Can Fasting Save Your Life? The Danger Of Visceral Fat & The Incredible Benefits Of Prolonged Water-Only Fasting With Dr. Alan Goldhamer

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The type of fasting that we do is the complete abstinence of all substances except water so it's therapeutic medically supervised water only fasting over a period of we routinely fast people up to 40 days.

We fool the satiety mechanisms of the brains of humans by putting chemicals in our feet. Salt oil and sugar are not food. They're hyper concentrated food by products. They're added to food to make food taste better. You know health results from healthful living. If you just eat a whole plant food S.S.F.E. diet and you eat to your satisfaction you will be able to maintain optimum weight.

But to the degree that you add salt oil and sugar to the food the only question is how far are you going to get. Four years ago at the peak of the pandemic I sat down with water fasting practitioner and proponent Dr. Allen Goldhammer for a conversation that quite stunningly aggregated an audience in excess of five million people and continues to garner attention to this day.

Well today he's back with the latest research on the benefits of prolonged fasting along with more evidence and experience based insights on the nature of metabolic health. What is driving the escalation of lifestyle disease and the essential habits required to achieve and sustain optimal weight and health.

All of which he details in his new book can fasting save your life. For those unfamiliar Dr. Goldhammer is a pioneer in plant based nutrition and the founder of True North Health Center where he is personally supervised over 25,000 patients during extended water only fast some lasting up to an astonishing 40 days. Final note before we get into it under no circumstances should anyone undertake a water fast of any length without the medical supervision of a trained professional.

In other words please please do not try this at home and without out of the way I give you the truly fascinating Dr. Allen Goldhammer. Allen is great to see you. Good to have you back here. I think it's been three years since we first sat down. It was in the middle of the pandemic.

We had an incredible conversation about all things fasting prolonged water only fasting and true north has been around 40 years at this point and I think you have overseen the medical supervision of something like 25,000. It's been around 25,000 prolonged water only fast during that period of time. Yeah, I mean this is essentially all I've done in my life. I got interested in fasting at 16 I'm 65 today and essentially that's really all I've been involved with my whole life.

Well, let's begin with the most kind of general question, which is what is fasting? I mean fasting has become quite the popular thing lately, but it can mean many different things. You do prolonged water only fasting, but there's intermittent fasting. There is time restricted eating. There is alternate day fasting twice weekly fasting.

There's the fasting mimicking diet that Walter Longo pioneered. There's minimally supplemented fasting. So what is fasting? What are we talking about when we're discussing this topic? Well, the type of fasting that we do is the complete abstinence of all substances except water in an environment of complete rest. So it's therapeutic medically supervised water only fasting.

There's a lot of fasting mimicking programs out there and they all have potential benefits and uses. Some of them have many advantages over the prolonged water only fasting and that they don't require the level of supervision. They don't require aggressive withdrawal of medications. They don't have the risk profile that medically supervised water only fasting could have if it's not done properly.

So particularly Walter Longo is popularized. A program where it's limited nutrition intake. It can be done by most people at home. It can be very helpful to the degree that it's used, but it's not long term water only fasting. And as beneficial as these intermittent fasting programs can be in helping with weight loss and helping people make behavioral changes.

They're not necessarily the same thing you'll see in patients, for example, that have specific illnesses and need to reverse those diseases that you'll that you would see with long term water only fasting. So is that a way of saying that in your experience prolonged water only fasting is a superior protocol when it comes to helping people with acute or chronic lifestyle diseases?

Like why is it that you've chosen to focus on this rather than these other protocols that are seeming to be much more a part of the mainstream discourse around fasting? Well, I think that when you can accomplish your goals with intermittent fasting or these other programs that has advantages, as I said, safer profile simple doesn't require going to a place and requiring medical supervision.

But many conditions won't respond to those protocols and when they don't respond, that's oftentimes when we see people when they've done their best, they've made diet and lifestyle changes. They've done what they can do to resolve the problem, but the blood pressure still persists. I know my colleague John McDougal calls us the punishment that if he has a patient, for example, that doesn't resolve their hypertension, which most do?

But for those that don't, you know, you get the hard cases. He'll send us over with apologies. Yeah, yeah, yeah, because what we do is a more intense process. It's not something that you know, you necessarily look forward to if you're ill. But the fact is it can be done safely, it can be done effectively. And when it's needed, there's nothing else that does exactly what water only fasting does.

Right. So at true North, the typical hard case that finds his or her way to your doorstep is somebody that you're going to supervise over a period of how long as they undergo this protocol. Fasting ranges from five to 40 days on water only and there's a period of half the length of the fast recovery in the supervised setting.

So typical patient might fast for two or three weeks, they might be with us a month. And those patients will oftentimes come in with specific complaints, high blood pressure, type two diabetes, autoimmune diseases, or some forms of cancer, particularly things like lymphoma. Right. And how do you decide then how long this fasting protocol is going to be on a case by case basis? Like who are the people that you recommend a 40 day fast versus, you know, just a handful of days?

So you don't know with certainty before the fast exactly how the fast is going to go. And so what we do is we try to estimate long and then you know, if we can get it done quicker, that's great. I've had enough experience and fast enough people I can usually by looking at their medical history reviewing their lab, get a pretty good idea of what that range is likely to be.

But there are patients that we expect to go a long time, but they get well really quickly. And so we just don't need to do it. Other people we're hoping are going to be a shorter fast, but it ends up being it takes longer to get the job done. In some cases, it's pretty simple in the sense that like, for example, if you have high blood pressure, we want to fast you till you have normal blood pressure.

So that when you eat well, you don't have to be dealing with medications and the risk profile. And we know based on how high your blood pressure is, what your medical history is in terms of kidney disease and other things, how long that's likely to take. Right. We can do the same thing with type two diabetics. We can look at your hemoglobin, anyone see get an idea of how much insulin resistance there is.

And a big factor is how much extra weight and extra visceral fat do you have because it's the obesity, the extra weight and the visceral fat that's responsible producing the inflammation that causes these problems. And so we want to bring people as close as possible down to their optimum weight.

Now, in some cases, people are not overweight, but they're over fat. And so those individuals, you know, you have to stay within the reserves. Other people might have plenty of fat reserves, but they may not have electrolyte reserves. They may have other issues to become a limiting factor. And that's why we're carefully monitoring patients examining them twice a day, monitoring their lab, your analysis, the variables that we can monitor so that we can get a good indication.

And we know we do that safely because we've published a safety study where we have actually shown that if you follow this protocol, you know, everybody that walks in gets to walk out. What do we know and not know about the causal or highly correlative relationship between visceral fat and the cascade of chronic lifestyle diseases that seem to proliferate across the world these days?

You know, everybody's worried about obesity and being fat and they think of it often as a cosmetic issue. And it's far from just a cosmetic issue. On your body, there's a type of fat called visceral fat particularly accumulates around the abdomen and organs that has hypermetabolic effects that produces inflammatory products, aisle 16, alpha acute phase reactive proteins. And these inflammatory components are thought to be responsible for the heart disease, the diabetes, the autoimmune disease.

And some forms of cancer. So getting rid of you can think of visceral fat like a tumor. So if you had a multi pound tumor in your body, you would be appropriately alarmed because of its effects and we go to inordinate effects to get rid of those types of tumors. And interestingly enough, let's say you went on a fast and lost 10% of your body weight. You might think, well, I lose 10% of my visceral fat, but that's not the case. You may be losing subcutaneous fat or muscle mass.

You would lose all those things. You'd lose muscle fiber, glycogen, water, and fat when you fast. And when you come off the fast, you regain water, fiber, glycogen, and protein. But not fat. When you follow a whole plant food, SOS free protocol, you'll continue to lose fat. And what's interesting is you don't just lose equal amounts of fat and visceral fat. You will lose disproportionate preferential mobilization of visceral fat.

For example, we used a Dexascandard to do some studies, typical male, fast for two weeks, loses 20% of their total fat, but 55% of their visceral fat. So the visceral fat is being mobilized much like tumors are. In other words, if you lose 10% of your body weight, you don't lose 10% of your breast tumor. You might lose 50% or all of the breast tumor.

So how does the body know that it wants to get rid of the breast tumor versus anything else? Because there is mechanisms in the body that preferentially mobilize materials and inverse proportion to their need. And visceral fat shouldn't be there. And as a consequence, the body appears to go in and deal with that first, which is really great because it's one of the great benefits of fasting is the preferential mobilization of visceral fat.

So people going in might think, I'm here to lose my subcutaneous fat. But the sort of good news and bad news is maybe not more of the visceral fat, but that's actually in your best interest. And I suppose there are people who are relatively lean, who nonetheless and unsuspecting to themselves also have high stores of visceral fat. Is it Dexascan, the only or the best way to figure out whether visceral fat is a problem for you if you're not kind of overtly obese?

Well, a Dexascan with specific software that's designed to measure body fat, which is what we used in our studies. We'll do that. I don't know that it's necessary for people to do that because what's great is if you adopt a whole plant food, SOS-free diet, engaging exercise, get enough sleep, your body is going to take you down to optimum weight.

If you're at optimum weight, it's going to start the conversion process of mobilizing fat and replacing it with muscle. It's interesting as people are losing weight, sometimes they're going through the weight loss process that'll actually be getting skinnier but heavier because muscles actually denser than fat.

So you have to be a little careful with the scale and even with Dexascaners knowing that you have excess visceral fat doesn't change what you need to do, which you need to do as adopt a health promoting diet and lifestyle program. And if appropriate, you can use fasting to make the process happen quicker. Why is it that it's water only? Why not supplement with just a little bit of food or some juices?

And then perhaps a related question being this idea that you use distilled water. Like to me, wouldn't some electrolytes be a good idea here? Like I'm still trying to understand completely why it has to be water only. Why it has to be so severe?

Well, it doesn't in the sense that all these intermittent fasting programs use various amounts of calories and supplements to do their protocol. And I got no problem with that to the degree that that's effective. But what works best particularly when you're trying to get into this deep seated fasting where you're getting mobilization of visceral fat, tumors and other materials, it works better to allow the body to go into the full fasting state rather than the fasting and in our experience.

We have to still prove that we're looking forward to doing some research hopefully with ultra long go to compare and contrast intermittent and total fasting. If intermittent fasting is working at resolving the problem, great for you. But if you have a problem that despite people's best efforts, it's not resolving, this is the next step. And it's what we have the most experience in.

