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

Episode Date: June 17, 2024

Dr. Alan Goldhamer is a pioneering researcher, founder and director of TrueNorth Health Center, and a leading expert on water-only fasting. This conversation explores the science behind fasting and its potential to reverse chronic diseases. We examine Dr. Goldhamer’s groundbreaking research, which involves fasting patients for upwards of 40 days, their success stories, the importance of a whole-food, plant-based diet, and the challenges of integrating fasting into mainstream medical practices. Throughout our discussion, Dr. Goldhamer provides insights into the obesity epidemic, details the connection between fasting and longevity, and offers his thoughts on the future of healthcare. Dr. Goldhamer is a maverick, and this conversation is instructive for anyone seeking to optimize their health. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors:  On: Enter RichRoll10 at the checkout to get 10% OFF 👉on.com/richroll Eight Sleep: Use code RICHROLL to get $350 OFF Pod 4 Ultra 👉eightsleep.com/richroll  AG1: Get a FREE 1-year supply of Vitamin D3+K2 AND 5 free AG1 Travel Packs 👉drinkAG1.com/richroll  This episode is brought to you by BetterHelp: Listeners get 10% OFF 👉BetterHelp.com/RICHROLL Check out all of the amazing discounts from our Sponsors 👉richroll.com/sponsors Find out more about Voicing Change Media at voicingchange.media and follow us @voicingchange

Physicians will tell you, look, here's the drugs you take and you'll be on these drugs the rest of your life. They will promise you if you do what you're told you'll never get well. The type of fasting that we do is the complete abstinence of all substances except water. So it's therapeutic, medically supervised, water only fasting. Over a period of... We routinely fast people up to 40 days. We fool the satiety mechanisms of the brains of humans by putting chemicals in our feed. Salt, oil, and sugar are not food. They're hyper-concentrated food byproducts that are added to food to make food taste better. You know, health results from healthful living.

If you just eat a whole plant food SOS free diet and you eat to your satisfaction, you will be able to maintain optimum weight. But to the degree that you add salt, oil, and sugar to the food, the only question is, how fat are you gonna get? Four years ago at the peak of the pandemic, I sat down with water fasting practitioner

and proponent Dr. Alan Goldhammer for a conversation that quite stunningly aggregated an audience in excess of 5 million people and continues to garner attention to this day. Well, today he's back with the latest research on the benefits of prolonged fasting, along with more evidence and experience-based insights on the nature of metabolic health,

what is driving the escalation of lifestyle disease, and the essential habits required to achieve and sustain optimal weight and health, all of which he details in his new book, "'Can Fasting Save Your Life? For those unfamiliar, Dr. Goldhammer is a pioneer in plant-based nutrition and the founder of True North Health Center,

where he has personally supervised over 25,000 patients during extended water-only fasts, some lasting up to an astonishing 40 days. Final note before we get into it, under no circumstances should anyone undertake a water fast of any length without the medical supervision of a trained professional. In other words, please, please do not try this at home.

And with that out of the way, I give you the truly fascinating Dr. Alan Goldhammer. Alan, it's great to see you. Good to have you back here. I think it's been three years since we first sat down. It was in the middle of the pandemic. We had an incredible conversation about all things fasting,

prolonged water only fasting. And True North has been around 40 years at this point. And I think you have overseen the medical supervision of something like 25,000 prolonged water only fast during that period of time. Yeah, I mean, this is essentially all I've done in my life. I got interested in fasting at 16, I'm 65 today. And essentially that's really all I've been involved

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

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

There's a lot of fasting mimicking programs out there, and they all have potential benefits and uses. Some of them have many advantages over the prolonged water-only fasting in that they don't require the level of supervision. They don't require aggressive withdrawal of medications. They don't have the risk profile that medically supervised water-only fasting could have if it's not done properly. So particularly Valter Longo has popularized a program where it's limited nutrition intake. It can be done by most people at home.

It can be very helpful to the degree that it's used, but it's not long-term water-only fasting. And as beneficial as these intermittent fasting programs can be in helping with weight loss and helping people make behavioral changes, they're not necessarily the same thing you'll see in patients, for example, that have specific illnesses and need to reverse those diseases

that you would see with long-term water-only fasting. So is that a way of saying that in your experience, prolonged water-only fasting is a superior protocol when it comes to helping people with acute or chronic lifestyle diseases? Like why is it that you've chosen to focus on this rather than these other protocols that are seeming to be much more a part of the mainstream discourse around fasting?

Well, I think that when you can accomplish your goals with intermittent fasting or these other programs, that has advantages. As I said, safer profile, simple, doesn't require going to a place and requiring medical supervision. But many conditions won't respond to those protocols. And when they don't respond, that's oftentimes when we see people. When they've done their best, they've made diet and lifestyle changes, they've done what they can do to resolve the problem, but the blood pressure still persists. I know my colleague, John McDougall, calls us the punishment that if he has a patient, for example, that doesn't resolve their hypertension, which most do, but for those that don't, he'll- You get the hard cases.

He'll send us over with apologies. Yeah, yeah, yeah, yeah. Because what we do is a more intense process. It's not something that you'd necessarily look forward to if you're ill. But the fact is it can be done safely. It can be done effectively. And when it's needed,

there's nothing else that does exactly what water-only fasting does. Right, so at True North, the typical hard case that finds his or her way to your doorstep is somebody that you're gonna supervise over a period of how long as they undergo this protocol? Fasting ranges from five to 40 days on water-only,

and there's a period of half the length of the fast recovery in the supervised setting. So a typical patient might fast for two or three weeks, they might be with us a month. And those patients will oftentimes come in with specific complaints, high blood pressure, type two diabetes, autoimmune diseases, or some forms of cancer, particularly things like lymphoma.

Right, and how do you decide then how long this fasting protocol is gonna be on a case-by-case basis? Like who are the people that you recommend a 40-day fast versus just a handful of days? Right, so you don't know with certainty before the fast exactly how the fast is gonna go. And so what we do is we try to estimate long

and then if we can get it done quicker, that's great. I've had enough experience and fasted enough people, I can usually, by looking at their medical history, reviewing their lab, get a pretty good idea of what that range is likely to be. But there are patients that we expect to go a long time, but they get well really quickly. And so we just don't need to do it. Other people we're hoping are going to be a shorter fast, but it ends up being, it takes longer to get the job done. In some cases, it's pretty simple in the sense that, like, for example, if you have high blood pressure,

we want to fast you till you have normal blood pressure so that when you eat well, you don't have to be dealing with medications and the risk profile. And we know based on how high your blood pressure is, what your medical history is in terms of kidney disease and other things, how long that's likely to take.

We can do the same thing with type two diabetics. We can look at your hemoglobin A1C, get an idea of how much insulin resistance there is. And a big factor is how much extra weight and extra visceral fat do you have? Because it's the obesity, the extra weight and the visceral fat that's responsible for producing the inflammation that causes these problems. And so we wanna bring people as close as possible down to their optimum weight. Now, in some cases, people are not overweight, but they're over fat.

And so those individuals, you have to stay within the reserves. Other people might have plenty of fat reserves, but they may not have electrolyte reserves. They may have other issues that become a limiting factor. And that's why we're carefully monitoring patients, examining them twice a day, monitoring their lab, their urinalysis, the variables that we can monitor so that we can get a good indication. And we know we do that safely because we've published a safety study

where we have actually shown that if you follow this protocol, everybody that walks in gets to walk out. Right. What do we know and not know about the causal or highly correlative relationship between visceral fat and the cascade of chronic lifestyle diseases that seem to proliferate across the world these days? Everybody's worried about obesity and being fat, and they think of it often as a cosmetic issue. everybody's worried about obesity and being fat. And they think of it often as a cosmetic issue. And it's far from just a cosmetic issue.

On your body, there's a type of fat called visceral fat. It particularly accumulates around the abdomen and the organs that has hypermetabolic effects. It produces inflammatory products, IL-6, TNL-alpha, acute phase reactive proteins. And these inflammatory components are thought to be responsible for the heart disease, the diabetes, the autoimmune disease, and some forms of cancer. So getting rid of, you can think of visceral fat like a tumor. So if you had a multi-pound tumor in your body, you would be appropriately alarmed because of its effects. And we go to inordinate effects to get rid of those

types of tumors. And interestingly enough, let's say you went on a fast and lost 10% of your body weight. You might think, well, I lose 10% of my visceral fat, but that's not the case. You may be losing subcutaneous fat or muscle mass. You would lose all those things. You'd lose muscle, fiber, glycogen, water, and fat when you fast. And when you come off the fast, you regain water, fiber, glycogen, and protein, but not fat.

When you follow a whole plant food SOS-free protocol, you'll continue to lose fat. And what's interesting is you don't just lose equal amounts of fat and visceral fat. You will lose disproportionate, preferential mobilization of visceral fat. For example, we used a DEXA scanner to do some studies. Typical male fast for two weeks loses 20% of their total

fat, but 55% of their visceral fat. So the visceral fat is being mobilized much like tumors are. In other words, if you lose 10% of your body weight, you don't lose 10% of your breast tumor. You might lose 50% or all of the breast tumor. So how does the body know that it wants to get rid of the breast tumor versus anything else? Because there is mechanisms in the body that preferentially mobilize materials in inverse proportion to their need. And visceral fat shouldn't be there. And as a consequence, the body appears to go in and deal with that first, which is really great because it's one of the great benefits of fasting is the preferential mobilization of visceral fat.

