No.1 Fasting Expert: Surprising Link Between Fasting & Cancer – DOAC Podcast (Transcript) 

So what is the type of fasting that you spend most of your time doing working on administering to patients?

DR ALAN GOLDHAMER: Right. Well, fasting is the complete abstinence of all substances in an environment of complete rest.

STEVEN BARTLETT: So what does that mean?

DR ALAN GOLDHAMER: That means that you’re actually resting while you’re fasting in order to get therapeutic fasting to be most effective. And the reason is if you’re very active when you’re fasting, your body has to produce more glucose in order to carry on the extra muscular and brain activity.

And the only way that it does that after glycogen reserves are depleted is through a process called gluconeogenesis, where the body breaks down lean tissue. So when you’re fasting, if your goal is to maximize fat loss and minimize lean tissue loss, it’s important that resting be a part of the protocol.

It’s true if people are more active when they’re fasting, they’ll lose more weight, but that extra weight won’t be fat, it’ll be lean tissue.

The Physiological Process of Fasting

STEVEN BARTLETT: So what happens to the body when someone fasts? And can you give me like an hour by hour or a play by play in terms of what actually is the sort of physiological sequence of events that are beneficial for one’s health?

DR ALAN GOLDHAMER: So it’s a really interesting, fairly well studied and complex physiological adaptation that human beings make to fasting. Normally, your brain burns glucose, which is…

STEVEN BARTLETT: What I get if I have a piece of bread or a bar of chocolate.

DR ALAN GOLDHAMER: Or if you break down protein, which can also break down into glucose, which is what happens after 24 hours of fasting. You’ve depleted your glycogen storage sugar stores in your muscles. And so then the body, in order to get the glucose it needs, has to either convert to burning fat or break down muscle in order to form glucose.

What the human being does is it converts its main burner of glucose, which is the brain, from burning sugar to burning fat. Now, if it didn’t do that, you could fast about a week, you’d enter starvation, deplete your protein stores and you’d starve to death.

Because you can convert your brain to burning fat instead of sugar, a 70 kilogram male can fast about 70 days. Now, that doesn’t mean they should fast 70 days, but they could fast up to 70 days because your main burner of glucose, your brain will convert to burning a completely different fuel, which is fat.

STEVEN BARTLETT: So let me see if I’ve got this correct. So if I’m on a typical American diet, I’m going to be eating lots of things and my body’s going to be breaking that down into this fuel source called glucose. If I stop eating the glucose, my body has this sort of evolutionary switch where it’s going to start burning my fat and turning that into this thing called ketones, which my brain can run on as well.

DR ALAN GOLDHAMER: That’s correct. And you have about 24 hours of glycogen stores or sugar stores in your muscles, in your liver. So when you stop eating for the first 24 hours, you’re still able to produce glucose from your glycogen stores.

But once you’ve depleted your glycogen source, now you’re stuck. You either burn fat or you break down lean tissue. Now, because the human brain is so ridiculously large, I mean, it’s two and a half times a chimp’s, it’s a huge glucose burning machine.

You had to have a way of being able to use some kind of other fuel for that brain. Otherwise, the first time spring comes late, all the human beings would have died. And so this biological adaptation was clearly important for our survival in large part because we have disproportionately large brains that burn ridiculous amounts of glucose.

Is This Evolutionary Mechanism Actually Healthy?

STEVEN BARTLETT: Just because the body does it as a survival mechanism doesn’t posit that it’s necessarily healthy, though, right?

DR ALAN GOLDHAMER: Absolutely. And what we’ve done though, is we’ve taken this biological adaptation, which by definition would be something the body’s capable of doing safely and efficiently and utilizing it in a very unusual situation. And that’s where people have consistently been exposed to dietary excess.

You know, in the world of our ancient ancestors, getting enough to eat and not getting eaten was the biological imperative of life. It was difficult to get enough to eat. In fact, most human beings that were born, modern humans probably didn’t live to reproduce. They didn’t pass on their DNA. We’re the results of the winners.

Most people, starvation, predation, had all kinds of challenges that would prevent people from reaching reproductive age. Taking a biological adaptation, something that’s natural to the body, and applying it in a situation where people had consistent exposure to dietary excess.

STEVEN BARTLETT: When you say dietary excess, you mean too much calories.

The Modern Problem: Diseases of Kings

DR ALAN GOLDHAMER: Too much calories. In fact, the diseases that we suffer today, the heart disease, the diabetes, the autoimmune diseases, some of the cancer, these used to be rare conditions that were called “the diseases of kings.” It was the wealthy elite kings that could consistently overeat, that would get the gout, that would get the heart disease. These weren’t common conditions that were present for the peasants. These were rarefied conditions.

They’ve become common conditions because now people are consistently being exposed to dietary excess. And more importantly, we’re fooling our brain satiety mechanisms into overeating by putting chemicals in our food.

And as the consequence, we have a situation today where 76% of people are overweight or obese. And the extra fat comes with something called visceral fat. It’s the fat that tends to accumulate around the belly and the organs. And it’s pro inflammatory, hyper metabolic, hypertrophic, it acts like a tumor.

You have people walking around, maybe they have 20 pounds of extra adipose tissue, they have 2 pounds of visceral fat, and that visceral fat is giving off inflammatory products that’s causing heart disease, cancer, diabetes, autoimmune diseases.

And what’s weird is these conditions are treated as if they’re completely independent, unrelated conditions. You have to go to a different kind of doctor to be even diagnosed and treated with these conditions. And yet they all seem to be associated with dietary excess, excess fat, excess visceral fat, and the inflammation that’s associated with that visceral fat.

The Transition from Glucose to Ketones

STEVEN BARTLETT: Let’s run through what happens inside the body when I start fasting and then I want to talk about fasting in a little bit more specifics, but what’s going on in the body? So you said in the first sort of 24 hours, 48 hours, my body is going to switch from using glucose as a fuel source to ketones.

DR ALAN GOLDHAMER: It’s going to predominantly shift. The brain and liver muscles are going to begin shifting. It’s a progression depending on your glycogen stores so that within 16 hours, 24 hours up to 48 hours. In that transition, you’ll be going from burning almost exclusively glucose in the brain to burning predominantly byproducts of fat metabolism, ketones and specifically beta hydroxybutyric acid.

STEVEN BARTLETT: Is that basically ketones?

DR ALAN GOLDHAMER: Ketones break down into different components. Beta hydroxybutyric acid becomes the predominant fuel of the brain. It’s a byproduct of fat metabolism. And the higher your beta hydroxybutyric acid is, the more BDNF is produced.

BDNF, brain derived neurotrophic factor is neurochemical that’s thought to be protective in the brain from oxidative damage. So that can result in things like Alzheimer’s disease and dementia.

When they do rat studies, rats in a cage, 30 rats, both cages, everything’s identical. They give half the rats a wheel. The rats with the wheel will run on the wheel and they don’t get Alzheimer’s disease. And they said, why? What is it about the exercise that’s preventing these rats from getting oxidative damage in their brain that results in dementia or Alzheimer’s type disease? And they found out it was BDNF. It’s dramatically higher with exercise. It also goes up with fasting.

In fact, it’s interesting if you look at all the cardiometabolic improvements that happen with exercise, the chemical changes that they, they also happen with fasting. And that’s not intuitively obvious because in fasting, you’re resting and exercise, you’re vigorous. You might say, what do these two seemingly unrelated phenomena have in common?

And what I think is going on is that both exercise and fasting undo the consequences of dietary excess. They reduce the fat, specifically the visceral fat, and the inflammation that leads to all these different diseases. And so every time you look at the benefits of exercise, you oftentimes see these corollaries with fasting.

Understanding Autophagy

STEVEN BARTLETT: And at some point in this fasting process, your body moves into a state of autophagy. I’ve heard that word a few times. What is that?

DR ALAN GOLDHAMER: So autophagy is how the body gets rid of senescent cells and waste products and cancer cells, and it kind of eats up that debris and does the housekeeping. And there’s some things that increase autophagy, and one of those things is fasting.

If you take rodents, for example, and you let them eat at libitum, they live as much as they want. They will live to a certain amount of time. If you take those rats and you periodically fast them, you can increase their lifespan from 30% to 100%, even though the diet’s the same. Just with periodic fasting or with systematic underfeeding.

If you limit, instead of giving them as much to eat as they want, you feed them at 60% of what they would eat if they ate unlimited amounts, and you can dramatically increase their lifespan.

It’s an interesting way of looking at it. From my viewpoint, though, they’re looking at it wrong. It’s not that fasting doubles your lifespan. It’s overfeeding cuts it in half. By overfeeding the rodents, they’re developing fat, visceral fat. They get the inflammation and you cut their lifespan in half. So what fasting is doing is allowing them to live their full span by getting rid of the consequences of dietary excess.

