fast. Who are those patients? What are they suffering with? What are they struggling with?

Guest (Dr. Alan Goldhamer): Because that's pretty extreme. One woman was a dentist who'd had a traumatic brain injury secondary to getting hit by a pole — an outdoor pole at a, ironically enough, a continuing education conference — and she developed a headache. She'd had constant daily head pain from 8 to 10 every minute of every day for 16 years. She came in and fasted for 41 days, during which time she resolved, to a large extent, her headaches. She refed. She had some prodromal symptoms, minor symptoms, and then did a second 40-day fast six months later. And now it's been 12 years. She has no headaches.

So in her case, she was motivated by, like a lot of our patients, pain, debility, and fear of death. And they were willing to do anything in order to be able to get well, including a long period of fasting. So the people that fast a long time oftentimes are very motivated individuals, mostly motivated by physical health goals. Not always. Some people are doing fasting for spiritual or other types of practices. But most of the people we have are just people that have not been successful resolving their conditions with diet and lifestyle change, with medications and drugs. And they say that it should be the True North Health Center, the last resort.

One of my colleagues, may he rest in peace, John McDougall, used to say we were the punishment. And if he had a patient that he would do the dietary changes with, but it wasn't successful at fully resolving the problem, he would apologize to them and say, "I'm so sorry, but you need to go to Goldhamer's place. Good luck to you." Because he thought that was one of the more difficult things that people were ever asked to do. I think it is the most difficult thing you ask people to do — not the fasting. That's not that difficult. What's difficult is to go back and live in a world designed to make you fat, sick, and miserable, and try to live healthfully, and live with integrity, and deal with the social outflux of being successful. As I said, a lot of times the people that I see that have the easiest time are the ones that aren't necessarily the most sociable kind of people.

Host (Steven Bartlett): Thank you so much for the work that you do, because it's fascinating, and you're providing another alternative treatment to people who are very often out of choice. Before I came here today, my wife said, "Don't be nervous to talk to him because it's just like..." You know, I speak 100 times a year to 50 to 100 people. And I said, "Yeah, Jennifer, it's just like talking to 50 to 100 people except doing it every day for 400 years." Thanks for getting the word out.

Guest (Dr. Alan Goldhamer): Well, no, my audience are open-minded. They're smart. They're savvy. They're curious, I hope, as well. So it's really fascinating. And I think, you know, when we think about these longer fasts, we often focus on the physiological changes that are going to take place. Like we talked about the glycogen reserves being depleted and the ketone bodies and all these things and the beta-hydroxybutyrate or whatever that big word was. But I actually think there's the really unappreciated part of all of this is the psychological change that takes place when you realize that you can accomplish something. But also, as you said, when you sort of rebalance and reset your dopamine levels and when your taste adapts to the fasted state and how that can act as an intervention, a psychological and physiological intervention, just to reset you a little bit.

Host (Steven Bartlett): Every year I do ketosis at least once, maybe sometimes twice or three times. I have a ketogenic diet. And it is, it's like a tremendous reset of my habits. It resets my habits. It resets my urges, my cravings.

Guest (Dr. Alan Goldhamer): Think about when a patient goes to a medical doctor and they say, "I have high blood pressure," and they say, "Listen, we promise you, if you do exactly what we tell you, we guarantee you, you'll never get well. You'll be sick the rest of your life and you'll be on these drugs forever." And there's not a one I've had so far that that turns out to be true for. It changes their entire paradigm. When they get overcome the problem that supposedly is helpless and hopeless and nothing can be done, it changes their view of reality.

Host (Steven Bartlett): Of course. I mean, what you're speaking to there is learned helplessness, where if someone tells you there's nothing you can do, then you do fall into — I mean, the studies show this — you fall into a state of learned helplessness where you actually stop trying to help yourself and you submit. I was actually reading a study the other day about rats who fell into a state of learned helplessness because they won't even try them all.

Guest (Dr. Alan Goldhamer): That's a really good example. The same happens with humans. If someone tells you something can't change, you're stuck, you're fucked. When you're ready to have a life-changing experience, we'd love you to be our guest. Come to the center, do a bit of a fast. I'm telling you, you're a great candidate. You'll have an intense but positive experience, and we'll make sure that if you walk in, you walk out.

Host (Steven Bartlett): Okay, good. That's a prerequisite of my visit. Thank you so much, Dr. Goldhamer. Keep doing what you're doing.

Guest (Dr. Alan Goldhamer): Thank you.

Host (Steven Bartlett): Thank you. Make sure you keep what I'm about to say to yourself. I'm inviting 10,000 of you to come even deeper into The Diary Of A CEO. Welcome to my inner circle. This is a brand new private community that I'm launching to the world. We have so many incredible things that happen that you are never shown. We have the briefs that are on my pad when I'm recording the conversation. We have clips we've never released. We have behind the scenes conversations with the guests and also the episodes that we've never ever released. And so much more. In The Circle, you'll have direct access to me. You can tell us what you want this show to be, who you want us to interview and the types of conversations you would love us to have. But remember for now, we're only inviting the first 10,000 people that join before it closes. So if you want to join our private closed community, head to the link in the description below or go to doaccircle.com. I will speak to you then.

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