MDAE E36 – The Benefits of Water Fasting for Exceptional Diabetes Health

Article written and reviewed by Cyrus Khambatta, PhD and Robby Barbaro, MPH
Published September 18, 2018
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Podcast Transcript

Alan Goldhamer, DC: Many people you can’t even get them to eat the food for a day, even for a meal, because it’s tasteless swill. They can’t eat that whole natural foods because it doesn’t have any salt, oil, and sugar that they’re addicted to. They are caught in the dietary pleasure trap. And so, when you fast them and then the good food tastes good, now they’re willing to go along. So here is who I say needs to fast. If you can’t do the diet and lifestyle changes because you’re too much of an addict, sometimes getting a little extra help is helpful. If you’ve done the diet lifestyle changes, but it’s not responding quickly enough, well, then that may be a way of facilitating. But the most important thing for everybody is to control what you put in your mouth, get the right amount of sleep your body needs to heal, and engage in appropriate productive activity.

Cyrus Khambatta, PhD: Welcome to the Mastering Diabetes Audio Experience, where we teach you how to sit in the driver's seat of your diabetes health for the rest of your life. We’ll teach you how to reverse insulin resistance, achieve your ideal body weight, gain energy and get your best A1c following more than 85 years of evidence-based research in the Mastering Diabetes Program.

Robby Barbaro: Our program teaches you how to reverse prediabetes and type 2 diabetes, and how to simplify your life with type 1 diabetes by maximizing your insulin sensitivity, using food as medicine.

Cyrus Khambatta, PhD: We're on a bold mission to reverse insulin resistance in 1 million people. We're glad to have you joining us.

Robby Barbaro: Welcome to the Mastering Diabetes Audio Experience. Thank you so much for taking the time to listen, and your interest in low-fat, plant-based, whole-food nutrition. On today's episode, we are sharing another interview from our 2018 Online Summit. If you have not checked out the 2018 Online Summit, I highly highly highly suggest going to our website www.masteringdiabetes.org, clicking summit in the navigation bar, and registering for free. You do not want to miss this. There's over 35 of the leading experts on diabetes health, we interviewed and the information is really, really powerful.

So, today we're going to be sharing an interview with Dr. Alan Goldhamer from TrueNorth Health. And he truly is a legend in the space of plant-based nutrition. He has a wealth of experience, clinical experience working with clients, and that's what really adds a lot of value to what he's presenting here.

So at TrueNorth Health, they teach people how to eat, and they also do water fasting. That's what they are primarily known for. And that's a controversial topic that people are quite confused about. So, Dr. Alan Goldhamer goes into the details of what is water fasting, how to do it safely, can people with type 1 diabetes, do water fasting. So he's going to go into all that in detail. He also talks about the confusion around prebiotics and probiotics. That's a very important topic that we haven't really covered with other experts. So, you're gonna hear that in today's episode.

You will also hear Dr. Alan Goldhamer talk about the book, he co-authored with Dr. Doug Lisle called “The Pleasure Trap”. And there's a lot of really, really game changing information honestly, what's in that book that helps people truly understand why they are struggling to make lifestyle changes, why people struggle to do the thing they know they want to do, that this is healthy, I know I want to do this, but for some reason, I don't do it. You know, that's something he talks about here in this interview. And The Pleasure Trap is a book you're definitely going to want to add to your reading list, if you are a person who is struggling with that where you really, really want to do this, but for whatever reason is challenging. There's a lot of good information in there. So this is a fantastic interview. I hope you guys enjoy it. Let's get right into it.

Cyrus Khambatta, PhD: Today, we are very honored to be here with Dr. Alan Goldhamer, who is an absolute legend in the world of plant-based nutrition. Dr. Goldhamer has been the director of the TrueNorth Health Center since 1984. Over the past 33 years, TrueNorth has supervised the care and fasting of over 20,000 patients. He’s the author of the Health Promoting Cookbook and the co-author of The Pleasure Trap with Dr. Doug Lisle. Dr. Alan Goldhamer has a wealth of knowledge about diabetes, about fasting, and about plant-based nutrition. And we are very honored to be here with him today. So, thank you so much for being with us here, Dr. Goldhamer.

Alan Goldhamer, DC: My pleasure. Glad to be here.

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Cyrus Khambatta, PhD: Fantastic. You’re one of the world’s experts on water fasting as a tool to reverse chronic disease and significantly improve metabolic health. So, can you provide our viewers, living with all forms of diabetes, with a little bit of a background on what fasting exactly is, and why it’s so beneficial for improvements in metabolic health?

Alan Goldhamer, DC: Well sure. Fasting is the complete abstinence of all substances except water in an environment of complete rest. And it’s a unique biological adaptation. It gives the body a chance to rapidly reverse many of the conditions associated with dietary excess. And diabetes happens to be one of those. You know, you have a situation where people have adequate insulin, but insulin is not working well because of insulin resistance. And dietary excess is thought to be one of the major contributing causes of that resistance. So, it’s not surprising that fasting would be a useful tool at reversing the consequences of dietary excess. And that’s exactly what we find. Conditions like Type 2 diabetes, like high blood pressure, autoimmune diseases, and some forms of cancer, like lymphoma, happen to respond exceptionally well to this period of this biological adaptation to fasting.