Calorie Restriction vs. Fasting

STEVEN BARTLETT: So isn’t the game here then, just to not eat as much versus fasting?

DR ALAN GOLDHAMER: Absolutely. The idea is to avoid excess intake that results in excess fat, that results in excess visceral fat. The problem is it’s very difficult to do that when they are putting chemicals in your feed that fool your satiety mechanisms and lead to overeating.

STEVEN BARTLETT: Satiety mechanisms being mechanisms that tell you whether you’re hungry or not.

DR ALAN GOLDHAMER: Right. Whether your brain signals you accurately that the amount of calories you have, if you, for example, just sit down and eat your fill of whole plant foods, you eat a certain amount and then you feel full. But if you put certain chemicals in the feed, you’ll eat significantly more before you trigger those satiety mechanisms and feel full.

Those chemicals that we put in our food are salt, oil, and sugar. Salt, oil and sugar are not food. They’re hyper concentrated components derived from food that are put back into food, and we put them into food to make food taste better. And what tasting better actually means is it results in more stimulation of dopamine in your brain.

Dopamine is the neurochemical associated with pleasure. The more dopamine, the more pleasure, the more you like it. And so it turns out that higher caloric density foods or foods that have chemicals like salt, oil and sugar in the food will stimulate more dopamine in the brain.

And that’s because your brain evolved in an environment of scarcity. It evolved where it was difficult to get enough to eat and avoid being eaten. And so richer foods had more value. And so the people that recognize the value of more concentrated foods tend to live, to reproduce and pass on their DNA.

Today we live in a world where we’ve corrupted the whole system. And so now we have unlimited amounts of hyper concentrated foods with these chemicals like salt, oil and sugar. So when you eat those foods, you will overeat. The only question is how much and what are the consequences?

STEVEN BARTLETT: Should we be intermittent fasting or should we just be restricting our calories? Are they the same thing?

The Benefits of Time-Restricted Feeding

DR ALAN GOLDHAMER: Well, there’s different tools available to allow for us to eat ad libitum but still meet optimum nutritional intake. One tool is intermittent fasting, that is, or time restricted feeding, which we’ve practiced for 40 years, which is basically don’t eat three to four hours before you go to bed at night.

So instead of eating right up till the time you go to sleep, you withhold calories after the last meal so that you have three to four hours of fasting every day. That gives you a 12 hour fast every day. And if you’re trying to lose weight, some people believe you could extend that fasting period another four hours in the morning, do some exercise in the morning, preferentially burning fat. And so that would give you a 16 hour fast and limit your feeding window to 8 hours.

STEVEN BARTLETT: And what’s the benefit of that? 16 hours.

DR ALAN GOLDHAMER: So people find by limiting the feeding window, they can limit some of the overeating. That a lot of eating is being done for reasons other than being hungry. Sometimes people at night, you know, they’ve had a big dinner and now they’re eating additional food, not necessarily because they’re hungry, but because they’re bored, they’re tired or they’re fatigued.

And sometimes when they’re fatigued and they eat and they feel stimulated, they think, “oh, they must have been hungry,” when in reality they were tired. Our suggestion is when you’re tired, go to sleep, and when you’re bored, engage in productive activities. And when you’re hungry, then you eat and if you limit your feeding window to eight hours, some people find that it’s a helpful tool of minimizing some of the overeating.

Now, it’s not going to work for everybody. If you have very high caloric needs, you’re a competitive athlete. Eight hours feeding window, particularly on high nutrient density, low caloric density foods may not give you enough feeding windows in order to get the calories that you need. When you’re trying to burn 3,500 to 4,000 calories a day on very low caloric density foods, you may need to have a 12 hour feeding window in order to be able to get the calorie density need. But for most of us that are trying to maintain or lose weight, having a narrow feeding window may prove to be of some benefit.

Why Cognitive Performance Improves During Fasting

STEVEN BARTLETT: When I’m in a ketogenic diet or when I guess I’m fasted, which is very rare, why is it that my cognitive performance seems to be significantly better? Because when I. People have heard me say this so many times, but it’s so true. When I’m eating, you know, a normal western diet, my ability to articulate myself and think and be creative seems to be diminished. Whereas when I’m avoiding carbohydrates and sugar, I seem to be able to think and talk better.

DR ALAN GOLDHAMER: I think again, it may not be that the ketones are helping you think better. It may be that the sugar vacillations are interfering with your cognitive function. For example, when people eat particularly refined carbohydrates, their insulin levels go up, drive the sugar down, they end up with low blood sugar levels, which can interfere with cognitive function. As a consequence of this vacillation that’s taking place with their blood sugar levels between insulin and glucose, when you go on a ketogenic type of an approach or you’re in a fasting state, everything is very stable as far as glucose is concerned and insulin is concerned.

STEVEN BARTLETT: Okay, so you don’t want to be on the sugar roller coaster if you’re doing important work.

DR ALAN GOLDHAMER: Being stable seems to help, help people in their cognitive function.

The Truth About Juice Fasting

STEVEN BARTLETT: So people talk a lot about juice fasting and I don’t know, there’s something about when people say that they’re on a juice fast, I always think, God, you’re going to be missing important nutrients. You’re not going to be getting the same quantity of protein necessarily, maybe, I don’t know, your gut microbiome is going to pay the price if you’re restricting yourself from having certain things. Is juice fasting advisable? Is it a healthy approach.

DR ALAN GOLDHAMER: So juice fasting isn’t technically fasting, because fasting is the complete abstinence of all substances. It’s a modified form of eating. So it’s a diet that’s high in sugar, very low in fiber, virtually no fiber on these juices.

Where it can be helpful is people that are trying to make dietary changes and they’re addicted to the artificial stimulation of dopamine in their brain that comes from the use of their highly refined diets. They’re trying to make a change, they’re trying to make a break. And because it’s sweet and very appealing, and they’ll drink the juices, they’ll get their 6 or 800 calories, they’ll feel relatively satiated, and it allows them to avoid the greasy, fatty, processed foods that sometimes they’re trying to get away from.

Personally, I think that water fasting has advantages over juice fasting in terms of the magnitude of the detoxifying effect, the impact that it has. But the advantages to juice fasting, or what they call juice fasting, is that it can be done without modifying medications. You’re still in a feeding physiology. It can be done safely by people without having to be in a controlled setting like you would for water fasting. So there’s advantages to the intermittent or modified fasting approaches. It’s not the basis of the research that we’ve published, which is actually water only fasting. We’re fasting people on water only from 5 to 40 days.

Water-Only Fasting: The Complete Protocol

STEVEN BARTLETT: 5 to 40 days. So tell me about that then. So who exactly would you prescribe a 40 day water fast to? And presumably in those 40 days, they have nothing but water.

DR ALAN GOLDHAMER: Right. Patients that are fasting in our facility are on fractionally steam distilled water only. That’s the only thing they take. They’re not taking supplements, medications.

STEVEN BARTLETT: What is that? Fractionally, you know, distilled water.

DR ALAN GOLDHAMER: So it’s purified water, highly purified water. So in our case, we’re using, in distillation, some people use reverse osmosis, different ways of getting all the hydrogenated helicarbons and the chlorine and everything out of the water. So just essentially what rainwater would be if the environment wasn’t polluted.

STEVEN BARTLETT: Okay.

DR ALAN GOLDHAMER: Now, in fairness, not everybody’s a good candidate for that type of fasting. In order to determine if you’re a good candidate, obviously you have to review the medical history and take a look at what people are doing in terms of their medical treatment, particularly in terms of medications. Basic laboratory testing to make sure kidney and liver function are intact or capable of adapting to fasting.

And when people fast, they need to rest. If people are active, we’ve already mentioned they’ll increase their weight loss, but that weight will be derived from breaking down lean tissue. We want to minimize lean tissue, maximize fat, particularly visceral fat.

It’s also important that they be monitored because people do have issues that can be aggravated by fasting. Fasting presents a dehydration response. There’s a physiological dehydration that occurs with fasting. There’s changes in electrolytes. So you need to make sure that people are being monitored appropriately.

And then the most important part probably is they need to be progressively refed. So when they’re eating after the fast, if they go back to too rapid refeeding, you can get into a problem. With post fasting edema, you can get refeeding syndrome. That could be a very serious or even potentially fatal problem. That can be completely avoided by following a reasonable protocol of realimentation after fasting. Which is the reason why we encourage patients that are doing fasting to do it either in a controlled setting or under some supervision so that they don’t make catastrophic errors in terms of how they do it.

STEVEN BARTLETT: When it’s that length, when it’s long.