So our research is all on water only fasting is that's how I was taught that's what's been done traditionally in the nature cure arena. Given the fact that most of the people who end up at true North and undergo this protocol are people who who have severe, you know, extensive chronic lifestyle ailments acute medical issues.

I would imagine a lot of them, if not most of them are on medications, perhaps even a battery of medications, which presents you with the challenge of getting people off of those medications. Like are they allowed to taper off of them or do they stop them completely? I think there's probably a lot of people who might be watching or listening to this who are thinking, I'm on all these medications.

My doctor told me like never to go off of them. You're saying you're going to come here and I'm going to get you off of them, which is, you know, contravenes what they've been hearing for probably a long time. Well, there's a wide variety of medications. And so the answer is a little bit complicated. But when you think about conditions like high blood pressure or diabetes, physicians will tell you, look, here's the drugs you take.

And you'll be on these drugs the rest of your life. They will promise you if you do what you're told, you'll never get well. And that's their experience. In our experience, if you're willing to undo the reasons why you have the high blood pressure or diabetes with aggressive diet lifestyle change in the use of fasting, we can get you not only off the medications safely, but you can stay off the medication.

And again, we've got data to support that with long-term follow-up now. I didn't have that last time I talked to you. But for example, we completed a study on 29 patients that were prospectively admitted into our trial. 28 were able to eliminate the need for medication and one ended up on half dose of medication. We followed those people at six weeks. They had maintained those results. And then we followed them at a year.

And the people that we were able to follow up at a year, 75% of them were able to maintain their weight loss and their drug-free normal blood pressure state. So what it shows is that highly motivated, self-selected people are not only able to get well with fasting, but they're able to maintain enough dietary control that they can sustain those results.

What was the differentiator between the 75% and the 25% was it diet and lifestyle adherence? Diet and lifestyle adherence was actually a problem in everybody. We didn't get 100% diet and lifestyle adherence in anybody. But 75% of them were able to hear well enough that they maintain their weight loss. And the people that maintain their weight loss maintain their normal blood pressure state.

People that were having struggle and regaining weight, those were some of the people that had struggle with recurrence of the hypertension. Again, I think that visceral fat is a major contributing factor to high blood pressure. And so if you can get people to and keep them at optimum weight, it's often much easier to control their blood pressure. It's not the only variable. There's also issues with kidney function, et cetera, that contribute to it.

But dietary compliance associates with weight management, dietary compliance associates with normal normalizing blood pressure. What are some of the other studies that have been conducted and have come out since we last spoke? Oh my gosh, you know, we have, I think you got a whole bunch of stuff in the air. 19 papers that we've published in peer review journals. And many of them have come out. Some of them literally in the last few months.

It's becoming, you know, it takes a couple of years sometimes to get studies published. And sometimes much longer because we not only have to show that people can get well fasting, but that they can stay well.

Because the criticism is, oh, yeah, you've got them locked up at the Trunorth Health Center. You know, you control variables. What happens when they go back to free living? And so, for example, when I was here last time, we talked about a woman that we had treated with follicular lymphoma stage three, who had undergone 21 days of fasting.

And resolved her cancer. At one year, we published a case report in the British medical journal. And they invited us to do a three-year follow-up. We did a three-year follow-up where whole body CT, she was able to maintain a cancer-free state. Now we have a 10-year follow-up on her. She continues to remain cancer-free. But not only that, since then, we were able to track other patients with follicular lymphoma, including stage four follicular lymphoma with metastasis to the bones.

That gentleman fasted 40 days. We had follow-up, did a second 40 day fast, and he continues to do well. We have other patients with follicular lymphoma, one, for example, that underwent chemotherapy. But as often happens a year or two later, it comes back more aggressive than ever.

That person also did well. So even people that had undergone treatment seem to be responding to fasting. Now we have a cohort that's been submitted for publication. We expect that to come out later this year. We're hoping that that's going to be the basis for a clinical trial. We will be able to take a large group of patients randomly assigned, some will undergo fasting in addition to standard of care versus standard of care. And what we expect to see is dramatic improvement.

Because health results from healthful living, if you get people living healthfully and they're willing to do it, it's remarkable what the body is able to do. That is really wild. I mean, it's not surprising that somebody is going to be able to get their hypertension under control, that they're going to be able to get their blood markers into optimal states, apob, HBA, one-C, things like that. And treat some of the conditions that are clearly associated with obesity and metabolic dysregulation.

But when you talk about cancer, and I think we talked about this last time, I can feel myself clenching. When you talk about cancer, it gets very intense. Like there's a lot of people who would call what you just said, blasphemy, because there's a certain way of treating cancer and a holistic approach raises eyebrows to say the least, to put it mildly.

Well, it's the first paper, the British Medical Journal case reports is published on alternative management of cancer. They publish the follow-up. We've got another journal that's publishing the call for response to that. It's very controversial. I got a lot of calls and a lot of questions and a lot of criticism. The reason we were able to get it published, though, is because it's well known that the treatment for follicular phoma doesn't affect all-cause mortality.

It often fails. And as I said, even if you get success where you're going to remission, it comes back. The important thing is to find a strategy that not only gets the tumors to go away, but keeps them away. And that's where the diet and the lifestyle change seems to be so impacting. And then we use fasting on a periodic basis in order to be able to maintain health.

It's interesting that the concern is that it's so dangerous. The perception is that it's so dangerous that why would you risk somebody's life doing something so radical like fasting when there's a simple standard medical treatment available?

chemotherapy or radiation. And which is why we publish a fasting safety study where we took all the patients and looked at their adverse events and carefully monitored and charted the outcomes and then published a paper in bio med central that is the first long term fasting safety study.

And what it showed clearly is that fasting when it's done according to this protocol can be done safely. Even Walter Longo wrote a book on fasting where he talked about don't do long term fasting because it's too dangerous. But the one caveat was unless you do it at the true North-Hell Center. In the new book, can fasting save your life? You have a whole thing on safety. And it was interesting how few cases there are of people having A.E.s adverse effects.

And of the people who have suffered some kind of adverse effect, they tend to be very mild. Well, there's, you know, there were 5,900 adverse events in the patients over that five-year period. But most of them, as you said, type one or type two events. These are the normal symptoms you would expect to see in fasting.

The nausea, the headache, the skin rashes, the dizziness, the irritability, the sleep disruption. These are inherent. They're almost universal in fasting. Fasting can be a very intense process.

Most of the category three events, which would be considered medically significant, were hypertensive crises. And you might say, well, why would people being treated for high blood pressure on a fast have a hypertensive crisis, which is defined as any time for any reason, systolic blood pressure is over 160. And the way it works is that people come in and their blood pressure is 220 over 100. And then it's 210 and then it's 190. And the next day it's 180. Every one of those is an adverse effect.

It's not causally related. And most of our category three events are people whose blood pressure is coming down or blips up as they come off meds and comes down. We had very little category, no category five, which is death. A category four, we've seen very rarely we had one hyponutrimic event where blood sodium goes too low. And that does occasionally happen. And that's why we monitor electrolytes.

It's easily solved. You break the fast. But if you didn't catch it, it could conceivably become a serious or life threatening problem. We've also used to worry about high low white blood counts that show up in fast. But now we know a little bit more about why that might be in 2016, Yoshinori,

Yoshimi won the Nobel Prize in medicine for his work on autophagy. And it turns out autophagy is how the body eats up cancer cells and age cells and gets rid of them. Well, it turns out fasting profoundly increases autophagy. And so what we realize now is happening is people have a lot of white blood cells, some of them are part of an active part of immune system, some of them are no longer functioning.

So if you want to fast the body rapidly clears out those non-functional cells, so your count stroke, your immune resistance doesn't drop. And we notice people are getting infections or problems in fasting, but their counsel drop. And we believe it's because they're clearing out those non-functional cells. And so to temper the count stroke, and then of course they normalize after fasting. And that might explain that observation that we see white counts dropping during fasting.

And so it is a very popular word that gets thrown around quite a bit, usually without a full understanding of what it means or the adequate amount of nuance. There's multiplicity of physiological processes and things that you can do that will instigate autophagy, exercise being one of course. So if you're interested, there are parallels between what's happening physiologically as a result of exercise induced stress and fasting. So I want to hear about that.

But also I'm curious around autophagy with respect to prolonged water only fasting versus the autophagy that you would see in a different version of fasting, say intermittent fasting or time restricted eating for example. Well, as far as comparing and contrasting water fasting from fasting mimicking approaches, we don't know what the differences are because that research hasn't been done yet. We haven't done that comparison.

That's one of the things we'd like to look at hopefully sooner rather than later. And of course that would be very interesting. So this is really fascinating because almost you find so much research on exercise and the benefits of exercise and the people that exercise have these biochemical changes. In fact, it's it's overwhelming how much benefit exercise seems to instill in people.

But the biochemical changes that occur in exercise often parallel and mimic fasting. And that's not intuitively obvious because you know an exercise you're out vigorously stressing the body and fasting you're resting, stressing the body maybe in a different way. But they both induced many of the same biochemical changes. For example, BD and F brain derived neurotrophic factor which protects the brain from developing Alzheimer's and dementia increases with exercise increases with fasting.

If you look at all the different biochemical changes that occur fasting, many of them also occur with fasting. You might say, why would that be? Why would something vigorous and something passive do the same thing? But if you think about it, they both have one thing in common is they undo the consequences of dietary excess and they're mobilizing fat and particularly visceral fat.

And I believe that excess fat and excess visceral fat is a fundamental contributing factor to many of these inflammation related diseases. So it's not shocking to find out that people that exercise vigorously get these improved biochemical changes and people that use fasting whether it's every day for 12 to 16 hours or occasionally for longer period of time are going to induce those changes and they do and they don't just happen while you're fasting.

A lot of these biochemical changes, these enzymatic changes persist. It's just like when you become a trained athlete, you get better at mobilizing glycogen stores. And it doesn't happen just while you're physically exercising. There's a change in enzymatic function that persists.

That's part of what being a trained athlete is. And the same thing happens with fasting. In fact, part of the justification for intermittent fasting, like limiting your feeding window to say to eight hours and fasting for 16 hours is the thought is that the changes that occur a little bit in those 16 hours, but humanically day after day after week after month may approximate some of the changes we see in long term fasting.