Robby Barbaro: So, when you say, like, “nothing but water and rest,” that means—and for how long can somebody do that?

Alan Goldhamer, DC: Well, we say nothing but water and rest in an environment of supervision. So, this isn’t something we’re recommending people do willy-nilly. Because there’s obviously some important parameters that people go through to determine who’s a good candidate for fasting, and to set up the baseline.

For example, anybody before they would undergo fasting would want to have a review of their medical history, a physical exam, and some baseline lab work done so that you could tell the difference between a good thing that’s happening in fasting and a bad thing. So, you know, fasting is a safe and natural process, but it’s not absolute protection against things going wrong, particularly in patients that are on medications or dealing with complex medical management situations. Fasting at the TrueNorth Health Center ranges from five to forty days. We typically do not do extended fasts beyond forty days, because they get a lot more metabolically complicated. But it really does vary depending on the patient. It’s not condition specific. It’s patient specific.

So, one patient, for example, with diabetes may undergo a period of fasting for ten days. Another patient may undergo a period of fasting for forty days. And some people, they may be able to resolve their issue. For example, high blood pressure may be resolved in a single fast. Another patient, there might be two or three fasts over a period of time to get their condition adequately resolved. And, unfortunately, we don’t always know precisely in advance how long that’s going to be. We know really well—in hindsight we’re brilliant—but in terms of predicting exactly what’s going to happen there’s a little bit of limitation there right now. Even though we’re actively involved in doing some clinical research looking at biomarkers in ways of predicting these things, that research is really virgin data right now. We’re one of the few places in the world that is actively engaged in evaluating long-term, water-only fasting and what its effects have on all these various biomarkers that have been discovered.

Robby Barbaro: Speaking of your research, can you can you go into some of the stuff you publish? I know you have published some work.

Alan Goldhamer, DC: Absolutely. We’ve been very fortunate in the research department. The TrueNorth Health Foundation, which is a 501(c)(3) nonprofit research organization that’s affiliated with us has done a good job. We’ve published a number of papers in the peer-reviewed literature, like “Medically Supervised Water-Only Fasting in the Treatment of Hypertension,” and in the treatment of borderline hypertension. We’ve also published papers looking at the effect of fasting on diabetes, as well as cost-of-care outcomes. We’ve recently completed/submitted a paper on fasting safety analysis.

We looked at five years of fasting patients and all their all-cause mortality complications. We were able to show that fasting, when it’s done appropriately, can be a safe and effective tool. That’s going to be significant as that paper is released, because it’ll open it up not only for us, but for all other researchers interested in looking at fasting. They’ll be able to get human subjects approval to do that.

Up til now, it was considered so outrageous that, you know, the mortality would be too high or something. They were just nervous about it. But this paper will hopefully change that. We’re also doing a study with Luigi Fontana at the Washington University in conjunction with the Buck Institute here, which is an anti-aging research center in Novato. And we’ve just completed the first trial where twenty-one subjects were evaluated before, and then after prolonged water-only fasting. And what they’re looking at are things like the number of mutations inside the lymphocytes, autophagy itself, the efficiency of these cells at eating up cancer cells, and other problems, all kinds of non-invasive biomarkers, and changes in the gut microbiome.

People have, you know, five pounds of bacteria living in your intestinal tract which is—it’s like an organ, if you think about it. And it’s very important to protecting us from outside agents, internal agents, producing materials like vitamin K, etc. So, the gut microbiome is an important part of our immune response. And it often gets disrupted because people take antibiotics, or they do things to strip the microbiome, not the least of which is eating a very poor diet. And when you think about it, when you have five pounds of organisms living in your gut they’re a living organism and they have waste products, have bacterial poo. And if that poo is toxic—if you produce TMA which becomes TMAO and you get heart disease and cancer, that’s a bad thing. But if your bacteria produces fertilizer, like vitamin K and other essential nutrients, that’s a good thing. So, we want the bacteria in our gut to be giving us fertilizer instead of toxic waste. And the way you control that is with essentially prebiotics. That is what you put in your mouth. And if you feed the bacteria in your gut soluble fibers like underground storage organ vehicles and vegetables, you get fertilizer. If you feed it meat, fish, fowl, eggs, dairy products, highly processed foods, you tend to get toxic waste.

So, we’re trying to look not only at the type of bacteria that lives in your digestive tract, the thousands of different strains, but also what are they giving off, and how does fasting affect that whole cycle. So that’s, again, all kind of new data, but it’s something that we’re actively involved with.

Cyrus Khambatta, PhD: Okay. Could you give our listeners a little bit of an insight into the difference between prebiotics and probiotics? Because I know it can get kind of confusing.

Alan Goldhamer, DC: Well, think about prebiotics as essentially the food that the bacteria eat. So, you know, if you don’t eat soluble fibers and the things that naturally feed the bacteria in your gut, the concern is that they will continue to try to find something to eat. And one of the things they can eat is the mucosal protective lining of your intestinal tract, which may be why people with ulcerative colitis, for example, don’t have much of that tissue left. If you feed them the foods that they do need they thrive, they survive. You get the balance you need. Taking probiotics is essentially taking bacteria into the intestinal tract under the theory that that’s going to somehow shift the balance.

