Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone. Welcome to today's episode. We are talking about intermittent fasting. I was going through previous podcast episodes and I realized somehow we have not talked about intermittent fasting, so we are going to make sure to address that today. Intermittent fasting has been quite popular over the last couple of years, so I'd like to talk a little bit about what is it, what are different ways in which people accomplish intermittent fasting? Is it even something I recommend? Which the answer is maybe yes, maybe no, depends on the situation. And then how can you apply some of the principles to really best support your health goals if it makes sense for you and your lifestyle? So let's go ahead and get started with this. I'm really excited to talk about this topic because it is very popular in the weight loss world right now. So I'm sure you've heard of intermittent fasting, but to take a step back and think about what is the definition, the idea that we intermittently fast is something we naturally do. Many people follow an eating regimen of 12 hours of eating and 12 hours of not eating. If you think about sort of a traditional day, someone who's working a daytime job, it's common that they may wake up and eat breakfast first thing in the morning, let's say seven, eight o'clock in the morning. Then they eat throughout the day, they have dinner and they may be done eating for the evening. So we typically in that type of eating schedule, maybe eating during 12 hours and then not eating during the 12 hours from dinnertime until we sleep, going to bed, sleeping, and then waking up the next morning. So there commonly is 12 hours of eating and 12 hours of not eating. And even if there is late night snacking for example, there's still a period, often eight or 10 hours where there's not eating behavior. And so it is common and normal for humans too fast for a period of time. And what intermittent fasting does is it takes that period of fasting and extends it. So many people will have a specific regimen. You often hear people talk about 16:8 fasting where people are fasting for 16 hours and eating during an eight hour window. That can look like a lot of different things. Typically though, people may be eating between 11:00 AM and 7:00 PM or 12:00 PM to 8:00 PM So there's very common ways in which people do it. There are people who do 20:4, so 20 hours of fasting and four hours of eating. So maybe eating between 1:00 and 5:00 or 2:00 and 6:00 is very common, but there's a lot of variations of this. There's even then prolonged fast where people may do fasting for full days. So regimens whereby which people fast for full 24 hours or 36 hours or 72 hours, and that starts getting into the more prolonged fasting, which is slightly different. So lots of different ways in which people can do this, and the question is why? Why are people doing fasting? Are there benefits of it? How does it even work or why would that even support your weight loss goals? So there's a lot of different reasons. Interestingly, we know that eating during discreet windows of time can be supportive in improving our insulin sensitivity. So one of the things that happens when we eat too much, when we eat too frequently is that our body is spending a lot of time in this energy storage mode. So very simply put, our body can be burning energy or it can be storing energy. It can't do those same two things or those two different things at the same time. It's either storing or it's burning. And so when we are eating food and there is glucose being consumed in our mouth, absorbed from our stomach into our bloodstream, our body is going to be in a mode by which it is taking that energy and deciding how it's going to move that into the body to be able to use that for later. It's storing it away when there's times that food is not being consumed in our mouth and we need energy. Our body then looks to our energy stores that can be in the form of glycogen, which is in our liver and in our muscle. Those are intermediate energy stores or looking to our fat mass, which is energy that's stored more long-term for later. So when we are fasting, what happens is that our body, if you were to wear a continuous glucose monitor, for example, if you are fasting for eight hours or 12 hours or 20 hours or 24 hours, the interesting thing that happens is that our glucose levels will stay fairly consistent during that fasting period. Our body needs to have these mechanisms by which when there is not food readily available, it can take other energy and use that to help fuel our body. And so we'll find that even during fasting times, our blood sugar levels stay really, really pretty stable. And so that's a really cool thing that is happening. And our body gets used to not only burning our glycogen stores, so anytime that our body doesn't have ready access to glucose in the bloodstream, it's going to dip into these intermediate energy stores. The short-term energy stores of glycogen that is in our liver, that's in our muscle and glycogen can be readily converted back into blood sugar, into glucose to be used in the cells. Our body. Now, during periods of time where we've depleted that glycogen, our body then starts needing to dip into fat stores. So when we are fasting and we are practicing doing this over time, our body gets that opportunity to dip into our fat stores, which is a really important way in order to support weight loss. So our body, when we're losing weight, it's coming from somewhere which is coming from our fat stores ideally, and we want to make sure that we're supporting that. So spending more time in that energy burning mode allows us to not only access our short and intermediate term storage, but to get to that long-term fat storage so that our body can start to lose weight. So it can be really helpful from a weight loss standpoint. It also will help to improve insulin sensitivity. So insulin is one of our primary energy storage hormones. And if it's not being utilized as often because we're not eating as frequently, our body can start to resensitize to insulin, meaning that after we eat the amount of insulin required to store energy away can become lower. So that can reduce the risk of things like diabetes or pre-diabetes and obesity, which is often related to insulin sensitivity. There's also data that says it may improve auto Fiji and cellular repair, meaning that it is during these periods of fasting that our body is doing a lot of repair of damaged cells throughout our body, and that fasting