And also we've noticed that people that do intermittent fasting and also people that exercise interestingly enough are much better fasters. Yeah, I was going to ask that. Is there any understanding of the difference between the average person or the person who's suffering from some form of chronic ailment, who's fasting versus say a highly trained athlete who's who's very accustomed to rigorous consistent exercise.

And does fasting have a different impact on that person versus the other person or do we not know I believe it does. In fact, we've got some evidence now looking at the idea of does fasting help healthy people, or just help sick people. And we did a study where we actually recruited eight metabolically healthy people, which as you know is a little bit more difficult than you'd imagine because only 12% of the population is metabolically healthy.

Even quote, thin people aren't necessarily not above the healthy. So we recruited healthy people. These happen to all the women is a woman study. And we looked at the changes. Now remember these people have normal blood pressure, normal weight, normal blood glucose levels. But we looked at the cardiometabolic measurements. And we looked at their biochemical changes and the magnitude of change was actually higher in the healthy people, even than the sick people.

What do you make of that? What I think is that the people that get the most benefit from fasting are the healthy people that are doing it preventively much like the people that get the most benefit from exercise tend to be healthy people that are doing it preventively rather than trying to induce it and see people doesn't mean sick people don't get benefit both from exercise and fasting.

But in terms of the magnitude of proportional change, I think the real cure for example of cancer is prevention. And the real you can't cure obesity. You can lose the weight and keep it off, but you can't go back to the changes without coming back. Same thing with high blood pressure. Same thing with diabetes.

Medicine is so busy looking for cures that they don't realize that these are all management strategies. And so all we're doing is using intermittent fasting or long term fasting diet, sleep and exercise to manage people's health to support the change associated with health rather than deteriorating into aging and disease.

We're trying to slow the aging process. You can't stop it, but you can slow it. You can make allow people to age normally rather than this facilitated aging that happens because of our conventional diets. You see it was smoking more apparently people get premature wrinkling of their face. It's like smokers face because wrinkles are nothing more than cross lancology tissue that comes from the

oxidative damage from the effect of smoking. So if you don't smoke you you still age you're still getting wrinkles. You're still going to age out, but it's much slower than that facilitated hyper inflammation from smoking. Same thing with alcohol.

The liver ages that you get cirrhosis of the liver. It's nothing more than fatty scar tissue from the damaging effect of alcohol. And the same thing with the diet. If you include salt oil and sugar in your diet, you're going to age the body more quickly than you would if you could eat a whole plant food diet.

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That answers two questions that I had. The first being this interesting distinction between your interest in fasting, which is treating people with significant chronic lifestyle ailments versus the majority of the discourse that you see out there, which is around the same time. Which is around health span extension and longevity when it comes to fasting. Like you're treating very sick people. You're seeing great results. You've been doing this for a very long time.

But everyone else is talking about telomeres and like, like sort of living forever on the other side, which, you know, on some level is a whole different conversation. But what you just said helps me understand where these two things meet and are actually of a piece. So there's been a hundred million modern humans born on the planet. We have good evidence that approximately five have lived past 117.

And one of them is questionable because they probably adopted the identity of their grandparents to avoid conscription in the military. But that's a different issue. So the point is, you have about one in 20 billion chance today of living past 117. Now maybe they'll figure out a way to extend lifespan. What I'm more concerned about is healthy lifespan. How well are you going to live in the time you have left? Most people spend the last 10 or 20 years of their life unhealthy and compromised.

I think that those years can be the best rather than the worst years of your life. And that's what we're interested in doing is avoiding the strokes in the heart attack, the debility, the arthritis that limits people's mobility, inability to exercise. And poor choices that they make in terms of diet and lifestyle. And the price they pay is they find themselves unable to talk, remove lying and nursing homes, beds, waiting for people to change their diaper.

Rather than having a good life and then a good death where you live your life and you go to sleep on night and you don't wake up because you've reached your genetic potential. And I think that we can dramatically reduce the debility that happens at the end of the years. And we're interested in doing a long term study to look at exactly that.

We want to rule a large number of people track them the rest of their life. And then compare, you know, what level of dietary adherence is associated with the best outcome. Does fasting actually help augment that and kind of tease that all apart because right now there's a lot of speculation, but not a lot of data. The second question that you answered was, why would a healthy person go to true, true north or or entertain undergoing one of these extended water fast.

You know, I just got my blood work done. It's like pretty good. Like, do I really need to go, you know, take a take a month off and go, will you hang out with you? You wouldn't be late. Whatever it is, you know, you're not going to need to take a month off because when we fast healthy people, it's usually very brief five to 10 days. It doesn't take the way we judge is we fast them until there are symptoms of results.

So some people don't have any symptoms. What if I don't have any symptoms? You're going to fast a week and be done. But what more often happens is and particularly in athletes that believe they're healthy because they're thin and have good muscle tone. They aren't always as adherent on the diet and lifestyle. And so when you put them on a fast, it turns out they do have some toxicity.

They do mobilize some accumulated any barrier products metabolism. They do go through some symptomatic change. Now, if you don't, that's a good sign. I use it diagnostically as well as well as therapeutically. But if you think about that intermittent fasting we're doing we're fasting for 16 hours to induce changes. When you do a week or fasting, it is dramatically more impacting than the smaller amount.

And using that diagnostically and potentially therapeutically, I believe will be proved to be useful. I can't prove it yet because we haven't done the research. But that's literally next on the list. What else do we know about what is happening physiologically when somebody is undergoing one of these extended fasts? Well, there's a lot of information that's available on the detailed physiology fast and essentially what's going on is the most important adaptation is the brain.

The brain is the biggest burner of glucose for humans. We have a ridiculously large brain, two and a half times, for example, the comparative mass of a chimp. If we couldn't fast, we wouldn't be able to go more than a week or 10 days before gluconeogenesis would reach on our protein mass and we didn't endostarvation and die. That would have been a problem for humans because they wandered away from the tropics unlike chimps that don't fast and can only go maybe a week or so.

And humans wandered all over the planet and all the humans that couldn't fast, they couldn't convert their brain from burning glucose to burning beta hydroxybutyric acid, they died. And we know that because literally everybody on the planet that's a modern human has this automatic conversion that happens when they go on fasting. The main changes to burning ketones or specifically beta hydroxybutyric acid, the body can serve it now a healthy lean male can fast up to 70 days.

Not that we would recommend you do that, but you would likely survive in a restful state 70 days. You would not be able to do that if you weren't able to convert your brain to burning fat. But this biological adaptation was so critical to humans that essentially anybody that didn't have it, it bit the dust.

And all we've done is take that ancient biological adaptation and apply it in a very unusual situation that only occurred recently in modern history and that's where people consistently overeat. What is the longest documented fast? 368 days in the medical literature, but that was in a very obese patient. How long ago was that? That was in the 70s, I believe. That's unbelievable. So that was unbelievable human being can do that.

Well, you can fast essentially as long as you have nutrient and fat stores. So we routinely fast people up to 40 days. So Moses, David, Elijah, Jesus and our patients fast as long as 40s, I tell them they're in good company. And what is the role of the liver and all of this? Well, the liver is one of the main detoxifying organs of the body. It's really important both for controlling glucose production and fasting as well as detoxification.

So, you know, liver plays an active and heavy load during fasting and oftentimes you'll get a lot of bile and other symptoms that are associated with liver function that can be quite distressing. But the net effect on liver function is very powerful. In fact, we have a study here that shows that fatty liver index dramatically improves with fasting consistently and objectively.

Fatty liver disease that's now become very common as people are on excess sugar and alcohol, etc. is a condition that seems to be able to be responsive to this kind of approach. There's an interesting thing that you say in your book, which is that the data also indicates that the beneficial effects of fasting persist even after the fasting period ends.

So, elaborate on that a little bit. Basically, that means that the beneficial impact of this experience has like a long tail, it isn't restricted to the time period in which you're actually fasting. Now, one of those, for example, detoxifying enzymes that are produced where the body is able to grab onto mobileized and eliminate materials.

Those enzymes don't just disappear because you're back in the feeding state. You maintain a higher circulating level of those. You're glycogen mobilizing enzyme systems. A lot of those systems are canalized and persisted. And it seems to be cumulative. If you notice patients that do periodic fasting, it gets easier and easier. Now, part of that may be because they're lowering their total load, part of it may be the diet, they're improving their health.

But just the ability to get into and stay in fasting seems to improve. You know how when people first start exercising, it's really painful. It's really tough. But if they can get through it and adapt and get the body to go through those acclimations, it gets easier until the point where you like it.

And the same thing happens with fasting. You get to the point where your blood glucose isn't being driven down by elevated insulin levels because you're eating some highly processed foods and your brain thinks you're starving and you get cravings and you get bingeing and you have all these jamming.

Blood sugar levels tend to stabilize, insolence levels tend to normalize. People if they have to skip a meal because they, you know, it's not this tragic problem because their ability to do adapters improved and fasting. You know, that's not just during fasting phenomena. It's an ongoing phenomena.

I understand the exercise analogy, like it's something that I tell people all the time, like yes, it's going to be uncomfortable and challenging and difficult in the beginning, but you will come to enjoy it. And yet, you know, I have a hard time believing that this could be the case with fasting, like the idea that you're going to go that long without eating any food just seems so unimaginable.

So talk a little bit about you mentioned cravings and the like, like what is the difference between appetite and hunger? I think there are people who would think what you're doing is putting people on a starvation protocol, but there's a difference between fasting and starvation and there's a difference between your appetite impulse and actual hunger.

Absolutely. So fasting is by definition means there's labar reserves available. If you deplete your labar reserves, then you enter starvation and then you die. So we don't do starvation because that would be really bad for our outcome data. So we only do fasting and we monitor people to make sure we don't transition from the fasting state to the starvation. Fortunately, it's very useful monitor that it's not a complex clinical challenge.

And appetite and hunger is a very important consideration because both us and the intermittent fasting advocates suggest that people not eat three to four hours before they go to bed at night. I mean, that's basically how you get your 16 hour fasting you eat an early dinner. Don't eat until you wake up, maybe defer breakfast and you've done some vigorous exercise, you know, delay breakfast a little bit. Now you have an eight hour window that you eat in that 16 hour.

Period of time is essentially time restricted eating and is thought to be it's thought to be helpful. People eat for a lot of reasons they eat because they're tired and if they eat they feel better so they assume they were hungry when really they were fatigued and they got stimulated by the food they eat because they're angry. So they have emotional distress so they eat and then they feel the dopamine stimulation from eating so they interpret that as they must have been hungry.

