In this episode, Riordan Clinic providers Dr. Ron and Laura Vasquez, MSN,APRN, NP-C dive deep into the workings of intermittent fasting. They discuss what it is, how to do it, and who is safe to try it.
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Ron Hunninghake: Well, welcome everyone. It’s Dr. Ron Hunninghake again. We’re doing the Real Health Podcast here from Riordan Clinic, and it’s my pleasure today to welcome back Laura Vasquez, who is a Nurse Practitioner at the Overland Park office. Laura, howdy.
Laura Vasquez: Hi Dr. Ron, Happy Friday.
Ron Hunninghake: Happy Friday, TGIF. And so anyway, today we’re going to tackle really something that’s just caught on like wildfire among people who are trying to get healthier, lose weight, improve their longevity. And it is intermittent fasting. Laura, why am I interviewing you? Are you an expert on intermittent fasting?
Laura Vasquez: I have been practicing intermittent fasting for about four years now.
Ron Hunninghake: Wow, that’s great.
Laura Vasquez: So I have a personal experience with it. And then working previously with patients with metabolic disorders, cardiovascular disorders, this is something that I brought to my patients as a way to help with their blood sugar control, possibly lose a little bit of weight, burn more fat. So there was a lot of benefits for my patients that I had previously worked with. And I continue to advocate for patients and educate about the benefits of intermittent fasting. It works great, and it’s a great tool to use for health.
Ron Hunninghake: Well, given the fact that about 78% of Americans are struggling with the metabolic syndrome, which is kind of a pre-diabetes, or in many cases, it’s already moved into diabetes, and given the fact that metabolic syndrome sets you up for all kinds of other problems; autoimmune disease, chronic inflammatory conditions, cancer, heart disease, as you mentioned, sleeping difficulties. So is this one treatment? How does this affect the root causes of metabolic syndrome?
Laura Vasquez: That’s a great question. So intermittent fasting is a time period where you will abstain from caloric intake. So you can still have water, if you wanted to have a little bit of tea. You can still have some liquids that don’t have fat, sugar. But the real benefits of it are multiple, so it affects multiple pathways in our body. One is insulin resistance, so when patients are having too much sugar in their bloodstream, their insulin levels have to increase. And over time that causes, like you mentioned, diabetes, obesity. That’s really the root driving force of that.
Laura Vasquez: With intermittent fasting, it helps reregulate your blood sugar. So your body is able to burn fats or ketone bodies instead of running on a glucose metabolism for that time period when you are in that fasting state. And so it really improves your metabolic flexibility and allows your body to do what it wants to do, is regulate, have healthy insulin levels, and regulate that blood sugar control.
Ron Hunninghake: You know who has really good metabolic flexibility? Kids. Now they can eat or not eat. Especially if they’re playing, they’ll forget to eat. Whereas adults who are struggling with metabolic syndrome, man, if they don’t eat, they crash, and that’s because their blood sugar will drop. And they’re looking for the fastest way to get their blood sugar back up again, which unfortunately is refined sugar oftentimes, or caffeinated beverages that are high in sugar, like pop and things.
Ron Hunninghake: And then the result is they’re on a roller coaster ride. They’re either low blood sugar or high blood sugar, and that’s their day. And this really tends to weaken their adrenals. They tend to get into bad eating habits. And they certainly can’t go very long between meals. So is this where intermittent fasting can be a benefit to people?
Laura Vasquez: Yeah, absolutely. It’s very easy to put into practice. So most people are fasting while they sleep, unless you’re raiding the refrigerator in the middle of the night. So you’re getting that time period, let’s say after you eat dinner or after you have a maybe evening snack, you may be fasting for 12 hours and not even realize that you’re doing that at this point. But it’s easy to increase your fasting window.
Laura Vasquez: So as we had talked about previously, I usually tell patients as well to increase that by an hour. Maybe starting out, you’re going to fast for 13 hours. So after you eat dinner, you’ll wait to eat in the morning for that 13-hour period. And then you can gradually increase that to 14 hours, 15, 16. So there’s different ways to intermittent fast. Some patients or people like to fast for a 24-hour period once a week or twice a week. And so there’s different ways to shorten your feeding window. And you’re going to get so many of these benefits, including just as we talked about, improving your metabolic flexibility, where you’re not having cravings, your mood is stable, reduce your brain fog, maybe promote some weight loss. So yeah, there’s so many different benefits to practicing this.
Ron Hunninghake: Intermittent fasting is not a diet per se.
Laura Vasquez: Correct. I like to say it’s not what you eat, but when you eat.
