The Fast Solution

The Fast Solution

Part 4 of 6The Aetiology of Obesity

Sugars

Simple carbohydrates - 1-2 sugarsComplex carbohydrates – long chains of sugars

Blood Sugar

Table Sugar

“Fruit” Sugar

Are sugars toxic?www.kidneylifescience.ca

Rising Consumption

www.kidneylifescience.ca

Beverage choices


Sugar sweetened beverages


Faith M S et al. Pediatrics 2006;118:2066-2075Fruit juice intake predicts increased adiposity gain in children from low-income families

Juice and Childhood Obesity

Increased offerings of whole fruits were associated with reduced adiposity gain


Sugar Sweetened Beverages

Nurses Health Study 1991-99Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged WomenJAMA 2004;292(8):927-934 Schulze MB

Consistent <1/wk

Consistent >1/day

<1/wk to >1/day

>1/day to <1/wk

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

2.04 2.21

4.2

0.15

Wei

ght G

ain

(kg)


Increased Diabetes

Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women JAMA 2004;292(8):927-934 Schulze MB

<1/mo 1-4/mo 2-6/wk >1/d0.8

1

1.2

1.4

1.6

1.8

2

1 1.06

1.49

1.83

Risk of DiabetesO

dds R

atio

Nurses Health Study 1991-99


Hormonal Obesity Theory

FatteningCarbohydrates

Increased Insulin level

Insulin Resistance Time Dependent

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar


Carbohydrates raise blood glucose

Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetesDiabetes. 2004 Sep;53(9):2375-82 Gannon MC

Usual Diet55% CHO Diet20% CHO Diet Co-factors

FatFibre Speed of Digestion


http://www.ncbi.nlm.nih.gov/pubmed/15331548


Fructose is ‘healthy’1983

“We see no reason for diabetics to be denied foods containing sucrose” John Bantle NEJM

1986 “No conclusive evidence (sugars) demonstrates a hazard” FDA

2006Can substitute sucrose “for other carbohydrates in the meal plan” ADA


Fructose

Natural

Food

Pre WW2

19771994

20000

10

20

30

40

50

60

Fructose Consumptiong/day per capita

Fructose

Berry AJCN 2007 88;895

Adolescent 1994 72.8 g/day


High Fructose Corn SyrupFructose

Low glycemic indexCheaperSweeter than glucosePrevented freezer burnMixes easilyExtends shelf-lifeHelps breads brownKeeps them soft

Found in almost all processed foods especially low fat foods

55% fructose 45% glucose


Obesity and HFCS


Total Sugars

Refined Sugar

HFCS

“High Fructose Corn Syrup “or “High Fructose Table Sugar”


Fructose Metabolism

Increased lipogenesis


Fructose causes insulin resistance

Impaired cellular insulin binding and insulin sensitivity induced by high-fructose feeding in normal subjectsAm J Clin Nutr. 1980 Feb;33(2):273-8 Beck-Nielsen H

Insulin Tolerance Tests25% worse with fructose

Glucose Fructose


6 days of high fructose dietIndication of hepatic insulin resistance

Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy MenDiabetes July 2005 54; no. 7 1907-1913, Tappy L

Endo

geno

us g

luco

se p

rodu

ction



Glucose Fructose

Oral Glucose Tolerance Testwww.kidneylifescience.ca

Fructose causes hyperinsulinemia

Glucose Fructose

Oral Glucose Tolerance Test


Fructose causes Insulin Resistance

Insulin Resistance!

JCI April 20, 2009 Havel et al. www.kidneylifescience.ca




Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose


Fructose Overfeeding and Triglycerides


TG increased 79%


Sugar and Triglycerides

NHANES 1999-2006

JAMA. 2010;303(15):1490-1497 VosCaloric Sweetener Consumption and Dyslipidemia Among US Adults

Mean of 15.8% of consumed calories were added sugars


Sugar and HDL

JAMA. 2010;303(15):1490-1497 VosCaloric Sweetener Consumption and Dyslipidemia Among US Adults


TG LDL HDL apoB sdLDL

18.213.9

3.5

27.2

44.9

2.5 3.6

-2.4

3

13.3

Fructose Glucose

% in

crea

se

Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humansJCI April 20, 2009 Havel et al.