They eat for all kinds of reasons, but the only reason to really eat is because you need cleric intake and not because you're angry tired or fatigued if you're tired you should go to sleep. If you're angry you should figure out a way to dissipate the effects of the anger or get rid of the source of it. If you're bored you should engage in productive activity and eating is not one of those things unless it's because you're hungry.

So not eating, say for example three hours before you go to bed eliminates a lot of that late night boredom tired eating stuff and then people are more inclined to want to go to sleep. That's exactly what you should do when you're tired. I struggle with this. I have a hard time falling asleep unless my stomach feels full. So when I do intermittent fasting I tend to eat late and not eat during the day and I've discovered that that is very disruptive to my sleep cycle.

I'll generally wake up at three o'clock in the morning or my REM states my deep states aren't adequate enough like it I don't think it's a net positive and so I've kind of stopped doing that. So I would challenge you that if you were to undergo prolonged fasting during the fast you may not have good sleep cycles and stuff it can be quite disruptive. But as a consequence of fasting you may find that the quality of your sleep may be better than it's ever been before.

I can't take exactly what all the mechanisms are but we see it very commonly people that have trouble either getting to sleep or staying asleep. Post fasting oftentimes are then able to sleep get to sleep and sleep through the night. Sometimes it's because people had by non-prostatic hypertrophy they're waking up six times to pee.

You don't eat before you go to bed you get the prostate inflammation down. Now you're only waking up one time so you have less sleep disruption better quality of sleep. Sometimes it's because when people eat late at night they experience just what you did is the digestive processes a pretty active process. You don't necessarily want this active biological process going on when you're trying to be in a restful state.

And so there may be other biochemical factors that you know we haven't really elucidated yet but whatever the net effect of fasting oftentimes is improving sleep cycles and improving sleep cycles is really important. Do you get the quality and quantity of sleep you need that's where energy comes from. That's that becomes a life changing thing in and of itself like independent of everything else.

Exercise. You don't have to sell me on that but people that actually regularly tend to sleep better overall than people that don't people that eat well tend to sleep better than those that don't and people that have used fasting appropriately oftentimes are able to correct in balances. I suspect there's a psychological piece at play here as well because anybody who shows up at true North and does let's say 40 days of fasting.

It's something that is so mind boggling that so few people have any experience with that I can't help but think that person is going to think differently of their own capacity and capabilities as a result of that.

And it reframes their sense of what's possible for themselves it's very empowering right it's to like undergo something like that and then on the other side of it say I can do hard things or now I'm up for a different type of challenge or I'm finally ready to now that I'm going to do it.

I'm going to do something like this now that I've proven to myself that I could do something like this I now feel like I'm capable of handling other dietary and lifestyle changes that have historically alluded me. You know it's natural to be afraid of starvation you know if it was people weren't very concerned. I'm terrified of you I'm terrified of this whole thing.

So they're they're naturally afraid of you know starvation and so it's sometimes when they feel hunger you know they interpreted it as you know a serious problem once you've gone through fasting first of all you tend not to have quite as much

isolation your blood sugar and insulin levels so there's not a much biological input afterwards it comes down but also you know I went for a week or I went for 10 days or I went for 40 days you know the idea of not eating on the plane isn't going to be terrifying and you're right there's a huge empowering impact there's probably more people to climb Mount Everest that have done than have done 40 day fast.

And nobody would say oh I did this huge challenge I ran this marathon I climb this mountain of course it's going to have an empowering effect on people and laying around doing nothing has the same kind of impact on people. You mentioned earlier that only 12% I don't know if it's is of the US population or the global population is actually metabolically fit.

It's not news that we're in a global health crisis but the statistics are still nonetheless incredibly alarming which you illustrate in in the beginning of the book. Three billion people globally have chronic diseases in the US 150 million people face chronic disease despite substantial health care expenditures six out of 10 US adults have some form of chronic disease.

There's 40 million deaths annually as a result of these illnesses health US health care costs have exceeded 3.5 trillion in 2022 and in the US over 70% of adults are overweight with 40% being obese like that is. Shocking so help me understand how we got here got here because of the pleasure trap the hidden force that I'm in self in happiness we fool the society mechanisms of the brains of humans by putting chemicals in our feed.

If you put these same chemicals in the feed of rats or mice or birds they the road and so gain 49% of their body weight in 60 days the birds will get so fat they can't even fly.

There is no obesity in wild animals you know even whales are what 9% body fat their lean means machines they just wear it on the outside of their body unless those animals get exposed to our highly processed foods with these chemicals added to it and then they'll get fat just like we do and they'll get the same diseases we do the breast cancer the colon cancer the heart disease the diabetes these changes occur in animals the same the way they do in us.

And the chemicals that we put in our feed that fool the society mechanisms allows to over eat in our responsible for the obesity and overweight that we see our salt oil and sugar. So that's why we advocate a whole plant food SOS free diet because salt oil and sugar are not food their hyper concentrated food by products they're added to food to make food taste better and that's what tasting better is as the artificial stimulation of dopamine in the brain.

And foods do taste better to us with those in fact they taste so much better that will systematically over eat them if you ask a person to eat their fill of say rice or anything they'll eat a certain amount.

Everything else being equal if you solve that up they'll eat more before they reach satiety before they feel satisfied and people say yeah because it tastes better that's right that's what it means is that it will stimulate that dopamine production and you will have to eat more before you feel satisfied. But if you just eat a whole plant food SOS free diet and you eat to your satisfaction you will be able to maintain optimum weight.

But to the degree that you add salt oil and sugar to the food the only question is how far are you going to get. And the implications of salt oil and sugar with respect to hyper palatability in our ultra processed food ecosystem which is the kind of food that we're all overeating that we find very difficult to only have a little bit of.

And then there's a distinction or a difference between the salt oil and sugar that finds its way into those foods versus a little bit of salt on your whole food on never as diet or you know one tablespoon of olive oil and. The sort of benefits that you can get from that type of oil in moderate amounts like why so severe to say it has to be SOS or nothing. And part of it may be biased by my patient population so I'm seeing the person that has high blood pressure diabetes or cancer.

And so their ability to just eat a little bit obviously failed because you know and so has 72% of the population in the United States who have achieved obesity or overweight and are now having excess visceral fat and they're dying prematurely and spending 20 years to be able to do it. So if a person in theory could eat small amounts maintain optimum weight optimum visceral fat optimum blood pressure and optimum glucose you might be able to make the case that those people would get away with it.

But that's not what my experience has been it's very much analogous to saying why do you tell alcoholics they can't drink at all can they just have a little beer and wine in the weekend or couldn't they just control their quantity and then they would be OK. This is true you know some people can have an occasional drink and not become a drunk but if you're a drunk it's not you.

So I can tell you right off the bat 72% of the population don't have any business adding salt only sugar to their food any more than an alcoholic has business adding alcohol into their diet. Could alcoholics learn to control and have a you know maybe there would be one I just don't get to see those people so I tell alcoholics don't drink at all just stop it.

And we tell people that are struggling with weight or health stop putting the chemicals in your body that fool your brain and lead you into doing the things that are causing the problem. If you have a person that's able to maintain optimum weight and health and have a little variation you know so be it now in reality that's exactly what happens because if you look at the study we did when you're fall upon they weren't 100% vegan ss free.

But they had maintained enough it here instead of the diet to maintain their weight loss and that resulted in them being normal blood pressure without medication so I'm more interested in the outcome than some philosophical argument but what can you get away with it what you can't you get away with. So the easiest way honestly just like it is an alcoholics just say don't drink and draw the line and be done with it rather than trying to figure out how much could you tie trade in still function.

I think with salt and sugar there's no natural relationship in my mind to adding those chemicals to the feed I wouldn't do it any animals I wouldn't do any humans if we want to get off to them health now is it going to turn out that will be able to be more flexible for certain people and they'll it's very very possible. But I don't get to see those people yeah no I understand listen I'm on your page you know I'm a alcoholic in recovery.

And you know abstinence is easier than moderation and as they say in in a in a secret program it's the great obsession of every alcoholic to like enjoy their drinking like a gentleman you know like and this is this is what you know leads people to their grave and I think there is an analogy that's our propo with perspective food I think we could quibble over whether food addiction is a real thing but when you look at the health statistics.

It's pretty clear that there's a level of powerlessness with respect to our ability to modulate our intake and you know abstinence you know being binary about these kinds of things actually makes it easier like it seems harsher and more restrictive but there's freedom in that and I think it eliminates the decision fatigue around it and it drives it you know it drives behavior in a more kind of clear trajectory forward.

So I get that but I think it would be interesting I'm trying to imagine the person who's listening to this right now who's thinking well I'm down with Alan when it comes to this fast but when I complete the fast why do I have to do this SOS thing what if I just did a really healthy Mediterranean diet and was very cautious about my salt oil and sugar intake as a result and I'm wondering whether there are any studies on that or the difference between somebody who undergoes the

prolonged water fast does the SOS diet versus the person who does the prolonged water fast and has you know a sort of quote unquote like healthy omnivorous diet in the wake of that yeah no I'm I think your point is well taken and that is research were actively and acutely interested in doing how strict you have to be to get the outcome and to avoid the pleasure trap and you know maybe it's not an absolute thing like it appears to be with alcohol and some of the least sure this powerful drugs but honestly

so based on behavior you know people don't want to be fat and they don't want to have this right they don't want to be sick and they're really trying they're spending billions of dollars trying to solve this problem we have a solution for if you would

adopt a whole plant food SOS for you diet it becomes exceedingly difficult to maintain obesity or your weight and the when people will no adapt to it they get to the point where they like the diet as much or more than they did when they were on the traditional because there's an addictive component, it's hard for people to imagine how could they possibly stand to eat a diet without salt, without oil, and without sugar.

And what's even more interesting is in the alternative health movement, many people will say, we'll get rid of the oil, even olive oil. And they realize, all of oil's less bad than the other oils, but being less bad, of course, doesn't make it good. It's still 9 calories a gram of highly processed fat, where we can get all the essential fat we need from the diet, from the whole plant foods. That's not so much challenge now. There's lots of people who have written about that.