DR ALAN GOLDHAMER: Well water fasting, we’re doing fasting anywhere from five to 40 days. So anywhere in that range, you want to make sure the person’s a good candidate, that they’re fasting in a controlled setting, that they rest and they refeed properly. So a person that has, say a 20 day fast would have 10 days of controlled refeeding. It’ll take about half the length of the fast to properly realiment after the fast. So that you’re ready to go back to hopefully a whole plant food, SOS free type diet.

STEVEN BARTLETT: And when you say SOS, you mean sugar, salt and oil? For context, yeah.

DR ALAN GOLDHAMER: SOS is the international symbol of danger. But it also stands for the chemicals added to food that make people fat, sick and miserable. And those are salt, oil and sugar.

Clinical Results: High Blood Pressure Success Stories

STEVEN BARTLETT: What kind of candidate would come to your clinic to do a five to 40 day water fast? What are the symptoms they have? What are the diseases, illnesses that they’re suffering with?

DR ALAN GOLDHAMER: Well, we get a variety of people and ages. The conditions we see are often the conditions that we publish papers on, because that’s what people know us for. So one of the most common conditions is high blood pressure. We did a study with our colleague T. Colin Campbell. As I mentioned, 174 people in a row were able to achieve normal blood pressure without medication.

We also did a prospective study recently with a colleague from the Mayo Clinic recently that we did. 27 people completed fasting with hypertension, 26 were able to achieve normal blood pressure without any medication. One required half their dose of medication and we had six reflops where they did well. And then we followed them at a year and we found that 76% of those people a year later had maintained their weight loss and the majority were still normal blood pressure without medication.

STEVEN BARTLETT: Were they still fasting after a year?

DR ALAN GOLDHAMER: No, of course they were fasting while they were at the center, they were back eating a healthy diet and they maintained a healthy enough diet for a year that they were able to maintain their blood pressure and their weight loss. And that’s very unusual because you don’t find good long term follow up showing that people are not only able to get well but sustain those behavioral changes.

STEVEN BARTLETT: So it’s more of an intervention in that regard. And how long were they fasted for those people?

DR ALAN GOLDHAMER: So the people in that study ranged, the average fasting was about two weeks. So they had two weeks of fasting that normalized their blood pressure, a week of refeeding and then even a year later the majority were able to sustain the behavioral changes such that they were able to keep their weight off and they were able to keep their blood pressure down without the need for medication.

The Physiological and Psychological Changes of Extended Fasting

STEVEN BARTLETT: And what’s going on there? Because there’s physiological changes that take place. If I went and did a full 40 day water fast with you, there’s some physiological things that can happen. Of course I’m going to go into ketosis, my fat’s going to start to become my primary fuel source. But there’s also going to be a physio psychological relationship. There’s going to be something that happens in my psychology. I mean you talked about dopamine. My brain is going to change in some respect. My relationship with food is going to shift in some respect.

DR ALAN GOLDHAMER: Absolutely. If you look at the outcome data, for example, we’ve got studies we’ve done with DEXA scanners that look at body composition changes during fasting. And so people that would lose, say fast for two weeks would lose 10% of their total body weight, 20% of their total fat, but 40% of their visceral fat.

STEVEN BARTLETT: Visceral fat being the bad fat inside the.

DR ALAN GOLDHAMER: Yeah, it’s the 10% of fat that produces the inflammation that’s thought to contribute to disease. Those same people would have only lost 6% of their lean tissue. Now, what’s interesting, like muscle water, you know, non fat tissue.

STEVEN BARTLETT: Yeah.

DR ALAN GOLDHAMER: So the lean tissue mass at six weeks was fully recovered. So that the percentage of their lean mass was actually higher at six weeks than it was at baseline. But the fat loss continues. So even though they’re gaining weight after fasting, because they’re putting their glycogen back in their muscles, which is about 2 pounds, they’re rehydrating, they’re putting fluid in, they’re putting fiber back in the gut. So the scale’s going up, but the fat loss even with that weight gain is continuing down.

And so what you look at is their whole body composition begins to change, and also their brain composition, too, probably in terms of their functional relationship to themselves. For one thing, a lot of people feel that any kind of pain is a bad thing. Any kind of pain is a bad thing, and pain must always be avoided. If they have a pain, they have to take a pill. They have to do something, because pain’s the evil issue there.

Athletes learn that pain isn’t always bad, that sometimes discomfort can be associated with a positive response. We find it’s easier working sometimes with athletes than people that have not been athletic because they’ve learned to push their body a little bit. And fasting creates a hormetic effect as well. Whereas there is some physiological stress that’s introduced, that stress is associated with a healing response.

STEVEN BARTLETT: Would it not just be healthier if it were simple to take those people and remove all the processed food from their diet and then keep them on, like, a Mediterranean diet with, like, high protein, high fiber? Would that not be a more healthy intervention? Because at least then I’m not going to lose. You mentioned I’d lose 6% of my lean tissue. At least then I wouldn’t lose any muscle necessarily.

The Unique Benefits of Water Fasting

DR ALAN GOLDHAMER: Well, I would agree that if your only goal is weight loss, diet and exercise are the key. Fasting introduces not just a chance to lose weight, but specifically to mobilize visceral fat. You will eventually mobilize that visceral fat with exercise alone. There’s an advantage to getting rid of that sooner rather than later, particularly for people that have high blood pressure, diabetes, autoimmune disease.

Because the sooner you get rid of the visceral fat and the inflammation, the sooner you can get them off the medications. The medications themselves present their own problems. And people don’t understand. If you have high blood pressure, you’re being medicated not for your high blood pressure, but for the diet that causes the high blood pressure.

Literally the day you change the diet to a health promoting diet, the need for medication begins to reduce. And if you don’t reduce the medication adequately, you can actually shut people down from consequences of excess medication.

STEVEN BARTLETT: Is there a different advantage between me doing the fast, the water fast, versus just going on the ketogenic diet if I was trying to reduce my visceral fat, which is that sort of stubborn fat around your organs?

DR ALAN GOLDHAMER: Yes, water fasting is a more efficient method of mobilizing specifically visceral fat. And the other problem with that, when we talk about a ketogenic diet, remember there’s a lot of different ways of getting into ketosis. You can do it with a high fat, high protein diet, which is commonly advocated. You know, the dead Dr. Atkins diet, mayonnaise, filet of fish, restaurant pizza, those kind of programs, those have some disadvantages.

High protein, particularly high animal protein, is actually thought to be one of the major contributing factors to many of these health compromises, including cardiovascular disease and cancer and inflammation and the rest of it. So we need protein. It’s an essential nutrient. You need about 10% of your calories from protein. When you get excess protein, you put yourself at risk for kidney disease, cardiovascular disease and other problems.

We need fat. Essential fatty acids are a critical part of our ability to be healthy. And you also need carbohydrates. You’re designed as a carbohydrate burning machine, but you get all the fat, all the protein and all the carbohydrates you need from a whole plant food diet. You don’t need to eat large amounts of animal foods, you don’t need to eat oils, you don’t need to eat refined carbohydrates to get the foods you need.

And in fact, a whole plant food SOS free diet gives you the quantity and quality of nutrients you need without some of the negative consequences or the risks of dietary excess that come from these more processed modern diets.

Water Fasting vs Other Interventions

STEVEN BARTLETT: So if you were to pitch to me the unique selling points of a water fast at your clinic versus any other intervention, medical or lifestyle, it would be the speed in which you are able to burn visceral fat and the speed in which you’re able to lower blood pressure is unlike anything else.

DR ALAN GOLDHAMER: It also reduces insulin resistance. There is no drug that reduces insulin resistance, but fasting does. And a significant percentage of our type 2 diabetics will achieve normal blood sugar levels without the need for medication. With fasting again, if you do diet and exercise consistently enough, long enough, you’re likely to get many of the same benefits.

There are some things, though, that seem to change in fasting that don’t change as well with these modified feeding regimes. For example, fasting, you know, when you have a computer and it gets corrupted and you turn it off and you turn it back on and you don’t know why, but now it works, you know, you’ve kind of rebooted or flashed the memory, whatever it is. Fasting does a similar thing in humans, it appears, and particularly when it comes to the gut microbiome.

The Gut Microbiome Reset

You’ve got trillions of creatures living just in your intestinal tract, particularly bacteria, but all kinds of organisms that are an important part of your digestive mechanisms, your immune response, and they’re different depending on what you eat. So if you’re eating an animal based diet, you have different organisms than if you’re on a plant based diet. If you’re on a high sugar diet, even fruit sugars and things, you get different organisms flourishing than you would if you’re in a fasting state.

In a fasting state, there’s a big drop off in total organisms. And then when you refeed, depending on how you refeed, you can actually regrow those organisms and repopulate that.

