Hypoglycemia from intermittent fasting??

[caligas]

I am an anesthesiologist so I’m looking for insight from my IM colleagues, especially endocrine.

My golf buddy claims that he occasionally gets hypoglycemia late in the morning when intermittent fasting. Totally healthy, non overweight 45 year old. No meds. Fasts from 6 pm to 10 am. Says he gets visual disturbances that sound like scotoma, maybe some lightheadedness. Reverses with food. Worse if exercise before food.

Seems like healthy pancreas/glucogon would prevent this, am I wrong?

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[DrMetal]

I am an anesthesiologist so I’m looking for insight from my IM colleagues, especially endocrine.

My golf buddy claims that he occasionally gets hypoglycemia late in the morning when intermittent fasting. Totally healthy, non overweight 45 year old. No meds. Fasts from 6 pm to 10 am. Says he gets visual disturbances that sound like scotoma, maybe some lightheadedness. Reverses with food. Worse if exercise before food.

Seems like healthy pancreas/glucogon would prevent this, am I wrong?

Yes, possible, he's fasting too long. I do intermittent fasting. I don't recommend more than a 12 hour fast. You can break the fast with a small meal, but it shouldn't be longer than 12 hours.

More importantly, what's his handicap?

 

[VA Hopeful Dr]

Yes, possible, he's fasting too long. I do intermittent fasting. I don't recommend more than a 12 hour fast. You can break the fast with a small meal, but it shouldn't be longer than 12 hours.

More importantly, what's his handicap?

Nonsense. I and plenty of other people do the 16 and 8 route without hypoglycemia.

 

[NewYorkDoctors]

While awaiting for an expert endocrine input , the internist in me asks … did he actually measure the glucose when he felt symptoms ? Don’t the endocrinologists do a 72 hour fast in hospital when working up insulinoma and even those patients last longer than a standard intermittent fasting time restricted eating duration ?

What was that triad called ? Whipples ? We’re all criteria met ?

Maybe he needed a snickers bar ? (This is not a high bMI joke . I’m just saying you’re not yourself when you’re hungry !)

 

[NotAProgDirector]

Is it possible? Sure. But I and many others fast for the Jewish holiday every year, 24 hours, without any issues. My experience is that people who complain of hypoglycemic symptoms on fasting often have normal blood sugars, and their symptoms are due to other issues.

 

[NewYorkDoctors]

not to derail the thread but why do you all do the time restricted eating? this is not a criticism. just wondering.

Compared to just calorie restriction alone it was not more beneficial for weight loss

https://www.nejm.org/doi/full/10.1056/NEJMoa2114833

BUT.... sometimes doing the time restriction has a BUILT in regimen and helps with caloric restriction as it is very cumbersome to count calories accurately unless you are preparing, weighing, and eating the same foods day in and day out.

I am aware of the metabolic benefits, anti-inflammatory benefits, and anti-aging properties of it though.

Anyway I maintain 12-13% body fat in my middle age and I work in the office with some hospital work at times (no inpatient rounding just bronchoscopies) despite being in front of a computer literally for 80 hours per week (also admin stuff for my office). I do so by holding a pedometer to my scrub pockets on the side (where it registers more accurately than on my belt) and then I simply walk in place in front of my standing desk while typing (as I am doing now). I am literally "walking like a hamster in an imaginary wheel." I don't like the walking treadmill as I have to think too much to maintain balance and interferes with my note writing. I no longer do the intermittent fasting because I need "boluses of calories" to keep my energy levels up throughout the day.

I have a home gym which I use once a week for weight lifting on sunday. I eat a ton of food on that day to power workouts. Other days I am literally walking like a hamster for 12-15 hours a day (including when I am home and doing child care and running around the home up and down stairs) and I am currently averaging about 50,000 steps a day (not marathon steps mind you but these low intensity steps that are better than sitting on my butt all day). I do get some exercise bike work in 10 minutes a day at high resistances. I have a CPET machine and I have been working to increase my VO2max (for personal satisfaction). but the point is I am no athlete and I have an 80 hour work week like everyone else.