That’s not so black and white, though. If you actually look at the available data, it’s not absolutely crystal-clear things work in any way near the way that people think they’re working or projecting they’re working as far as probiotics. Prebiotics there’s less controversy. We know that the diet you eat seems to be a critical tool in maintaining a normal type of strain, as well as making sure that the bacteria that you have are nourishing you instead of poisoning.

Cyrus Khambatta, PhD: Fantastic. So, fiber rich foods tend to be a very good prebiotic. But are there specific fiber rich foods which tend to be more powerful than others?

Alan Goldhamer, DC: Well, that’s one of the things we’re looking at. It turns out that a lot of these high soluble fiber vegetables, starchy vegetables that we think of as being so critical to maximizing human health, all seem to have great potential benefit. But I think it’s a little early to start specifically pointing at one food or another food. And, in fact, if you read Dr. Campbell’s book, Whole, you know, he makes a big point about the fact that you need to look at the diet as a whole, rather than necessarily trying to isolate particular nutrients or particular food factors. That we’d probably be better served describing the diet accurately as a whole-plant-food diet that’s free of sugar, oil, and salt. We talked about plant-food diet that’s SOS-free. SOS, of course, is the international symbol for danger. And it stands for salt, oil, and sugar. Sugar, of course, being including refined carbohydrates.

Cyrus Khambatta, PhD: Fantastic. Okay. So, you referenced earlier the fact that it sounds like, you know, when a patient checks into TrueNorth Health Center they don’t know how long they’re going to be fasting for. You guys don’t go in with some predetermined set of time that says patient A is going to be here for ten days. So, what is it that you’re tracking that will give you an indicator for somebody living with diabetes type, either prediabetes or type 2 diabetes? What is it you’re tracking?

Alan Goldhamer, DC: We are using fasting therapeutically, but we’re also using it diagnostically. Because a lot of things you can tell by how the person is responding in fasting where they are in resolving their condition. So, the parameters and the variables do vary depending on the patient. For example, a healthy person that’s just coming in preventively, which, by the way, I think may be who gets the most benefit of all from fasting are healthy people using it to maintain health. Normally, we just fast until they’re asymptomatic. That’s usually a relatively short period of time: five to ten days. And then we move on.

But let’s say, for example, a person has high blood pressure. And they’re starting off and their blood pressure is 240/120 and they’re capped out on five medications. Well, ideally, we want to fast them long enough to get them to have normal blood pressure without the need for medication. And normal, healthy blood pressure is probably closer to 90/60 than it is, you know, 240/120. And that period of the time may be from five to forty days. And in some cases, we’ll only be able to get them down so far and they run out of reserves. We have to refeed them and then do it again. So, it’s not exactly possible to say with precision exactly what the ideal number of days of fasting is. We can guess pretty well when we review their history, their exam, their labs. We can get a pretty good idea this person is probably going to have to fast three to four weeks to normalize their condition. And, however long the fast is they need half the length of recovery.

So, if a person fasts, for example, four weeks, we know we need a couple weeks of controlled refeedings. That refeeding is one of the most critical parts of fasting. Too rapid a return to refeeding can result in problems, conditions like food shock or refeeding syndrome. It can be a serious business. So, we definitely want to make sure if we’re going to undertake a fast, we have enough time to do it right.

Robby Barbaro: Yes. And I’ve heard that so many times in the past how important the refeeding process is. People don’t pay enough attention to that.

Alan Goldhamer, DC: Yes.

Robby Barbaro: OK. So, we educate our audience with diabetes about the power of intermittent fasting for weight loss, improved fasting blood glucose, and reduced cholesterol. Can you tell us the difference between intermittent fasting and prolonged fasting?

Alan Goldhamer, DC: Yes. Intermittent fasting has been popularized by Valter Longo and Mattson and others. And they talk about the fact that if you narrow the feeding window, so let’s say you don’t eat before a certain time in the morning or after a certain time at night you can get a 12, 14 or 16 hour fast every day between dinner, and then when you break your fast with break-fast, whatever time that happens to be. And they believe that, even that short period of fasting will induce metabolic changes associated with improving overall function. And cumulatively that habit may be good. Now it’s possible that’s absolutely true just as they described it. The other possibility is that when you narrow the feeding window you tend to eat less overall. And if people eat less overall, they tend to get profound metabolic benefits. Because, let’s face it, diabetes, hypertension, autoimmune diseases, many of these forms of cancer, are conditions of dietary excess. So, anything you do to get people to eat less excess is likely to result in metabolic improvement, weight loss, etc.

And it is true that narrowing the feeding window may help some individuals reduce their overconsumption of total calories, regardless of what specific type of diet they may happen to follow, in addition to the metabolic changes that happen with short term-intermittent fasting. I have to say, though, the data’s not in yet, but I project and predict what we’re going to find is that prolonged fasting has a geometrically larger impact on some of these biomarkers than we will with intermittent fasting. And the reason I guess that is because I see, I use intermittent fasting with virtually everybody. We follow those practices with all of our patients, inpatients, and outpatients. And we see benefit with that. But it pales in comparison to the profound changes you see quickly with long-term fasting. A three-week water fast, for example, can take, you know, many months of carefully controlled feeding in order to induce the same biological changes.

