The Fast Solution
Part 4 of 6
The Aetiology of Obesity
Sugars
Blood Sugar
“Fruit” Sugar
Simple carbohydrates - 1-2 sugars
Complex carbohydrates – long chains of sugars
Table Sugar
Are sugars toxic?
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Rising Consumption
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Beverage choices
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Sugar sweetened beverages
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Juice and Childhood Obesity
Increased offerings of whole fruits were associated with reduced adiposity gain
Faith M S et al. Pediatrics 2006;118:2066-2075
Fruit juice intake predicts increased adiposity gain in children from low-income families
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Sugar Sweetened Beverages
4.5
4.2
4
Weight Gain (kg)
3.5
3
2.5
2
2.04
2.21
1.5
1
0.5
0.15
0
Consistent
<1/wk
Consistent
>1/day
<1/wk to
>1/day
>1/day to
<1/wk
Nurses Health Study 1991-99
Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women
JAMA 2004;292(8):927-934 Schulze MB
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Increased Diabetes
Risk of Diabetes
2
1.83
Odds Ratio
1.8
1.6
1.49
1.4
1.2
1
1
1.06
0.8
<1/mo
1-4/mo
2-6/wk
>1/d
Nurses Health Study 1991-99
Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in
Young and Middle-Aged Women JAMA 2004;292(8):927-934 Schulze MB
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Hormonal Obesity Theory
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Diabetes
Fatty Liver
Insulin Resistance
Time Dependent
Metabolic Syndrome
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Carbohydrates raise blood glucose
Usual Diet
55% CHO Diet
20% CHO Diet
Co-factors
Fat
Fibre
Speed of Digestion
Effect of a high-protein, low-carbohydrate diet on blood glucose control in people
with type 2 diabetes
Diabetes. 2004 Sep;53(9):2375-82 Gannon MC
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Fructose is ‘healthy’
1983
“We see no reason for diabetics to be
denied foods containing sucrose” John
Bantle NEJM
1986
“No conclusive evidence (sugars)
demonstrates a hazard” FDA
2006
Can substitute sucrose “for other
carbohydrates in the meal plan” ADA
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Fructose
Fructose Consumption
g/day per capita
60
50
40
30
20
Fructose
10
0
Adolescent 1994 Berry AJCN 2007 88;895
72.8 g/day
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High Fructose Corn Syrup
Fructose
Low glycemic index
Cheaper
Sweeter than glucose
Prevented freezer burn
Mixes easily
Extends shelf-life
Helps breads brown
Keeps them soft
Found in almost all processed foods
especially low fat foods
55% fructose 45% glucose
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Obesity and HFCS
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“High Fructose Corn Syrup “or “High Fructose Table Sugar”
Total Sugars
Refined Sugar
HFCS
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Fructose Metabolism
Increased
lipogenesis
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Fructose causes insulin resistance
Glucose
Fructose
Insulin Tolerance Tests
25% worse with fructose
Impaired cellular insulin binding and insulin sensitivity induced by high-fructose
feeding in normal subjects
Am J Clin Nutr. 1980 Feb;33(2):273-8 Beck-Nielsen H
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Endogenous glucose production
Fructose causes insulin resistance
6 days of high fructose diet
Indication of hepatic insulin resistance
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin
Sensitivity in Healthy Men
Diabetes July 2005 54; no. 7 1907-1913, Tappy L
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Fructose causes insulin resistance
Glucose
Fructose
Oral Glucose Tolerance Test
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Fructose causes hyperinsulinemia
Glucose
Fructose
Oral Glucose Tolerance Test
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Fructose causes Insulin Resistance
Insulin
Resistance!
JCI April 20, 2009 Havel et al.
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Hormonal Obesity Theory
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Diabetes
Fatty Liver
Insulin Resistance
Metabolic Syndrome
Fructose
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Fructose Overfeeding and
Triglycerides
TG increased 79%
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo
Lipogenesis and Insulin Sensitivity in Healthy Men
Diabetes July 2005 54; no. 7 1907-1913, Tappy L
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Sugar and Triglycerides
NHANES
1999-2006
Mean of 15.8% of
consumed calories were
added sugars
JAMA. 2010;303(15):1490-1497 Vos
Caloric Sweetener Consumption and Dyslipidemia Among US Adults
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Sugar and HDL
JAMA. 2010;303(15):1490-1497 Vos
Caloric Sweetener Consumption and Dyslipidemia Among US Adults
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Fructose and Lipids
Fructose
Glucose
% increase
44.9
27.2
18.2
13.9
2.5
TG
13.3
3.6
LDL
3.5
HDL
-2.4
3
apoB
sdLDL
Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral
adiposity and lipids and decreases insulin sensitivity in overweight/obese humans
JCI April 20, 2009 Havel et al.