I admit it is very awkward if anyone saw me doing this... but that's the beauty of having a private office room.

Just a thought if anyone wanted to "walk like a hamster" over a couple of months to reduce body fat percentage without having to become a weekend warrior or whatever the term is.

When I supervise a patient on CPET, I am often doing a little "jog in place" movement. To the patient I am providing motivation. But I am really trying to get my step count up lol

 

[DrMetal]

Nonsense. I and plenty of other people do the 16 and 8 route without hypoglycemia.

Oh I don't doubt it. If you ate a large dinner at 6 pm, you could certainly go until 12pm next day before eating.

Here's my regimen, works like a charm:
6:00AM light breakfast (<250 calories)
6:00PM dinner normal to large size (~1000 calories)
All you can drink coffee between 6 am and 6 pm.
Moderate amounts of whiskey 6pm to 12:00 am (yes, I know, Whiskey has some calories, but I just can't refrain, I need it)

Is it possible? Sure. But I and many others fast for the Jewish holiday every year, 24 hours, without any issues. My experience is that people who complain of hypoglycemic symptoms on fasting often have normal blood sugars, and their symptoms are due to other issues.

Absolutely. The psychosomatic component is huge.

 

[NewYorkDoctors]

Oh I don't doubt it. If you ate a large dinner at 6 pm, you could certainly go until 12pm next day before eating.

Here's my regimen, works like a charm:
6:00AM light breakfast (<250 calories)
6:00PM dinner normal to large size (~1000 calories)
All you can drink coffee between 6 am and 6 pm.
Moderate amounts of whiskey 6pm to 12:00 am (yes, I know, Whiskey has some calories, but I just can't refrain, I need it)



Absolutely. The psychosomatic component is huge.

Yep three meals a day and "breakfast is the most important meal of the day" was meant for farmers, athletes, and other laborers.

I have found #1 barrier to significant weight loss is unsupportive family members.

"What ? that quack doctor told you to eat less? you're gonna get sick if you don't maintain your nutrition!"

so on so forth

Yes ultraprocessed foods are full of chemicals to get people more hungry and less satiety.
Moreover, the dopamine reward pathways are all messed up in the obese. This is "not a will power issue" for the appetite I totally agree there is evidence. I took the Columbia obesity course. I am aware of the evidence.

But there is "willpower" in wanting to take the 10,000 + step challenge everyday.

But are the obesity medicine specialists just going to harp on this academic mental master******* or are they gonna get in there with their patients and get those steps in?


Addendum: anyway, since I am able-bodied I do usually do not push this stance too hard with my patients. in NYC some people view this as being "able-ist." I do gauge each patient and see what their ability is. I would never ask my 70 year old BMI 32 patient who restrictive lung disease and OSA to go outside in the NYC winter and snow to walk 10,000 steps... rather I am trying to figure out additional means of "non-exercise activity thermogenesis" for patients to do. A common thing is I ask them at TV time at night instead of sitting on your couch watching TV, stand behind your couch in comfortable shoes, hold yoru sofa for safety, and watch TV while you just walk in place. It's tiring at first but you can do it! get a discount bargain basement pedometer to hook to your pants and keep breaking your high score day after day!

For the patients who buy in this is a sustainable and long term benefit. No patient needs to get down to 12% body fat and have their abs showing. (unless that is their personal desire) Rather I just want their restrictive lung disease, OSA, and metabolic syndrome better. It doesn't take too much to build this habit.

But most patients just want GLP1 agonist therapy. For non-diabetics and those who do not have commercial insurance to cover the weight loss only brands, I tell them yeah you might get pancreatitis and hey rats got medullary thyroid carcinoma! That usually stops them from asking for it

 

[chessknt]

Agree with above, if there isnt a glucometer-confirmed value it is bull****. Could be any number of issues besides hypoglycemia, PO intake causes a cascade of hormonal changes throughout the body, not just glucose changes.