Some people say, well, look, you've got to get rid of the sugar. The refined carbohydrates cause the insulin to go crazy, they're empty calories, they suppress the immune system, they disrupt the gut microbiome, and a lot of people will agree, okay, we've got to get rid of the refined sugars. We've got to get rid of those. And some people will say, get rid of the oil and the sugar.

Okay, we'll get rid of those now that food choices are narrowing, where I really pissed a lot of people off, including your viewers, was when I suggested that we get enough sodium from the diet, that we don't need to add salt to the diet in order to get the sodium that we need, the gram a day that's needed, including by athletes that are sweating. And that if you want to increase your sodium intake, you could still do that from whole foods.

You can eat more tomatoes and charred, and other things that are naturally very high in sodium. You don't need to add salt. That got, I think, a hundred and some... If you agree, I'm sorry. If you agree, I'm sorry. Yeah, that's how you count and clearly crazy I am. And because of the sugar. You can't answer them now, you know? So here's your opportunity to address that.

The data is coming out more and more that sodium is a problem, not just for high blood pressure, but I mean, just think about the gut microbiome in general. You've got a bacterial rich environment. You're putting a high sodium concentration. Do you think that that sodium could have an effect on bacterial population? They've got, of course, it can. I mean, we use salt as a preservative for goodness sake.

The data is not conclusive, but it's definitely coming out more in the favor that limiting sodium seems to be a highly beneficial health promoting component. Now, the argument might be, well, how much? I don't know. Do you have to be completely free of added sodium and just rely on the sodium that comes in the food or can you get away with a little bit and still be healthy? I don't know.

I do know, though, that in my experience in managing, for example, hypertensive patients, salt restriction becomes one of the critical components of maintaining long-term success. Today's episode is sponsored by BetterHelp. So at this point, we're officially about halfway through 2024. So I want you to take a moment and reflect back on the aspirations you set for yourself back in January. How's it going? Have you slipped? Are you still doing that thing?

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A little investment now can pay massive dividends down the line. I want to double click on the SOS whole plant food diet for somebody who's never heard those terms before. What are we talking about specifically? What does that look like? And perhaps even share some examples of what a daily series of meals might look like. So a whole plant food diet is just that. The diet is made up of whole plant food. So I know it's we're talking about brown rice grains.

Not necessarily, we don't use the glutinous grains, the wheat, rye, and the barley. We certainly don't use, encourage the breads. And you know, bread is a great example. They call it the staff of life, right? People really like bread. But if you take away the salt, the oil, and the sugar from bread, then they call it matza. And it's punishment on Passover. Nobody's getting too crazy about the wheat and the water. It's the additives that are added.

And if you take wheat berries and you boil them and eat them, it's 500 kHz a pound. You take bread, it's 1500 kHz a pound, before you turn it into a butter boat and spread coagulated cow pass all over it. So the bottom line is how you process these foods can make a big difference in terms of whether they're helpful or not helpful. So we're talking about grains in the gooms, so beans, lentils, peas, this kind of thing.

But cooked like soup, and you know, whole grains, rather than necessarily processed all the way down. We're talking about fresh fruit, but not necessarily fruit, juices, and dried fruits, and highly processed fruits. We're talking about vegetables, both raw and cooked. And we're talking about all kinds of vegetables, starchy vegetables like Hubbard squash, and butternut squash, and potatoes, and sweet potatoes.

We're talking about the variety of green vegetables, particularly, and getting these, you know, high-minimal content foods into us. And again, I'd rather see people eating more whole foods that necessarily than relying entirely on juices, and processed foods where you remove the soluble fiber, which is so critical to maintaining a healthy gut microbiome. And then we're not, and we're using small quantities of nuts and seeds, and we're concentrated to higher fat plant foods.

What we're not using though are animal foods, so meat, fish, foul eggs, and dairy products, oil, salt, and sugar. So basically what I tell people is they should go inside themselves, look at a food. I don't know if they should eat it. Just say, do I really, really, really want it? And if the answer's truly yes, you know, you can't have it. Because you can't nothing. If you really, really, really want it, it's likely banging on the pleasure trail.

Yeah, that begs the question of cravings and how powerful they can be. And back to the point about the psychological piece to all of this, and the kind of extended metaphor of alcoholism or addiction versus the landscape in which you operate. I went to a treatment center to get sober. And I was there for a hundred days. And part of that was a reeducation. Part of that was abstinence, the physiological response to removing myself from this substance.

But there's also, and the empowerment piece, of course. But in the course of that extended period of time, you're pattern interrupting. You're not doing the thing that you've always been doing. And you feel all the cravings. And all of the emotions come up and the resistance. And you have an opportunity in a controlled environment to sit with that discomfort. And what you realize is that if you sit with it long enough, it dissipates.

And with that comes a dawning realization that you can choose a different behavior. And that those cravings over time will decrease in their intensity. And that in and of itself set aside physiological changes. All of it, just the idea that cravings are not static, that they are modulated, and that the more time and distance you put between yourself and that food or that substance or that behavior, that the cravings will recede into the background.

And so, and that doesn't mean that they don't crop up from time to time, and you have to confront them. But you have enough experience knowing that you can kind of sit with that discomfort, and it will change. And I think that is a huge dawning realization that in and of itself becomes a very empowering thing when people go off into their lives. And they find themselves at a bar and somebody says, what do you want to drink? Or they're at a dinner party. And they say, what do you want to eat?

Or they're at a buffet in Las Vegas, and they have a choice about what's going to end up on their plate. Yeah, I think that's absolutely the truth. And this way, you don't tell newly recovered alcoholics to become a bartender. It's probably not the best choice. And we kind of know that's intuitively obvious. You wouldn't want to tell an alcoholic that they should go out and get a job as a bartender that that's going to help them. Now, it's true.

I have a lot of patients that are recovered alcoholics, and they're working as bartenders. And they do OK in that environment. It doesn't impact their ability to maintain sobriety. But it wouldn't be a first choice. And you don't want to tell people that are struggling with these eating issues. You should go to work where there's big piles of candy all around. And everybody's going to put social pressure on you to engage in short-term pleasure seeking self-indulgent behavior.

It doesn't make it easier. And that's exactly what happens to people when they leave true North Health. They're going out into a world where everything, convenience, practical, social pressures are all going to be everybody's going to be trying to undermine their success. Do you have any experience with people with prolonged sobriety or people that have kind of undergone 12 step or something like that coming to true North? Do they tend to be more or less successful than the average person?

Because they're already enured to this type of behavior modification. Long-term recovered addicts are the best. That's what I should say. That was very interesting. That was the most adherent. Because they already know. They already got them on. You don't even have to say anything to me. They got it. I can't care when. Like, how hard is this going to be?

You know, in some ways, though, the feedback I've gotten is that it's actually in some ways even more difficult, not physiologically short-term, but long-term. Because socially, if you go to a party and they try to push, I'll call and you say, well, I can't trick, I'm a recovered. They might tolerate that and let you go by. But you started to do that with diet. Forget about it. Where are you going to get your protein from? This is good for you. This is blah, blah, blah. There's no letting up.

How do you counsel people on the social piece? Because I think that is an underestimated limiter in all of this. There's our capacity to make these behavioral changes. But when pressed and in the context of friends or loved ones, there's a whole matrix of confusing signaling and emotions that come into play that ultimately lead people to laps, even against their best judgment. My first advice is usually make new friends. But that's probably not the most practical solution for most people.

The reality is that Dr. Lyle, our psychologist, explained to me how cognitive behavioral therapy works. And as I understood it or what I got out of it, it's a way of helping people manipulate other people's behavior so they don't annoy them as much. And so that's why I got interested in it. So the idea is that you can change your response to other people's behavior if you understand really where they're coming from and what the limitations are. You don't have to be angry.

For example, he uses an example. If you're an elevator and somebody's poking you in the back with a sharp stick, you don't like being poked in the back with a sharp stick. You might get angry. Turn you see it's a blind person just trying to figure out where they are in reality. You're still going to step out of the way. But you don't have to be angry about it because you realize they're doing the best they can.

And the reality is if you understand the limitations that some of the people you're interacting with are working under, you don't have to be angry about the fact that they're not only not supportive but actively trying to undermine your success. And you can communicate sometimes with people and help them modulate their behavior so they leave you alone or at least be not antagonistic. And if you can't, make new friends.

When people leave true North after they've had this experience and you set them on their way with a whole protocol around the SOS diet, is there a caloric restriction piece to this? Are they allowed to eat as much as they want? Is that a case-by-case basis? Well, the people that are successful are the ones that avoid under-eating. Under-eating is a bigger problem on this approach than overeating is because when you're eating a whole plant food, SOS free diet, you have to eat a lot.

There's a lot of eating going on because you're eating a pound or two of salad and vegetables, you're eating fresh fruits. This is stuff you have to chew and you have to chop. And it's a bigger volume of food. Sometimes people are not used to eating large volume of food or they think a while getting weighed if I eat that much. They aren't thinking caloric density. And as a consequence, they'll under-eat and then they have trouble maintaining energy you can't even do in their exercise.

They're not gonna be successful. So I'd rather see people eating a little more of low-density foods. And maybe they only lose a pound a week and say the two pounds a week. But they're more likely to be successful long run than the one that's under-consuming what their body actual needs are. They need to eat enough to maintain optimum weight, just not current weight. That is a common retort with people who play around with adopting a plant-based diet.

I felt lethargic, I didn't have enough energy. It's like, well, you're probably used to eating a certain amount of food and you don't understand that you actually can and should eat more now as a result. And that experience that you're having is most likely tied to caloric under-consumption. And there's huge psychological overlay because people have all kinds of issues about volume.

If they're conscious about their weight, I tell them, if they put their meal down at work, people should come in and go, oh my gosh, you're not gonna eat all that, are you? Because if they don't react with shock and awe, they got the wrong size bowl. I mean, eating enough is my bigger concern. Now, the problem is you also have to avoid the highly processed foods and that's really hard.

I mean, 93% of calories consumed in industrialized country come from either animal foods or highly processed foods. Seven percent is fruits and vegetables. A third of that's potatoes served as French fries or potato chips. I mean, right now the stuff we're asking people to eat is the decoration on the plate. You can go out, you can go to restaurants where there's nothing that meets standards.

You know, it can be very challenging because so much of what people are doing is highly processed fried, fractionated foods. That's what most of the calories people are eating and that's how we've supersized the people. And it's a big ask to say, you need to eat this way, but you're probably not gonna have the ability to go to the restaurants you like to go to. It's gonna be challenging when you offer dinner with friends. It's tricky socially to kind of navigate that.