Fructose and Lipids


Fructose and Blood Pressure

NHANES III 2003-2006 4,528 adults who developed hypertensionIncreased Fructose Associates with Elevated Blood PressureJ Am Soc Nephrol 21: 1543–1549, 2010 Jalal D www.kidneylifescience.ca

Reducing SSB lowers blood pressure

Reducing Consumption of Sugar-Sweetened Beverages Is Associated with Reduced Blood Pressure: A Prospective Study among U.S. AdultsCirculation. 2010 June 8; 121(22): 2398–2406 Chen L

Tertiles of reduction in sugar sweetened beverages


Fructose and Fatty Liver


6x increase in DNL


“An increase in liquid carbohydrates leads, perversely, to even greater caloric consumption”

SSBs are addictive

JAMA. 2004;292(8):927-934 Schulze MB





Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose

Sugar


Wheat

To increase yield, seed head sizes increased


Dwarf Wheat

99% of wheat grown worldwide


Broadbalk Wheat Experiment

Evidence of decreasing mineral density in wheat grain over the last 160 yearsJ Trace Elem Med Biol. 2008;22(4):315-24 Fan MS

Introduction of high yieldSemi dwarf wheat




Up to 5% of the wheat kernel removed

70% of the germ

Whole Wheat

Contains most of vitamins, protein and fat


Whole Grain Processing


Multi-grainMay be 2 refined grains

Rice flour Dried potatoesCorn flour


Speed of Digestion

Modern Flour MillTraditional Stone grinder


Flour

White flour 70% carbohydrate by weight

75%


Amylopectin

Amylopectin C is the least digestible (Legumes)Amylopectin B (Bananas, potatoes)Amylopectin A (Wheat)

Most digestible

Whole Wheat

Bread

Banan

a

Snick

ers Bar

Kidney Bean

s0

1020304050607080

Glycemic Index

Wheat is more efficiently converted to blood sugar than nearly all other carbohydrate foods


ExorphinsDigestion of gluten yields morphine-like compounds ‘exorphins’

Ability to cross blood brain barrier


COMFORT FOODS

Comfort foods (affect mood) often contain wheat and other highly refined carbohydrates

Mashed Potatoes and GravyIce CreamApple PieMac and CheesePancakesSpaghetti and Meatballs


Problems with Wheat1. Modern wheat is of lower

nutritional value2. Modern processing removes

most of vitamins, fibre and fats

3. Modern milling (as opposed to stone ground) increases speed of digestion

4. High in amylopectin A (highly digestible)

5. May be addictive “Wheat Belly”


The China Study

“In both China Study I and II, wheat is the strongest positive predictor of body weight (r = 0.65, p<0.001) out of any diet variable”rawfoodsos.com


Asian conundrum



Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose

WheatSuper-carbohydrate


How can we break the cycle?



Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose


Resistance requires:1. High Level2. Persistence


Fasting

“Our food should be our medicine. Our medicine should be our food. But to eat when you are sick is to feed your sickness." Hippocrates


Fasting mythsPuts body in “starvation mode” Deprives body of nutrientsWeight loss from muscle/ waterCauses hypo-glycemia“Yo-yo” dietOverwhelmed with hungerIt’s “crazy”


HUNGER DISAPPEARS“The most astonishing aspect of this study was

the ease with which prolonged starvation was tolerated.” E Drenick JAMA 1964 Jan 11; 187:100-105

“A sense of well-being was associated with the fast” JAMA. 1962;181(4):309-312 Duncan GG

Effect of an acute fast on energy compensation andfeeding behaviour in lean men and women

Int J Obesity (2002) 26, 1623 – 1628 Stubbs RJ

Increased intake from 2436 to 2914 calories on the day after a fast

Over 2 days (2436 x 2) = 4872

Fasting 2914Net deficit 1958 calories


382 day fast

Weight 456 to 180 lbs then remained stable Features of a successful therapeutic fast of 382 days' duration Postgrad Med J(569); Mar 1973


http://www.ncbi.nlm.nih.gov/pmc/journals/174/

http://www.ncbi.nlm.nih.gov/pmc/journals/174/

http://www.ncbi.nlm.nih.gov/pmc/issues/170206/

Fasting reduces plasma insulin

Glucose remains in normal limits but plasma insulin decreases significantlyN Engl J Med 1974; 291:1275-1278

Plasma Insulin02468

1012

BaselineFasting

Fasting: The History, Pathophysiology and ComplicationsWest J Med 1982 Nov; 137:379-399


Fasting reduces plasma insulin

Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolismAm J Clin Nutr 2005;81:69 –73 Heilbronn LK