 

[DrMetal]

Agree with above, if there isnt a glucometer-confirmed value it is bull****. Could be any number of issues besides hypoglycemia, PO intake causes a cascade of hormonal changes throughout the body, not just glucose changes.

Quite true. And a high golf handicap yields many excuses (don't I know it).

 

[VA Hopeful Dr]

not to derail the thread but why do you all do the time restricted eating? this is not a criticism. just wondering.

Compared to just calorie restriction alone it was not more beneficial for weight loss

https://www.nejm.org/doi/full/10.1056/NEJMoa2114833

BUT.... sometimes doing the time restriction has a BUILT in regimen and helps with caloric restriction as it is very cumbersome to count calories accurately unless you are preparing, weighing, and eating the same foods day in and day out.

I am aware of the metabolic benefits, anti-inflammatory benefits, and anti-aging properties of it though.

Anyway I maintain 12-13% body fat in my middle age and I work in the office with some hospital work at times (no inpatient rounding just bronchoscopies) despite being in front of a computer literally for 80 hours per week (also admin stuff for my office). I do so by holding a pedometer to my scrub pockets on the side (where it registers more accurately than on my belt) and then I simply walk in place in front of my standing desk while typing (as I am doing now). I am literally "walking like a hamster in an imaginary wheel." I don't like the walking treadmill as I have to think too much to maintain balance and interferes with my note writing. I no longer do the intermittent fasting because I need "boluses of calories" to keep my energy levels up throughout the day.

I have a home gym which I use once a week for weight lifting on sunday. I eat a ton of food on that day to power workouts. Other days I am literally walking like a hamster for 12-15 hours a day (including when I am home and doing child care and running around the home up and down stairs) and I am currently averaging about 50,000 steps a day (not marathon steps mind you but these low intensity steps that are better than sitting on my butt all day). I do get some exercise bike work in 10 minutes a day at high resistances. I have a CPET machine and I have been working to increase my VO2max (for personal satisfaction). but the point is I am no athlete and I have an 80 hour work week like everyone else.

I admit it is very awkward if anyone saw me doing this... but that's the beauty of having a private office room.

Just a thought if anyone wanted to "walk like a hamster" over a couple of months to reduce body fat percentage without having to become a weekend warrior or whatever the term is.

When I supervise a patient on CPET, I am often doing a little "jog in place" movement. To the patient I am providing motivation. But I am really trying to get my step count up lol

That's why. Its just plain easier.

 

[caligas]

Yes, possible, he's fasting too long. I do intermittent fasting. I don't recommend more than a 12 hour fast. You can break the fast with a small meal, but it shouldn't be longer than 12 hours.

More importantly, what's his handicap?

7 (but he can play to a 4 when it counts)

 

[sloh]

Plenty of guys in the fitness space maintain ~10% bf while intermittent fasting 12 hrs or more with no hypoglycemia. And if any cohort was at a higher risk of hypoglycemia it’d be them over gen pop. It’s not ideal for maximal muscle retention but that’s a different topic. The person described by OP is just experiencing non-specific effects from the hunger.

 

[sloh]

not to derail the thread but why do you all do the time restricted eating? this is not a criticism. just wondering.

Compared to just calorie restriction alone it was not more beneficial for weight loss

https://www.nejm.org/doi/full/10.1056/NEJMoa2114833

BUT.... sometimes doing the time restriction has a BUILT in regimen and helps with caloric restriction as it is very cumbersome to count calories accurately unless you are preparing, weighing, and eating the same foods day in and day out.

I am aware of the metabolic benefits, anti-inflammatory benefits, and anti-aging properties of it though.

Anyway I maintain 12-13% body fat in my middle age and I work in the office with some hospital work at times (no inpatient rounding just bronchoscopies) despite being in front of a computer literally for 80 hours per week (also admin stuff for my office). I do so by holding a pedometer to my scrub pockets on the side (where it registers more accurately than on my belt) and then I simply walk in place in front of my standing desk while typing (as I am doing now). I am literally "walking like a hamster in an imaginary wheel." I don't like the walking treadmill as I have to think too much to maintain balance and interferes with my note writing. I no longer do the intermittent fasting because I need "boluses of calories" to keep my energy levels up throughout the day.