And a lot of restaurants have a hard time accommodating that. And if they do, it's a pretty dire, unpalatable situation.

Actually, if you go to a place that actually has a cook, somebody that's cooking it rather than just reheating the practice materials that are so common in many of the restaurants nowadays, often if you call ahead and you say, look, we have some in our group, can you make a couple baked potatoes or sweet potatoes and some salad, you can get a beautiful dish, it can work out really nicely.

If you plan ahead or you go to a restaurant you're used to going to and you have a relationship with the waiter or the waitress, they can oftentimes, if the restaurant has some kind of food in the kitchen and somebody that can put it together, that can work out really well. It's just not always the case. Do you guys do some consulting or counseling around, okay, you're gonna go to Thanksgiving, you're gonna be with the family, here's how it's always gone down, but here's what you're gonna say.

We spend a lot of time, you know, still being the good graces of your loved ones. We spend a lot of time teaching people little strategies how to go along and get along and not piss people off and how to keep your mouth shut. And you know, there are strategies that you can implement. The most important thing is if you're dealing with people that love you and you explain to them that this is not a judgment on them, it's just an adaptation you're making.

How much trouble are you, if you ask them, could you put a couple of potatoes on for me? Or can I bring a salad for everybody? Cause they don't wanna go through all the process of making that, what are they gonna say? Oh no, that putting a potato on us, too much trouble, we don't want you here. That's not gonna happen.

If you explain to a person and you aren't judgmental about it, you don't wanna become a born again natural hygienist and walk in the room and say, oh, I can hear your vessels thickening from over here, you're not gonna eat that dead decaying flesh. I mean, you keep your mouth shut, you don't need to do that. It's just your issue for you, you know, and it is possible now to get it. Yeah, I think top line, how can you be part of the solution rather than the problem?

And if the family or the community of friends like already know that you're kind of jagged in terms of your diet, there's already a lot of judgment. Oh no, here comes so and so, I was gonna be a whole thing or whatever, but if you come open-hearted with a solution, like, hey, I'm bringing food for everybody, as opposed to, I'm gonna come and be a problem because I'm gonna make everybody change what they're doing to accommodate me. I think that's where the problems come in.

I'm sure that you experienced some of the same issues choosing not to drink in a setting where most people are drinking and they can be very uncomfortable sometimes. Initially, what you realize though is that you think everybody's thinking about you, but they're thinking about themselves. People don't care, they really don't. Food's a little bit different because there's a lot of emotion wrapped up in food and the sharing of food is how we share love.

And that can be tricky and complicated, especially when there's historic patterns and a way of doing things over time, but go ahead, sorry. If people will just stop getting in others' people's business, like stop worrying about what they're eating and just not, because that's where the people get into trouble. It's not, they're trying to eat well. You must not eat well. You haven't been on Twitter lately then, have you? People seem to care a lot about what other people are eating.

Well, they want other people to eat like they are so they can feel supportive. They need to stop looking to other people for their support, get their internal support, and let them be, because you're not going to change them because you make snide comments about their dietary habits and try to prove that what you're doing is better. Just keep your mouth shut, set a good example, answer only questions that are asked and maybe you'll figure out a way to survive it.

What do you make of all the tribalism around diet? What is that about? I really don't know. I was hoping you would tell me. Yeah, it's very strange, but it's very passionate and heated. We're seeing it now with the carnivore diet. That's really grown way more than I would have suspected and adherents of that lifestyle are very passionate in their views. What do you make of that diet? Well, you see variations on this diet throughout the last 40 years I've been in practice.

And what's good for short-term weight loss and there is a fasting mimicking effect of going on a carnivoreal diet because you get into ketosis, there's a hunger-blunting mechanism, and they were already eating meat three times a day. So it's not like a fundamental necessarily definitely except they got rid of the carbohydrates. And short-term, they may lose some weight.

Long-term, of course, we know what the consequences of high-fat protein diets are and it's going to show up in it begins to manifest. Whether it be early on the gallbladder disease or later the cancer and other problems that come about. And I know they're vehement in defending it. But the data is the data, the facts, the facts. You can't go on that diet long-term as a broad recommendation to the population to expect that that's going to be an overall and that improvement in health.

Because the standard American diet is so crappy, though, almost anything you do in getting rid of refined carbohydrates is going to induce some beneficial changes including weight loss. So you can't argue short-term. We've got to really look long-term. You've got to look to the scientific literature. I mean, I have to see, I've been surprised myself watching fasting work, but not really understanding how well it worked until we got the data back.

And you really, and then look at, now I'm getting 30 or 35 years of follow-up on patients. And you're hearing the same stories. Everybody they know is dying. Some of them are outlive their kids. It actually creates its own challenges and stress, just being so far outside the norm on health. I mentioned last time when I was here, my mom, when she was 92, I'd outlive all her friends and she told me, Alan, warn your patients. If they do this diet, make younger friends.

And she said much younger because even 10 years younger when you're 90s, isn't young enough? Yeah. We talked a little bit last time about the medical establishments, sort of lack of embrace of you to put it politely. I mean, you are a maverick and what you're doing and what you're advocating is somewhat radical and orthogonal to the protocols of the way our medical system and our healthcare system operate. I'm curious, has that changed at all in the interim period since we last spoke?

What's going on there? Yeah, I think it has. I think I've gone from being a criminal quack to being a cutting edge researcher and you can witness the 19 papers we've published in the literature, including British medical journal, curious, some major impact journals are accepting the case reports and the studies that we're publishing. And I think that that has been beneficial.

I think that the work Walter Longo and others have done publishing major drone metabolism 2015 did a fabulous piece is making it at least you can discuss it without it being just immediately shut down as crazy. So I think it is starting to shift. I think that the diet clearly has changed. I mean, if you think 40 years ago, if you had people like John McDougal in 1980, section, you know, pioneer writing the McDougal program, looked on like he was, you know, not job.

Now, the idea of plant-based eating as being a health promoting and reasonable, I think has, you know, at least general discussion. People aren't necessarily adopting it in mass but they're at least tolerating it. I wouldn't think you'd have the same social impact, you know, because you're trying, you didn't happen to have animal foods or something on your plate. Nobody was going to think you're going to die that day from acute deficiency.

Fasting, the intermittent fasting, I think, has become pretty much accepted. You got 10,000 medical offices selling pro-law. So I mean, you know, there's definitely an acceptance. Long term water-only fasting, it's going to be up to us and the other people advocating it to prove that it can be done safely and effectively. We're starting to do that now with these publications.

What is a study that you'd like to see conducted that has not yet been conducted that would put to rest some of the myths or misconceptions? Well, we are going to be doing a study with a major HMO. We've gotten excellent feedback from them. What we're going to be doing is we're going to, once again, look at high blood pressure because it's just common problem.

And we're going to be doing the first RCT, randomized control trial where they'll get their standard of care and in addition, the 40 people standard of care, 40 people randomly assigned, will get a three week stay at Trumor of Health Center and go fasting and get the additional education. And this is a practice already advocating a plant-based diet. So these are people that are already being encouraged to try to eat healthfully.

In addition, they're going to get some fasting and they're going to do some long term trapping of those people. And then what's going to happen, we know what the results are going to be. We did a study with the Mayo Clinic, as I mentioned, we had excellent long term results, including one year follow-up. Once we've done that, we're going to approach the same HMO and try to do a prospective randomized control trial in the treatment of lymphoma, which will be much more controversial.

And then our hope is that we'll have good enough success that they'll be forced to integrate fasting into their standard protocol and we'll help them do that. And that's part of our foundation's mission is to get fasting to be more accepted in the mainstream. And it may only be for this one condition, but at least that'll be the start that we think we might be able to accomplish. And we've got some good relationships with this major group so that we're optimistic that we can pull it off.

One of the things that opens you to criticism is the fact that these studies deal with small sample sizes. And I would suspect a part of that is because there's only so many people who are doing these extended water fast, is there a way to increase sample size with respect to these studies to kind of rebut that issue that occurs? Well, we've, you know, the analysis has been done. We know what size samples you have to have in order to get statistical significance.

And it's deceptive because the effect sizes are so large, we don't need large ends in order to reach statistical significance and be clinically valid. And so we're meeting those and that has not been a criticism in the studies that we've done today, even though they are relatively small scale studies. Now, yes, would we like to see a large scale study? Well, what's the limiting factor? We only have 79 beds. So we can only process so many people, well, you know, we can process 1200 people a year.

So we can't take on studies more than that. So we don't need to in order to prove the points that we're trying to prove right now. Given all the success that you've had at True North and the fact that you've been doing it for 40 years, it's curious why there aren't versions of True North in major cities across the world. Like why hasn't this model been more readily replicated by other people who can see what you're doing and the success that you're getting? I think there will be.

We have a residency training program. We trained doctors that are interested in doing something worthwhile with their life, how to use diet and fast need to get people well. That program has been successful. And the economics of it aren't successful. It's healthcare that's not covered by insurance in terms of the stay at the center. It's we're a 501c3 nonprofits. So we have very modest fees. If you charged a lot of money, the problem is it takes time.

You have people that are 30 days sometimes, you know, three weeks, six weeks. It would be a very costly process if you had to charge $2,000 a day like they do in the hospital. So we charge a couple hundred bucks a day. We can make it work, but you can't make it lucrative because we're a nonprofit organization. You know, we got a lot of less pressure than most places would. We have modest facilities. We don't do advertising. We don't have to do promotion.

We don't have any of the normal expenses that businesses would if you were to go out and do that. So I think it will become more acceptable. But it probably needs to become integrated into the conventional healthcare system because almost all healthcare is paid by these insurance modules or Medicare. That's why we're trying to get it into the HMO so that if they're able to offer it, it becomes acceptable part of the mainstream.

I can see a situation much like, again, with the parallels with treatment centers and rehab and addiction, an entrepreneur coming along and replicating your model, but making it for profit, turning the place into like a high-end five-star spa situation and charging an unbelievable amount of money and catering to a high-net worth person who's extremely unhealthy, who would just pay anything to be supervised to get to the other side. That's where all the other healthcare facilities are.