So people going in might think, I'm here to lose my subcutaneous fat, but the sort of good news and bad news is maybe not more of the visceral fat, but that's actually in your best interest. And I suppose there are people who are relatively lean who nonetheless and unsuspecting to themselves also have high stores of visceral fat. Is a DEXA scan the only or the best way to

figure out whether visceral fat is a problem for you if you're not kind of overtly obese? Well, a DEXA scan with specific software that's designed to measure body fat, which is what we used in our studies, we'll do that. I don't know that it's necessary for people to do that because what's great is if you adopt a whole plant food SOS-free diet, engage in exercise, get enough sleep, your body's going to take you down to optimum weight. And even if you're at optimum weight, it's going to start the conversion process of mobilizing fat and replacing it with muscle. You know, what's interesting is people are losing weight. Sometimes they're going through the weight loss process. They'll actually be getting skinnier, but heavier because muscle is actually denser than fat. So you have to be a little careful with the scale. And even with DEXA

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

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

that all these intermittent fasting programs use various amounts of calories and supplements to do their protocol. And I got no problem with that to the degree that all these intermittent fasting programs use various amounts of calories and supplements to do their protocol. And I got no problem with that to the degree that that's effective. But what works best, particularly when you're trying to get into this deep seated fasting,

where you're getting mobilization of visceral fat, tumors and other materials, it works better to allow the body to go into the full fasting state rather than the fasting mimicking state in our experience. We have to still prove that. We're looking forward to doing some research, hopefully with ultra long ago to compare and contrast

intermittent and total fasting. If intermittent fasting is working at resolving the problem, great. Good for you. Right. But if you have a problem that despite people's best efforts, it's not resolving, this is the next step. And it's what we have the most experience in. So our research is all on water-only fasting

because that's how I was taught. That's what's been done traditionally in the nature cure arena. Given the fact that most of the people who end up at True North and undergo this protocol are people who have severe, extensive chronic lifestyle ailments, acute medical issues. I would imagine a lot of them,

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

who are thinking, I'm on all these medications. My doctor told me like never to go off of them. You're saying you're gonna come here and I'm gonna get you off of them, which is, contravenes what they've been hearing for probably a long time. Well, there's a wide variety of medications. And so the answer is a little bit complicated.

But when you think about conditions like high blood pressure or diabetes, physicians will tell you, look, here's the drugs you take, and you'll be on these drugs the rest of your life. They will promise you if you do what you're told, you'll never get well. And that's their experience. In our experience, if you're willing to undo the reasons why you have the high blood pressure or diabetes with aggressive diet and lifestyle change

and the use of fasting, we can get you not only off the medication safely, but you can stay off the medication. Again, we've got data to support that with long-term follow-up now. I didn't have that last time I talked to you. But for example, we completed a study on 29 patients that were prospectively admitted into our trial.

28 were able to eliminate the need for medication and one ended up on half dose of medication. We followed those people at six weeks and they had maintained those results. And then we followed them at a year. And the people that were able to follow up at a year, 75% of them were able to maintain their weight loss and their drug-free normal blood pressure state. So what it shows is that highly motivated, self-selected people are not only able to get well with fasting, but they're able to maintain enough dietary control that they can sustain those results. What was the differentiator between the 75% and the 25%? Was it diet and lifestyle adherence? Diet and lifestyle adherence was actually a problem in everybody. We didn't get 100% diet and lifestyle adherence in anybody,

but 75% of them were able to hear well enough that they maintained their weight loss. And the people that maintained their weight loss maintained their normal blood pressure state. People that were having struggle in regaining weight, those were some of the people that maintain their weight loss maintain their normal blood pressure state. People that were having struggle in regaining weight, those were some of the people that had struggle with recurrence of the hypertension. Again, I think that visceral fat is a major contributing factor to high blood pressure. And so if you can get people to and keep them at optimum weight, it's often much easier to control their blood pressure. It's not the only variable.

There's also issues with kidney function, et cetera, that contribute to it. But dietary compliance associates with weight management, dietary compliance associates with normalizing blood pressure. What are some of the other studies that have been conducted and have come out since we last spoke?

Oh my gosh, we have, I think- You got a whole bunch of stuff in front of you. 19 papers that we've published in peer review journals. And many of them have come out. Some of them literally in the last few months. It's becoming, it takes a couple of years sometimes to get studies published and sometimes much longer because we not only have to show

that people can get well fasting, but that they can stay well. Because the criticism is, oh yeah, you've got them locked up at the True North Health Center. You control all the variables. that people can get well fasting, but that they can stay well. Because the criticism is, oh yeah, you've got them locked up at the True North Health Center. You know, you control all the variables. What happens when they go back to free living? And so, for example, when I was here last time,

we talked about a woman that we had treated with follicular lymphoma, stage three, who had undergone 21 days of fasting and resolved her cancer. At one year, we published a case report in the British Medical Journal, and they invited us to do a three-year follow-up. We did a three-year follow-up where whole body CT, she was able to maintain a cancer-free state. Now we have a 10-year follow-up on her. She continues

to remain cancer-free, but not only that, since then we were able to track other patients with follicular lymphoma, including stage four follicular lymphoma with metastasis to the bones. That gentleman fasted 40 days. We had follow-up, did a second 40-day fast, and he continues to do well. We have other patients with follicular lymphoma, one, for example, that underwent chemotherapy, but as often happens a year or two later,

it comes back more aggressive than ever. That person also did well. So even people that had undergone treatment seem to be responding to fasting. Now we have a cohort that's been submitted for publication. We expect that to come out later this year. We're hoping that that's going to be the basis for a clinical trial where we'll be able to take a large group of patients randomly assigned. Some will undergo fasting in addition to standard of care versus standard of care. And what we expect to see is dramatic improvement because health results from healthful living.

If you get people living healthfully and they're willing to do it, it's remarkable what the body's able to do. That is really wild. I mean, it's not surprising that somebody is going to be able to get their hypertension under control, that they're gonna be able to get their blood markers

into optimal states, ApoB, HbA1c, things like that, and treat some of the conditions that are sort of clearly associated with obesity and metabolic dysregulation. But when you talk about cancer, and I think we talked about this last time, like I could feel myself clenching, you know, because when you talk about cancer,

it gets very intense. Like there's a lot of people who would call what you just said blasphemy because there's a certain way of treating cancer and a holistic approach raises eyebrows to say the least, to put it mildly. Well, it's the first paper the British Medical Journal case reports has published on alternative management of cancer. They published the follow-up. We've got another

journal that's publishing the cohort. What was the response to that? It's very controversial. I got a lot of calls and a lot of questions and a lot of criticism. The reason we were able to get it published though is because it's well known that the treatment for follicular lymphoma doesn't affect all-cause mortality. It often fails. And as I said, even if you get success where you're going to remission, it comes back. And so the important thing is to find a strategy that not only gets the tumors to go away, but keeps them away. And that's where the diet and the lifestyle change seems to be so impacting. And then we use fasting on a periodic basis in order to be able to maintain health.

It's interesting that the concern is it's so dangerous. The perception is that it's so dangerous that why would you risk somebody's life doing something so radical like fasting when there's a simple standard medical treatment available. Right, chemotherapy or radiation. And which is why we published a fasting safety study where we took all the patients and looked

at their adverse events and carefully monitored and charted the outcomes and then published a paper in Biomed Central that is the first long-term fasting safety study. And what it showed clearly is that fasting, when it's done according to this protocol, can be done safely. Even Walter Longo wrote a book on fasting where he talked about don't do long-term fasting because it's too dangerous.

But the one caveat was, unless you do it at the True North Health Center. In the new book, Can Fasting Save Your Life?, you have a whole thing on safety. And it was interesting how few cases there are of people having AEs, adverse effects. And of the people who have suffered some kind of adverse effect, they tend to be very mild.

Well, there were 5,900 adverse events in the patients over that five-year period, but most of them, as you said, are type one or type two events. These are the normal symptoms you would expect to see in fasting, the nausea, the headache, the skin rashes, the dizziness, the irritability, the sleep disruption. These are inherent. They're almost universal in fasting. Fasting can be a very intense process. Most of the category three events, which would be considered medically significant, were hypertensive crises. And you might say, well, why would people being treated for high blood pressure on a fast have a hypertensive crisis, which is defined as any time for any reason, systolic blood pressure is over 160. And the way it works is if people come in and their blood pressure is 220 over 100, and then it's 210,

and then it's 190, and the next day it's 180, every one of those is 220 over 100. And then it's 210 and then it's 190 and the next day it's 180. Every one of those is an adverse event. It gets, yeah, it gets- It's not causally related. Yeah, I understand. And most of our category three events are people whose blood pressure is coming down or blips up as they come off meds and comes down.

We had very little category, no category five, which is death. Category four, we've seen very rarely, we had one hyponatremic event where blood sodium goes too low. And that does occasionally happen. And that's why we monitor electrolytes. It's easily solved.

You break the fast. But if you didn't catch it, it could conceivably become a serious or life-threatening problem. We've also used to worry about low white blood counts that show up in fasting, but now we know a little bit more about why that might be. In 2016, Yoshinori Yashumi won the Nobel Prize in Medicine

for his work on autophagy. And it turns out autophagy is how the body eats up cancer cells and age cells and gets rid of them. Well, it turns out fasting profoundly increases autophagy. And so what we realize now is happening is people have a lot of white blood cells. Some of them are part of an active part of your immune system. Some of them are no longer functioning. When you go on a fast, the body rapidly clears out those non-functional cells. So your counts drop, your immune resistance doesn't drop. And we notice people aren't getting infections or problems in fasting, but their counts will drop. And we believe it's because

they're clearing out those non-functional cells. And so, temporary counts drop, and then, of course, they normalize after fasting. And that might explain, you know, that observation that we see white counts dropping during fasting. Autophagy is a very popular word that gets thrown around quite a bit, usually without a full understanding of what it means or the adequate amount of nuance. There's multiplicity of physiological processes and things that you can do that will instigate autophagy, exercise being one, of course.

So I'm interested, A, there are parallels between what's happening physiologically as a result of exercise-induced stress and fasting. So I wanna hear about that. But also I'm curious around autophagy with respect to prolonged water-only fasting versus the autophagy that you would see in a different version of fasting, say in intermittent fasting

or time-restricted eating, for example. Right, well, as far as comparing and contrasting water fasting from fasting mimicking approaches, we don't know what the differences are because that research hasn't been done yet. We haven't done that comparison. That's one of the things we'd like to look at, hopefully sooner rather than later.

And of course that would be very interesting. So this is really fascinating because you find so much research on exercise and the benefits of exercise and that people that exercise have these biochemical changes. In fact, it's overwhelming how much benefit exercise seems to instill in people. But the biochemical changes that occur in exercise often parallel and mimic fasting. And that's not intuitively obvious because in exercise, you're out vigorously stressing the body.