Cyrus Khambatta, PhD: Yeah. So, this brings up a good point here. Because a lot of our clients and a lot of people who are living with diabetes, they don’t have the time/they can’t come into TrueNorth. So, what can they do in the comfort of their own home?

Alan Goldhamer, DC: Remember, since the condition is dietary excess, getting rid of the dietary excess is going to be key, whether they do the fast or not. It’s controlling diet, sleep, and exercise. That’s where the big payoff is going to be. If you can’t do—get the benefits, say, of a long-term fast—or maybe it’s not appropriate. Not everybody’s a good candidate for long-term fasting anyway. You have to do it, you have to have a little more patience. You have to work harder at it. But if you can get the diet controlled, get the exercise controlled, you get the sleep controlled, you get the condition controlled, it’s just a question of time. How long it takes the body to make those changes. The one advantage to a medically supervised fasting is you can induce those changes quickly. People feel better and they’re more willing to comply. But that doesn’t mean they don’t get to the same place if they’re willing to be disciplined over a period of time and make the diet and lifestyle changes.

The problem is, though, many people you can’t even get them to eat the food for a day, even for a meal, because it’s tasteless swill. They can’t eat that whole natural foods because it doesn’t have any salt, oil, and sugar that they’re addicted to. They are caught in the dietary pleasure trap. And so, when you fast them and then the good food tastes good, now they’re willing to go along. So here is who I say needs to fast. If you can’t do the diet and lifestyle changes because you’re too much of an addict, sometimes getting a little extra help is helpful. If you’ve done the diet lifestyle changes, but it’s not responding quickly enough, well, then that may be a way of facilitating. But the most important thing for everybody is to control what you put in your mouth, get the right amount of sleep your body needs to heal, and engage in appropriate productive activity.

Cyrus Khambatta, PhD: Pretty straightforward. Okay. So, you talked about The Pleasure Trap. Okay. The Pleasure Trap is a book that you co-authored with Doug Lisle. Can you give our audience some insight into what the book is about, and why it’s one of the most prolific books on the psychology of eating?

Alan Goldhamer, DC: Yeah. I think it’s an important book. It’s my favorite book. And The Pleasure Trap is the hidden force that undermines health and happiness. It basically deals with the fact that the pleasure neurochemical in your brain, dopamine, is what your brain uses to get your body to do what it needs to survive and reproduce. And so, basically all our behavior is driven by short-term pleasure-seeking behavior. We want as much dopamine as possible. And that worked well in a natural setting, because it let us eat as much as we could whenever we could push everybody else out of the way. So, we managed to get enough to eat, live, and reproduce. You realize most people didn’t live to reproduce. Most humans born on the planet never passed on their DNA. They’re the losers. They’re not your relatives. Your relatives were the ones that got enough to eat. They got it. They didn’t get eaten. And they lived, and they passed on their DNA. And, so, the basic idea is in the world of scarcity which we evolved in, this mechanism allowed us to survive. And it’s the genes that you have in your brain today that directs your behavior.

The problem is, you changed the environment. Now we live in an environment of abundance. And those genes that drive us to get as much to eat as we can of the most concentrated foods available, they lead us astray. And that’s why 70-plus percent of the population are overweight and obese in an industrialized society. Because of the pleasure trap. The artificial stimulation of dopamine in the brain that comes from the chemicals that we add to our food like sugar, oil, and salt. It also can, you can induce a pleasure trap from cocaine or alcohol or any addictive drug. The hallmark of addiction is your continuing to consume the substance not only to feel good but to avoid feeling bad, because it’s an artificial stimulation, the dopamine. In the natural setting there’s only two behaviors that stimulate dopamine in a concentrated way: food and sex. That’s it. Food and sex.

As you’d expect, those are what’s going to drive you to get enough to eat and reproduce. Oh, by the way, if you’re a male it’s entirely different. Then it’s sex and food. Either way, food and sex or sex and food, those normal natural stimulants in dopamine kept our species alive. Today, we have things like drugs, and we have things like chemicals that we add to our food like sugar, oil, and salt. And that’s where, the reason why you have this epidemic of obesity and all the diseases, including diabetes, that go along with it are because of the pleasure trap. And that’s what the book really clearly explains.

This is not a book that tells you what you want to hear. But it does tell you what you need to know in order to understand why it’s so difficult to do what you need to do, even when you understand it and believe it. Because you live in a world designed to make you fat, sick, and miserable. And everybody’s going to give you what you want, not what you need. And what you want is how to indulge in those behaviors without paying the price. And what you need is to figure out how to escape the dietary pleasure trap.

Cyrus Khambatta, PhD: Okay. So, if I’m understanding you properly, you’re basically saying if I identify myself as being a food addict, then all I have to do is just have more sex; is that right? Is it that simple?

Alan Goldhamer, DC: Absolutely. If you have enough sex that you don’t have time to eat any of the the highly processed heated, beated, treated, chopped foods, you’re probably going to make a lot of improvement.

Cyrus Khambatta, PhD: That’s exactly right. Because it’s a form of exercise, too. So, if somebody finds out that they’re actually a food addict and they’re caught in the pleasure trap and they understand intellectually that that’s where they are what can they do to escape the pleasure trap?