STEVEN BARTLETT: I’m right in thinking if you do a water fast, you’re going to wipe out a lot of the bacteria in your gut, including the bad ones, but also some good ones. And then you can reintroduce certain foods that will bring back the good bacteria.

DR ALAN GOLDHAMER: That’s why refeeding after fasting is so important. If you refeed carefully, you have a chance to reestablish that normal microfloral balance. And that may be why we see such good response in many of these GI related conditions, like ulcerative colitis and Crohn’s disease and chronic constipation, irritable bowel syndrome.

But you also see it affecting things like depression and anxiety. And probably they say 90, 95% of the dopamine and serotonin that’s produced by the body is actually produced in the gut. And so the balance in your gut microbiome may be critically involved in cognitive function as well as what’s going on in the digestive system itself. So we’re just now learning the impact that fasting has and the effect that microbiome has and the relationship that those two things have together.

STEVEN BARTLETT: There was a 2024 study that found after a seven day water only fast levels of harmful fusobacteria dropped by more than 80%. And the gut microbiome shifted to a healthier balance. So it’s clearly doing some of the work to wipe out some of the bad, unhealthy gut microbiome bacteria, which gives you an opportunity to, I guess, reset the gut microbiome, which is really interesting, especially if you, as you say, you have some of those sort of gut centric diseases.

Gender Considerations in Fasting

Is there a gender component to this between sort of men and women? Because obviously women have menstrual cycles and certain hormone fluctuations that men don’t have. So do you have to think about gender when you’re thinking about fasting?

DR ALAN GOLDHAMER: Well, we know that women have complicated systems in different ways than men and they have different diseases too that show up. Fibrocystic breast disease, dysmenorrhea, menorrhagia, polycystic ovarian syndrome. All of these conditions that males don’t know anything about seem to be associated with excess estradiol hormones.

When estradiol is high, there’s a higher association with many of these conditions. Estradiol normally breaks down to something called estriol and it’s excreted in the urine. And what breaks it down is the gut microbiome and liver function. And the gut microbiome and liver function are both profoundly affected by fasting.

For example, we’ve got, in studies we’ve done looking at fatty liver disease, we show significant changes and reversal of fatty liver disease with fasting. And as I mentioned, the gut microbiome goes through a whole kind of rebooting. And that may be why patients that come in with those symptoms, the fibrocystic breast disease, the dysmenorrhea, menorrhagia, et cetera, often get profound short term improvement and long term benefit post fasting.

Now, all of these things, I have to say, fasting is great, but unless it’s a motivating factor to make the diet and lifestyle changes, I wouldn’t be optimistic about long term outcomes when we use fasting. We’re also providing intense education to try to get people motivated to adopt healthy diet and lifestyle habits. And it’s those diet and lifestyle habits that are going to be necessary to sustain the benefits.

Case Study: Lymphoma Treatment

I mean, I’ll give you an example. In lymphoma, which is a type of cancer, we published a paper in the British Medical Journal Case Reports on a young woman who had follicular lymphoma, had progressed for a couple years and interestingly enough, her doctor, her oncologist told her that diet didn’t matter, that diet wasn’t related to this particular type of cancer. She could eat whatever she wanted to, but nonetheless, she decided to come in rather than go through chemotherapy and underwent fasting.

And we did three weeks of fasting during which time you could literally feel these tumors disappearing. She had her follow up CT scan, ended a year. We submitted this case report and it was interesting because BMJ said, “Well, maybe she got lucky. And yes, it progressed for two years, yes, it went away in 21 days of fasting, but maybe it was just naturally the time for it to go into remission.” A small percentage of lymphoma patients do go through spontaneous remission.

So they said, “Why don’t you follow her for three years and see whether she can sustain that?” Because we can treat lymphoma with drugs and the tumors will go down, but they tend to come back. And that’s the problem. It doesn’t really reduce necessarily all cause mortality because the condition isn’t actually resolved.

So we followed her for three years and I told her that she had to stick strictly to the dietary protocol or it would be fatal because I’d track her down and kill her. And she did stick to the diet. And at three years we have CT evidence that she was cancer free. And we submitted that to BMJ. And interestingly enough, at first they rejected the follow up that they invited and we kind of appealed that and eventually they did decide to publish the follow up.

And then we followed her for 10 years and she continues to be cancer free and she continues to follow a whole plant food SOS free diet. And she went public with her story, she told some podcasts about what her experience with. And so we got a lot of lymphoma patients coming to True North Health.

And now we’ve published a case series which is a series of lymphoma patients, including one particular gentleman that was even more progressive was the stage four that had already metastasized into the bones. He had failed chemotherapy. He also did well. And we did a three week fast with him. Interestingly enough, his oncologist was quite antagonistic because he was concerned the fasting would make him too weak for treatment.

But he came in, he did the treatment, did well, went back to the oncologist who said, “Wow, that’s really impressive. Why don’t you go back and do some more of that.” He came back, we did another 39 day fast and he was able to get dramatic improvement. And again, those studies have been published in peer reviewed journals, but he didn’t go into remission with lymphoma, it would be considered remission, but it’s not a cure.

Management vs Cure

It’s just like you can’t cure lymphoma any more than you can cure obesity. You can lose the weight and keep it off, but if you go back to doing the things that cause it, it’s coming back. You can’t cure high blood pressure. You can normalize the pressure. I’ve got people who’ve been normal pressure for decades now, but if they go back to eating the greasy, fatty, slimy, salty processed food, it’ll come back. Because you’re managing it, you’re not curing it.

The whole concept of a cure is a little bit of a misnomer in medicine. Cure just means you’re alive five years after treatment. Doesn’t mean that you’ve actually resolved the underlying cause of the condition.

STEVEN BARTLETT: Interesting. And we have 120 plates here, which is how much food someone would be passing up if they did a 40 day diet. So that’s how many meals that they would miss on a 40 day water fast, which is a lot of food. Staggering when you see it.

The Body’s Healing Response During Fasting

DR ALAN GOLDHAMER: And it’s a lot of work for the body to digest that food. And when you take that work away, those energies are able to be diverted to dealing with some of the accumulated problems that people have built up, whether it’s excess fat and visceral fat, it’s diabetes, it’s autoimmune diseases where the body’s actually attacking itself.

I don’t know if most people realize that, but in autoimmune diseases like rheumatoid arthritis or ulcerative colitis, ankylosing spondylitis, these conditions, it’s actually your immune system that’s attacking your tissues. And the theory is that a lot of that is because you have the immune system being compromised by gut leakage. Where people have leaky tight junctions in their intestinal tract, they’re absorbing materials. And in genetically vulnerable people, the immune system becomes hyper reactive and begins to attack its own tissues.

You know, if it attacks your thyroid, we call it Hashimoto’s thyroiditis. If it attacks your joints, you might call it rheumatoid or osteoarthritis, different names for different inflammatory conditions, all triggered by leaking of materials into the intestinal tract.

When you go on a fast, first of all, you’re not eating, and so there’s not the inflammatory oxidative damage and free radicals that are causing the leaking to begin with. And second of all, the body’s healing processes are able to be accentuated. And so the gut leakage is able to heal.

After you heal the gut and go back to eating diet that’s not full of free radicals, you’re not smoking, you’re not drinking alcohol, with all of the free radicals from peroxidation of alcohol, you’re not eating high fat foods and particularly heated fat foods and fried foods, et cetera. There’s not the onslaught of oxidative damage. And now you can manage those conditions with a whole plant food SOS free diet.

Now that doesn’t mean they’re cured. If they go back to eating the other foods, they’re going to flare up their condition. But to the degree they’re willing to eat healthily, they can manage their condition without the medications oftentimes that are very powerful and have often long term side effects.

STEVEN BARTLETT: When someone does a water fast with you, if they’re doing a 40 day water fast, do you make sure that they get electrolytes and vitamins and other things? Are there other things that you have to give them?

Monitoring During Water Fasting

DR ALAN GOLDHAMER: No, we’re just giving them water. But we are monitoring their electrolytes and their blood levels to make sure that their reserves are being recycled adequately and they’re normal.

If, for example, potassium gets below a certain point or sodium gets below a certain point, then we go back into a refeeding mode. We’re given broths and juices and other materials in order to refeed them. We don’t allow them to develop symptoms secondary to deficiency.

Now what’s interesting is potassium. For example, normal potassium might be 3.5. Fasting tolerances would be 3.0. If it goes below 3.0, then we’re going to terminate the fast. But generally people are so efficient at recycling their nutrients during fasting that they stay within normal limits without us having to do premature termination.