They're all expensive high-end and they are even go further to pay. They're not five-star, though. Well, many of the resorts are. I mean, there's a lot of health resorts around. They just don't offer fast. They're not doing prolonged, I'm talking about specific to prolonged water-only. Oh, don't forget that. No, because the people that are gonna pay the big bucks don't wanna have to do anything uncomfortable. They wanna be told what they wanna hear.

And if you look at most of the examples of resorts, they're pretty good about giving people what they want. I mean, even the Prittigan Center's now serving salmon and all kinds of stuff. So they're gonna try to accommodate the people's needs, but it's a different model. We're essentially a human-subjects laboratory that looks like a clinic. And the research is funded by the participants themselves that are participating in the program. That's not a good business model, okay?

It works well for our needs, and we've managed to survive. But if you are an entrepreneur, you wanna charge large amounts of money, but that means you have to get people what they want. This is not what they want. Yeah, that's a tricky one. They went the end result. They went fasting, mimicking drugs. But maybe they don't want it, but they do want it.

So they're gonna pay a lot of money as long as the place is really nice, and then they're locked up, you know, and they can't leave, and they're gonna pay a lot of money to prevent them from being able to leave. I could see a certain clientele who might be up for help. Well, I hope that different versions of this do become available, so it means everybody's needs. Because obviously, you know, we can only handle so many people.

The size of our facility wasn't based economically, it was based on the numbers we needed to build to do our studies. And so we grew the facility to the size we needed so we could actually conduct- Right, to fund the foundation- Exactly, to fund the research. Exactly, yeah. That way it doesn't- I get a lot of very successful people that come as patients and give me lots of advice about how, like for example- Business advice, yeah. Yeah, you're running a terrible business here, Alan.

They say you're ridiculous. Look at this, the way you set price in a business is you keep raising the rates until you don't have a three-month waiting list. And then, you know, that's the price point. When it drops down it's only six-week waiting list, that's the right point. That's not our model.

Our model is to get people to come in long enough, stay long enough and come back as necessary, so they can prove that we're right, that health is from health-ful-living, that fasting is a safe and effective tool. So if the goal is to make the most money, you don't do this business model, you do the business model, you give people what they want to hear. That's very funny. We talked about metabolic dysregulation.

We talked about diabetes and obesity, but there's also some other very interesting kind of case studies that you talk about in the book. There's the person who has like the sporadic growth on their face. There's psoriasis, rheumatoid arthritis, autoimmune conditions. Talk a little bit about some of these other success stories that you've had with very unlikely conditions that seem to be resolved through fasting, which seems like a crazy magic trick.

It turns out that a lot of these conditions also were caused by dietary excess. Like for example, this is a paper we published just recently, 2023, an integrated complimentary therapies called Prolong Water Only Fasting in the Management of Hashimoto's Thyroiditis, a case report. Hashimoto's Thyroiditis is the most common cause of hypothyroidism. It's where the immune system attacks your own thyroid.

And interesting, there's a theory that they notice the gene, the HLADQ gene that's common in these patients, is the same gene associated with people that have gluten sensitivity. And so the theory is that people eat gluten, 1% of the population get siliac disease, where the immune system attacks the intestine for a psoriasis, you have to not eat gluten. On other people, the immune system doesn't attack the intestinal system, but attracts the thyroid. And that's called Hashimoto's Thyroiditis.

We've known that the immune system is taking out the thyroid. It hasn't been clear about why is it doing that? Well, it turns out that gluten and dairy products, the diet you eat can dramatically affect your issue. In this particular case, we were able to use fasting to bring the symptoms that are associated with this condition under control. This was a 61-year-old, and she had weight gain issues, a deem, a joint pain constipation, cold sensitive brain fog.

All the symptoms that go along with this condition, and she ended up undergoing fasting for 21 days, had 10 days refeeding, had fabulous outcome data. And obviously not just on terms of her thyroid function, but she lost weight as she'd expect her blood pressure dropped from 134 down to 108. Her thyroid or TSH went from 61, which is very high, down to 6.8. So CRP, which is a measure of inflammation, went from 13 down to 1.2. So huge clinical impact on how she felt and how she functioned.

What you would normally think Hashimoto's Thyroiditis would be responsive to diet and fasting, but it is. And was there follow-up long-term? Well, right now, this paper was just published in 2023. So she's continued to do well so far, but we don't have long-term effect. Some of these other cases where we've been tracking them for 10 years, it's obviously quite impressive. I wanted to point out though that we'd have cases that we published here that were we just did the diet.

So in other words, they didn't even involve prolonged water only fasting. One was an 82-year-old gentleman who had atrial fibrillation, all kinds of cardiac related symptoms hypertension. We put him on the diet only and then took him off his medications. He was on a number of medications. Weed him off his cardiac medications. And not only did he completely normalize his blood pressure and his cardiac rhythm and get off all of his medications, but they thought he was having dementia.

He actually woke up because he wasn't having dementia. All right, we was having polypharmacy. He was having negative reactions to his host of medications that he was taking. So here's the guy who ate carefully. Our medical doctors helped him. Weed his medications safely. And what was fascinating, we submitted this case part. This is also the British medical journal. And one of the reviewers said, wow, what an impressive case. But what made you suspect it was the drugs?

Wow, because these are medications that people are commonly put on. You mentioned a carotic lesion on a face that often these lesions just fall off during fasting. Again, these products are more common in patients that have active inflammation. Fast and tense to reduce it. The body is able to stimulate the healing responses. And so we'll get impressive cases like plaque psoriasis, which is disfiguring really dramatic condition. Most doctors will tell you, diet has nothing to do with it.

Or maybe they might say, well, maybe you shouldn't need too much dairy products or something. Where we have in the photos that are present on the study show within 10 days of fasting, you're starting to see changes, and then two month follow up. And just dramatic resolution of plaque psoriasis that sustained as long as people are willing to do a health-promoting diet. That's very interesting. A lot of people suffer from that. And it's very resistant to treatment.

People spend years trying to figure out how to resolve it, many unsuccessfully. And we've found that it responds consistently. And it is difficult. It's not an easy condition to treat. But it does respond. And we've had significant clinical responses to it. And it's not like shocking to me, because autoimmune diseases, diseases where the body's attacking itself are often associated with gut leakage, where proteins get absorbed.

And then genetically vulnerable people, the immune system reacts inappropriately. And most of youritis conditions are essentially autoimmune conditions, whether it's Hashimoto's thyroiditis or vasculitis or rheumatoid arthritis or asthma or plexeritis. These all have this gut leakage that appears to be a part of the component. When you fast, the inflamed gut gets to heal.

And then when you go on a whole plant food, SOS-free diet, you don't have the oxidative damage that's coming from the highly processed foods and the animal foods. And so you're able to manage the condition. If you take those patients and put them back on conventional diets, so oftentimes, their symptoms recur. So I don't think you're curing it. You're managing it, just like you can't cure obesity. You can lose the weight and keep it off, but go back to the old diet. Guess what?

You're going to get overweight again. Have you had success or experience with people that have other forms of bowel disorders, like ulcerative colitis, other things that are related, leaky gut, et cetera? Territable bowel chronic constipation ulcerative colitis are some of the conditions that we have the most experience with. Because these are conditions that typically don't respond well to conventional medical treatment.

We tend to get the people that have tried everything and they're desperate. And that's traditionally been our- Yeah, I know people that have struggled for years trying to figure out a way to get it under control. Getting it under control is easier than keeping it under control. Because keeping it under control requires dietary control. That means things like gluten and wheat and sugar, keeping a whole plant food diet going. And then there's another problem.

As many of these conditions are also aggravated by the hormonal changes associated with chronic stress. So when people are under chronic stress, they have a different hormonal production and stuff that makes them vulnerable to lots of things. And so some patients have to actually change their life. So they're not driving two hours a day to a job they hate and working in places they despise, doing things they don't want to do.

They have to actually find things that give them joy in life in order to be able to get well and stay well. Right, so fasting isn't this panacea that heals all. And one of the things you're always quick to say is that it's a practice, not a magic pill, basically. I mean, it does, it's pretty dramatic. The results here, but I think it's important to place it in context of all the other kind of co-founding factors. It's dramatic because you're dramatically changing the diet and lifestyle.

It's an environment to dramatically change the diet and lifestyle. And so if you don't change the diet and lifestyle, you won't see the sustained results. If you just change the diet and lifestyle, sometimes it'll take care of itself eventually. Fasting as I see it is a way to happen faster. It's sort of like psychedelics are a meditation. It's a super highway to the same destination. Is that how you, is that a fair and a good thing? I don't know anything about psychedelics.

So I don't know the personal experience, but basically it allows you to access a certain state that you could achieve through a very devoted practice of meditation over a long period of time, but you can reliably and immediately achieve that instantaneously. Yeah, I don't know if it's instantaneous, but I do think that the fasting is a great facilitator. And like I said, I would always encourage people, and we do, to adopt the diet and lifestyle changes.

And if you get to the point where you're frustrated because you're not making adequate progress, then we can talk about whether it's coming to the center and fasting, or now we have the opportunity for people to fast remotely, which has also been helpful to people that maybe can't come to California or don't have the resources. And that's through our telemedicine practice, which since our conversation three years ago, we've had to dramatically expand.

And so now we have doctors familiar with fasting that are able to help people where they are, go through, if they're appropriate candidates, go through fasting, now they have to work with their local doctor. So it still requires the same protocol. History, exam, lab, monitoring, rest, proper refeeding. The problem with remote fasting isn't that there's any problem fasting, particularly if you have a supportive doctor, you can get the lab, you can do this stuff. It's getting people to rest.

Sometimes it's hard for them not to be too active. It's, and then most critically, getting them to refeed properly after fasting. Too rapid a return to animation can lead to refeeding syndrome and other problems that can be serious or even fatal. So it's important if you're going too fast on your own that you use the same protocol that we use at Trunorthal Center, which is why we've written this new book, Confasting Save Your Life.

And in that book, as you saw, we have detailed protocols that patients doctor can use to explain what kind of testing and monitoring needs to be done so that they can make sure that that gets done. It goes through the side effects, the concerns, adverse events, the data's all there. It summarizes all of this literature that we've done, literature other people have done on fasting, and it's brought together in a cohesive manner.

And so people can read that book, they can share it with their physician. They can use our coaches through the telemedicine practice to provide them personal eye support because their doctor may be able to help them monitor them medically. They're not going to know how to deal with the issues that come up in fasting. Sure. And it's not an inpatient situation. So they're not there monitoring them multiple times a day.