I have a home gym which I use once a week for weight lifting on sunday. I eat a ton of food on that day to power workouts. Other days I am literally walking like a hamster for 12-15 hours a day (including when I am home and doing child care and running around the home up and down stairs) and I am currently averaging about 50,000 steps a day (not marathon steps mind you but these low intensity steps that are better than sitting on my butt all day). I do get some exercise bike work in 10 minutes a day at high resistances. I have a CPET machine and I have been working to increase my VO2max (for personal satisfaction). but the point is I am no athlete and I have an 80 hour work week like everyone else.

I admit it is very awkward if anyone saw me doing this... but that's the beauty of having a private office room.

Just a thought if anyone wanted to "walk like a hamster" over a couple of months to reduce body fat percentage without having to become a weekend warrior or whatever the term is.

When I supervise a patient on CPET, I am often doing a little "jog in place" movement. To the patient I am providing motivation. But I am really trying to get my step count up lol

Have you heard of constrained total daily energy expenditure? The returns on increased TDEE from physical activity are quite poor, especially if the physical activity is performed regularly. Hadza tribe TDEE pretty much the same as sedentary US despite being on their feet all day and hunting/gathering. Lots of resources cover this topic if you google “constrained TDEE.” The weight loss/maintenance people witness as a result of adopting more fitness into their life is largely calorie control, not physical activity. It’s just hard to tease out which is doing the work bc most people adopt both at the same time.

https://www.researchgate.net/publication/274317202_Energy_expenditure_and_activity_among_Hadza_hunter-gatherers

 

[NewYorkDoctors]

Have you heard of constrained total daily energy expenditure? The returns on increased TDEE from physical activity are quite poor, especially if the physical activity is performed regularly. Hadza tribe TDEE pretty much the same as sedentary US despite being on their feet all day and hunting/gathering. Lots of resources cover this topic if you google “constrained TDEE.” The weight loss/maintenance people witness as a result of adopting more fitness into their life is largely calorie control, not physical activity. It’s just hard to tease out which is doing the work bc most people adopt both at the same time.

https://www.researchgate.net/publication/274317202_Energy_expenditure_and_activity_among_Hadza_hunter-gatherers

nice thanks for the update

for myself (and a handful of motivated patients) I use resting VO2 and CPET testing for their VO2 at anaerobic threshold and peak VO2 to adjust their estimated energy expenditure every few months.
there is quite a bit of change over time.
it is indeed true that people who lose a lot of weight (adipose and muscle) will have a "slower metabolism" and that is evident by a slightly lower VO2/kg at rest and at exercise.

however the corollary there is if one works on building up peak VO2 then that "increases metabolism" and hence energy expenditure increases

but it does not help in that the physical education in AMerica from grade school is lacking and it does not help that public school these days (in NYC anyway) will label someone trying to promote physical activity as "able-ist." You reap what you sow I suppose.

 

[dozitgetchahi]

Is it possible? Sure. But I and many others fast for the Jewish holiday every year, 24 hours, without any issues. My experience is that people who complain of hypoglycemic symptoms on fasting often have normal blood sugars, and their symptoms are due to other issues.

Exactly.

It reminds me of the people who talk about “subjective fevers” who have never actually taken their temp during the episodes…and if they do, they’re normal or marginally elevated. If you don’t have low glucose readings during the episodes, it’s not hypoglycemia:

 

[ICmyFuture]

As an endocrinologist I will deny this referral. But seriously what's his handicap?