Refeeding Protocol After Fasting

STEVEN BARTLETT: And when you finish a long fast, like a 40 day fast, what are the or even a shorter fast, like a five day fast? What is the protocol for refeeding them? What do you give them? What do you avoid? What’s the speed in which you give them calories?

DR ALAN GOLDHAMER: Again, they get a day of fresh fruit and vegetable juices for every week of fasting, more or less. So they’re going to get about 600 calories of fresh fruit and vegetable juices if they have a three week fast for about three days.

STEVEN BARTLETT: What’s the thinking here? What’s the underlying thought?

DR ALAN GOLDHAMER: The idea is that we want to introduce initially food without fiber. So if there’s any digestive challenges that’s short lived. We want to introduce food starting in the morning rather than at night, so if there’s any challenges it doesn’t disrupt their sleep. We want to make sure that they’re rehydrating and getting some glucose without necessarily overloading their capacities.

Once they’ve acclimated to the juices, which are relatively easy to absorb and bring up blood sugars relatively quickly, moving them out of the fasting phase into more of a feeding phase. Then we’ll introduce raw fruits and vegetables which introduce some fiber. And then we’ll introduce more concentrated foods like steamed and starchy vegetables, until by the length, half the length of the fast refeeding they’re back to a whole plant food SOS free diet, the kind of diet that we want them to sustain forever.

Fasting Benefits for Healthy People

STEVEN BARTLETT: And what about healthy people? Healthy people come to you as well and do fasting. It’s not just people that have these sort of severe health predicaments. I think I’m pretty healthy. Is there a reason or a benefit to someone like me fasting?

DR ALAN GOLDHAMER: You know, we did a study actually on this very question about what happens to healthy people that fast. And although there’s tremendous improvements in sick people, it turns out when you look at the cardiometabolic risk factors, when you look at even things like weight and percent body fat and visceral fat on healthy people, people that are within healthy limits, there’s additional improvement.

Their blood cholesterol drops even lower. Their blood pressures drop lower, their percent fat drops even lower. In fact, proportionally, the people that get the most benefit of fasting are healthy people that are doing it preventatively, but they tend to need short fasts, not long fast.

You’re not necessarily taking a healthy person doing a 40 day fast. These are five to 10 day periods of time rather than the very longer fasts are usually because there’s a condition that takes that long to resolve. We want to fast as short as possible, but long enough to resolve the problem. If you come to me with blood pressure that’s 210 over 100, capped on five medications, you’re likely going to need a longer fast than a person that’s 140 over 90 without medication.

Recommended Fasting Frequency for Healthy Individuals

STEVEN BARTLETT: If I’m a healthy person, how frequently and for what length should I be thinking about fasting, if at all?

DR ALAN GOLDHAMER: I think you should be fasting every day for 12 hours. And then, you know, we don’t know what the ideal is. That’s one of the things we’re going to be doing in this study is trying to figure that out. But what we do in practice is we have people fast once a year for a week. If they’re clinically stable, they don’t have any healing crisis. Their numbers all look good. That’s it. We move on.

And even that week of fasting, though, has a profound effect on healthy people. I might mention, though, that most people that think they’re healthy, when you actually objectively look at their biomarkers, aren’t as healthy as they think. Many people are maintaining higher visceral fat, higher inflammatory markers, higher lipid levels than what they probably ideally should be, even though they’re asymptomatic.

They say somewhere around 2 to 2.5% of people are actually objectively measuring out as healthy. Some studies say as much as 12%, depending on the standards that you’re using to define health.

Personalized Fasting Recommendations

STEVEN BARTLETT: So speaking directly to the viewer now, who sat at home, and there’s a reason why they clicked on this conversation. They found the subject matter in the title, the thumbnail, somewhat compelling if you were speaking directly to the different personas of people listening.

So you’ve got maybe someone who is healthy, someone who has maybe got a little bit of a weight on that they might want to shift, someone that’s got specific diseases and has been given diagnosis and maybe is given pills, going through these different personas one at a time. How would you prescribe water fasting to them? And what would you sort of tell them the benefits for them would be? If we’re thinking about these different personas? So starting with the person on the left side of the spectrum who is largely healthy but is interested in maybe how it will make them feel or whatever.

# For Healthy Individuals

DR ALAN GOLDHAMER: So for the healthy person, the main benefit that I see of fasting is it’s a forced period of rest and introspection. You get a certain clearing of the palate. We’ve actually done a study on this. It’s on our site where we looked at the sensitivity to sugar, the sensitivity to salt. It’s actually enhanced during fasting.

And so by fasting once a year, people kind of recalibrate their palate, and it makes it easier for them to make better choices. Sometimes there’s been some slipping and sliding along the dietary regime as people go along. During the course of the year, it reboots the gut microbiome. It tends to enhance cognitive capacities as well as probably brain serotonin and dopamine levels. It can affect people’s mood states and just how they feel about themselves and the world around them.

It’s obviously not as dramatic, is when you take a person that’s in agonizing pain or debility and you see those dramatic changes.

# For Weight Loss

STEVEN BARTLETT: What about then, if I want to just lose some weight. What protocol should I use for water fasting and what kind of results would I expect to see in what time frame?

DR ALAN GOLDHAMER: We never know exactly how long a patient’s going to fast until we see how they respond to fasting, because fasting itself is as much diagnostic as it is therapeutic. But usually we can get a pretty good idea.

I always try to get people as close to their optimum weight as possible, whether it’s with diet and exercise or with fasting. We don’t think maintaining extra fat is a good thing. We think for every pound of excess fat you have on your body, there’s all kinds of downstream consequences.

And so if a person say, for example, 20 pounds overweight, they think they feel best, say 150 pounds, but they’re 170 pounds. We know that it will take them about three weeks to lose that weight because people lose an average of about a pound a day. So I wouldn’t have any concern, assuming everything else looks okay, fasting that person for three weeks.

I’d be concerned about fasting them into an emaciated state. I don’t want to get them very weak, I don’t want to have them debilitated, I don’t want to get them depleted. And so we’re going to monitor them carefully to make sure that we’re well within their reserves. But you know, a person that’s a bit overweight, that has maybe their blood pressure is a little bit higher, their blood sugar is a little bit higher, maybe they have some joint pain, maybe they have some various symptoms, we want those things to resolve.

So we’re going to estimate how long do we think this person’s going to need to fast to get to the point when they feed, they’ll keep getting healthier rather than sicker.

Research Data on Fasting Results

STEVEN BARTLETT: Can you explain these four graphs to me here? There’s some four graphs that come from work you’ve done.

DR ALAN GOLDHAMER: Okay, well, this is outcome data that comes from studies that we’ve published. And this basically is looking at the percent body weight change. And if you look at the bottom graph, you’ll notice it’s over time.

STEVEN BARTLETT: Yeah.

DR ALAN GOLDHAMER: Okay, so we’re looking at the percentage body weight change during fasting and you notice during refeeding it actually comes down a little bit more. Even though people are realimating they’re losing fat, they’re regaining water and muscle and then they’re able to maintain that percent body change. This is 65 day follow up.

STEVEN BARTLETT: So on that, for people that aren’t watching the video right now and are just listening to audio. What is it essentially saying happens and in what period of time, with what protocol?

DR ALAN GOLDHAMER: So in this particular study, these people lost about 10% of their body weight over an average of two weeks of fasting. They refed for a week at the facility and then they were followed up 65 days later. And at 65 days later, you’ll notice they’d maintained their total body weight change and then just a little bit more, and now they’d been back to eating and exercising.

In the next graph percent body weight. This is the visceral fat mass and visceral fat again. Visceral fat is the 10% of the fat that makes up the fat that typically accumulates around the belly and in the organs. It’s the fat that’s hypertrophic, hyper metabolic, hyper. It produces inflammation. It acts like a tumor. So it shouldn’t be there.

STEVEN BARTLETT: There’s subcutaneous, which is on the outside, and then there’s visceral, which is on the inside. And the stuff in the inside is the worst.

The Body’s Fat Storage Programming

DR ALAN GOLDHAMER: It’s fat that wouldn’t normally be there. Here’s the problem. You evolved in an environment of scarcity. Storing fat is so critical to survival in a world of deficiency or of depletion that the body does everything it can to store fat. Because the people that store fat in a natural setting, they live to reproduce in the modern world. It’s become a disadvantage because we live in this very unnatural environment where you can get dietary excess.

And so even the body’s designed for an environment of deficiency. It’s really responding with that genetic programming. And so it stores fat even though it’s not healthful for you. As far as the body’s concerned, spring might come late. The more fat you store, the better. And as a consequence, that visceral fat is associated with these diseases of dietary excess.