Alan Goldhamer, DC: It’s very similar to saying what do you do if you find that alcohol has begun to dominate your life and now you have to keep drinking to avoid the withdrawal effect. The answer is not put your alcohol in a smaller cup or drink your alcohol with a spoon and put the spoon down between each bite. The answer is what do we tell alcoholics? You have to stop drinking. Alright. You don’t tell them to moderate their alcohol. You don’t tell alcoholics to just have beer and wine and you’ll be fine. It doesn’t work. So, if you have a person that’s obese or has conditions like diabetes, you can’t say well just eat less, or put your food on a smaller plate, or chew your food and put the fork down and then you won’t be fat or sick anymore.

What you have to do is acknowledge the fact that you are—because, listen, they’ve tried. It’s not like people haven’t tried to regulate the quantity. So, what you have to do is just stop eating the chemicals that are fooling your brain leading to the condition that’s causing the problems. And that means you have to adopt a whole-plant-food diet that’s free of SOS. No more salt, oil and sugar. If you do that, you’re going to be successful. You’re gonna to lose weight. If you’re a male, average two to three pounds a week. For a female, one to two pounds a week. You’re going to find that your insulin resistance begins reducing. That your objective variables start to improve. You’ll be able to wean out or eliminate the need for medication. You’ll be able to achieve your optimum weight and health. Is it easy? No. Because you’re an addict. And it’s hard giving up that artificial stimulation to dopamine. People like that. They’re used to it. They want it. But if you’re willing to do the experiment of giving yourself a chance to get healthy, you will get there. Now, some people it’s too difficult.

And that’s why we lock them up at the TrueNorth Health Center. We help them make that transition in a more facilitated manner. Other people can. All they need is the information. They implement the information. They begin to make the changes. You know, it happens a lot to me. People call up because we’re booked ahead a lot. We’ll try to get them on the diet first to prepare for the fast. And by the time it’s time to come in they’re already better.

Cyrus Khambatta, PhD: Right.

Alan Goldhamer, DC: What can you do?

Cyrus Khambatta, PhD: Right. Okay. So, you’re saying, you’re saying it’s not a question of having to go to zero food? You’re saying it’s just a question of going to zero foods that contain salt, oil, and sugar? And once you’re there you can start to see a lot of improvement right off the bat?

Alan Goldhamer, DC: Any animal food. So, we eliminate animal foods and SOS. So, vegan SOS-free eating. So, what that means is you have fruit, salad, steamed vegetables, potatoes, rice, and beans. Now, it is true some diabetics have to even restrict their diet further. For example, you can’t feed all diabetics generous quantities of fruits because their ability to regulate those simple sugars is more limited. We have to go into more of the vegetable—steaming, starchy vegetable materials in order to help them gain short-term control. Now, eventually as insulin resistance is reduced, their ability to be varied within that whole natural-food diet may increase.

But even within the context of that diet, there may be further restrictions that are necessary. Now, in some cases, people are so fragile that the only way we can really get them stabilized is to go through this period of medically supervised fasting. But that’s a relatively small percentage of the population. Basically, those are, you know, we get a lot of our patients from other plant-based doctors who often talk about us as the punishment. They say our signs should say, “TrueNorth Health Center, the Last Resort.” And so, they’ve done their best with whatever the variation of the program is. But if they’re not responding well enough they’ll, like, apologize to them and send them to the TrueNorth Health Center. And, so, that’s, you know, understandable. But because it is a very strict protocol. But for people that are, you know, sick, sometimes they need a really strict protocol to get the results they want.

Robby Barbaro: So, speaking of the people that would need a fast, let’s talk a little bit about fasting at home. When is that safe? How do you do that safely? How long can some do that? So, let’s say for someone living with type 2 diabetes or prediabetes would that be safe?

Alan Goldhamer, DC: I wouldn’t recommend prolonged water-only fasting without having first a history exam and laboratory monitoring. Now, it is true that some people can do that if they have a cooperative physician. You know, they can get the monitoring they need on a daily basis without necessarily being at TrueNorth Health Center. But what I would recommend at home is to take advantage of the intermittent-fasting techniques, the reduced-calorie techniques, and just eating the healthy diet. But if we’re talking about prolonged water-only fasting, that’s really best done under direct supervision of a doc that understands what’s going on in an environment of complete rest.

That doesn’t really happen well at home. And that’s where a lot of the things you hear about,the horror stories about fasting happen. And it’s not in a controlled setting. It’s home. There’s a lot of things that people could do at home. For example, you could subscribe to a service that help you do a home appendectomy. And they could guide you through that on the internet. But the outcomes wouldn’t be very good. You’d have complications and problems. I wouldn’t recommend you do home appendectomies. I wouldn’t recommend doing prolonged water-only fasting. And particularly not for people that have complications like diabetes. You know, it can get quite intense sometimes.

Cyrus Khambatta, PhD: So, what about somebody who’s living with type 1 diabetes who says, “I want to come to TrueNorth and fast for the next two weeks?”

Alan Goldhamer, DC: Well, we wouldn’t do water only fasting typically in true type 1 diabetics, because you need insulin in order to be able to adapt to the fasting process itself. So, type 1 diabetes, in other words, if your c-peptide says you’re not making insulin and you’re truly are a type 1, not a type 1.5 diabetic, water-only fasting probably would not be the approach that we would be taking. We would be focusing on the diet, sleep, exercise, getting that fine tuned in, and being a little bit more patient. Once those islet cells are destroyed, it’s unlikely that those are going to regenerate under current, you know, approaches.