Ron Hunninghake: It’s not what you eat, but it’s when you eat. And what you’re saying is that there’s a lot of flexibility in how people can do this. Matter of fact, I would say a lot of people do intermittent fasting and don’t even know they’re doing it. Maybe if they skip breakfast, either not intentionally but just because they run out of time, they’re intermittent fasting. But what would be the problem with just skipping meals? How is this not intermittent fasting?
Laura Vasquez: The body likes to be on certain rhythms. And so I believe when you do consciously set up intermittent fasting into your schedule or your lifestyle, your body knows when to expect to eat. So I typically like to intermittent fast for about 16 hours. So I’ll stop eating about 7:00 at night, break my fast around 11:00 AM. My body is used to that feeding window and that fasting window. And so I feel like it’s improved my mood, it’s improved my mental clarity. It improves your appetite. You would think you would be having periods where you feel really hungry, but over time as you practice this, you will stabilize your appetite. And so your body knows when to expect to eat and break your fast around 11:00 or 12:00. So it’s easy to do. I’m so sorry. I don’t know what the question was, but I kept talking.
Ron Hunninghake: Well, what I was getting at is that it sounds like intermittent fasting does involve intentionality. In other words, you hear about this as being beneficial for your health. You know you’ve skipped meals before and maybe you didn’t feel very good because you got low blood sugar. But now with intermittent fasting, what you’re going to do is maybe start out two days a week. And instead of eating your breakfast right at 7:00, maybe you’re going to delay it to 8:00 or 9:00 and see how you feel. And if that works out, you stabilize that. And then another week or two down the road, you decide I’m going to go to 9:30 or 10:00.
Ron Hunninghake: And as you gradually create the ability of your metabolism to sustain a fast without getting really tired or irritable, you’ll notice just what you were saying, that you start to feel better. And sure enough, a few pounds have dropped off. And you haven’t really dieted because the psychology of dieting is… I mean, most people know that diets really don’t work for most people. I mean, they can’t sustain it, they don’t like it. And in the initial phases of intermittent fasting, I don’t think you really need to make a big dietary change, though you can improve the effects of intermittent fasting by making some changes in your diet.
Ron Hunninghake: So Laura, what would you suggest some of the gradual changes that people could make in their diet that would make this intermittent fasting work better for them?
Laura Vasquez: I typically will educate my patients on what to eat when they break their fast. So instead of grabbing a pastry or a donut or some kind of refined carbohydrate, I will have them break their fast with protein and some healthy fats, like perhaps a salad with mixed nuts, a vinaigrette, maybe salmon or chicken, whatever form of protein. So I want them to break their fast with fiber, protein, and healthy fats.
Laura Vasquez: I have found that when you have been fasting you typically, although you are hungry and ready to break your fast, you’ve changed hormones in your body. And so as soon as you start eating and your body starts digesting, it doesn’t take as much food to typically fill you up as it may have before when your blood sugar was erratic and you were starting your day off with some refined carbohydrates or sugar in your coffee. Your appetite is, I feel, more controlled. And so that’s how I approach it with my patients is breaking their fast with a really healthy, whole food meal.
Ron Hunninghake: I think that issue of control is really important in intermittent fasting because I hear a lot of people say, “I just can’t control what I eat.” And I think it’s due to fluctuations in their blood sugar. And what’s happened to most Americans who are either in metabolic syndrome or heading towards it is that their body is spending most of its time in what’s now being called glucosis, where glucose is the ruling, shall we say energy nutrient that people depend upon, and they get hooked on all kinds of sugary type things. And when they have low blood sugar, they look for more sugar.
Ron Hunninghake: And what I understand intermittent fasting to really be good about is that it helps us become better fat burners, which is called ketosis. So metabolic flexibility means that you can spend time in ketosis and feel good, or if you do eat some carbohydrates, yeah, your body can shift back into glycolysis and do just fine. But the real advantages of intermittent fasting is that it’s an easy way to get into a state of ketosis. And so then what are the benefits of ketosis? I think you mentioned some of them already.
Laura Vasquez: Yeah. So we run on either a glucose metabolism, or we can run on a ketone metabolism, which is fat body. So burning fat for fuel, or sugar for fuel. Our bodies are designed to do both. And so, as you mentioned, when you become more metabolically flexible, you’re able to switch back and forth between those metabolisms without feeling bad. And so burning those ketones, it’s a healthier fuel source for ourselves, especially the brain loves fat. And so that is why you feel maybe more mentally clearer or your mood is stabilized because you’re burning a cleaner fuel source in your body. There’s lots of research on the impacts of cancer prevention or healing cellular damaged DNA when you’re in ketosis. So it’s an easy way to get into ketosis. And then obviously watching the diet as well. But I think it gets easier over time for patients as they feel better when they’re in ketosis.
