The Biggest Loser is a long-running American TV reality show that pits obese contestants against one another in a bid to lose the most weight.
The weight-loss regimen has two components: a calorie-restricted diet calculated to be approximately 70 percent of each contestant’s energy requirements, typically 1200 to 1500 calories per day, combined with an intensive exercise regimen that is typically far in excess of two hours a day.7 This is the classic “Eat Less, Move More” approach endorsed by all the nutritional authorities, which is why The Biggest Loser diet scores well on the 2015 U.S.
News & World Report ranking of best fast weight- loss diets.8 And it does work, but only in the short term.
When studied, average weight loss was 127 pounds over six months.
That’s amazing.
Over the long-term, season two contestant Suzanne Mendonca said it best when she stated there is never a reunion show because “We’re all fat again.”9 These contestants’ basal metabolic rates, the energy needed to keep the heart pumping, the lungs breathing, the brain thinking, the kidneys detoxing, and so on, dropped like a piano out of a twenty-story building.
Over six months, their basal metabolism dropped by an average of 789 calories.
Simply stated, they were burning 789 calories less each and every day.
That’s an almost insurmountable hurdle to continued weight loss.
As metabolism drops, weight loss plateaus.
Chronic caloric reduction forces the body to shut down in order to match the lowered caloric intake.
This compensation is sometimes called “starvation mode.” Once
expenditure drops below intake, the even more familiar weight regain begins.
Goodbye reunion show.
Even after six years, the metabolic rate does not recover.10 But this is not exactly news.
This metabolic slowdown in response to caloric restriction has been scientifically proven for over fifty years.
In the 1950s, Dr.
Ancel Keys’s famous Minnesota Starvation Experiment11 placed volunteers on a diet of 1500 calories per day.
Despite the study’s name, this diet restricted calories by 30 percent over the subjects’ usual diets, a degree of calorie restriction not dissimilar to many weight-loss diets recommended today.
In response, the subjects’ basal metabolic rate dropped about 30 percent.
They felt cold, tired, and hungry.
When they resumed their typical diet, all their weight came right back.
Reversing type 2 diabetes relies upon burning off the body’s excess glucose, so the daily calorie-restricted diet will not work.
The secret to long-term weight loss is to maintain your basal metabolism.
So what doesn’t put you into starvation mode?
Actual starvation!
Or at least the controlled version: intermittent fasting.
Fasting triggers numerous hormonal adaptations that do not happen with simple caloric reduction.
Insulin drops sharply, preventing insulin resistance.
Noradrenaline rises, keeping metabolism high.
Growth hormone rises, maintaining lean mass.
Controlled experiments prove this point.
Over four days of continuous fasting, basal metabolism (measured as resting energy expenditure, REE) does not drop.
Instead, it increases by 12 percent.
The VO2, another measure of basal metabolism that tracks the amount of oxygen used per minute, similarly rises.12 Many other studies have confirmed these findings.
Twenty-two days of alternate daily fasting also did not result in any decrease in basal metabolic rate.13 Figure 15.3.
Metabolic changes over four days of fasting14
Remember the portion-control versus fasting study in the previous section?
The portion-control strategy dropped basal metabolism by 76 calories per day.
By contrast, fasting was not associated with any statistically significant drop in energy expenditure.
In other words, daily caloric reduction causes starvation mode where fasting does not.
The study concluded: “Importantly, ADF (Alternate Daily Fasting) was not associated with an increased risk for weight regain.” The importance of this statement will not be lost on anybody who has ever tried to lose weight.
You can lose weight on virtually any diet, but maintaining this weight loss is the real battle.
Fasting works because it keeps basal metabolism high.
Why?
It’s a survival mechanism.
Imagine you are a cave dweller in the Stone Age.
It’s winter and food is scarce.
If your body goes into starvation mode, you will not have the energy to go out and find food.
Each day the situation will get worse and eventually you will die.
The human species would have become extinct long ago if our bodies slowed down every time we didn’t eat for a few hours.
During fasting, the body opens up its ample supply of stored food, body fat.
Basal metabolism stays high, and instead of using food as our fuel, we use food our bodies have stored as body fat.
After all, that’s exactly why we stored it in the first place.
Now we have enough energy to go out and hunt some woolly mammoth.
During fasting, we first burn glycogen stored in the liver.
When that is
finished, we use body fat.
Oh hey, good news: there’s plenty of fat stored here.
Burn, baby, burn.
And since there is plenty of fuel, there is no reason for basal metabolism to drop.
That’s the difference between long- term weight loss and a lifetime of despair.
That’s the knife edge between success and failure.
Simply put, fasting provides beneficial hormonal changes that are entirely prevented by the constant intake of food, even when the calories in that food are reduced.
It is the intermittency of the fasting that makes it so much more effective.
If we want our bodies to burn off the sugar that is causing type 2 diabetes, we need the fire of our basal metabolism to remain stoked.
We can forge our new diabetes-free bodies in the crucible of fasting.
FASTING OR REDUCING CARBS: WHICH IS BETTER?