And, so, type 1 diabetes—we treat a lot of them, but we don’t typically do prolonged water-only fasting in those patients. Now, there are some people that are diagnosed as type 1 and they’re not really type 1. They’re actually making a little bit of insulin. And some of those people are the ones you read about online that say they overcame their type 1 diabetes by fasting and now they’re normal enough. And it is true. We’ve had some of those patients. But they’re almost certainly not truly type 1 diabetics. They’re truly patients that still were making some insulin. And just very, very strict diets were allowing them to maintain normal sugar levels without exogenous support.

Cyrus Khambatta, PhD: Ok. So, the danger then, the fasting, for somebody living with type 1 diabetes, is that they still need some basal amount of insulin?

Alan Goldhamer, DC: Right. It’s very difficult to keep them out of a hypo. You know water-only fasting state. You can get into some really serious, life-threatening complications with ketoacidosis. So again, we’ve probably done more of it than most people. And it’s not something that I would recommend. I have to say of the few complications I’ve ever seen in my practice, most of them were in type 1 diabetics that we were trying to get here real quick.

Cyrus Khambatta, PhD: Got it. Okay, so, let’s talk about breaking a fast now. Suppose you’ve fasted somebody for two weeks and they’ve seen a significant improvement. How do you break a fast?

Alan Goldhamer, DC: I think this is one of the most important, and the areas where the most mistakes are made. You need to remember that you do a lot of mobilization of intermediary products, metabolism, fasting, and so, you’re mobilizing a lot of junk from the cells you really don’t want inside the cells. But it takes a while to get that stuff out of the body. Most of it is eliminated, actually, in the urine as the blood is being processed by your kidneys. So, even though you’ve mobilized a lot of stuff through fasting, you haven’t necessarily eliminated everything yet. And those early days of refeeding, a significant amount of detoxification is still taking place.

And the theory is that if you go too rapid into that refeeding or do it inappropriately, you may undo some of the benefits that you’ve gotten by mobilizing materials by preventing them from being properly eliminated and processed. The way we do it at TrueNorth Health Center is for every week of fasting, now this is just as a general rule, obviously there’s some individual variation, depending on the patient’s condition. For every week of water-only fasting there’s usually a week of fresh juices, which usually are vegetable dominated, but also some fruit juices, at least in nondiabetics. And then there’s a week of raw materials. Usually vegetables and/or fruit. And then there’s a day of more concentrated, like steamed vegetables. So, for example, the 14-day fast might have a day or two of juice, a day or two of raw foods, and then we’d introduce some steamed foods, and then some starchy foods. It would take half the length of the fast get them back to healthy, plant-based, SOS free eating. So that 14-day fast would take about seven days of this progressive refeeding.

Now most people think they’re going to be ravenously hungry and want to eat everything under the sun. That’s not true if what you’re eating is whole, natural foods coming off the fast. Leptin levels are increased and normalized. Appetite is actually modulated. And most people find they feel full relatively simply, unless they poison themselves with a bunch of sugary, processed crap. And then, of course, they set up the whole pleasure trap addictive cycle and get into binge eating and get in trouble.

But when people actually break the fast properly, they’re usually very satisfied. They don’t feel hungry. They’re not ravenous. They’re not feeling deprived. They really enjoy their food. A lot of them are shocked because the chard tastes so salty. They think someone added salt to the chard. Well, it tastes like it always tastes, but now they can actually taste it, because one of the changes in fasting is neuroadaptation. So, the tastes actually come alive. And now, people go from thinking whole, natural foods are tasteless swill to being something they actually enjoy. And that’s actually one of the big benefits of fasting is you can get people to a point where good foods actually taste good.

Robby Barbaro: That’s awesome. Okay. So, you have been doing this for a long time. You’ve helped thousands of people over many years. What is the number one challenge that you see people face when it comes to lifestyle change, and how do you help them overcome that?

Alan Goldhamer, DC: Well, I think there’s a number of big challenges that people face. It’s interesting, when they’re at the TrueNorth Health Center, food typically isn’t a big problem. They like the food, particularly after fasting. And, you know, when somebody else is doing the shopping, and chopping and preparing it, and all they have to do is come down and eat, that usually seems to be a rather pleasant and positive thing. Which tells me food itself isn’t necessarily the big challenge; the problem is all the shopping, chopping, prepping, energy that it takes to get and eat and digest the food.

People have so little time in their lives that they don’t have time to go shopping, or to get food, or to make food, or to eat food. They don’t even have time to eat the food, because they’re driving two hours a day to a job they hate, to work with people they despise, for a company they detest, to make products they don’t believe in, to make money they don’t need, because they think they have a problem with their life because of short-term, pleasure-seeking, self-indulgent-behavior deficiency. And so, one of the big challenges is getting people to change how they think about the important things in life. For example, health and happiness. You know, the single biggest predictor of happiness turns out to be health.