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Ron Hunninghake: So I’m going to acknowledge that for the last maybe year and a half, two years, I started doing intermittent fasting, and mostly just by not eating breakfast, and very intentionally not eating breakfast. And it doesn’t mean now there’s some days, some weekend days or now and then I’ll have breakfast, and it doesn’t screw up your intermittent fasting. It’s a choice thing and that’s, I think one of the real advantages. People don’t have to feel like they’re on a diet or they’re being forced into some kind of reregulation of their eating. And the benefits though; clearer mind, more energy, not having to go run look for snacks because of low blood sugar, and then the weight loss. So weight loss is a gradual benefit of intermittent fasting. But is it something that people should be the looking for as the reason to do intermittent fasting?
Laura Vasquez: No. I typically don’t see patients lose a substantial amount of weight. Again, that’s individual because some patients who have a lot of insulin resistance, they may lose more weight once they start practicing intermittent fasting for someone, who again, may have been a little more metabolically flexible to begin with. Yeah, but it’s not truly a weight loss plan. It can be incorporated into a healthy plan to stabilize weight. Because again, if you’re promoting ketosis, that is going to help burn some of that excess fat that you don’t need on the body.
Laura Vasquez: But I think overall, lots of research showing intermittent fasting decreases inflammation. And we know that when you’re in an inflamed state, as a lot of Americans are at this point with the obesity epidemic, then you’re walking around with a higher level of inflammation. And that does not help promote weight loss when you have a lot of inflammation, it promotes weight gain.
Laura Vasquez: And so overall the intermittent fasting, I think one of the greatest benefits is that reduction of inflammation and helping to stimulate your immune system. So those are really, for me, when I educate patients on preventing chronic disease or reversing chronic disease, this is a great tool to use for those inflammatory disorders. And so that’s what I really think is probably the greatest benefit.
Ron Hunninghake: When I first started out, I first heard about it, I was concerned that medically, I would be causing my patients to lose muscle mass if they were fasting, because I was taught don’t fast because you’re going to lose muscle mass. Is there any credence to that?
Laura Vasquez: That is a myth. So actually research has proven that when you are in a fasting state, you increase your level of human growth hormone, which promotes lean muscle mass, and again, fat loss. So it’s actually the opposite of what we would think. If you were in a fasting state where for days and you go into starvation mode, that’s when you’re going to see the muscle loss or decrease in metabolism. But yeah, those are actually myths that I think a lot of people think of when they think of fasting. So it’s not true.
Ron Hunninghake: So your metabolism is not going to go down when you do intermittent fasting.
Laura Vasquez: No, they actually showed that you can increase your metabolic rate by 3- 14% with intermittent fasting. So it actually increases your metabolic rate.
Ron Hunninghake: Okay. Maybe we should talk a little bit about, let’s say people, they’re listening, they haven’t done this before, what would be a kind of first step in terms of choosing a type of intermittent fasting for them?
Laura Vasquez: I like to have people, as we mentioned briefly, I like to have people look at what they’re doing currently. So maybe they are eating a late night snack before they go to bed. That may be something they go ahead and decide not to do. And they choose that fasting window. So maybe it’s 8:00 PM to Noon.
Laura Vasquez: But I like to have them start slow. So whatever they’re doing currently, maybe they’re doing about a 12 or 13-hour fast every night unintentionally. I like to have them start that for first week by adding an hour and see how they feel. And that second week, go ahead and add another hour to your fasting window. So maybe they’re up to 15. And then try to work to 16. Some people typically will feel best with like a 16-hour fast and an 8-hour feeding window. Some people feel great and are able to do 18-hour fast with a 6 hour window. Or like I mentioned, they may want to do one day a week, a 24-hour fast. And they find that makes them feel better, that’s easier for them to do, so there’s so many ways. I like to have my patients see what feels best for them.
Ron Hunninghake: Some people are going to want to skip breakfast, so to speak. And that would be where you’re extending your fasting time in the morning. There are those people I know though that say, “I got to have breakfast for what I do.” And so for them, they would have their breakfast, and have a lunch, a late lunch, and then not eat a supper.
Laura Vasquez: Exactly.
Ron Hunninghake: So it can go either way. And it depends upon how that person feels, the hours of their job, those types of the things. And because this is a flexible program, people can shift that around, like weekends could be different than weekdays. Or you could do it different ways if you were on vacation or if you had different days off. So the beauty of this is you can individualize it to fit your own schedule and your own metabolic makeup.