And in fasting, you're resting, stressing the body maybe in a different way. But they both induced many of the same biochemical changes. For example, BDNF, brain-derived neurotrophic factor, which protects the brain from developing Alzheimer's and dementia, increases with exercise, increases with fasting. If you look at all the different biochemical changes that occur with fasting, many of them also occur with fasting. And you might say, why would that be? Why would something vigorous and something passive

do the same thing? But if you think about it, they both have one thing in common, is they undo the consequences of dietary excess, and they're mobilizing fat and particularly visceral fat. And I believe that excess fat and excess visceral fat is a fundamental contributing factor to many of these inflammation-related diseases. So it's not shocking to find out that people that exercise vigorously get these improved biochemical changes and people that use fasting, whether it's every day for 12 to 16 hours or occasionally for a longer period of time, are going to induce those changes. And they do. And they don't just happen while you're fasting. A lot of these biochemical changes, these enzymatic changes persist. It's just like when you become a trained athlete,

you get better at mobilizing glycogen stores. And it doesn't happen just while you're physically exercising. There's a change in enzymatic function that persists. That's part of what being a trained athlete is. And the same thing happens with fasting. In fact, part of the justification for intermittent fasting, like limiting your feeding window to say to eight hours and fasting for 16 hours is the thought is that the changes that occur a little bit in those 16 hours, but cumulatively day after day, after week, after month may approximate some of the changes we see in long-term fasting. And also we've noticed that people that do intermittent fasting and also people that exercise, interestingly enough,

are much better fasters. Yeah, I was gonna ask that. Is there any understanding of the difference between the average person or the person who's suffering from some form of chronic ailment who's fasting versus say a highly trained athlete who's very accustomed to rigorous consistent exercise. And does fasting have a different impact on that person

versus the other person or do we not know? I believe it does. In fact, we've got some evidence now looking at the idea of does fasting help healthy people or is it just help sick people? And we did a study where we actually recruited eight metabolically healthy people, which as you know, is a little bit more difficult

than you'd imagine, because only 12% of the population is metabolically healthy. Even quote thin people aren't necessarily metabolically healthy. So we recruited healthy people. These happen to all be women, because it was a women's study. And we looked at the changes.

Now remember, these people have normal blood pressure, normal weight, normal blood glucose levels. But we looked at the changes. Now, remember, these people have normal blood pressure, normal weight, normal blood glucose levels. But we looked at the cardiometabolic measurements and we looked at their biochemical changes. And the magnitude of change was actually higher in the healthy people even than the sick people. What do you make of that? What I think is that the people that get the most benefit from fasting are the healthy people that are doing it preventatively, much like the people that get the most benefit from exercise tend to be healthy people that are doing it preventatively rather than trying to induce it in sick people. It doesn't mean sick people don't get benefit both from exercise and fasting, but in terms of the

magnitude of proportional change, I think the real cure, for example, of cancer is prevention. And the real, you can't cure obesity. You can lose the weight and keep it off, but you can't go back to the changes without it coming back. Same thing with high blood pressure. Same thing with diabetes. Medicine is so busy looking for cures that they don't realize

that these are all management strategies. And so all we're doing is using intermittent fasting or long-term fasting, diet, sleep, and exercise to manage people's health, to support the change associated with health rather than deteriorating into aging and disease. We're trying to slow the aging process. You can't stop it, but you can slow it.

You can allow people to age normally rather than this facilitated aging that happens because of our conventional diets. You see it with smoking more apparently. People get premature wrinkling of their face. It's like smoker's face, because wrinkles are nothing more than cross-linked collagen tissue

that comes from the oxidative damage from the effect of smoking. So if you don't smoke, you still age, you're still getting wrinkles, you're still gonna age out, but it's much slower than that facilitated hyperinflammation from smoking. Same thing with alcohol. The liver ages out. You get cirrhosis of the liver.

It's nothing more than fatty scar tissue from the damaging effect of alcohol. And the same thing with the diet. If you include salt, oil, and sugar in your diet, you're going to age the body more quickly than you would if you could eat a whole plant-free diet. That answers two questions that I had. The first being this interesting distinction between your interest in fasting, which is treating people with, you know, significant chronic lifestyle ailments versus the majority of the discourse that you see out there, which is around health span extension and longevity when it comes to fasting.

Like you're treating very sick people, you're seeing great results. You've been doing this for a very long time, but everyone else is talking about telomeres and like sort of living forever on the other side, which on some level is a whole different conversation, but what you just said helps me understand where these two things meet and are actually of a piece.

There's been a hundred million modern humans born on the planet. We have good evidence that approximately five have lived past 117. And one of them is questionable because they probably adopted the identity of their grandparent to avoid conscription in the military, but that's a different issue.

So the point is- Is there evidence of that? Yeah, you have about one in 20 billion chance today of living past 117. Now, maybe they'll figure out a way to extend lifespan. What I'm more concerned about is healthy lifespan. How well are you going to live in the time you have left? Most people spend the last 10 or 20 years of their life unhealthy and compromised. I think that those years can be the best rather than the worst years of your life. And that's what we're interested in

doing is avoiding the strokes and the heart attack, the debility, the arthritis that limits people's mobility, inability to exercise, and poor choices they make in terms of diet and lifestyle. And the price they pay is they find themselves unable to talk or move lying in nursing beds, waiting for people to change their diaper rather than having a good life and then a good death where you live your life and you go to sleep one night and you don't wake up because you've reached your genetic potential. And I think that we can dramatically reduce the debility that happens at the end of the years. And we're interested in doing a long-term study to look at exactly that.

We wanna enroll a large number of people, track them the rest of their life, and then compare, you know, what level of dietary adherence is associated with the best outcome? Does fasting actually help augment that? And kind of tease that all apart, because right now there's a lot of speculation,

but not a lot of data. The second question that you answered was, why would a healthy person go to True North or entertain undergoing one of these extended water fasts? You know, I just got my blood work done. It's like pretty good. Like, do I really need to go, you know, take a month off and go and hang out with you?

You wouldn't get to take a month off. And lay in bed while I'm just, whatever it is, you know? You're not gonna need to take a month off and go and hang out with you? You wouldn't get to take a month off. And lay in a bed while it's just, whatever it is. You're not gonna need to take a month off because when we fast healthy people, it's usually very brief, five to 10 days. It doesn't take, again, the way we judge is we fast them until their symptoms resolve. So some people don't have any symptoms.

Well, what if I don't have any symptoms? Well, then you're gonna fast a week and be done. But what more often happens is, and particularly in athletes that believe they're healthy because they're thin and have good muscle tone, they aren't always as adherent on the diet and lifestyle. And so when you put them on a fast, it turns out they do have some toxicity. They do mobilize some accumulated inimmunomodular products and metabolism. They do go through some symptomatic change. Now, if you don't, that's a good sign. I use it diagnostically

as well as therapeutically. But if you think about that intermittent fasting we're doing, we're fasting for 16 hours to induce changes. When you do a week of fasting, it is dramatically more impacting than the smaller amount. And using that diagnostically and potentially therapeutically, I believe will be proved to be useful. I can't prove it yet,

because we haven't done the research, but that's literally next on the list. Right. What else do we know about what is happening physiologically when somebody is undergoing one of these extended fasts? Well, there's a lot of information that's available on the detailed physiology of fasting, but essentially what's going on

is the most important adaptation is the brain. The brain is the biggest burner of glucose for humans. We have a ridiculously large brain, two and a half times, for example, the comparative mass of a chimp. If we couldn't fast, we wouldn't be able to go more than a week or 10 days before gluconeogenesis would break down our protein mass

and we'd end up into starvation and die. That would have been a problem for humans because they wandered away from the tropics, unlike chimps that don't fast and can only go maybe a week or so. Humans wandered all over the planet and all the humans that couldn't fast, they couldn't convert their brain from burning glucose to burning beta-hydroxybutyric acid, they died. And we know that because literally everybody on the planet that's a modern human has this automatic conversion that happens when they go on fasting. The brain changes to burning ketones or specifically beta-hydroxybutyric acid.

The body conserves it. Now a healthy, lean male can fast up to 70 days. Not that we would recommend you do that, but you would likely survive in a restful state 70 days. You would not be able to do that if you weren't able to convert your brain to burning fat. And so this biological adaptation was so critical to humans that essentially anybody that didn't have it bit the dust. And all we've done is take that ancient biological adaptation and apply it in a very unusual situation

that has only occurred recently in modern history. And that's where people consistently overeat. What is the longest documented fast? 368 days in the medical literature. But that was in a very obese patient. How long ago was that? That was in the 70s, I believe. That's unbelievable. So that was- It's unbelievable a human being could do that. Well, you can fast essentially as long as

you have nutrient and fat stores. So we routinely fast people up to 40 days. So Moses, David, Elijah, Jesus, and our patients fast as long as 40 days. I tell them they're in good company, you know? And what is the role of the liver in all of this? Well, the liver is one of the main detoxifying organs of the body. It's really important both for controlling glucose production in fasting as well as detoxification. And so, you know, liver plays an active and heavy load during fasting. And oftentimes you'll get a lot of bile and other symptoms that are associated with liver function that can be quite distressing.

But the net effect on liver function is very powerful. In fact, we have a study here that shows that fatty liver index dramatically improves with fasting, consistently and objectively. So this fatty liver disease that's now become very common as people are on excess sugar and alcohol, et cetera, is a condition that seems to be able to be responsive

to this kind of approach. There's an interesting thing that you say in your book, which is that the data also indicates that the beneficial effects of fasting persist even after the fasting period ends. So elaborate on that a little bit. Basically, that means that the beneficial impact of this experience has like a long tail. It isn't restricted to the time period in which you're

actually fasting. No, one of those, for example, detoxifying enzymes that are produced where the body is able to grab onto, mobilize, and eliminate materials, those enzymes don't just disappear because you're back in the feeding state. You maintain a higher circulating level of those. You're glycogen mobilizing enzyme systems. A lot of those systems are canalized and persist. And it seems to be cumulative. If you notice, patients that do periodic fasting, it gets easier and easier. Now, part of that may be because they're lowering their total load. Part of it may be the diet. They're improving their health. But just the ability to get into and stay in fasting seems to improve.

You know how when people first start exercising, it's really painful. It's really tough. But if they can get through it and adapt and get the body to go through those acclimations, it gets easier and to the point where you like it. And the same thing happens with fasting. You get to the point where, you know, your blood glucose isn't being driven down by elevated insulin levels because you're eating some highly processed foods and your brain thinks you're starving and you get cravings and you get binging and you have all these challenges. Blood sugar levels tend to stabilize. Insulin levels tend to normalize. People, if they have to skip a meal because they, you know, it's not this

tragic problem because their ability to adapt is improved. And fasting, that's not just a during fasting phenomenon. It's an ongoing phenomenon. I understand the exercise analogy. Like it's something that I tell people all the time, like, yes, it's gonna be uncomfortable and challenging and difficult in the beginning, but you will come to enjoy it.