If you compromise your health, it’s hard to experience the balance of your life experience as highly positive. So, if you get the perspective that, hey, I want to be a happy person, well that means, I need to also be a healthy person. And to be a healthy person, I have to live healthfully. And that means I have to eat, sleep, and exercise appropriately. So, getting that whole philosophical priority squared way, I think, is one of the big challenges. Once people have that, then some of the logistical parts tend to start falling into place.

Cyrus Khambatta, PhD: Yeah, oftentimes we hear from our clients, and beyond, who say that they feel like they don’t deserve the ability to put attention towards themselves. That if they do, that they’re being selfish, because they’re not being able to hang out with their kids, or give attention to their husband, or their wife. And so, I think, you know, what you’re touching on here is actually just like a fundamental sort of thought process, which actually isn’t true to the first place.

Alan Goldhamer, DC: And we explain this in The Pleasure Trap. Dr. Lisle does a really good job of explaining why people think and feel the way they do, and how you, and what you have to be aware of. Because the truth is other people, for example, well, first let’s talk about the fact that the limiting factor in life is clearly time. No matter how rich you are, you only get 168 hours a week. You can’t buy any more time. And so, how you spend your time turns out to be one of the most important things to determine whether you’re going to be healthy and happy. But other people believe that there’s no one thing you can do with your time that’s more valuable than meeting their needs. They really believe that.

And they will do everything they can to manipulate you, and intimidate you, and threaten you into making sure their needs get met as best as possible. And no matter how much of your time you give to meeting their needs, it will never be quite enough, whether it’s a two-year-old, your mate, or your boss. And so, you have to realize that, okay, I only have 168 hours a week. I can only delegate so much to certain things. And if I start cutting my sleep time because somebody wants me at work early, if I start cutting my exercise time, it’s like I take care of everybody else’s needs. If I start cutting my feeding time because I’ve got so many other important issues on my plate, you’re going to compromise your health and ultimately your happiness.

So, the way that it should work is first you eat well, exercise, get enough sleep, and then the time you have left you go to work. Now the problem is, that doesn’t always leave enough time to do everything people think they need to do. Particularly, for example, if they spend two hours a day commuting. So sometimes I try to convince patients maybe it would be better to cut those two hours of high-stress commuting time out by figuring out a way to either move where you live or move where your work, so that you don’t have to invest that two hours a day. And sometimes it turns out even though you might have to take a pay cut by making that change, the amount of value you get from your increased time may be enough that now you can eat well and live well and be healthy and happy.

So, again, it comes back to priorities. What’s the most important priority? If it’s to be healthy and happy, then you’ve got to figure out how to structure your life where you have the ability to do that. And I know it’s easier said than done, but ultimately, I’m just looking at the people who are successful and they figure out how to do that.

Cyrus Khambatta, PhD: I love it. Tell us what do you eat on a daily basis? I want to know.

Alan Goldhamer, DC: So, I’m very fortunate, because I eat 20 of my 21 meals a week at the TrueNorth Health Center. And the TrueNorth Health Center serves only whole-plant-food, SOS free food. So, there’s no temptations. It’s very easy. We come in, we have oftentimes a grain, like oatmeal or corn. We have fresh fruit or greens. May have some nuts, or seeds, or flaxseeds for breakfast, depending on the day.

At lunch we always have a huge salad. I always tell patients they know they have a big enough salad, if they don’t have scale to weigh out and see a pound of salad or something. All they have to do is put their salad down and wait for the people at work to walk into the dining room with them. And they’ll immediately go, “Oh, my gosh! You’re not going to eat all that are you?” Then you know you’re doing okay. If they don’t react with shock and awe, you’ve got the wrong size plate.

And then, you know, they have big salads like we do at lunch at the TrueNorth Health Center. And we have a beautiful salad bar, so you can pick all the stuff that you want. And then we have steamed vegetables. And again, it should look like, you know, what would be considered a family-sized platter for a family of four or six. You know, large amounts of vegetables. And then just enough complex carbohydrates, whether it’s potatoes, rice, or beans so you don’t get too skinny and weak.

We also might include a small amount, maybe an ounce a day of raw nuts or seeds or a little avocado in the diet. Plenty of water in between meals, and basically nothing else. No meat, fish, fowl, eggs, dairy products, oil, salt, or sugar. We eliminate all the heated, beated, treated, chopped, processed crap. And what’s left is an abundant quantity of high-nutrition, low-density foods. And that’s what I do each and every day.

Robby Barbaro: Where is the other one meal?

Alan Goldhamer, DC: Well, the third meal is dinner. The same thing: salad, steamed vegetables. If I have potatoes at lunch, I might have beans at night. Whatever. You can rotate. You get to have whatever you want within the context of whole, natural foods. Now, if you’re a diabetic, we might say well let’s keep the amount of fruit down to either nothing or very small, for a piece or two a day, so that we don’t overload your capacity, until we know that your hemoglobin A1c is 5.5 range, etc, etc.

So, I’m not saying there’s not a little tweaking. If you’re trying to lose weight, we’re eating more raw vegetables and maybe a little less of the more concentrated carbohydrates. If we’re trying to gain weight, maybe we have a little bit less salad. We have a little bit more of the complex carbohydrates. We’re trying to lose weight, we have salad first, fill up on that, and then have the more concentrated foods. You’re still hungry, a little bit more salad. If you’re trying to gain weight, we might have complex carbohydrates first and then, you know, have some salad at the end. So, you manipulate, depending on if you’re trying to get a higher or lower density diet. It’s not rocket science, but it works pretty well.