period gives it the opportunity to do that. So we see some of these potential benefits. There are downsides however, and I do want to highlight those because I think in the excitement about intermittent fasting, it's something that people are quick to jump on board, but it may not really be the right fit for everybody. So certainly someone who is using medications that lower their blood sugar, so particularly if you have diabetes type one or type two. But basically if you are taking insulin or other medications that can lower your blood sugar, you need to be really careful about intermittent fasting. It's certainly something that can be done, especially for a type two, someone with type two diabetes. That can be a way to help improve the type two diabetes, but that needs to not be done on one's own. It needs to be done under the guidance of a physician or someone who is experienced so that you're not going to put yourself at risk of having low blood sugars that can be not only dangerous, but even life-threatening or deadly. So it's important to make sure if you have blood sugar lowering medications, you do this with the advice of your physician. We also would not recommend this for a pregnant woman. We know that pregnancy is the period of time where our body is supposed to be growing, both growing our own fat stores in order to promote breastfeeding later on, as well as growing energy stores for the placenta and for the baby so that the baby can grow. So we do not recommend intermittent fasting in pregnant women, in pregnant women. The other thing I will say is that we have to be really cognizant about recommending intermittent fasting during binge eating disorder. We talked about binge eating disorder a couple of weeks ago, and binge eating disorder is very common and it's commonly not screened for. And so before we're giving recommendations for intermittent fasting, it's important to know if there's a history of predisposition or active binge eating disorder because as we talked about in that binge eating disorder episode, there can be this cycle of restriction that then leads into a binge. And so interestingly, intermittent fasting can almost play into that fasting and binging cycle in that there's a period of time in which we're not eating. And then when we do have an eating window, we now have permission. We're hungry. All of the emotions that can be associated with that, that have not been well managed, we now have almost given ourselves permission to be able to binge during that time. And so for binge eating disorder, we often will recommend spacing energy needs and energy intake throughout the day in order to support more regulated metabolism. And so I do recommend that if you have any concern that you might have binge eating disorder, if you listen to that episode and you're like, oh gosh, that really sounds like me. I would not start intermittent fasting without talking with your doctor first, without talking with someone who has talked to you about potentially binge eating disorder and making sure that you're not putting yourself in a situation where potentially you could make that worse. So we certainly don't recommend that for a binge eating disorder. So a lot of people though may be able to implement intermittent fasting in a way that is supportive of their health goals. One of the things that I will encourage my patients is to start and sort of step into it in a way that feels really easy. I recommend all of my patients to pay attention to what are their hunger signals, what are their satiety signals? And a lot of times we can utilize that then to make decisions about the times in which we are eating. So that would be the very first step that I would recommend for anyone. And it's really interesting. There are people for whom they wake up in the morning and they're simply not hungry. I am one of those people, and I remember even back in middle school, the bus came really early in the morning. Our bus would come at about seven o'clock in the morning. And so eating breakfast was something that needed to be done in the mid six o'clock or late six o'clock hour. And I wasn't hungry. I would wake up and be absolutely not hungry, and it makes sense for a child who's going to school. We didn't have lunch until whatever time midday. It was important for me to consume something at that time. And so I remember my mother, would she probably talk to lots of people to decide what is the best thing to support my middle school student because she's not hungry at all, but needs to take something before getting on the bus. And she would buy me those carnation instant breakfast little packets, and I would mix a packet of it into a cup of milk. And even that was sort of repulsive. I would literally plug my nose and chug it. And it's funny, maybe the equivalent of doing a nutrition drink or a protein drink that a lot of people do and has become very popular now, but that was just my way or her way of making sure that I got energy before I left for school in the morning. And so I did that all the way through middle school, honestly most of the way through high school as well. But then when I went to college and had a little bit more flexibility in my schedule, and even now I'm just not hungry in the morning I wake up first thing, I usually drink a couple of beverages. I have water, I have tea, I have things like that that I really enjoy, but I usually don't find that I get hungry until 10, 11 o'clock in the morning, sometimes even noon, depending on the day. And so what I do then is just lean into that in the morning I have all of the beverages that I typically would have, and then in that 10, 11, 12, as I'm getting hungry, I start eating. So if you were someone who does not naturally wake up hungry and you have a little bit of flexibility in your schedule such that you could eat at 10 or 11 or even 9, 9, 10, 11, 12, whenever your body is starting to recognize that you're hungry, that would be sort of an easy first step to take of I'm just going to pack a breakfast, bring it with me and eat it when my body is feeling hungry. So that in a lot of ways we can start to stretch, but just really paying attention to what is my body asking for and how can I acknowledge that with the food that I'm eating? Another thing to think about is making sure that your body is used to burning fat for energy. So a lot of times when we are used to eating processed carbohydrates frequently, our blood sugars are always doing this up and down thing. We feel really hungry. We eat something like a bread or a muffin or