And yet, I have a hard time believing that this could be the case with fasting. Like the idea that you're gonna go that long without eating any food just seems so unimaginable. So talk a little bit about, you mentioned cravings and the like, like what is the difference between appetite and hunger? I think there are people who would think what you're doing is putting people on a starvation protocol, but

there's a difference between fasting and starvation. And there's a difference between your appetite impulse and actual hunger. Absolutely. So fasting is by definition means there's labile reserves available. If you deplete your labile reserves, then you enter starvation and then you die. So we don't do starvation because that would be really bad for our outcome data. So we only do fasting and we monitor people to make sure we don't transition from the fasting state to the starvation. Fortunately, it's very easy to monitor that. It's not a complex clinical challenge. And appetite and hunger is a very important consideration because both us and the intermittent fasting advocates suggest that people not eat three to

four hours before they go to bed at night. I mean, that's basically how you get your 16-hour fasting. You eat an early dinner, don't eat till you wake up, maybe defer breakfast until you've done some vigorous exercise, delay breakfast a little bit. Now you have an eight hour window that you eat in. That 16 hour period of time is essentially time restricted eating and is thought to be helpful. People eat for a lot of reasons.

They eat because they're tired. And if they eat, they feel better. So they assume they were hungry when really they were fatigued and they got stimulated by the food. They eat because they're angry. So they have emotional distress. So they eat and then they feel the dopamine stimulation from eating. So they interpret that as they must've been hungry.

They eat for all kinds of reasons, but the only reason to really eat is because you need caloric intake and not because you're angry, tired, or fatigued. If you're tired, you should go to sleep. If you're angry, you should figure out a way to dissipate the effects of the anger or get rid of the source of it. If you're bored, you should engage in productive activity. And eating is not one of those things unless it's because you're hungry. And so not eating, say, for example, three hours before you go to bed eliminates a lot of that late night boredom, tired eating stuff. And then people are more inclined to want to go to sleep. And that's exactly what you should do when you're tired. I struggle with this.

I have a hard time falling asleep unless my stomach feels full. So when I do intermittent fasting, I tend to eat late and not eat during the day. And I've discovered that that is very disruptive to my sleep cycle. I'll generally wake up at three o'clock in the morning or my REM states, my deep states aren't adequate enough.

Like I don't think it's a net positive. And so I've kind of stopped doing that. So I would challenge you that if you were to undergo prolonged fasting, during the fast, you may not have good sleep cycles and stuff that can be quite disruptive. But as a consequence of fasting, you may find that good sleep cycles and stuff. It can be quite disruptive. But as a consequence of fasting, you may find that the quality of your sleep may be better than it's ever been before.

I can't tell you exactly what all the mechanisms are, but we see it very commonly. People that have trouble either getting to sleep or staying asleep, post-fasting oftentimes are then able to sleep, get to sleep and sleep through the night. Sometimes it's because people have benign prostatic hypertrophy. They're waking up six times to pee. You don't eat before you go to bed. You get the prostate inflammation down. Now you're only waking up one time, so you have less sleep disruption, better quality of sleep. Sometimes it's because when people eat late at night, they experience just what you did. It's the digestive process. It's a pretty active process. You don't necessarily want this active biological process going on

when you're trying to be in a restful state. And so there may be other biochemical factors that we haven't really elucidated yet, but whatever, the net effect of fasting oftentimes is improving sleep cycles. And improving sleep cycles is really important. If you get the quality and quantity of sleep you need, that's where energy comes from.

Right, that becomes a life-changing thing in and of itself, like independent of everything else. Exercise. You don't have to sell me on that. But people that exercise regularly tend to sleep better overall than people that don't. People that eat well tend to sleep better than those that don't.

And people that have used fasting appropriately oftentimes are able to correct imbalances. I suspect there's a psychological piece at play here as well because anybody who shows up at True North and does, let's say, 40 days of fasting, it's something that is so mind-boggling that so few people have any experience with that I can't help but think

that person is going to think differently of their own capacity and capabilities as a result of that. And it reframes their sense of what's possible for themselves. It's very empowering, right? It's to like undergo something like that. And then on the other side of it,

say I can do hard things or now I'm up for a different type of challenge or I'm finally ready to, now that I've proven to myself that I could do something like this, I now, or I'm finally ready to, now that I've proven to myself that I could do something like this, I now feel like I'm capable of handling other dietary and lifestyle changes that have historically eluded me.

You know, it's natural to be afraid of starvation. You know, if it wasn't, if people weren't very concerned and motivated. Why do you think I would come to True North? I'm terrified of you. I'm terrified of this whole thing. Go ahead, sorry. So they're naturally afraid of starvation.

And so sometimes when they feel hunger, they interpret it as a serious problem. Once you've gone through fasting, first of all, you tend not to have quite as much vacillation in your blood sugar and insulin levels. So there's not as much biological input afterwards. It calms down. But also you realize I went for a week or I went for 10 days or I went for 40 days. You know, the idea of not eating on the plane isn't going to be terrifying. And you're right.

There's a huge empowering impact. And there's probably more people that have climbed Mount Everest than have done 40 day fast. And nobody would say, oh, I did this huge challenge. I ran this marathon. I climbed this mountain. Of course, it's gonna have an empowering effect on people. And laying around doing nothing has the same kind of impact on people. You mentioned earlier that only 12%, I don't know if it's of the US population

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

Six out of 10 US adults have some form of chronic disease. There's 40 million deaths annually as a result of these illnesses. US healthcare costs have exceeded 3.5 trillion in 2022. And in the US, over 70% of adults are overweight with 40% being obese. Like that is shocking. So help me understand how we got here.

We got here because of the pleasure trap, the hidden force that undermines health and happiness. We fooled the satiety mechanisms of the brains of humans by putting chemicals in our feed. If you put these same chemicals in the feet of rats or mice or birds, the rodents will gain 49% of their body weight in 60 days. The birds will get so fat they can't even fly. There is no obesity in wild animals. You know, even whales are, what, 9% body fat. They're lean, mean machines. They just wear it on the outside of their body. Unless those

animals get exposed to our highly processed foods with these chemicals added to it. And then they'll get fat just like we do, and they'll get the same disease as we do. The breast cancer, the colon cancer, the heart disease, the diabetes, these changes occur in animals the same way they do in us. And the chemicals that we put in our feed that fool the satiety mechanisms allow us to overeat, and are responsible for the obesity and overweight that we see are salt, oil, and sugar, SOS. And that's why we advocate a whole plant food SOS-free diet. Because salt, oil, and sugar are not food. They're hyper-concentrated food byproducts. They're added to food to make food taste better.

And that's what tasting better is, is the artificial stimulation of dopamine in the brain. And foods do taste better to us with those. In fact, they taste so much better that we'll systematically overeat them. If you ask a person to eat their fill of say rice or anything, they'll eat a certain amount. Everything else being equal, if you salt that up,

they'll eat more before they reach satiety, before they feel satisfied. And people say, yeah, because it tastes better. That's right. That's what it means, is that it will stimulate that dopamine production and you will have to eat more before you feel satisfied. If you just eat a whole plant food SOS free diet and you eat to your satisfaction, you will be able to maintain optimum weight. But to the degree that you add salt, oil, and sugar to the satisfaction, you will be able to maintain optimum weight. But to the degree that you add salt, oil, and sugar to the food, the only question is how fat are you going to get? I understand the implications of salt, oil, and sugar with respect to hyper-palatability in our

ultra-processed food ecosystem, which is the kind of food that we're all overeating, that we find very difficult to only have a little bit of. But is there a distinction or a difference between the salt, oil, and sugar that finds its way into those foods versus a little bit of salt on your whole food omnivorous diet or one tablespoon of olive oil and the sort of benefits that you can get from that type of oil in moderate amounts? Like why so severe to say it has to be SOS or nothing? Well, part of it may be biased by my patient population. So I'm seeing the person that has high blood pressure or diabetes or cancer. And so their ability to just eat a little bit obviously failed because, you know,

and so has 72% of the population in the United States who have achieved obesity or overweight and are now having excess visceral fat and they're dying prematurely and spending 20 years debilitated. So if a person in theory could eat small amounts, maintain optimum weight optimum visceral fat optimum blood pressure and optimum glucose you might be able to make the case that

those people would get away with it but that's not what my experience has been it's very much analogous to saying why do you tell alcoholics they can't drink at all can't they just have a little beer and wine on the weekend or couldn't they just control their quantity and then they would be okay? And it is true. Some people can have an occasional drink and not become a drunk, but if you're a drunk, it's not you. So I can tell you right off the bat, 72% of the population don't have any business adding salt, oil, and sugar to their food any more than an alcoholic has business adding alcohol into their diet. Could alcoholics learn to control and have a... Maybe there would be one. I just don't get to see those people. So I tell alcoholics learn to control and have a, you know, maybe there would be one. I just don't get to see those people.

So I tell alcoholics, don't drink at all. Just stop it. And we tell people that are struggling with weight or health, stop putting the chemicals in your body that fool your brain and lead you into doing the things that are causing the problem. If you have a person that's able to maintain optimum weight and health and have a little variation, you know, so be it. Now, in reality, that's exactly what happens.

Because if you look at the study we did one year follow-up on, they weren't 100% vegan SOS free. But they had maintained enough adherence to the diet to maintain their weight loss. And that resulted in them being normal blood pressure without medication. So I'm more interested in the outcome than some philosophical argument about what can you get away with or what can't you get away with. So the easiest way, honestly,

just like it is in alcoholics, just say don't drink and draw the line and be done with it, rather than trying to figure out how much could you titrate in and still function. I think with salt, oil, and sugar, there's no natural relationship in my mind to adding those chemicals to the feed. I wouldn't do it in the animals. I wouldn't do it in the animals.

I wouldn't do it in humans if we want to get optimum health. Now, is it going to turn out that we'll be able to be more flexible for certain people? And they'll, yeah, it's very, very possible. But I don't get to see those people. Yeah, no, I understand.