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Fructose and Blood Pressure
NHANES III 2003-2006
4,528 adults who developed hypertension
Increased Fructose Associates with Elevated Blood Pressure J Am Soc Nephrol 21: 1543–
1549, 2010 Jalal D
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Reducing SSB lowers blood
pressure
Tertiles of reduction in sugar sweetened beverages
Reducing Consumption of Sugar-Sweetened Beverages Is Associated with Reduced
Blood Pressure: A Prospective Study among U.S. Adults
Circulation. 2010 June 8; 121(22): 2398–2406 Chen L
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Fructose and Fatty Liver
6x increase in DNL
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo
Lipogenesis and Insulin Sensitivity in Healthy Men
Diabetes July 2005 54; no. 7 1907-1913, Tappy L
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SSBs are addictive
JAMA. 2004;292(8):927-934 Schulze MB
“An increase in liquid carbohydrates leads, perversely, to
even greater caloric consumption”
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Hormonal Obesity Theory
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Diabetes
Sugar
Fatty Liver
Insulin Resistance
Metabolic Syndrome
Fructose
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Wheat
To increase yield, seed head sizes increased
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Dwarf Wheat
99% of wheat grown worldwide
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Broadbalk Wheat Experiment
Introduction of
high yield
Semi dwarf wheat
Evidence of decreasing mineral density in
wheat grain over the last 160 years
J Trace Elem Med Biol. 2008;22(4):315-24 Fan MS
Whole Wheat
Up to 5% of the wheat
kernel removed
70% of the germ
Contains most of vitamins, protein and fat
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Whole Grain Processing
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Multi-grain
May be 2 refined grains
Rice flour
Dried potatoes
Corn flour
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Speed of Digestion
Traditional Stone grinder
Modern Flour Mill
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Flour
75%
White flour 70% carbohydrate by weight
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Amylopectin
Glycemic Index
Amylopectin C is the least
digestible (Legumes)
Amylopectin B (Bananas,
potatoes)
Amylopectin A (Wheat)
Most digestible
80
70
60
50
40
30
20
10
0
Whole Banana Snickers Kidney
Wheat
Bar
Beans
Bread
Wheat is more efficiently converted to blood sugar
than nearly all other carbohydrate foods
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Exorphins
Digestion of gluten yields morphine-like
compounds ‘exorphins’
Ability to cross blood brain barrier
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COMFORT FOODS
Mashed Potatoes and
Gravy
Ice Cream
Apple Pie
Mac and Cheese
Pancakes
Spaghetti and Meatballs
Comfort foods (affect mood) often contain wheat and
other highly refined carbohydrates
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Problems with Wheat
1. Modern wheat is of lower
nutritional value
2. Modern processing removes
most of vitamins, fibre and
fats
3. Modern milling (as opposed
to stone ground) increases
speed of digestion
4. High in amylopectin A
(highly digestible)
5. May be addictive
“Wheat Belly”
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The China Study
“In both China Study I and II, wheat is the strongest positive
predictor of body weight (r = 0.65, p<0.001) out of any diet
variable”
rawfoodsos.com
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Asian conundrum
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Diabetes
Wheat
Super-carbohydrate
Fatty Liver
Insulin Resistance
Metabolic Syndrome
Fructose
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How can we break the
cycle?
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Diabetes
Wheat
Super-carbohydrate
Resistance requires:
1. High Level
2. Persistence
Fatty Liver
Insulin Resistance
Metabolic Syndrome
Fructose
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Fasting
“Our food should be our medicine. Our medicine should be our
food. But to eat when you are sick is to feed your sickness."