Well, it means there's certain people that maybe wouldn't be good candidates for that. We would encourage them to come inpatient. But there are many people that are relatively healthy, that are on medication, that they might be a good candidate for a shorter, fast at home. And we've done other things. We've made all of our daily lectures freely available to anybody through our website. We use live streaming. So we're live streaming our lectures so they can get the benefit.

We have a Roku channel now, freely available all of our recorded video so they can get the educational experience. They just have to have a home environment where they can rest. I mean, you can't take care of four kids and drive to the store and do all that kind of stuff if you're fasting. You have to build a rest. But if you can and you have a supportive doctor and you utilize our telemedicine coach, that is a way that we've been able to successfully help people.

Like we had a huge problem during the pandemic. 15% of our patients come from foreign countries. They couldn't come into the country. And so we were working with remote doctors and we were able to successfully help people that really needed that. Now, there are some limitations. We don't do long, you don't go over three weeks with remote fasting because it gets more complicated to get deep.

But we don't do it with people that aren't stable off medications and we don't do it with people that report candidates for fasting. So, but for the right person, this is another way for them to get that experience. I would imagine an additional challenge is finding a supportive doctor. Like how many doctors are actually gonna be supportive when the average person goes to their GP and says, I wanna do this thing.

The book hopefully will redress some of that, but I imagine that that patient is gonna experience some resistance. We have a number of doctors that have trained with us through residency internship programs that are out there in the world. There's also the College of Lifestyle Medicine whose many of their doctors are supportive of fasting. And there's also some of the integrative medical doctors out there that have become more supportive of fasting.

And remember, Walter Longo has 10,000 offices that are making pro-lone available. Many of those doctors might be supportive. And then once a doctor has one patient and they have success, all of a sudden, we're seeing all kinds of their patients. Now, again, some people are better candidates for inpatient care. Some people are fine for outpatient care.

And one of the benefits of the free consult that I do with people is to help them, are they a candidate for fasting, are they a candidate for home fasting if so that we can come up with a doctor that provides those services. If they really need to do it inpatient, they can come to the center, they can go to the other places that do this kind of thing. Or maybe what they need to do is just adopt the diet lifestyle principle long enough to where then they become a good candidate for those changes.

So we're trying to make sure that whoever does it, does it intelligently and does it safely. Not everybody's gonna follow our advice, but at least we can feel good that we've done our best to make the educational services available to everybody, to make the services available to people at home that are good candidates for that. And we have a facility for people that are better candidates to come inpatient. Who isn't a good candidate for inpatient?

So a person that's on medications that you can't safely withdraw. For example, if you've had a recent pulmonary embolism, cardiac arrest, you have atrial fibrillation and you're on any coagulant therapy medication, you don't just stop those drugs because it can induce a stroke. So it's very careful protocol to withdraw those meds and you don't fast on those medications because they can become like many medications greatly patentiated during fasting.

They will work differently in the physiology of fasting than they are in the physiology of feeding. And so fasting medications don't go together. There are a few exceptions. Sometimes we'll allow some hormone replacement therapies like thyroid replacement therapy, stuff to modify the dose and monitor it, but it's not an absolute barrier. But we discuss that in detail in confessing savior life.

We talk about who's a candidate, who's not a candidate, you know, what has to happen in terms of medication? But it's basically you have to get people stable off meds. You have to have people that have a condition that we believe are likely to respond to fasting. We don't want to be doing experiments on people, particularly remotely, unless we kind of know what their condition is and what symptoms they're likely to experience. So we can educate them about that.

You need to have a person that's willing to try to eat healthfully after fasting. It's no good to do a fast and then go on some crap diet and get terrible symptoms and then blame fasting. You know, that's, I don't know how interested in that. We're trying to actually get a good net long term result and that means we have to limit working with people that are, you know, willing to try to do these things. Not everybody's going to be perfect. A lot of people are going to struggle.

But if they aren't going to make a good faith effort, it's probably not the best thing to do. They should be doing some other kind of program that isn't, you know, going to put them in risk. How do you make that determination during the intake process to gauge willingness? Well, first of all, they filled out a detailed medical questionnaire. So I have their medical history that I've reviewed before I've talked to them. And we asked those questions in the questionnaire to gauge where they are.

And also I've interviewed tens of thousands of people. I mean, essentially that's what I do is I talk to people on the phone about their specific issues and try to direct them in the right place. And I've been doing it for 40 years. I got a pretty good idea who's likely to behave and who's not going to behave and who's a good candidate and who's not. And you know, witness that everybody that's walked into the center, 25,000 people now for fasting, probably close to 40,000 people overall.

Everybody that's walked in has walked out. So we're pretty good at making sure we don't bring in people that are not good candidates. Not everybody has an uneventful state. There are patients that have serious side effects that we have to deal with occasionally. We'll have to hospitalize a patient. If they get into an issue, we'll get, you know, have to get diagnostics done, whatever. But as the safety studies show, this is a comparatively safe process when it's done according to protocol.

What is your personal fasting practice? I fast every day. And it's, so you never eat. I fast every day for 16 hours. I'm sure. Or as close to 16 hours as I can manage. You're not a 65-year fast. I fast every year. So you fit you to a 16-hour fast every day. Every day between the hours of what and what? Well, I usually have, depending on which morning it is, because I play basketball in the mornings. But so depending how long the basketball goes, I'm eating between eight and nine in the morning.

I'm not eating after five, five, 30, you know, at night. So I have a window in there, a feeding. And then I don't have anything before or, you know, after dinner. So I do that every day. I fast once a year. I fast for a week if I'm doing okay. No symptoms, then I'll stop it. If I have symptoms, I'll go however long it takes to resolve the symptoms. I don't like fasting. You have to rest when you fast. You can't play basketball. It's really annoying. It's something.

My wife is Dr. Marano is really strict about it because I fast, she's my supervisor when I fast. And she won't let me on my computer. That's the hardest part of all. I let the patients have their computer. What do you do all day? Oh, I just lay around and meditate and rest. And it's awful. But, you know, I don't have symptoms, which is interesting. Because I've done this, I mean, I've, you know, I never smoked, never had a drink. I never, you know, I've been a vegetarian since I've 16 years old.

So I've not had the exposure. So there's not a lot. I don't use medications. I don't use drugs. So the fast itself is boring. Nothing happens in terms of untoward symptoms. But you still have to rest. And for me, that's the big challenge is slowing down. And I do. I find it some of the most beneficial intervention I do is fasting, but it's not pleasurable. Sure. And your blood work is a, yeah, it's going to be. Yeah, my blood works good. My blood works great. My blood pressure is great.

You know, I, but again, I started as a kid. So, you know, you had expected to be doing this in a long time. It's so interesting. It seems so severe and radical to undergo these things. But so many people, thousands and thousands of people have benefited from what you're doing. You practice it yourself. What is radical though? Radical is radical. It means root or cause. That's the fundamental thing we're doing is we're actually getting to the reason people have these problems.

We spent all of our time and money treating the leading causes of death, heart disease, cancer, stroke, diabetes. Instead of the leading cause of death, we don't deal with the actual causes of death, which is smoking, drinking, eating animal foods and highly processed for fine carbohydrates. If we put our time and energy treating the actual causes of death instead of the leading cause of death, we'd probably be a lot that are off. The reason isn't going away.

We talked about the statistics earlier. They're quite dire, but I don't see in a eradication of highly palatable, ultra-process foods disappearing from our food environment anytime soon. If anything, it just continues to metastasize and people are getting more and more sick and fatter and fatter. It doesn't appear to be headed in a great direction, which demands these types of interventions to save people's lives and get them on a different track. What is your prescription for the world?

How are we going to, as a collective, conquer this challenge that we have in terms of our food system to create something better? Honestly, for the sake of humanity. To me, if I look at humanity as a whole, it would be very stressful, and I don't like stress.

What I do is, instead, I look at the fact that I'm going to do everything I can do to influence the one or one and a half or 2% of the population that are hungry for information willing to make these changes and hope that if we can get those people optimizing their health, that they'll set a good example in the 100th monkey effect you'll kick in, and maybe it'll have some downstream effect, maybe not in this generation, but in future generations.

I'm not going to try to take on the world as a whole. I only want to work with the highly motivated people that are willing to do what it takes to actually get and stay healthy and prove that this is an approach that can help them spend the last 20 years of their life healthy and happy. And to kind of end this, maybe look to camera and say, what is the message that you want the person who's listening to this or watching to understand? Maybe that person has their own health challenges.

They're trying to figure out what to do about it. They're a little bit scared or intimidated by what you shared and aren't really sure-footed about how to take that first step or where to begin. Well, health results from healthful living. So if you want to be healthy, you've got to pay the price and live healthfully. That means diet. Our particular version is a whole plant food SOS. Free diet, other people have different opinions, but healthy diet, hopefully.

Regular exercise within your capacity. Abundant sleep, so developing the ability to get to sleep in a cool dark and quiet place and maintain good sleep hygiene. Fast every day for 12 to 16 hours. Fast occasionally is appropriate. And try to figure out strategies to minimize stress perhaps by only focusing on the things you can do something about and not worrying about the things that you have no potential to control. I think we covered it.

Is there anything we didn't get to that you feel compelled to share or talk about? No, I think this book that we've written is a really good book. I hope people read it. I hope they like it. And I'll be interested to hear what feedback we'll get after this show. The book is great. It's called Can Fasting Save Your Life. Everybody should pick it up. We'll link it up in the show notes.

And in the description below the video, you can go to the True North website to learn more about everything that Alan is doing and the center there. You can maybe they can find the email on that website if they want to get in touch with you. Yeah, if they want to get in touch with you. What they go is they go to True North Health.com. They fill out the registration forms which gets me their medical history.

And we offer them a no cost screening call so we can kind of give them help them review their options and point them in the right direction. That's great. You're doing great work. You are truly a servant to humankind. And I appreciate what you're doing. And the gift that you're sharing and thank you for coming here today. And getting into it with me, I think people are going to really enjoy it. Thank you. Yeah, it's great. Thank you. Peace. Peace. We're brought to you today by Eight Sleep.

This episode was brought to you by AG1. Try AG1 and get a free one year supply of vitamin D3 plus K2 and five free AG1 travel packs with your first subscription at drinkag1.com slash ritual. That's drinkag1.com slash ritual. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation.

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