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

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

in a more kind of clear trajectory forward. So I get that, but I think it would be interesting. I'm trying to imagine the person who's listening to this right now, who's thinking, well, I'm down with Alan when it comes to this fast, but when I complete the fast, why do I have to do this SOS thing? What if I just did a really healthy Mediterranean diet

and was very cautious about my salt, oil, and sugar intake as a result? And I'm wondering whether there are any studies on that or the difference between somebody who undergoes a prolonged water fast does the SOS diet versus the person who does the prolonged water fast and has a sort of quote unquote like healthy omnivorous diet in the wake of that. Yeah. No, I think your point is well taken and that is research we're actively and acutely interested in doing. Finding out how strict you have to be to get the outcome

and to avoid the pleasure trap. And maybe it's not an absolute thing like it appears to be with alcohol and some of these powerful drugs. But honestly, based on behavior, people don't wanna be fat and they don't wanna have visceral fat and they don't wanna be sick.

And they're really trying, they're spending billions of dollars trying to solve this problem. We have a solution for it. If you adopt a whole plant food SOS free diet, it becomes exceedingly difficult to maintain obesity or overweight. And when people neuroadapt to it, they get to the point where they'll like the diet as much or more than they did when they were on the traditional diet. Because there's an addictive component, it's hard for people to imagine

how could they possibly stand to eat a diet without salt, without oil, and without sugar. And what's even more interesting is in the alternative health movement, many people will say, well, get rid of the oil, even olive oil. And they realize olive oil is less bad than the other oils, but being less bad, of course, doesn't make it good.

It's still nine calories a gram of highly processed fat where we can get all the essential fat we need from the diet, from the whole plant foods. That's not so much challenge now. There's lots of people that have written about that. Some people say, well, look, you got to get rid of the sugar. The refined carbohydrates cause the insulin to go crazy.

They're empty calories. They suppress the immune system. They disrupt the gut microbiome. And a lot of people agree, okay, we got to get rid of the refined, the sugars. We've got to get rid of those. And some people say, get rid of the oil and the sugar. Okay, we'll get rid of those.

Now that food choices are narrowing, where I really pissed a lot of people off, including your viewers, was when I suggested that we get enough sodium from the diet. We don't need to add salt to the diet in order to get the sodium that we need, the gram a day that's needed, including by athletes that are sweating.

And that if you want to increase your sodium intake, you could still do that from whole foods. You can eat more tomatoes and chard and other things that are naturally very high in sodium. You don't need to add salt. That got, I think, a hundred and some angry comments. Yeah, that's how- You counted them. Completely crazy I am.

Because of the sugar. Well, answer them now. So here's your opportunity to address that. The data is coming out more and more that sodium is a problem, not just for high blood pressure, but I mean, just think about the gut microbiome in general. You've got a bacterial rich environment. You're putting a high sodium concentration. Do you think that that sodium could have an effect on bacterial population in the gut? Of course it can. I mean, we use salt

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

I do know, though, that in my experience in managing, for example, hypertensive patients, salt restriction becomes one of the critical components of maintaining long-term success. I wanna double click on the SOS whole plant food diet. For somebody who's never heard those terms before, what are we talking about specifically? What does that look like?

And perhaps even share some examples of what like a daily series of meals might look like. So a whole plant food diet is just that. The diet is made up of whole plant foods. So in other words, we're talking about brown rice, grains, not necessarily, we don't use the glutinous grains, the wheat, rye, and the barley. We certainly don't use't encourage the breads.

Bread is a great example. They call it the staff of life, right? People really like bread. But if you take away the salt, the oil, and the sugar from bread, then they call it matzah, and it's punishment on Passover. Nobody's getting too crazy about the wheat and the water. It's the additives that are added. And if you take wheat berries and you boil them and eat

them, it's 500 calories a pound. You take bread, it's 1500 calories a pound before you turn it into a butter boat and spread coagulated cow pus all over it. So the bottom line is how you process these foods can make a big difference in terms of whether they're helpful or not helpful. So we're talking about grains and legumes, so beans, lentils, peas, this kind of thing, but cooked like soup and whole grains rather than necessarily processed all the way down. We're talking about fresh fruit, but not necessarily fruit juices and dried fruits and highly processed fruits. We're talking about vegetables, both raw and cooked. And we're talking about all kinds of vegetables, starchy vegetables like Hubbard squash and

butternut squash and potatoes and sweet potatoes. We're talking about the variety of green vegetables particularly and getting these high mineral content foods into us. And again, I'd rather see people eating more whole foods necessarily than relying entirely on juices and processed foods where you remove the soluble fiber, which is so critical to maintaining a healthy gut microbiome. And then we're using small quantities of nuts and seeds and more concentrated higher fat plant foods. What we're not using though are animal foods. So meat, fish, fowl, eggs, and dairy products, oil, salt, and sugar. So basically what I tell people is they should go inside themselves, look at a food. If they want to know if they should eat it, just say,

do I really, really, really want it? And if the answer's truly yes, you know. You can't have it. Cause you get nothing. If you really, really, really want it, it's likely banging on the pleasure trail. Yeah, that begs the question of cravings and how powerful they can be.

And back to the point about the psychological piece to all of this and the kind of extended metaphor of alcoholism or addiction versus the landscape in which you operate. I went to a treatment center to get sober and I was there for a hundred days. And part of that was a re-education. Part of that was abstinence,

the physiological response to removing myself from this substance. But there's also, and the empowerment piece, of course, but in the course of that extended period of time, you're pattern interrupting. You're not doing the thing that you've always been doing and you feel all the cravings and all of the emotions come up and the resistance. And you have an opportunity in a

controlled environment to sit with that discomfort. And what you realize is that if you sit with it long enough, it dissipates. And with that comes a dawning realization that you can choose a different behavior and that those cravings over time will decrease in their intensity. And that in and of itself, set aside physiological changes, all of it, just the idea that cravings are not static, that they are modulated and that the more time and distance you put between yourself and that the more time and distance you put

between yourself and that food or that substance or that behavior, that the cravings will recede into the background. And that doesn't mean that they don't crop up from time to time and you have to confront them, but you have enough experience knowing that you can kind of sit with that discomfort and it will change.

And I think that is a huge dawning realization that in and of itself becomes a very empowering thing when people go off into their lives and they find themselves at a bar and somebody says, what do you wanna drink? Or they're at a dinner party and they say, what do you want to eat? Or they're at a buffet in Las Vegas

and they have a choice about what's gonna end up on their plate. Yeah, I think that's absolutely the truth. You know, it's just why you don't tell newly recovered alcoholics to become a bartender. You know, it's probably not the best choice. And we kind of know that's intuitively obvious. You wouldn't want to tell an alcoholic

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

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

to this type of behavior modification? Long-term recovered addicts are the best patients. That was my instinct. They're the most adherent. Cause they already know. They totally got the model. You don't even have to say anything to me. They got it.

I kicked heroin. Like how hard is this gonna be? You know, in some ways though, the feedback I've gotten is that it's actually in some ways even more difficult, not physiologically short term, but long term. Because socially, if you go to a party and they try to push alcohol and you say,

oh, I can't drink, I'm gonna recover. They might tolerate that and let you go by. But start to do that with diet, forget about it. Where are you gonna get your protein from? This is good for you. This is blah, blah, blah. There's no letting up. How do you counsel people on the social piece?

Because I think that is an underestimated limiter in all of this. There's our capacity to make these behavioral changes, but when pressed and in the context of friends or loved ones, there's a whole matrix of confusing signaling and emotions that come into play that ultimately lead people to lapse even against their best judgment.

My first advice is usually make new friends, but that's probably not the most practical solution for most people. The reality is that Dr. Lyle, our psychologist, explained to me how cognitive behavioral therapy works. And as I understood it or what I got out of it is it's a way of helping people manipulate other people's behavior so they don't annoy them as much. And so that's why I got interested in it. So the idea is that you can change your response to other people's behavior if you understand really where they're coming from and what the limitations are. You don't have to be angry. For example, he uses an example,

if you're in an elevator and somebody's poking you in the back with a sharp stick, you don't like being poked in the back with a sharp stick. You might get angry. You see it's a blind person just trying to figure out where they are in reality. You're still going to step out of the way, but you don't have to be angry about it because you realize they're doing the best they can. And the reality is if you understand the limitations that some of the people you're interacting with are working under, you don't have to be angry about the fact that they're not only not supportive, but actively trying to undermine your success. And you can communicate sometimes with people and help them modulate their behavior so they leave you alone, or at least be not

antagonistic. And if you can't, make new friends. When people leave True North after they've had this experience and you set them on their way with a whole protocol around the SOS diet, is there a caloric restriction piece to this? Are they allowed to eat as much as they want? Is that a case-by-case basis? Well, the people that are successful are the ones that avoid under eating. Under eating is a bigger problem on this approach than overeating is, because when you're eating a whole plant food, SOS free diet, you have to eat a lot.

There's a lot of eating going on because you're eating a pound or two of salad and vegetables. You're eating fresh fruits. This is stuff you have to chew and you have to chop. And it's a bigger volume of food. Sometimes people are not used to eating large volume of food or they think, well, I'll gain weight if I eat that much. They aren't thinking caloric density.