In fasting, the body preferentially mobilizes that visceral fat. It gets rid of it. Just like if you go on a fast and have a breast tumor, you lose 10% of your body fat. You don’t necessarily lose 10% of the tumor. You might lose 50% of the tumor, you might lose the entire tumor because the body has some intelligence to it in terms of how it’s mobilizing these tissues.

You can take a person, an animal, for example, and starve it to death. And if you measure its nervous system, you’ll find the nervous system isn’t depleted even when it’s starved to death. It will preserve those tissues in preference to the visceral fat or the fat tissues.

Blood Pressure and Body Composition Changes

And so this graph is showing that visceral fat not only comes down during fasting, but it keeps coming down and it continues to come down with refeeding. And this particular graph here, this is blood pressure. So again, blood pressure comes down during fasting, it comes down even lower with refeeding. And people that are following diet and lifestyle changes are able to maintain that pressure without medication.

So if you look at our study, people that started with stage three hypertension, so there are 180 or higher systolic blood pressure, they lost an average of 60.6 on systolic blood pressure, not counting the fact that the baselines were often taken on medication.

And the final graph here that you’ve got is percent in lean mass. So lean mass also go down in…

STEVEN BARTLETT: Fasting because your lean mass, again, lean…

DR ALAN GOLDHAMER: Mass, is your fluids. Your muscle lean mass goes down, but then it recovers during refeeding and realimentation. And the percentage of lean mass, which includes your muscle mass at six week follow up, was actually higher in those patients than it was at baseline.

STEVEN BARTLETT: Are they exercising that during recovery?

DR ALAN GOLDHAMER: They are not during fasting.

Fasting and PCOS Treatment

STEVEN BARTLETT: And you mentioned PCOS earlier on when we were talking about the implications for women. Have you ever done any studies or had patients come to your fasting clinic that have symptoms of PCOS?

DR ALAN GOLDHAMER: Yes, we treat. We’ve had dozens and dozens of patients with polycystic ovarian syndrome. And it’s a condition that responds consistently to fasting. It also responds to diet and lifestyle change. But understand, many of the people that have made the diet changes but are not, not been successful, are then referred to us for fasting. We always want to try the diet first because a lot of things resolve just by getting a person on a good diet and exercise program.

STEVEN BARTLETT: And PCOS for people that don’t know, I’m sure a lot of men don’t know about PCOS, but some of them will because they might have fertility problems with their partner. My partner’s been very public that she has PCOS and she’s found that the ketogenic diet, removing sugar from her diet, has had a profound impact on recalibrating her menstrual cycle.

Yes, her menstrual cycle was very inconsistent, irregular. Could be up to 60 days or longer or not at all. And then when she removed sugar from her diet and carbohydrates, it’s now perfect.

DR ALAN GOLDHAMER: Right.

STEVEN BARTLETT: So it’s like every 28, whatever days it is. And so I was wondering if you know there’s lots of women that are suffering with a variety of different hormonal challenges or things like PCOS, if you have any case studies from your clinic of that resetting their menstrual cycles or reversing the symptoms of PCOS.

DR ALAN GOLDHAMER: Right. It’s not uncommon for us to have women that, for example, have their plumbing’s good in terms of their tubes and whatnot, but they’re having difficulty initiating pregnancy, they fast, they reboot, and sure enough, within a cycle or two, they’re able to achieve pregnancy.

And it’s not unusual to have people that have disrupted dysmenorrhea, menorrhasia, et cetera, within usually not the very first cycle, but the second cycle will normalize function. I think the reason for that is the hormones and stuff that for the next cycle are already kind of set up and where you see the change is often at that six week follow up.

Fasting as Stress and Hormonal Balance

STEVEN BARTLETT: So let’s be clear, because if you fast, it is a form of stress on the body, isn’t it?

DR ALAN GOLDHAMER: Yes.

STEVEN BARTLETT: From everything I know about sort of evolution, if you’re fasting, your menstrual cycle’s probably going to stop. If you’re doing an extended fast because your body sends a signal to say, listen, we don’t have the resources in here to give, give a kid life, so we’re going to shut down.

DR ALAN GOLDHAMER: If you take yourself below optimum weight or below optimum fat, yes, that’s true. Disruption of menstrual cycle happens with excess weight loss of any kind or rapid weight loss. But for the patients that we’re fasting, oftentimes it’s quite the opposite. They’re able to actually normalize their hormonal cycle.

And as I mentioned, it may be the conversion of estradiol to estriol because of improvement in the gut microbiome that’s responsible for normalization of that and other hormonal issues that maybe we haven’t even been able to measure yet.

STEVEN BARTLETT: Because your body needs energy to do to perform its menstrual cycle. Am I right in my thinking there? That if the body senses you don’t have the energy to have a baby, it’s going to shut down your menstrual cycle, because having a baby would, I think.

DR ALAN GOLDHAMER: If it doesn’t have the reserves. So if you’re in. The thing is, many patients though, even though they’re fasting, they are in a depleted state. And so you don’t see universal disruption of menstrual function because people are fasting, but you know Athletes oftentimes see it when their percent body fat goes too low, they will become amenorrheic.

Psychological Benefits and Fear Reduction

STEVEN BARTLETT: Do you see when someone comes to your clinic and does one of these extended fasts that there’s other areas of their life that also improve that are completely sort of like unrelated to the benefits from the fast? And I’m talking about willpower here and their ability to motivate themselves and be disciplined and persistent.

DR ALAN GOLDHAMER: And I don’t think there’s any question that those factors are involved. You know, it’s also just education and fear. People think if they get on a plane in New York and they flew to California, they would die of starvation over Colorado. They think the pretzels that they ate saved their life.

And once people have fasted for five days or 10 days or 40 days, the idea of having to skip a meal doesn’t seem quite so terrifying. You know, if there’s not something that they, that’s healthful eating, they just skip the meal until the next one. And they’re not afraid of the, of the, that they’re going to die or that they’re going to enter starvation or they’re going to have depletion. A lot of people have a lot of fear in their head that’s completely illogical, unnecessary and harmful.

Maximum Fasting Duration and Safety

STEVEN BARTLETT: It’s so true. When you tell me that someone can actually fast for what’s the longest a person could fast for without severe consequences.

DR ALAN GOLDHAMER: They say that a 70 kilogram male could fast about 70 days. But the longest we fast people is 40 days. And what happens is you get beyond 40 days, everything gets a little bit more delicate. You have to be a lot more careful with electrolyte balance and other things.

And so 40 days, understand is only 1% of our patients, the vast majority are fasting between 2 weeks and 4 weeks. So it’s 10 days or 14 days or 20 days. That’s where the big bell curve is. You have a small number of people that need to fast longer than that.

STEVEN BARTLETT: And you see this as a medical intervention. You don’t see this as something that these people should be doing on a frequent monthly basis. You see this as a medical intervention for people with specific issues.

DR ALAN GOLDHAMER: Predominantly, I think that everybody should fast every day for 12 hours. I think that everybody, including healthy people, would probably should at least consider fasting once a year for a week and that anybody that has a condition where it’s appropriate to fast should fast however long it takes to resolve the condition, however frequently it takes to get well.

So we do have some patients that we’re fasting two or three times during a year because they can’t fast long enough the first fast to. To resolve the condition. But, you know, they don’t have enough reserves to be able to do, you know, a longer fast. So we will do it periodically until the condition resolves.

Safety Concerns and Medical Supervision

STEVEN BARTLETT: And what are the safety concerns with water fasts?

DR ALAN GOLDHAMER: Yeah, well, the biggest and most obvious concerns are orthostatic hypotension. When people are used to having high blood pressure and you lower their pressure, their brain’s used to higher profusion levels. When you drop the pressure, they can get dizzy at first until they get used to having normal blood pressure. And you don’t want people falling over and fainting and breaking something or having a problem.

Dehydration is a hormetic effect of fasting, and it’s an important part of stimulating the healing crisis. But you also don’t want to get somebody so depleted that they get into cardiac dysrhythmia or they have problems. And that’s why we monitor people twice a day and we make sure that they maintain balance.

One of the things we did in “Can Fasting Save Your Life?” Is we laid out all the protocols so a person could really understand what’s going on in fasting, you know, what the benefits are. But we also wrote it so that their physicians would stop thinking they’re crazy because they’re interested in doing something like that.

Because at first blush, this sounds like kind of crazy that you’re going to have a person take nothing but water for a prolonged period of time, and somehow that’s going to be a good thing. But when you really look at the science and you look at the experience we’ve had, you found when it’s done according to protocol, it is a safe, and it can be an effective intervention at giving the body a chance to heal itself.

Common Misconceptions About Fasting

STEVEN BARTLETT: What are the big misconceptions about fasting that you encounter consistently?