a bowl of cereal or instant oatmeal and we get this quick energy spike and then we feel this crashing down that happens from that afterwards. And if we were look at our blood sugar throughout the day, we'd see this quick up this quick down this quick up, this quick down, and that down feeling feels really crashy. It feels really awful, and you really are looking for a quick hitter of energy again. And so a lot of times the best way to get that is by consuming more sugar in the form of flour, in a sweetened beverage, something that gives you that next sort of quick hit of energy. So the best thing we can do is start to train our bodies to have more sustained energy, and we can do that by having meals that contain lots of fiber, protein, and even fats in order to give us and then help to create some staying power with that meal so that we don't feel like we're riding this blood sugar rollercoaster that can be driving us really up and down. Once we've shifted our eating habits to include more of those fibers, proteins and fats, we might find that our energy levels throughout the day just feel a lot more even. And once we're feeling that, we may find that a really hardy breakfast that we've eaten, for example, might stick with us until noon or one. And so let's say you're used to eating breakfast and then eating a snack and then eating lunch and then eating a snack and then eating dinner. If you switch up your eating regimen such that your breakfast sticks with you feels like it is providing that satiety that's lasting throughout the morning, you might find that instead of needing a mid-morning snack that at noon or at 1:00 PM, you're finally starting to feel that hunger kick in. And so you can start to shift your eating even if it's still happening throughout the day. Let's say it's still breakfast, lunch, and dinner, and you're not necessarily eating in an eight hour window or something like that. You're still eating in very discreet time periods. So you're eating breakfast, you've got a while because you've got some good satie sticking with you until you're eating lunch. Then again, that good satiety sticking with you until you're eating dinner. And interestingly, even that can make a huge difference. We talked about this on the podcast about menopause. If you haven't listened to that episode with Dr. Heather Awad, it was amazing. Go back and take a listen to that. But this eating during very discreet periods of time, even that can be very, very beneficial. So if you're going to eat a food, having that as one consolidated meal rather than feeling like you're needing to graze throughout the day can be supportive of being discreetly in energy storage mode and then having even between meals, periods of time where your body can dip into energy burning mode and practice accessing your fat stores. And over time as you're doing that and your body gets used to burning fat for energy, both from the foods that we consume as well as burning our own fat stores, we're able to dip into those fat stores more readily and feel this sort of even level of energy throughout the day that just feels good. When we feel hungry, it feels more like a gentle knocking at the door rather than this ravenous frantic panic that can happen sometimes when we have that blood sugar crashing sensation. If you are interested in trying a fast and not sure if it's going to work, another thing you can do is do a modified fast by which maybe you're not going to be eating solid food, but decide that you're going to have bone broth or a protein shake or something like that instead of eating a full meal. And so that might be something that you give a try and see, okay, if I have a protein shake for breakfast, how long does that stick with me until I need to eat lunch? Or maybe you have a really nourishing breakfast and then midday if you're feeling hungry but not terribly so have a protein shake, for example. So you might try some meal replacement or substituting something like a protein shake, like bone broth can be an excellent way to do sort of a modified fast that can feel really great. It is important if you're doing fasting to make sure that you have plenty of hydration and you want that to come from low calorie or no calorie even drinks. So thinking about things like waters, teas, coffee, we do know that having fat can actually extend that fasting state. And so a lot of my patients will use things like even heavy whipping cream, sometimes half and half in order to get that fat to feel like they're extending their fast and give them a little bit of satiety there. That can be the right fit depending on your personal goals if you have any concerns about cholesterol and that type of thing. But that can be a really great trick to put heavy whipping cream in your coffee, for example, can make your coffee feel really decadent and can last you for a few hours. So maybe you're able to start eating later in the morning or midday. So there can be some different things that you try here. But my best recommendation is to really listen to what your body's asking for. And at the very beginning, just paying attention to, am I hungry? Am I full? And utilizing that to start eating during discreet windows. Eating breakfast when you're eating breakfast, eating lunch, when you're eating lunch, eating dinner, when you're eating dinner, choosing foods that provide fullness and give you that lasting satiety with lots of fiber, protein and healthy unsaturated fats. And as you start shifting your eating in that way, you may find that intermittent fasting naturally comes to you or not, but either way, your body needs what it needs. And only if you're doing this and you're like, oh my gosh, I have no idea what I'm doing. Is this working? Is this not working? Is this a healthy option for me? Make sure you consult your physician. If you're looking for support, it's great to see someone like myself who's a board certified obesity medicine physician. I would love to support you in your goals. If you are interested in working with me as a patient, you can learn more about us and join the practice at www.sarahstombaughmd.com. It's S-A-R-A-H-S-T-O-M-B-A-U-G-H md.com. I would love to see you in the practice. We're enrolling new patients right now. There's never been a better time because we just brought on a health coach who is supporting patients with coaching and personal training as well. And so if that is something you were interested in, I would love to support you in that way. Thank you so much for joining me this week. I will see you on next week. Bye-Bye.