And as a consequence, they'll under-eat and then they have trouble maintaining energy. You can't get them doing their exercise. They're not going to be successful. So I'd rather see people eating a little more of low-density foods. And maybe they only lose a pound a week instead of two pounds a week. But they're more likely to be successful long run than the one that's under consuming

what their body actual needs are. They need to eat enough to maintain optimum weight, just not current weight. That is a common retort with people who play around with adopting a plant-based diet. Like, oh, I felt lethargic. I didn't have enough energy. It's like, well, you're probably used to eating

a certain amount of food and you don't understand that you actually can and should eat more now as a result. And that experience that you're having is most likely tied to caloric under consumption. And there's huge psychological overlay because people have all kinds of issues about volume. If they're conscious about their weight,

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

I mean, 93% of calories consumed in industrialized country come from either animal foods or highly processed foods. 70% is fruits and vegetables. A third of that's potatoes served as french fries or potato chips. I mean, right now, the stuff we're asking people to eat is the decoration on the plate. You can go to restaurants where there's nothing that meets standards. It can be very challenging because so much of what people are doing is highly processed, fried, fractionated foods. That's what most of the calories people are eating. And that's how we've supersized the people. And it's a big ask to say, you need to eat this way, but you're probably not going to have

the ability to go to the restaurants you like to go to. It but you're probably not gonna have the ability to go to the restaurants you like to go to. It's gonna be challenging when you go out for dinner with friends. It's tricky socially to kind of navigate that. And a lot of restaurants have a hard time accommodating that. And if they do, it's a pretty dire, unpalatable situation. Actually, if you go to

a place that actually has a cook, somebody that's cooking it rather than just reheating the packaged materials that are so common in many of the restaurants nowadays, often if you call ahead and you say, look, we have somebody in our group. Can you make a couple of baked potatoes or sweet potato and some salad? You can get a beautiful dish. It can work out really nicely. If you plan ahead or you go to a restaurant you're used to going to and you have a relationship with the waiter or the waitress, they can oftentimes, if the restaurant has some kind of food in the kitchen and somebody that can put it together, that can work out really well. It's just not always the case. Yeah. Do you guys do some consulting or counseling around,

okay, you're going to go to Thanksgiving. You're going to be with the case. Yeah. Do you guys do some consulting or counseling around, okay, you're gonna go to Thanksgiving, you're gonna be with the family, here's how it's always gone down, but here's what you're gonna say. We spend a lot of time- So that you can, you know, still be in the good graces of your loved ones. We spend a lot of time teaching people little strategies,

how to go along and get along and not piss people off and how to keep your mouth shut. And, you know, there are strategies that you can implement. The most important thing is if you're dealing with people that love you and you explain to them that this is not a judgment on them, it's just an adaptation you're making, how much trouble are you if you ask them, could you put a couple of potatoes on for me? You know, or can I bring a salad for everybody? Because they don't want to go through all the process of making that. What are they going to say? Oh, no, that putting a potato on?

No, it's too much trouble. We don't want you here. That's not going to happen. If you explain to a person and you aren't judgmental about it, you don't want to become a born again natural hygienist and walk in the room and say, oh, I can hear your vessels thickening from over here. You're not going to eat that dead, decaying flesh. I mean, you keep your mouth shut.

You don't need to do that. It's just your issue for you, you know, and it is possible to navigate it. Yeah, I think top line, how can you be part of the solution rather than the problem? And if the family or the community of friends like already know that you've kind of jagged in terms of your diet,

there's already a lot of judgment. Oh no, here comes so-and-so, it's gonna be a whole thing or whatever. But if you come open-hearted with a solution, like, hey, I'm bringing food for everybody, as opposed to I'm gonna come and be a problem because I'm gonna make everybody change what they're doing to accommodate me,

I think that's where the problems come in. I'm sure that you experienced some of the same issues, choosing not to drink in a setting where most people are drinking, and they can be very uncomfortable sometimes. Initially, what you realize though, is that you think everybody's thinking about you, but they're thinking about themselves.

People don't care. They really don't. Food's a little bit different because there's a lot of emotion wrapped up in food. And, you know, the sharing of food is how we share love. And that can be tricky and complicated, especially when there's historic patterns and, you know, a way of doing things over time.

But go ahead, sorry. If people will just stop getting in other people's business, like stop worrying about what they're eating and just not, because that's where the people get into trouble. It's not, they're trying to eat well. You haven't been on Twitter lately then, have you? People seem to care a lot

about what other people are eating. Well, they want other people to eat like they are so they can feel supported. They need to stop looking to other people for their support, get their internal support and let them be because you're not going to change them because you make snide comments about their dietary habits and try to prove that what you're doing is better.

Just keep your mouth shut, set a good example, answer only questions that are asked and maybe you'll figure out a way to survive it. What do you make of all the tribalism around diet? What is that about? I really don't know. I was hoping you would tell me. Yeah, it's very strange,

but it's very passionate and heated. We're seeing it now with the carnivore diet. Like that's really grown way more than I would have suspected. And adherents of that lifestyle are very passionate in their views. What do you make of that diet? Well, you see variations on this diet

throughout the last 40 years I've been in practice. And what's good for short-term weight loss, and there is a fasting mimicking effect of going on a carnivore diet, because you get into ketosis, there's a hunger blunting mechanism, and they were already eating meat three times a day. So, I mean, it's not like a fundamental necessary difference, except they got rid of

the carbohydrates. And short-term, they may lose some weight. Long-term, of course, we know what the consequences of high-protein diets are, and it's going to show up and it begins to manifest, whether it be early on the gallbladder disease or later the cancer and other problems that come about. Now, I know they're vehement in defending it, but the data is the data, the facts are the facts. You can't go on that diet long-term as a broad recommendation to the population and expect that that's going to be an overall net improvement in health. Because the standard American diet is so crappy though, almost anything you do, like getting rid of refined carbohydrates, is going to induce some beneficial changes,

including weight loss. So you can't argue short-term. We've got to really look long-term. You've got to look to the scientific literature. I mean, I have to say, I've been surprised myself watching fasting work, but not really understanding how well it worked until we got the data back. And you really, and then look at, I'm getting 30 year, 35 year follow-up on patients. And you're hearing the same stories. Everybody they know is dying. Some of them are outlived their kids. You know, it actually creates its own challenges and stress just, you know, being so far outside the norm on health. I mentioned last time I was here, my mom, when she was 92, had outlived all her friends. And she told me, Alan, warn your patients.

If they do this diet, make younger friends. And she said much younger because even 10 years younger when you're in your 90s isn't young enough. Yeah. We talked a little bit last time about the medical establishments, sort of lack of embrace of you, to put it politely. I mean, you are a maverick and what you're doing and what you're advocating

is somewhat radical and orthogonal to the protocols of the way our medical system and our healthcare system operate. I'm curious, has that changed at all in the interim period since we last spoke? What's going on there? Yeah, I think it has. I think I've gone from being a criminal quack to being a cutting edge researcher. And you can witness the 19 papers we've published in the literature, including British Medical Journal, Curious. Some major impact journals are accepting the case reports and the studies that we're publishing. And I think that that has been beneficial. I think that the work Walter Longo and others have done,

publishing major, you know, Journal of Metabolism 2015 did a fabulous piece, is making it that at least you can discuss it without it being just immediately shut down as crazy. So I think it is starting to shift. I think that the diet clearly has changed. I mean, if you think 40 years ago, if you had people like John McDougall in 1986, pioneer writing the McDougall program, looked on like he was nut job. Now, the idea of plant-based eating as being health promoting and reasonable, I think has at least general discussion. People aren't necessarily adopting it in mass, but they're The idea of plant-based eating as being health promoting and reasonable, I think has, you know, at least general discussion.

People aren't necessarily adopting it in mass, but they're at least tolerating it. I wouldn't think you'd have the same social impact, you know, because you're trying, you didn't happen to have animal foods or something on your plate. Nobody was gonna think you're gonna die that day from acute deficiency.

Fasting, the intermittent fasting, I think, has become pretty much accepted. You've got 10,000 medical offices selling Prolon. So, I mean, you know, there's definitely an acceptance. Long-term water-only fasting, it's going to be up to us and the other people advocating it to prove that it can be done safely and effectively. We're starting to do that now with these publications. What is a study that you'd like to see conducted that has not yet been conducted that would put to rest some of the myths or misconceptions? Well, we are going to be doing a study with a major HMO. We've gotten excellent feedback from

them. What we're going to be doing is we're going to once again look at high blood pressure because that's a common problem. And we're going to be doing the first RCT, randomized control trial, where they'll get their standard of care. And in addition, 40 people, standard of care, 40 people randomly assigned will get a three-week stay at Truman Health Center and go fasting and get the additional education. And this is a practice already advocating a plant-based diet. So these are people that are already being encouraged to try to eat healthfully. In addition, they're going to get some fasting and then we're going to do some long-term trapping of those people. And then what's going to happen, we know what the results are going to be. We did a study with the Mayo Clinic. As I mentioned, we had excellent long-term results, including one

year follow-up. Once we've done that, we're going to approach the same HMO and try to do a prospective randomized control trial in the treatment of lymphoma, which will be much more controversial. And then our hope is that we'll have good enough success that they'll be forced to integrate fasting into their standard protocol and we'll help them do that. And that's part of our foundation's mission is to get fasting to be more accepted in the mainstream. And it may only be for this one condition, but at least that'll be the start that we think we might be able to accomplish. And we've got some good relationships with this major group so that we're optimistic that we can pull it off. One of the things that opens you to criticism is the fact that these studies deal with small sample sizes. And I would suspect a part of that is

because there's only so many people who are doing these extended water fasts, is there a way to increase sample size with respect to these studies to kind of rebut that issue that recurs? Well, the analysis has been done. We know what size samples you have to have in order to get statistical significance. And it's deceptive because the effect sizes are so large, we don't need large ends in order to reach statistical significance and be clinically valid. And so we're meeting those. And that has not been a criticism in the studies that we've done to date, even though they are relatively small-scale studies. Now, yes, would we like to see a large-scale study? Well, what's the limiting

factor? We only have 79 beds. So we can only process so many people. We can process 1,200 people a year. So we can't take on studies more than that. But we don't need to in order to prove the points that we're trying to prove right now. Given all the success that you've had at True North and the fact that you've been doing it for 40 years, it's curious why there aren't versions of True North in major cities across the world? Like why hasn't this model been more readily replicated by other people who can see what you're doing and the success that you're getting? I think there will be.

We have a residency training program. We train doctors that are interested in doing something worthwhile with their life, how to use diet and fasting to get people well. That program has been successful and the economics of it aren't successful. It's healthcare that's not covered by insurance in terms of the stay at the center. We're a 501c3 nonprofit, so we have very modest fees.

If you charged a lot of money, the problem is it takes time. You have people who are there 30 days, sometimes three weeks, six weeks. It would be a very costly process if you had to charge $2,000 a day like they do in the hospital. So we charge a couple hundred bucks a day. We can make it work, but you can't make it lucrative because we're a nonprofit organization. We got a lot of less pressure than most places would. We have modest facilities. We don't do advertising. We don't have to do promotion. We don't have any of the normal expenses that businesses would if you were to go out and do that. So I think it will become more acceptable.

But it probably needs to become integrated into the conventional health care system because almost all health care is paid by these insurance modules or Medicare. That's why we're trying to get it into the HMO so that if they're able to offer it, it becomes an acceptable part of the mainstream. I could see a situation much like, again, with the parallels with treatment centers and rehab and addiction, an entrepreneur coming along and replicating your model, but making it for profit, turning the place into like a high-end five-star spa situation and charging an unbelievable amount of money

and catering to a high net worth person who's extremely unhealthy, who would just pay anything to be supervised to get to the other side. That's where all the other healthcare facilities are. They're all expensive, high end, and they even go further. They're not five star though.