Cyrus Khambatta, PhD: Absolutely. I can tell by the way that you talk this is not the first time you’ve said these words before. But you also are like, you’re very eloquent in the way that you describe, sort of like, the thought processes that we have, and the ways that we can actually overcome them. So, thank you for your time. Thank you for doing what you do. Thank you for writing books. Thank you for helping people at TrueNorth, and for really being a source of inspiration for thousands of people around the world.

Alan Goldhamer, DC: If any of your viewers would benefit from it, I’d like to mention that we do have a nice service, I think, that we offer. It’s free. And that’s if a person goes on to our website at healthpromoting.com and completes the registration forms, they can call for a free conversation with me. And I’ll help them fine tune, if there’s anything we can do that might be useful, or anything that they can do that they’re not already doing that might be useful for moving in the direction of health. So, in addition to our website, which has a lot of information, both videos and articles and studies, we also have this service that’s available to your viewers if they’re interested.

Robby Barbaro: That’s terrific. Good. Make sure you don’t get your phone system broken, so be careful with that.

Cyrus Khambatta, PhD: I love it. Yeah. Thank you so much for your time, Dr. Goldhamer. You’re a wealth of knowledge and we really appreciate it.

Robby Barbaro: We really hope you enjoyed that episode, you've learned a lot and you're going to now take this information and put it into action. If you are living with diabetes, or you want to make sure you don't develop diabetes, you may want to consider joining our coaching program.

So we have an incredibly robust coaching program at an incredibly affordable price. At the time of this recording, we have a waitlist, so if you want to get into our coaching program, you have to go to www.masteringdiabetes.org, click Coaching in the top navigation bar and get your name on the waitlist.

We offer a lot in this coaching program, the price ends up being less than $0.70 cents a day. And we offer an online course that gives you everything you need to know about how to transition to a low-fat, plant-based, whole-food lifestyle one step at a time. And it's only the pertinent information, only exactly what you need. The whole point is to not make it overwhelming. So that's the way we've designed this online course in a step by step manner.

Start with goal setting, you learn some of the science, you start changing breakfast, when you're ready, you start changing lunch, and when you're ready, you start changing dinner, and there's lessons about intermittent fasting all along the way, all the nuances about your blood glucose and what to expect and medications, and all that is covered in the online course.

The second tool we offer in our coaching program is a private community where our coaches answer questions within 24 hours. So every time you make an original post, sharing something or asking a question, one of our amazing coaches is going to reply within 24 hours. This community is on Facebook and outside of Facebook, for those who don't want to use Facebook.

So it's an incredible, incredible resource to get your questions answered every step of the way. We have two people in that group that have completely reversed type two diabetes as our coaches. That's Adam Sud, and Marc Ramirez. And we also have Kylie Buckner, RN, who's a registered nurse as one of our lead coaches in the coaching program. And you also have Cyrus and me chiming in when necessary. So we have you covered on all fronts, no matter what type of diabetes you're living with, we're there for you every step of the way.

People are also sharing lots of food pictures and recipes in the community. We're sharing meal planning tips, our team, we're sharing new recipes, we do challenges together. So the community is a really robust aspect of this program. And really, really important for people to have long term success on our program.

The third tool in our coaching program is twice monthly live Q&A calls. And these are fantastic with the first and third Sunday of every month, we use Zoom Video Conference so you can see us and we can see you if you choose to turn on your camera. Or you could just call in with your phone and we answer questions until everybody's questions are answered. And it's really fun. It's great to have that back and forth communication, and we can cover a lot in a short period of time.

The online community is obviously very helpful, you should get any urgent questions answered right away through the community. But it's also nice to have that dialogue and go back and forth on a video conference call. So that's the other tool we offer. And that's the Coaching Program.

So we have amazing results. I'm sure you've heard them on our podcast, seen our testimonials on YouTube and on our website, we want you to experience the same success, okay, our incentives are so aligned it's not even funny. We want you to have the best health ever so we can show the diabetes community how successfully a low-fat, plant-based, whole-food diet reverses insulin resistance. It's a win-finity situation, we want you to succeed so, so much. We all benefit and we work very hard as a team to make sure that you get the results you're looking for. That's our point with the coaching program. So again, make sure to get on our waitlist, go to www.masteringdiabetes.org, click coaching and I can't wait to work with you soon.

​Have a great day!

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About the author 

Cyrus Khambatta, PhD and Robby Barbaro, MPH

Cyrus Khambatta, PhD, and Robby Barbaro, MPH are the coauthors of the New York Times bestselling book Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes. They are the cofounders of Mastering Diabetes, a coaching platform that teaches people how to reverse insulin resistance via low-fat, plant-based, whole-food nutrition. Cyrus has been living with type 1 diabetes since 2002, and has an undergraduate degree from Stanford University and a PhD in Nutritional Biochemistry from UC Berkeley. Robby was diagnosed with type 1 diabetes in 2000, and has been living a plant-based lifestyle since 2006. He worked at Forks Over Knives for 6 years, and earned a Master’s in Public Health in 2019.