BOTH INTERMITTENT FASTING and low-carbohydrate, healthy-fat (LCHF) diets effectively reduce insulin, and thus can cause weight loss and reverse type 2 diabetes.
Fasting lowers insulin maximally, so it is quite simply the quickest and most efficient method.
Still, the very low, carbohydrate diet does remarkably well, giving you 71 percent of the benefits of the fasting without actual fasting.15 Compared to the standard 55 percent carbohydrate diet, low-carbohydrate diets reduce insulin by roughly half, despite similar calorie intakes.
Fasting reduces that by another 50 percent.
That’s power.
Notably, these studies demonstrate that the benefits of carbohydrate restriction on blood glucose were not simply due to calorie restriction.
This is useful knowledge, considering how many health professionals keep parroting that “It’s all about the calories.” Actually, it’s not.
If it were true, then a plate of brownies would be as fattening, and as likely to cause type 2 diabetes, as a kale salad with grilled salmon and olive oil, as long as the calories were equal.
But this notion is clearly ridiculous.
The more we eat ultra-processed, insulin-stimulating food, the more we need to fast to bring those insulin levels back down.
And nothing beats fasting for bringing down insulin.
But should we fast or follow a LCHF diet?
It’s not a question of either/or.
We can incorporate both fasting and a LCHF diet for maximal benefits.
If dietary interventions reduce both blood glucose and insulin for type 2 diabetes, why do we need medications at all?
We don’t.
Type 2
diabetes is a dietary disease, and fixing the diet will reverse the disease.
FASTING FOR TYPE 2 DIABETES
FASTING ALLOWS US to naturally empty the sugar from our body (the sugar bowl).
Once empty, any incoming sugar will no longer spill out into the blood, and we will no longer meet the criteria for diabetes.
We will have reversed the disease.
As far back as 1916, Dr.
Joslin reported the benefits of fasting for diabetes.
In the modern era, reports dating to 1969 confirm these benefits.
Thirteen obese patients were hospitalized to treat their weight issues and were found incidentally to also have type 2 diabetes.
They fasted for seventeen to ninety-nine days and averaged a 43-pound weight loss.
Diabetes completely reversed, without exception.
Interestingly, this reversal did not depend upon weight loss,16 reflecting yet again that it is not total fat loss that matters, but ectopic fat loss.
Certain general principles apply to fasting with type 2 diabetes.
How long it takes to reverse the disease depends on the intensity of the fasting regimen and the length of time you’ve had the disease.
More intensive fasting will give quicker results, but if you have had type 2 diabetes for twenty years, it is unlikely to reverse in several months.
It will take longer, though the exact time differs from patient to patient.
Fasting when taking medications IF YOU ARE taking medications, then you must speak with your physician before starting a fast.
Diabetic medications are prescribed based on your current diet.
If you change your diet without adjusting your medications, then you risk triggering hypoglycemic reactions, which are extremely dangerous.
You may feel shaky, sweaty, or nauseated.
In more severe cases, you could lose consciousness or even die.
Carefully monitoring and adjusting your medications is essential.
Some diabetes drugs are more likely to cause hypoglycemia, especially insulin and sulfonylureas.
Metformin, DPP-4 inhibitors, and SGLT2 inhibitors have a lower risk of hypoglycemia, so these are preferred.
If you are taking medication for diabetes, and again, talk to your physician first, it’s important to monitor your blood glucose
frequently with a standard home monitor.
Check your blood sugar at least twice a day and ideally up to four times a day on both fasting and non- fasting days.
If you are not taking medication, this is not necessary.
Blood glucose may drop slightly but should remain in the normal range.
Your physician can direct you on how to reduce or hold diabetic medications, and especially insulin, during fasting days.
They can be taken on an as-needed basis when blood glucose goes too high.
Modestly elevated blood glucose is not often a problem, since it can be expected to come down with fasting.
In my Intensive Dietary Management (IDM) program, for example, the target blood glucose is 8.0 to 10.0 mmol/L while fasting, if you are taking medication.
This range is higher than the non-fasting norm.
Mildly elevated blood glucose levels are not harmful in the short term, and this higher range creates a margin of safety to prevent the far more dangerous hypoglycemic reactions.
I consider this to be an acceptable trade-off.
The long-term goal is to successfully reduce and then stop all medications and still be able to maintain your sugars in the normal range.
If you are unsure whether to take medication or not, it is generally better to use less medication during fasting.
If blood glucose rises too high, you can always take more medication to compensate.
However, if you overmedicate and hypoglycemia develops, you must eat some sugar to treat it.
That will break the fast and is counterproductive to reversing the diabetes.
Again, consult with your doctor for guidance.
Medications unrelated to diabetes can often be taken as usual during fasting, though you must discuss them with your physician first.
However, certain medications are best taken with food to avoid side effects.
When taken on an empty stomach, metformin and iron supplements often cause diarrhea and stomach upset.
Magnesium supplements can cause diarrhea.
Aspirin may cause stomach pain and ulcers.
Many aspirin preparations are coated to prevent this side effect but it may still occur.