Well, many of the resorts are. I mean, there's a lot of health resorts around. They just don't offer fasting. They're not doing prolonged, I'm talking about specific to prolonged water only. Oh, no, forget that. No, because the people that are going to pay the big bucks don't want to have to do anything uncomfortable. They want to be told what they want to hear. And if you look at most of the examples of resorts, they're pretty good about giving people what they want. I mean, even the Pritikin Center is now serving salmon and all kinds of stuff. So they're going to try

to accommodate the people's needs, but it's a different model. We're essentially a human subjects laboratory that looks like a clinic. And the research is funded by the participants themselves that are participating in the program. That's not a good business model. It works well for our needs, and we've managed to survive. But if you are an entrepreneur, you wanna charge large amounts of money, but that means you have to give people what they want.

This is not what they want. Yeah, that's a tricky one. They want the end result. They want fasting mimicking drugs. But maybe they don't want it, but they do want it. So they're gonna pay a lot of money as long as like the place is really nice and then they're locked up, you know, and they can't leave and they're gonna pay a lot of money as long as like the place is really nice and then they're locked up, you know, and they can't leave

and they're gonna pay a lot of money to prevent them from being able to leave. I could see a certain clientele who might be up for that. Well, I hope that different versions of this do become available to meet everybody's needs. Cause obviously, you know, we can only handle so many people. The size of our facility wasn't based economically,

it was based on the numbers we needed to be able to do our studies. And so we grew the facility to the size we needed so we could actually conduct. Right. To fund the foundation, to fund the research. Exactly. So that's why it doesn't, like I get a lot of very successful people that come as patients and give me lots of advice about how, like for example- Business advice. Yeah. You're running a terrible business here, Alan. They say you're ridiculous. Look at this.

The way you set price in the business is you keep raising the rates until you don't have a three-month waiting list. And then, you know, that's the price point. When it drops down, it's only six-week waiting list. That's the right point. That's not our model. Our model is to get people to come in long enough, stay long enough, and come back as necessary so they can prove that we're right, that health is from healthful living,

that fasting is a safe and effective tool. So if the goal was to make the most money, you don't do this business model. You do the business model where you give people what they wanna hear. It's very funny. We talked about metabolic dysregulation. We talked about diabetes and obesity,

but there's also some other very interesting kind of case studies that you talk about in the book. There's the person who has like the keratic growth on their face. There's psoriasis, rheumatoid arthritis, autoimmune conditions. Talk a little bit about some of these other success stories that you've had with very unlikely conditions

that seem to be resolved through fasting, which seems like a crazy magic trick. It turns out that a lot of these conditions also were caused by dietary excess. Like for example, this is a paper we published just recently, 2023, in Integrative and Complementary Therapies called Prolonged Water-Only Fasting and the Management of Hashimoto's Thyroiditis, a case report. Hashimoto's thyroiditis is the most common cause of hypothyroidism. It's where the immune system attacks your own thyroid. And interesting, there's a theory that they notice the gene,

the HLA-DQ gene that's common in these patients is the same gene associated with people that have gluten sensitivity. And so the theory is that people eat gluten, 1% of the population gets celiac disease, where the immune system attacks the intestine very serious, you have to not eat gluten. And other people, the immune system doesn't attack the intestinal system, but it tracks the thyroid. And that's called Hashimoto's thyroiditis. We've known that the immune system is taking out the thyroid. It hasn't been clear about why is it doing that? Well, it turns out that gluten and dairy products, the diet you eat can dramatically affect your issue.

In this particular case, we were able to use fasting to bring the symptoms that are associated with this condition under control. This was a 61-year-old, and she had weight gain issues, edema, joint pain, constipation, cold sensitivity, brain fog, all the symptoms that go along with this condition. And she ended up undergoing fasting for 21 days, had 10 days refeeding, had fabulous outcome data. And obviously not just on terms of her thyroid function, but she lost weight as you'd expect. Her blood pressure dropped from 134 down to 108. Her thyroid or TSH went from 61, which is very high

down to 6.8. Okay. So CRP, which is a measure of inflammation, went from 13 down to 1.2. So huge clinical impact on how she felt and how she funked. And you wouldn't normally think Hashimoto's thyroiditis would be responsive to diet and fasting, but it is. And was there follow-up long-term? Well, right now now this paper was just published in 2023. So she's continued to do well so far, but we don't have long-term effect. You know, some of these other cases where we've been tracking them for 10 years,

it's obviously quite impressive. I wanted to point out though, that we've have cases that we've published here that where we just did the diet. So in other words, they didn't even involve prolonged water only fasting. One was an 82-year-old gentleman who had atrial fibrillation, all kinds of cardiac related symptoms, hypertension. We put him on the diet only and then took him off his medications. He was on a number of medications, weaned him off his cardiac medications. And not only did he completely normalize his blood pressure and his cardiac rhythm and

get off all of his medications, but they thought he was having dementia. He actually woke up because he wasn't having dementia at all. He was having polypharmacy. He was having negative reactions to his host of medications he was taking. So here's a guy who ate carefully. Our medical doctors helped him wean his medication safely. And what was fascinating, we submitted this case report. This was also the British Medical Journal.

And one of the reviewers said, "'Wow, what an impressive case, "'but what made you suspect it was the drugs?' Wow. Because these are medications that people are commonly put on. You mentioned carotid lesion on a face. Often, these lesions just fall off during fasting.

Again, these products are more common in patients that have active inflammation. Fasting tends to reduce it. The body is able to stimulate the healing responses. active inflammation, fasting tends to reduce it. The body's able to stimulate the healing responses. And so we'll get impressive cases like plaque psoriasis, which is a disfiguring, really dramatic condition. Most doctors will tell you diet has nothing to do with it. Or maybe they might say, well, maybe you shouldn't eat too much dairy products or something. And the photos that are present on the study show within 10 days of fasting, you're starting to see changes and then two month follow up

and just dramatic resolution of plaque psoriasis that's sustained as long as people are willing to do a health promoting diet. That's very interesting. A lot of people suffer from that and it's very resistant to treatment. People spend years trying to figure out how to resolve it, many unsuccessfully.

And we found that it responds consistently and it is difficult. It's not an easy condition to treat, but it does respond. And we've had significant clinical responses to it. And it's not like shocking to me because autoimmune diseases, diseases where the body's attacking itself, are often associated with gut leakage, where proteins get absorbed and in genetically vulnerable people, the immune system reacts inappropriately. And most of your itis conditions are essentially autoimmune conditions, whether it's Hashimoto's, thyroiditis, or vasculitis, or rheumatoid arthritis, or asthma, or eczema, or plaque psoriasis. These all have this gut leakage that appears to be a part of the component.

When you fast, the inflamed gut gets to heal. And then when you go on a whole plant food SOS-free diet, you don't have the oxidative damage that's coming from the highly processed foods and the animal foods. And so you're able to manage the condition. If you take those patients and put them back on conventional diet,

so oftentimes their symptoms recur. So I don't think you're curing it, you're managing it. Just like you can't cure obesity. You can lose the weight and keep it off, but go back to the old diet, guess what? You're gonna get overweight again. Yeah. Have you had success or experience with people

that have other forms of bowel disorders like ulcerative colitis, other things that are related, leaky gut, et cetera? Irritable bowel, chronic constipation, ulcerative colitis are some of the conditions that we have the most experience with because these are conditions that typically don't respond well to conventional medical treatment. We tend to get the people that have tried everything and they're desperate. And that's traditionally been our- Yeah, I know people that have struggled for years trying to figure out a way to get it

under control. Getting it under control is easier than keeping it under control because keeping it under control requires dietary control. That means, you know, things like gluten and wheat and sugar, you know, keeping a whole plant food diet going. And then there's another problem is many of these conditions are also aggravated by the hormonal changes associated with chronic stress. So when people are under chronic stress, they have a different hormonal production associated with chronic stress. So when people are under chronic stress, they have a different hormonal production and stuff that makes them vulnerable to lots of things. And so some patients have to actually change their life.

So they're not driving two hours a day to a job they hate and working in places they despise, doing things they don't wanna do. They have to actually find things that give them joy in life in order to be able to get well and stay well. Right, so fasting isn't this panacea that heals all. And one of the things you're always quick to say is that it's a practice, not a magic pill, basically.

I mean, it's pretty dramatic, the results here, but I think it's important to place it in context of all the other kind of co-founding factors. It's dramatic because you're dramatically changing the diet and lifestyle. It's an environment to dramatically change the diet and lifestyle. And so if you don't change the diet and lifestyle,

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

So I don't know from personal experience, but basically it allows you to access a certain state that you could achieve through a very devoted practice of meditation over a long period of time. But you can reliably and immediately achieve that instantaneously. Yeah, I don't know if it's instantaneous,

but I do think that the fasting is a great facilitator. And like I say, I would always encourage people, and we do, to adopt the diet and lifestyle changes. And if you get to the point where you're frustrated because you're not making adequate progress, then we can talk about whether it's coming to the center in fasting, or now we have the opportunity for people to fast remotely, which has also been helpful to people that maybe can't come to California or don't have the resources. And that's through our telemedicine practice, which since our conversation three years ago, we've had to dramatically expand.

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

it's hard for them not to be too active. And then most critically, getting them to refeed properly after fasting. Too rapid a return to alimation can lead to refeeding syndrome and other problems that can be serious or even fatal. So it's important if you're going to fast on your own, that you use the same protocol that we use at True North House Center, which is why we've written this new book, Can Fasting Save Your Life? And in that book, as you saw, we have detailed protocols that the patient's doctor can use to explain what kind of testing and monitoring needs to be done so that they can make sure that that gets done. It goes through the side effects, the concerns, adverse events. The data's all there. It summarizes all of this literature that we've done, literature other people have done on fasting, and it's

brought together in a cohesive manner. And so people can read that book. They can share it with their physician. They can use our coaches through the telemedicine practice to provide them personalized support because their doctor may be able to help them monitor them medically. They're not gonna know how to deal with the issues that come up in fasting.