 

[Drrrrrr. Celty]

Have you heard of constrained total daily energy expenditure? The returns on increased TDEE from physical activity are quite poor, especially if the physical activity is performed regularly. Hadza tribe TDEE pretty much the same as sedentary US despite being on their feet all day and hunting/gathering. Lots of resources cover this topic if you google “constrained TDEE.” The weight loss/maintenance people witness as a result of adopting more fitness into their life is largely calorie control, not physical activity. It’s just hard to tease out which is doing the work bc most people adopt both at the same time.

https://www.researchgate.net/publication/274317202_Energy_expenditure_and_activity_among_Hadza_hunter-gatherers

Eh. As someone who routinely cuts and bulks. I agree that the kitchen is where you find your abs. However life is easier when your cardio allows you the ability to slam an extra 200 calories of oreos in your post-workouth smoothie while still being in a calorie deficit and losing a pound a week.

The reality is that we focus too much on simple weight. We don't focus on body composition and muscle mass. when I started med school I was normal body weight, but my BF was 26-27%.

Now I'm overweight, but my BF percent is sub 20%.

 

[sloh]

an extra 200 calories of oreos in your post-workouth smoothie

I could inhale 4 Oreos so quickly haha. And it would still feel like a tease.

 

[caligas]

As an endocrinologist I will deny this referral. But seriously what's his handicap?

See 👆

 

[rokshana]

I am an anesthesiologist so I’m looking for insight from my IM colleagues, especially endocrine.

My golf buddy claims that he occasionally gets hypoglycemia late in the morning when intermittent fasting. Totally healthy, non overweight 45 year old. No meds. Fasts from 6 pm to 10 am. Says he gets visual disturbances that sound like scotoma, maybe some lightheadedness. Reverses with food. Worse if exercise before food.

Seems like healthy pancreas/glucogon would prevent this, am I wrong?

unless you deplete your glucose store in the liver and the glycogen has nothing to work on...liver stores about 12-18 hours of glucose for immediate release...IF long enough, could lead to hypoglycemia...

 

[rokshana]

Nonsense. I and plenty of other people do the 16 and 8 route without hypoglycemia.

just because you have people that can go longer doesn't mean that hypoglycemia isn't possible...and frankly really doubt that they are completely NPO for 16 hours...

 

[rokshana]

While awaiting for an expert endocrine input , the internist in me asks … did he actually measure the glucose when he felt symptoms ? Don’t the endocrinologists do a 72 hour fast in hospital when working up insulinoma and even those patients last longer than a standard intermittent fasting time restricted eating duration ?

What was that triad called ? Whipples ? We’re all criteria met ?

Maybe he needed a snickers bar ? (This is not a high bMI joke . I’m just saying you’re not yourself when you’re hungry !)

yes its whipple's triad...neuroglycopenic symptoms, blood glucose <70 and symptoms resolve with ingestion of carbs.

and true enough...i have done plenty of 72 hour fasts and rarely does anyone get to <50 for the testing to be done...but plenty of people get into the 60s and even the 50s...but eventually the insulin is suppressed and the liver kicks in...

guy probably gets symptomatic in the 70s and treats it...doesnt allow glucagon the time to really kick in

 

[VA Hopeful Dr]

just because you have people that can go longer doesn't mean that hypoglycemia isn't possible...and frankly really doubt that they are completely NPO for 16 hours...

Uhh, as I do that literally every day I'm pretty sure I know what I'm talking about as far as what goes in my mouth and when.

That said you're right, I'm not completely NPO from 8pm to noon. I take a Sudafed with a sip of water around 6am most days

 

[NewYorkDoctors]

I used to try out the ketogenic diet (the true one literally count and less than 25g carbs per day and trying to avoid processed salty meats ) and intermittent fasting and did 20:4 ratio . Boy would I get hungry at times . I was never “truly npo “ but would ingest things withoutbcalories like water, tea , black coffee (okay some calories in there I suppose ) and apple cider vinegar . I would measure my blood BHB and blood glucose at the end of a fast to get my GKI . I recall despite fasting for so long the glucose would usually be in the 90s and BHB 3-5 . But I did have lotsa adipose back then to enter the Krebs cycle with .

Of note I don’t tecommmend the Keto to patients (unless highly sophisticated patient - even then they don’t need me ) becuase it’s very easy for one to accidentally eat over 25g or carbs if one is not sophisticated enough to track carbs , it’s easy to go into caloric surplus with 9kcal per gram of fat , and it quickly devolves into a dirty Keto of buying a Wendy’s baconator and just not eating the bread ..