Stable blood sugars


Fasting maintains resting metabolic rate

Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism Am J Clin Nutr 2005;81:69–73 Heilbronn LK


Fasting improves insulin sensitivity

Effect of intermittent fasting and refeeding on insulin action in healthy menJ Appl Physiol 99: 2128–2136, 2005 Halberg N

Glucose Infusionrate

Euglycemic clamp


Fasting increases norephinphrine

Resting energy expenditure in short-term starvation is increased as a result of an increase in serum norepinephrineAm J Clin Nutr 2000;71:1511–5 Zauner C


Fasting increases Growth Hormone

Growth Hormone:Increases availability and utilization of fats for fuelPreserves muscle mass

Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in manJ Clin Invest. 1988 April; 81(4): 968–975 Ho KY

Integrated GH concentration


Intermittent caloric restriction is better

Randomized trial25% caloric reduction

The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN


Baseline 1 month 3 months 6 months4.8

5.3

5.8

6.3

6.8

7.3

IERCER

Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN

Insulin

Intermittent caloric restriction is better


Fasting preserves lean muscle mass

Improvements in Coronary Heart Disease Risk Indicators by Alternate-Day Fasting Involve Adipose Tissue ModulationsObesity (2010) 18, 2152–2159 Varady KA


Obesity (2010) 18, 2152–2159 Varady KA

Fasting improves lipids


Fasting breaks the cycle



Insulin Resistance

Fibre Obesity

High TGLow HDL

Hypertension

Diabetes

Metabolic Syndrome

Fatty Liver

High Protein

Cortisol

Vinegar

Fructose

WheatSuper-carbohydrate Fasting

But Insulin resistance IS diabetes


Diabetes USA

American Diabetes Association recommends diabetics eat MORE carbohydrates not less


Fasting reduces Diabetes

The Effect of Short Periods of Caloric Restriction on Weight Loss and Glycemic Control in Type 2 Diabetes Diabetes Care. 1998 Jan;21(1):2-8 Williams KV

P<0.05





Fasting associated with reduced Diabetes and CAD

Usefulness of Routine Periodic Fasting to Lower Risk of Coronary Artery Disease among Patients Undergoing Coronary AngiographyAm J Cardiol 2008 Oct 1; 102(7); 814-19 Horne BD


Fasting associated with less Diabetes and CAD

Prospective cohort study

Age BMI DM CAD0

10

20

30

40

50

60

70

80

FastNon Fast

Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography Am J Cardiol. 2012 Jun 1;109(11):1558-62 Horne BD






Food Rationing decreases Diabetes


Diabetes is a Reversible Disease!

Changes of insulin sensitivity and beta cell function are reversibleReversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerolDiabetologia 2011 Oct;54(10):2506-14, Lim EL

Hepatic Glucose Production


Surgical TreatmentRoux-En-Y Gastric BypassSleeve GastrectomyLaparoscopic banding

>90% cure rates for diabetes


Surgery cures diabetes

Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with DiabetesN Engl J Med 2012;366:1567-76 Schauer PR

Basically surgically enforced fasting regimenswww.kidneylifescience.ca

Fasting vs. Bariatric Surgery

Rapid Improvement of Diabetes After Gastric Bypass Surgery: Is It the Diet or Surgery?Diabetes Care. 2013 Mar 25, Lingvay Ihttp://www.ncbi.nlm.nih.gov/pubmed/23530013


0

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87.3

4 DietDiet + Surgery

Wei

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oss (

kg)

Series11200

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1500

1293

1478

Daily

Gly

cem

iaPr

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Diabetes

High Protein

Fructose


Fasting

Fasting

Bariatric surgery without the surgery – Fasting!

How to Cure Type 2 Diabetes


Can We Cure Type 2 Diabetes?No Diabetes – no diabetic nephropathy, no diabetic foot ulcers, diabetic retinopathy, reduced stroke, MI, cancersNo Drugs, no surgery, no cost, no long term side effects6-12 month intensive fasting regime to cure diabetes


Time to get started…

Jason Fung’s Intensive Diabetes Dietary Management (IDDM) Clinichttp://kidneylifescience.ca/drjasonfung

The Fast Solution

Documents

consumption of sugar

pounds of sugar

insulin fructose doesnt

blood glucoseeffect

weight gain

insulin directly9carbohydrates

blood glucose control

incidence of type