Hippocrates
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Fasting myths
Puts body in “starvation
mode”
Deprives body of
nutrients
Weight loss from muscle/
water
Causes hypo-glycemia
“Yo-yo” diet
Overwhelmed with
hunger
It’s “crazy”
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HUNGER DISAPPEARS
“The most astonishing aspect of this study was
the ease with which prolonged starvation was
tolerated.” E Drenick JAMA 1964 Jan 11;
187:100-105
“A sense of well-being was associated with the
fast” JAMA. 1962;181(4):309-312 Duncan GG
Effect of an acute fast on energy compensation and
feeding behaviour in lean men and women
Int J Obesity (2002) 26, 1623 – 1628 Stubbs RJ
Increased intake from 2436 to 2914 calories on
the day after a fast
Over 2 days (2436 x 2) =
Fasting
Net deficit
4872
2914
1958 calories
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382 day fast
Weight 456 to 180 lbs then remained stable
Features of a successful therapeutic fast of 382 days' duration Postgrad Med J(569); Mar 1973
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Fasting reduces plasma insulin
Glucose remains in normal
limits but plasma insulin
decreases significantly
N Engl J Med 1974; 291:1275-1278
15
10
Baseline
5
Fasting
0
Plasma Insulin
Fasting: The History, Pathophysiology and Complications
West J Med 1982 Nov; 137:379-399
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Fasting reduces plasma insulin
Stable blood sugars
Alternate-day fasting in nonobese subjects: effects
on body weight, body composition, and energy
metabolism
Am J Clin Nutr 2005;81:69 –73 Heilbronn LK
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Fasting maintains resting
metabolic rate
Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and
energy metabolism Am J Clin Nutr 2005;81:69–73 Heilbronn LK
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Fasting improves insulin sensitivity
Euglycemic clamp
Glucose
Infusion
rate
Effect of intermittent fasting and refeeding on insulin action in healthy men
J Appl Physiol 99: 2128–2136, 2005 Halberg N
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Fasting increases norephinphrine
Resting energy expenditure in short-term starvation is increased as a result of an increase in serum
norepinephrine
Am J Clin Nutr 2000;71:1511–5 Zauner C
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Fasting increases Growth Hormone
Growth Hormone:
Increases availability and
utilization of fats for fuel
Preserves muscle mass
Integrated GH concentration
Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth
hormone secretion in man
J Clin Invest. 1988 April; 81(4): 968–975 Ho KY
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Intermittent caloric restriction is better
Randomized
trial
25% caloric
reduction
The effects of intermittent or continuous energy restriction on weight loss and metabolic
disease risk markers Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN
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Intermittent caloric restriction is better
7.3
6.8
Insulin
6.3
IER
CER
5.8
5.3
4.8
Baseline
1 month
3 months
6 months
Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN
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Fasting preserves lean muscle mass
Improvements in Coronary Heart Disease Risk Indicators by AlternateDay Fasting Involve Adipose Tissue Modulations
Obesity (2010) 18, 2152–2159 Varady KA
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Fasting improves lipids
Obesity (2010) 18, 2152–2159 Varady KA
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Fasting breaks the cycle
Vinegar
High Protein
Fattening
Carbohydrates
Fibre
Obesity
High TG
Low HDL
Increased
Insulin level
Hypertension
Cortisol
Wheat
Super-carbohydrate
But Insulin
resistance IS
diabetes
Diabetes
Fasting
Fatty Liver
Insulin Resistance
Metabolic Syndrome
Fructose
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Diabetes USA
American Diabetes Association recommends
diabetics eat MORE carbohydrates not less
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Fasting reduces Diabetes
P<0.05
The Effect of Short Periods of Caloric Restriction on Weight Loss and Glycemic
Control in Type 2 Diabetes Diabetes Care. 1998 Jan;21(1):2-8 Williams KV
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Fasting associated with
reduced Diabetes and CAD
Usefulness of Routine Periodic Fasting to Lower Risk of Coronary Artery Disease among
Patients Undergoing Coronary Angiography
Am J Cardiol 2008 Oct 1; 102(7); 814-19 Horne BD
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Fasting associated with less
Diabetes and CAD
80
70
Prospective
cohort study
60
50
40
Fast
30
Non Fast
20
10
0
Age
BMI
DM
CAD
Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients
undergoing coronary angiography Am J Cardiol. 2012 Jun 1;109(11):1558-62 Horne BD
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Food Rationing decreases
Diabetes
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Diabetes is a Reversible
Disease!
Hepatic Glucose Production
Changes of insulin sensitivity and beta cell function
are reversible
Reversal of type 2 diabetes: normalisation of beta cell function in association with
decreased pancreas and liver triacylglycerol
Diabetologia 2011 Oct;54(10):2506-14, Lim EL
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Surgical Treatment
Roux-En-Y Gastric Bypass
Sleeve Gastrectomy
Laparoscopic banding
>90% cure rates for
diabetes
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Surgery cures diabetes
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
N Engl J Med 2012;366:1567-76 Schauer PR
Basically surgically enforced fasting regimens
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Fasting vs. Bariatric Surgery
8
7.3
1500
1478
1450
6
Diet
5
4
3
2
1
0
4
Diet +
Surgery
Daily Glycemia
Pre vs Post
Weight Loss (kg)
7
1400
1350
1300
1293
1250
1200
Rapid Improvement of Diabetes After Gastric Bypass Surgery: Is It the Diet or Surgery?
Diabetes Care. 2013 Mar 25, Lingvay I
http://www.ncbi.nlm.nih.gov/pubmed/23530013
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How to Cure Type 2 Diabetes
High Protein
Fattening
Carbohydrates
Wheat
Super-carbohydrate
Increased
Insulin level
Fasting
Diabetes
Bariatric surgery
without the
surgery – Fasting!
Fasting
Fructose
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Can We Cure Type 2 Diabetes?
No Diabetes – no diabetic
nephropathy, no diabetic foot
ulcers, diabetic retinopathy,
reduced stroke, MI, cancers
No Drugs, no surgery, no cost,
no long term side effects
6-12 month intensive fasting
regime to cure diabetes
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Time to get started…
Jason Fung’s Intensive Diabetes Dietary Management (IDDM) Clinic
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