But it did get my waistline under 36inches .
But getting it down to current 31inches had to rely on good old exercise a metric ton and eat non processed foods . Work both sides of the equation so to say .

 

[rokshana]

Uhh, as I do that literally every day I'm pretty sure I know what I'm talking about as far as what goes in my mouth and when.

That said you're right, I'm not completely NPO from 8pm to noon. I take a Sudafed with a sip of water around 6am most days

Your n=1 does not make that the case for everyone…16:8 is not easy, and for most patients not sustainable for the long term.
And if your patients all have that type of discipline…good for you…

 

[VA Hopeful Dr]

Your n=1 does not make that the case for everyone…16:8 is not easy, and for most patients not sustainable for the long term.
And if your patients all have that type of discipline…good for you…

Prove it.

 

[NewYorkDoctors]

Prove it.

meh im inclined to agree with rokshana on this point.

"healthy" people with intact dopamine-serotonin reward systems can do 24 hour fasts or longer routinely with no issues. but those people do not come to see us doctors in general

most of the patients we see (which by selection bias are unhealthy people) have disordered leptin/ghrelin and dopamine reward systems. asking them to fast more than a few hours without Zepbound on board is asking them to "suffer."
Sure an individual can "overcome this" over time. But there are too many other "social barriers" in place.

don't forget all that ultraprocessed garbage in the Western diet that is chock full of chemicals designed to increase the desire to eat more unhealthy garbage

also don't forget all the unsupportive family members who insist on three meals a day despite not being laborers, farmers, etc..

also don't forget social media with lots of "foodie pics."

i can go on.

like that quote from Agent K in Men in Black

 

[VA Hopeful Dr]

meh im inclined to agree with rokshana on this point.

"healthy" people with intact dopamine-serotonin reward systems can do 24 hour fasts or longer routinely with no issues. but those people do not come to see us doctors in general

most of the patients we see (which by selection bias are unhealthy people) have disordered leptin/ghrelin and dopamine reward systems. asking them to fast more than a few hours without Zepbound on board is asking them to "suffer."
Sure an individual can "overcome this" over time. But there are too many other "social barriers" in place.

don't forget all that ultraprocessed garbage in the Western diet that is chock full of chemicals designed to increase the desire to eat more unhealthy garbage

also don't forget all the unsupportive family members who insist on three meals a day despite not being laborers, farmers, etc..

also don't forget social media with lots of "foodie pics."

i can go on.

like that quote from Agent K in Men in Black
View attachment 381247

Cool, then prove it.

 

[NewYorkDoctors]

Cool, then prove it.

i cant it's all anecdotal. which supports both sides of the argument.

but I am inclined to agree with you that it is medically possible to last longer as plenty of people on youtube have done very prolonged fasts and proven its fine if they have no underlying disease and are not on hypoglycemic agents. and those who do it reap the rewards plentifully.

but whether or not patients can actually do it and finish the job... I'm inclined to be nihilistic and say probably not. too many other barriers in place

my anecdote is I pull teeth doing this obesity management (because if I don't the PCPs keep gaslighting the patients back to me restrictive lung disease due to obesity... the PCPs that refer to me are no more than glorified mid-levels honestly. While I am sure their knowledge base is far larger than a midlevel, they simply want greater volumes of low complexity patients to do a 99213 and dont want to bother to flex some brain power for a 99214/5) out of the hundreds of patients with OSA / restrictive lung disease I have diagnosed... I count 7 of them who followed by advice and successfully increased physical activity, did increased step counts, and lost significant weight. 5 of them also have DM so they had the help of Ozempic and farxiga but go figure.... i'll take it!)