Sure, and it's not an inpatient situation. So they're not there monitoring them multiple times a day. Well, it means there are certain people that maybe wouldn't be good candidates for that, and we would encourage them to come inpatient. But there are many people that are relatively healthy, that are on medications. They might be a good candidate for a shorter fast at home. And we've done other things. We've made all of our daily lectures freely available to anybody through our website. We use live streaming. So we're live streaming

our lectures so they can get the benefit. We have a Roku channel now, freely available, all of our recorded video, so they can get the educational experience. They just have to have a home environment where they can rest. I mean, it's not, you can't take care of four kids and commute, drive to the store and do all that kind of stuff if you're fasting. You have to build a rest. But if you can, and you have a supportive doctor and you utilize our telemedicine coach, that is a way that we've been able to successfully help people. Like we had a huge problem during the pandemic. 15% of our patients come from foreign countries. They couldn't come into the country. And so we were working with remote doctors, and we were able to successfully

help people that really needed that. Now, there are some limitations. We don't do long, we don't go over three weeks with remote fasting because it gets more complicated as you get deeper. We don't do it with people that aren't stable off medications and we don't do it with people that are poor candidates for fasting. So, but for the right person, this is another way for them to get that experience. I would imagine an additional challenge

is finding a supportive doctor. Like how many doctors are actually gonna be supportive when the average person goes to their GP and says, I want to do this thing. The book hopefully will redress some of that, but I imagine that that patient is going to experience some resistance. number of doctors that have trained with us through residency internship programs that are out there in the world. There's also the College of Lifestyle Medicine, whose many of their doctors are supportive of fasting. There's also some of the integrative medical doctors out there that have become more supportive of fasting. And remember, Valter Longo has 10,000 offices making Prolon available. Many of those doctors might be supportive. And then once a doctor has one patient and they have success, all of a sudden we're seeing all kinds of their patients. Now, again, some people are better candidates for inpatient care. Some people are fine for outpatient

care. And one of the benefits of the free consult that I do with people is to help them. Are they a candidate for fasting? Are they a candidate for home fasting? If so, then we can hook them up with a doctor that provides those services. If they really need to do it inpatient, they can come to the center. They can go to the other places that do this kind of thing. Or maybe what they need to do is just adopt the diet and lifestyle principle long enough to where then they become a good candidate for those changes. So we're trying to make sure that whoever does it, does it intelligently and does it safely. Not everybody's going to follow our advice, but at least we can feel good that we've done our best to make the educational services available to everybody, to make the services

available to people at home that are good candidates for that. And we have a facility for people that are better candidates to come inpatient. Who isn't a good candidate for inpatient? So a person that's on medications that you can't safely withdraw. For example, if you've had a recent pulmonary embolism, cardiac arrest, you have atrial fibrillation and you're on an anticoagulant therapy medication, you don't just stop those drugs

because it can induce a stroke. So it's very careful protocol to withdraw those meds and you don't fast on those medications because they can become, like many medications, greatly potentiated during fasting. They will work differently in the physiology of fasting than they are in the physiology of feeding. And so fasting medications don't go together.

There are a few exceptions. Sometimes we'll allow some hormone replacement therapies like thyroid replacement therapy stuff to modify the dose and monitor it. But, you know, it's not an absolute barrier. We discuss that in detail in Can Fasting Save Your Life? We talk about who's a candidate, who's not a candidate, what has to happen in terms of medication. But it's basically, you have to get people stable off meds. You have to have people that have a condition that we believe are likely to respond to fasting. We

don't want to be doing experiments on people, particularly remotely, unless we kind of know what their condition is and what symptoms they're likely to experience so we can educate them about that. You need to have a person that's willing to try to eat healthfully after fasting. It's no good to do a fast and then go on some crap diet and get terrible symptoms and then blame fasting. You know, I'm not interested in that. We're trying to actually get a good net long-term result. And that means we have to limit working with people that are, you know, willing to try to do these things. Not everybody's going to be perfect.

A lot of people are going to struggle, but if they aren't going to make a good faith effort, it's probably not the best thing to do. They should be doing some other kind of program that isn't, you know, going to put them at risk. How do you make that determination during the intake process to gauge willingness? Well, first of all, they filled out a detailed medical questionnaire. So I have their medical

history that I've reviewed before I've talked to them. And we ask those questions in the questionnaire to gauge where they are. And also I've interviewed tens of thousands of people. And also I've interviewed tens of thousands of people. I mean, essentially that's what I do is I talk to people on the phone about their specific issues and try to direct them in the right place. And I've been doing it for 40 years. I got a pretty good idea who's likely to behave and who's not gonna behave

and who's a good candidate and who's not. And witness that everybody that's walked into the center, 25,000 people now for fasting, probably close to 40,000 people overall, everybody that's walked in has walked out. So we're pretty good at making sure we don't bring in people that are not good candidates. Not everybody has an uneventful stay. There are patients that have serious side effects that we have to deal with. Occasionally we'll have to hospitalize a patient. If they get into an issue, we'll have to get diagnostics done, whatever. But as the safety studies show,

this is a comparatively safe process when it's done according to protocol. What is your personal fasting practice? I fast every day. So you never eat? I fast every day. So you never eat? I fast every day for 16 hours. Or as close to 16 hours as I can manage. You're on a 65 year fast.

I fast every year. So you do a 16 hour fast every day. Every day. So you eat between the hours of what and what? Well, I usually have, depending on which morning it is, because I play basketball in the mornings. But so depending how long the basketball goes, I'm eating between eight and nine in the morning.

I'm not eating after five, 5.30 at night. So I have a window in there of feeding. And then I don't have anything before or after dinner. So I do that every day. I fast once a year. I fast for a week. If I'm doing okay, no symptoms, then I'll stop it. If I have symptoms, I'll go however long it takes

to resolve the symptoms. I don't like fasting. You have to rest when you fast. You can't play basketball. It's really annoying. My wife is, Dr. Marano, is really strict about it because I fast, she's my supervisor when I fast, and she won't let me on my computer.

That's the hardest part of all. I let the patients have their computer. What do you do all day? Oh, I just lay around and meditate and rest. And it's awful, but you know, I don't have symptoms, which is interesting because I've done this. I mean, I've, you know, I never smoked, never had a drink. I never, you know, I've been a vegetarian

since I was 16 years old. So I've not had the exposure. So there's not a lot, I don't use medications, I don't use drugs. So the fast itself is boring. Nothing happens in terms of untoward symptoms, but you still have to rest. And for me, that's the big challenge is slowing down.

And I do, I find it some of the most beneficial intervention I do is fasting, but it's not pleasurable. Sure. And your blood work is, yeah, it's gonna be. Yeah, my blood work's good. My blood work's great, my blood pressure's great. But again, I started as a kid, so you would expect it to be. You've been doing this a long time.

It's so interesting. It seems so severe and radical to undergo these things, but so many people, thousands and thousands of people have benefited from what you're doing. You practice it yourself. What is radical though? Radical is radicus. It means root or cause.

That's the fundamental thing we're doing is we're actually getting to the reason people have these problems. We spend all of our time and money treating the leading causes of death, heart disease, cancer, stroke, diabetes. Instead of the leading cause of death, we don't deal with the actual cause of death, which is smoking, drinking, eating animal foods and highly processed refined carbohydrates. If we put our time and energy treating the actual causes of death instead of the leading causes of death,

we'd probably be a lot better off. The reason isn't going away. We talked about the statistics earlier. They're quite dire, but I don't see an eradication of highly palatable ultra-processed foods disappearing from our food environment anytime soon. If anything, it just continues to metastasize

and people are getting more and more sick and fatter and fatter. It doesn't appear to be headed in a great direction, which demands these types of interventions to save people's lives and get them on a different track. What is your prescription for the world? Like, how are we going to, as a collective, conquer this challenge that we have

in terms of our food system to create something better? I mean, honestly, for the sake of humanity. Yeah, you know, to me, if I look at humanity as a whole, it would be very stressful and I don't like stress. So what I do is instead, I look at fact that I'm going to do everything I can do to influence the one or one and a half or two percent of the population that are hungry for information, willing to make these changes and hope that if we can get those people optimizing their health, that they'll set a good example and the hundredth monkey effect will kick in and maybe it'll have some downstream effect,

maybe not in this generation, but in future generations. So I'm not gonna try to take on the world as a whole. I only wanna work with the highly motivated people that are willing to do what it takes to actually get and stay healthy and prove that this is an approach that can help them, you know, spend the last 20 years of their life healthy and happy.

And to kind of end this, maybe, you know, look to camera and say, what is the message that you want the person who's listening to this or watching to understand? Maybe that person has their own health challenges. They're trying to figure out what to do about it. They're a little bit scared or intimidated by what you shared and aren't really sure-footed about how to take that first step or where to begin? Well, health results from healthful living. So if you wanna be healthy,

you gotta pay the price and live healthfully. That means diet. Our particular version is a whole plant food SOS free diet. Other people have different opinions, but a healthy diet, hopefully. Regular exercise within your capacity. Abundant sleep, so developing the ability to get to sleep in a cool, dark

and quiet place and maintain good sleep hygiene, fast every day for 12 to 16 hours, fast occasionally as appropriate and try to figure out strategies to minimize stress perhaps by only focusing on the things you can do something about and not worrying about the things that you have no potential to control. I think we covered it.

Is there anything we didn't get to that you feel compelled to share or talk about? No, I think this book that we've written is a really good book. I hope people read it. I hope they like it. And I'll be interested to hear what feedback we'll get after this show.

The book is great. It's called, Ken Fasting, Save Your Life. Everybody should pick it up. We'll link it up in the show notes and in the description below the video. You can go to the True North website to learn more about everything that Alan is doing and the center there.

Maybe they can find the email on that website if they wanna get in touch with you. Yeah, if they wanna- What's the best way? What they go is they go to truenorthhealth.com. They fill out the email on that website if they wanna get in touch with you. Yeah, if they wanna- What's the best way? What they go is they go to truenorthhealth.com, they fill out the registration forms, which gets me their medical history, and we offer them a no cost screening call so that we can kind of give them,

help them review their options and point them in the right direction. That's great. You're doing great work. You are truly a servant to humankind and I appreciate what you're doing and the gift that you're sharing. And thank you for coming here today and getting into it with me.

I think people are gonna really enjoy it. Thank you. Yeah, it's great. Thank you. Peace. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today,

visit the episode page at richroll.comcom where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts,

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