DR ALAN GOLDHAMER: Well, one thing is people think that you’re going to become depleted because they don’t understand the recycling capacity of the body when fasting is done properly, and that they’re going to deplete their muscles and that the weight they lose in fasting is immediately regained after fasting. So there’s no, you know, beneficial reproportioning of the body composition.

And they’re driven by the fear, and I think instinctive fear that, you know, we’re designed to be intimately concerned about getting enough to eat, because in a natural setting, that’s a constant biological imperative. You’re always struggling, try to get enough to eat.

And because we live in a constant state of deprivation in a natural setting, the use of fasting was never anything other than a survival tool, an adaption the body could make only under force, not by choice. But it is interesting that every major religion, the Jews, the Jains, the Hindus, the Muslims, the Christians, the Buddhists, all have a deep respect and tradition about fasting. There’s a reason, because it changes the way you feel about yourself and the world around you.

STEVEN BARTLETT: It’s so linked to spiritual traditions like meditation and clarity of mind and spiritual experiences.

DR ALAN GOLDHAMER: And I think because it is difficult to do that, some of the benefits you mentioned earlier may be part of the. Part that are hard for us to quantify.

STEVEN BARTLETT: Yeah. What is the most important thing we haven’t talked about as it pertains to fasting that we should have talked about?

The Mechanisms of Fasting

DR ALAN GOLDHAMER: We haven’t talked about the different kinds of mechanisms which might be going on in fasting, that sometimes people are interested. We’ve talked about weight loss. That’s kind of an obvious one. If you don’t eat, you’re going to lose weight. But there’s also a natural effect. The body gets rid of the excess sodium accumulated in the body. And that has a profound effect because literally, people will lose several pounds of fluid a day early on in fasting just because their body’s been holding on to this in order to buffer the effect of sodium.

Sodium, you know, you think about it, you take a tablespoon of it, it’s an emetic, it’ll make you throw up. If you take enough of it, it’ll kill you. It’ll actually have. There’s an LD50 with it. Even though it’s an essential nutrient, in small amount, in excess quantity, it’s associated with hypertension and not to mention obesity.

And you might say, well, why would sodium, which has no calories, make people fat? And it’s because sodium stimulates what’s called passive overeating. So if you eat till you’re full of anything, say brown rice, you just eat till you reach your satiety. You don’t want anymore, everything else being equal. Salt that rice up and eat till you’re full. You’ll eat more before you feel satisfied.

And people say, “Yeah. Cause it tastes better.” But that’s what tasting better means. It means it results in more dopamine stimulation in the brain. So your brain is going to get fooled with salt.

Ultra-Processed Foods as Carrier Agents

And if you take some foods, like, for example, bread, the staff of life, 1500 calories a pound before you turn it into a butter boat and spread coagulated cowpass all over it. And you remove the salt, oil, sugar and yeast, what do you get? It’s called matzah and it’s punishment on Passover. Nobody’s getting fat eating matzah, but they’re certainly having trouble with bread and bread related products. And it’s because the wheat and the water become a carrier agent for these chemicals.

Take beef, boil it and gnaw on it. Do you like plain boiled beef? Not so much. It’s a carrier agent for the sauces, the salt, the things that it’s carrying to the palate. So we’re using ultra processed foods as carrier agents for these chemicals. And that’s why we’re in trouble. 70% of the calorie of the average person is ultra processed food. And we haven’t even talked about the chemicals and other things besides the salt, oil and sugar, the emulsifiers, the other things that are thought to affect gut microbiome.

So the natriuretic effect of fasting is a kind of rebooting effect that gets rid of the sodium. We haven’t talked about detoxification. If you take a fat biopsy of human beings.

STEVEN BARTLETT: A what?

DR ALAN GOLDHAMER: A fat biopsy.

STEVEN BARTLETT: What’s that?

Detoxification Through Fasting

DR ALAN GOLDHAMER: A biopsy. You take a piece of fat or a piece of tissue and you analyze it. What you find is there’s hundreds of different chemicals, PCB, dioxin, pesticide, red heavy metals in everybody to varying degrees. People have different degrees of vulnerability to that in fasting. The body rapidly mobilizes those materials and eliminates them.

In fact, some people have said, “Oh, it does it so efficiently, you shouldn’t fast that the body doesn’t know what it’s doing and it would put it out too quickly and it overloads your system and so don’t do it.” But the reality is the body, this is a biological adaptation. It does a good job of mobilizing the materials and eliminating them.

If you, you take that fat biopsy and you say, where did all those fats come? Where did all those toxins come from? As much as 90% of some of those toxins came from eating animal foods which biologically concentrate those pollution in their environment. And then when you eat the animal food, you get its entire lifetime accumulation of toxins. And so when you fast, you kick in the system you use to get rid of that stuff. And every time you do it, it gets better.

And so these are things that don’t necessarily happen to the same degree with our juice fasting or our modified feeding regime.

The Autonomic Nervous System

We talked about the autonomic nervous system. This is the part of the nervous system that controls all the stuff you don’t think about. Like, for example, if you were to go out running and your heart didn’t speed up, you would be in big trouble and potentially die. But it doesn’t happen because your heart automatically speeds up and pumps more blood that you need. And that’s controlled by the autonomic or automatic nervous system.

It has two parts, the sympathetic and the parasympathetic. Parasympathetic, they have to be in balance. And we’ve invented hundreds of healing systems to try to rebalance the autonomic nervous system. Massage, biofeedback, homeopathy, chiropractic manipulation, osteopathic manipulation, acupuncture, relaxation, biofeedback. How do you think all these things make people feel better? At least to some degree? It’s to the degree they help rebalance the autonomic nervous system.

The most powerful way to rebalance the autonomic nervous system, in my experience, is fasting. Fasting is a profound impact on this autonomic, sympathetic, parasympathetic balance.

Taste Neuroadaptation

And I think one of the most profound effects, honestly, is effect on taste neuroadaptation. As I mentioned, we did a study on how you taste things. And when you go on a fast, good foods start to taste good. When you first come off a conventional diet, this kind of food is disgusting, tasteless swill. People have no interest in it. They can’t imagine how anybody could choke it down.

STEVEN BARTLETT: What kind of food?

DR ALAN GOLDHAMER: Well, whole fruits, vegetables, you know, simple foods without salt, oil and sugar added to it. They just can’t even imagine how anybody could eat that. But after fasting, whole plant foods start to taste good. And the longer you eat them, the better they taste. You get to the point where you actually would prefer to eat whole plant foods rather than the salty, greasy, fatty, processed foods that everybody else is eating.

So these are big changes that occur in fasting that are not necessarily as easily objectified from a research standpoint point, but have a profound difference on how people feel and how they live their lives.

STEVEN BARTLETT: Yeah, I noticed that as well. When I was on the ketogenic diet, I noticed that the things that I would usually get cravings for, suddenly there was no cravings at all. And funnily enough, when you’re talking about taste changing, when I was on a ketogenic diet, things tasted sweeter. And I don’t mean I actually don’t mean because obviously I wasn’t really eating much sugar. It was actually some sugar free drinks just tasted significantly sweeter. They were zero sugar drinks. But clearly because of some of the sweeteners in there, I almost couldn’t drink them. But when I came off the ketogenic diet and I started having carbohydrates again, those drinks didn’t taste so sweet anymore.

DR ALAN GOLDHAMER: But it’s your palate that changes. The ketogenic diet is a fasting mimicking diet. It mimics some of the effects of fasting, not the least of which is changes in taste, what’s called taste neuro irritation or sensitivity. And it’s not carbohydrates that desensitize you, it’s refined carbohydrates. And so if you get people on a whole plant food diet, you know, fruits and vegetables, whole simple foods, they maintain that acuity of taste. But as soon as you put them back on refined carbohydrates, the processed carbohydrates, then they begin to go back into the dietary pleasure trap.

STEVEN BARTLETT: Got you this one. And I guess what is the, what is the. The next step? If someone is curious, what would you recommend they do?

Getting Started with Fasting

DR ALAN GOLDHAMER: Well, we have, I think, a really valuable free service for your viewers and that’s that if they go to our website and complete the registration forms at truenorthhealth.com I offer a free phone conversation with them to tell them whether this might be something they should be considering and try to point them in the right direction. If they’re really interested, they can read our book “Fast and Save Your Life” and it will tell you and your doctor everything you need to know about what it takes to safely get into a fast through a fast and what the benefits of fasting are thought to be.

STEVEN BARTLETT: I’ll link all of that below for anybody that is curious and wants to learn more. If and just as a sort of a disclaimer, if people are doing water fasting, they should seek medical advice and medical support. They should seek a consultation from someone who knows what they’re doing before just trying to do this at home.