Laura Vasquez: Absolutely. I’ve had patients before that, as you mentioned, they’re not home from work until later, and they want to eat with their family. And so skipping breakfast for them is the best way to intermittent fast. Or vice versa. Some people take medications in the morning or feel that they need to eat before they get to work. So they typically just have an earlier dinner or a late lunch. And so it is extremely flexible and individualized. And just like anything, patients can really try it out and see what feels best for them. And, yeah, it’s just a great thing to start incorporating if you’re not already doing it.
Ron Hunninghake: One benefit I think we got to mention is that because you’re getting better at not having your blood sugar drop, I, myself and I think a lot of people have told me that they sleep better. Because during the night, I think a lot of people have low blood sugar which wakes them up or causes a restlessness. And if you can fast during the day, that means you can fast better during the night and you’ll have a better night’s sleep. So that’s a definite benefit. Maybe we should talk about who should not do metabolic fasting or what’s the wrong way to do metabolic fasting intermittently.
Laura Vasquez: Yeah. So I think in terms of who should not do intermittent fasting, there really is no research that shows this is harmful to any individual, again, because you can do it in so many different ways which you can figure out what works best for you.
Laura Vasquez: I have had patients who have adrenal fatigue, which may be elevated cortisol levels, chronically, or low cortisol levels, either one. They typically don’t feel as good doing longer fasts. So they wouldn’t be a great candidate for an 18-hour or a 24-hour fast because it does put a little bit of good stress on the body. But I will have those patients who we know they have some adrenal issues or we feel they do, I will have them do again, a 12-hour, see how they feel, try to increase it. And once they’re not fasting and they’re in that feeding window, I do like them to have protein. And maybe they eat every 2-3 hours, just very small, like more snacks of healthy fat and protein. They typically feel better when they’re eating every few hours, just even if it’s not a lot or a big meal.
Laura Vasquez: That is really the only patient that I’ve ever worked with who I feel may have a little more trouble getting into the fasting state or not feel as good if they fast for a long period.
Ron Hunninghake: And it might be good for someone to find themselves a coach, someone who, like yourself, has done intermittent fasting and knows about nutrition and can provide some guidance and feedback if there are issues. I know another big question that’s out there right now. What about my morning coffee or my morning tea? Do I have to fast from morning coffee or tea?
Laura Vasquez: No, you actually can have your coffee, but you would want to have it black. So you do not want to put cream, half and half, sugar. That’s going to take you out of that fasting state and you’re going to initiate digestion. I would still encourage patients not to overdo the coffee when you’re fasting, because that again can stimulate cortisol levels or blood sugar spikes if you’ve had too much caffeine. So do it in moderation, but yes, have the tea without the honey or sugar, make sure you’re hydrating. It’s a great time, when you wake up, to drink a big glass of water. You can even put herbs or lemon, lime in your water. That has zero calories. So there’s lots of no-calorie or low calorie beverages that you can drink while you’re fasting.
Ron Hunninghake: Also because this intermittent fasting creates a state of ketosis, couldn’t a person also use some MCT oil in their coffee as a way of kind of helping the brain get some of the better oils for thinking and energy? And that way, you would have a little bit more substance if you were having some blood sugar dips during that timeframe.
Laura Vasquez: Yes. I love that suggestion. I have done that in the past and I don’t do that consistently, but that’s a great idea to promote continued ketosis and give them some healthy energy in the morning.
Ron Hunninghake: So really all of this boils down to a wellness technique, that in wellness you’re learning ways to take better care of yourself and to promote healthier functioning of your body. And this is a lifestyle choice that anyone can do. And if they go about it slowly and read up on it, or listen to this podcast a couple times, you should be able to initiate this and start to derive benefits really very quickly from it. It takes a little while for the more extended fast to become operational in your body, but certainly short… It’s really like an exercise program. You don’t go out there and try to run 10 miles the first time. You want to kind of ease into it and get your body acclimated to a higher level of fitness. And so this is one way of creating better metabolic fitness.
Laura Vasquez: Yes, that’s all absolutely true. I really encourage anyone who has not tried intermittent fasting to make a goal to start incorporating this into your lifestyle. And just as we’ve talked about, some of the techniques of starting slow and listening to your body. And I think our listeners will find numerous benefits once they start adopting this into their daily routine.
Ron Hunninghake: Well, Laura, thank you very much. I hope this has inspired people to give it a try, ease into it, find out that they are capable of doing it, and deriving great benefits. So thank you for your wisdom and your background experience in this. And hopefully we can help our patients live better and longer through intermittent fasting.
Laura Vasquez: Thank you so much, Dr. Ron. I really am passionate about this topic, so I’m glad we got to discuss this today.
Ron Hunninghake: Yep. This is definitely a way to experience real health. Thank you everyone for listening in and we’ll be back next time.
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