DR ALAN GOLDHAMER: They want to make sure they’re a good candidate with history, exam and lab. They want to make sure if they do fast, they’re fasting in a restful state, staying hydrated properly, and that they refeed carefully because it can be a serious problem if you don’t do it properly.

STEVEN BARTLETT: Is there a particular case study that comes to mind when you think about the power of fasting? I know you talked a little bit about the lady that had lymphoma, which I read about in the British Medical Journal. I think it was 2015.

The Power of Consistent Data

DR ALAN GOLDHAMER: I think even more powerful than individual case reports are these studies that we’ve done involving dozens and in some cases almost 200 people. And the consistency of the data this works is the most effective treatment that’s ever been shown in treating the leading cause of death and disability, which is high blood pressure and its consequences. If a person has essential hypertension and they fast long enough, they’re going to normalize their blood pressure. And if they’re willing to do dangerous and radical things like eat well, exercise and get to bed on time, they can sustain those results.

The Biggest Lie Ruining Lives

STEVEN BARTLETT: We have a closing tradition on this podcast where the last guest leaves a question to the next guest, not knowing who they’re leaving it for. And the question left for you is quite a tricky one, but it’s interesting. It is what is the biggest lie that you think is ruining most people’s life?

DR ALAN GOLDHAMER: I think one of the biggest mistakes is that people think that health comes from pills, potions, powders and treatments instead of healthful living. Health is the direct result of healthful living, and that means diet, sleep, exercise.

STEVEN BARTLETT: But they’re hard, especially in the world we live in where, you know, everything I see is trying to play with the neurotransmitters, chemicals in my brain to get me to be addicted and to.

DR ALAN GOLDHAMER: Well, people are trying to sell the pleasure trap. They’re trying to tell you what you want to hear, not what you need to know. What you want to hear is that there’s a way to not do hard things but still get good benefits. And what you need to know is how to do hard things so you can be successful.

The Defining Trait of the 21st Century

STEVEN BARTLETT: I think that’s like the defining trait of the 21st century is like your ability to do what you know you should for long term benefits, not short term benefits. I think like delayed gratification is maybe the defining trait of the like the 21st century. I mean we’ve all heard of like the those cookie experiments they did on those kids to see which kids would take the cookie and which ones would wait for two cookies later. But I think the further in my life I’ve gone, the more I’ve realized that actually like every self help book ever written could be one page and it could just say like delay gratification, like do the thing that is in the best interest of long term you versus short term you.

DR ALAN GOLDHAMER: I think that there’s three characteristics that everybody should aspire for. Whether it’s a mate, whether it’s employee or whether it’s a friend. What you really are looking for is honesty, integrity and intelligence. So honesty means they’re going to tell the truth. Integrity is they’re going to do the right thing. And intelligence means they’re going to do things right.

STEVEN BARTLETT: And that applies for ourselves. Right as well. And would it be have high integrity and be intelligent with your own decisioning?

DR ALAN GOLDHAMER: I think those are the characteristics that determine both success but more importantly happiness. The people that I meet that are happy have high degrees of all three of those things. Some people are very intelligent, but they don’t necessarily do the right thing. Some people are honest, but they’ll tell the truth, but they won’t necessarily tell the whole truth. So you have to have all three, I think to have a high degree of probability of success.

STEVEN BARTLETT: And what are you working on at the moment? What’s keeping you busy at this moment in time?

Major Longevity Study Launch

DR ALAN GOLDHAMER: We’re in the process of getting ready to launch a major study. We’re going to enroll between 2 and 3,000 people for the rest of their life and we’re going to track them and try to see if we can avoid the average 16 years of debility that greet people at the end of their life.

We believe with diet, sleep, exercise and periodic fasting we can avoid the debility that’s so common and that make the last 20 years of people’s lives the best years of their life instead of the worst.

The 1% Who Do 40-Day Fasts

STEVEN BARTLETT: You know, you said at your clinic, 1% of patients do the 40 day fast. Who are those patients? What are they suffering with? What are they struggling with? Because that’s pretty extreme.

DR ALAN GOLDHAMER: One woman was a dentist who’d had a traumatic brain injury secondary to getting hit by a pole, an outdoor pole, at a, ironically enough, a continuing education conference. And she developed a headache and she’d had constant daily head pain from 8 to 10, every minute of every day for 16 years.

And she came in and fasted for 41 days, during which time she resolved to a large extent her headaches. She refed, she had some prodromal symptoms, minor symptoms, and then did a second 40 day fast six months later. And now it’s been 12 years. She has no headaches.

So in her case, she was motivated by, like a lot of our patients, pain, debility and fear of death. And they were willing to do anything in order to be able to get well, including, you know, a long period of fasting.

So the people that fast a long time oftentimes are very motivated individuals, mostly motivated by, you know, physical health goals. Not always. Some people are doing fasting for spiritual or other types of practices. But most of the people we have are just people that have not been successful resolving their conditions with diet and lifestyle change, with medications and drugs.

And you know, they say that it should be the True North Health Center, the last resort. One of my colleagues, may he rest in peace, John McDougall, used to say we were “the punishment” and if he had a patient that he would do the dietary changes with it. But it wasn’t successful at fully resolving the problem. He would apologize to them and say, “I’m so sorry, but you need to go to Goldhamer’s place. Good luck to you.” Because he thought that was one of the more difficult things that people were ever asked to do.

I think it is the most difficult thing you ask people to do. Not the fasting that’s not that difficult. What’s difficult is to go back and live in a world designed to make you fat, sick and miserable and try to live healthfully and live with integrity and deal with the social outflux of being successful. As I said, a lot of times the people that I see that have the easiest time are the ones that aren’t necessarily the most sociable kind of people.

The Psychological Reset of Fasting

STEVEN BARTLETT: Thank you so much for the work that you do because it’s fascinating. And you’re providing another alternative treatment to people who are very often out of choice.

DR ALAN GOLDHAMER: Before I came here today, my wife said, “Don’t be nervous to talk to him because it’s just like, you know, I speak 100 times a year to 50 to 100 people.” And I said, “Yeah, Jennifer, it’s just like talking to 50 to 100 people except doing it every day for 400 years.” Thanks for getting the word out.

STEVEN BARTLETT: Well, no, my audience are open minded. They’re smart, they’re savvy, they’re curious. I hope as well. So, so it’s really fascinating and I think when we think about these longer fasts, we often focus on the physiological changes that are going to take place. Like we talked about the glycogen reserves being depleted and the ketone bodies and all these things, and the beta-hydroxybutyrate or whatever that big word was.

But I actually think there’s the really unappreciated part of all of this is the psychological change that takes place when you realize that you can accomplish something. But also, as you said, when you’re, you sort of rebalance and reset your, your dopamine levels and when you, your, your chain, your taste adapts to the fasted state and how that can act as an intervention, a psychological and physiological intervention just to reset you a little bit.

Every year I, I do ketosis at least once, maybe sometimes twice or three times. I have a ketogenic diet and it is, it’s like a, it’s like a tremendous reset of my habits. It resets my habits, it resets my urges, my cravings.

Breaking the Paradigm of Learned Helplessness

DR ALAN GOLDHAMER: So think about when a patient goes to a medical doctor and they say, “Oh, I have high blood pressure.” And they say, “Listen, we promise you, if you do exactly what we tell you, we guarantee you you’ll never get well, you’ll be sick the rest of your life and you’ll be on these drugs forever.” And there’s not a one I’ve had so far that that turns out to be true.

For it changes their entire paradigm when they get overcome the problem that supposedly is helpless and hopeless and nothing can be done changes their. It changes their view of reality.

STEVEN BARTLETT: Of course. And I mean what you’re speaking to there is learned helplessness where if someone tells you there’s nothing you can do, then you do fall into, I mean, the studies show this, you fall into a state of learned helplessness where you actually stop trying to help yourself and you submit. I was reading, I was actually reading a study the other day about rats who, who fell into a state of learned helplessness because, oh, and they won’t even. They won’t even try anymore.

DR ALAN GOLDHAMER: Yeah, well, that’s a really good example.

STEVEN BARTLETT: Yeah. The same happens with humans. If someone tells you something, something can’t change, you’re stuck. You’re fucked.

DR ALAN GOLDHAMER: When you’re ready to have a life changing experience, we’d love you to be our guest. Come to the center. Do a bit of a fast. I’m telling you, you’re a great candidate. You’ll have a intense, but, you know, positive experience.

STEVEN BARTLETT: Okay.

DR ALAN GOLDHAMER: And we’ll make sure that if you walk in, you walk out.

STEVEN BARTLETT: Okay, good. That’s a prerequisite of my visit. Thank you so much, Dr. Goldhamer. Keep doing what you’re doing.

DR ALAN GOLDHAMER: Thank you.

STEVEN BARTLETT: Thank you.

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