 

[dozitgetchahi]

i cant it's all anecdotal. which supports both sides of the argument.

but I am inclined to agree with you that it is medically possible to last longer as plenty of people on youtube have done very prolonged fasts and proven its fine if they have no underlying disease and are not on hypoglycemic agents. and those who do it reap the rewards plentifully.

but whether or not patients can actually do it and finish the job... I'm inclined to be nihilistic and say probably not. too many other barriers in place

my anecdote is I pull teeth doing this obesity management (because if I don't the PCPs keep gaslighting the patients back to me restrictive lung disease due to obesity... the PCPs that refer to me are no more than glorified mid-levels honestly. While I am sure their knowledge base is far larger than a midlevel, they simply want greater volumes of low complexity patients to do a 99213 and dont want to bother to flex some brain power for a 99214/5) out of the hundreds of patients with OSA / restrictive lung disease I have diagnosed... I count 7 of them who followed by advice and successfully increased physical activity, did increased step counts, and lost significant weight. 5 of them also have DM so they had the help of Ozempic and farxiga but go figure.... i'll take it!)

I won’t go into too many details because I don’t want to type all night, but basically during my last two years of medical school and into residency I managed to drop about 80 lbs simply by doing the following:

- I cut out soda and drank only water and coffee.

- I went low carb, but *not* keto etc. I dropped a fair amount of grains and focused on lean meat, eggs, nuts, vegetables, and eating clean. My diet was arguably some combination of “paleo” and vegan, but not the “dirty paleo” diets I see out there where people are eating pounds of bacon and steaks etc etc every day. (One of the fascinating things I realized from doing this is that I feel awful if I get a large dose of carbs, especially if this is from pasta etc. As a teenager I’d have these episodes where I felt godawfully tired after dinner and I wondered why it was happening…turns out lot of that was carb induced, after a big plate of spaghetti etc.)

- Portion control. Average American portions are way out of hand.

- Daily aerobic exercise, usually 30-60 min of jogging, brisk walking, etc. I did sub in some resistance training later on.

I went from a 40 inch waist to a 34. My peak weight was 284 lbs. My nadir was 198. I stayed in the 200-210 range for about 5 years, until the pandemic unfortunately unglued a lot of the progress I made…I’m back up in the 250 range and am working on getting it back down.

At no time did I fast. I feel like 100% garbage if I attempt to fast for any more than 6 hours or so, and I have been this way ever since I was a little kid…I can’t think straight, I’m grumpy as hell, I don’t feel good, etc etc. The folks who fast for Ramadan, Jewish holidays etc…more power to them, but I would not be a functional physician or human being if I had to do that. I hear all this noise about life extension etc from fasting…again, more power to the people who do that, but if I shave a few years off my life so as to not be a miserable grumpy hungry brain fogged loon for big portions of my life, I’ll take that deal.

That said, my point is that I do not think fasting is necessary to achieve big progress in terms of one’s health and wellness. Just reasonable portions, clean eating, ditching the carb excess that often characterizes the American diet, and decent amounts of exercise.

 

[NewYorkDoctors]

I won’t go into too many details because I don’t want to type all night, but basically during my last two years of medical school and into residency I managed to drop about 80 lbs simply by doing the following:

- I cut out soda and drank only water and coffee.

- I went low carb, but *not* keto etc. I dropped a fair amount of grains and focused on lean meat, eggs, nuts, vegetables, and eating clean. My diet was arguably some combination of “paleo” and vegan, but not the “dirty paleo” diets I see out there where people are eating pounds of bacon and steaks etc etc every day. (One of the fascinating things I realized from doing this is that I feel awful if I get a large dose of carbs, especially if this is from pasta etc. As a teenager I’d have these episodes where I felt godawfully tired after dinner and I wondered why it was happening…turns out lot of that was carb induced, after a big plate of spaghetti etc.)

- Portion control. Average American portions are way out of hand.

- Daily aerobic exercise, usually 30-60 min of jogging, brisk walking, etc. I did sub in some resistance training later on.

I went from a 40 inch waist to a 34. My peak weight was 284 lbs. My nadir was 198. I stayed in the 200-210 range for about 5 years, until the pandemic unfortunately unglued a lot of the progress I made…I’m back up in the 250 range and am working on getting it back down.

At no time did I fast. I feel like 100% garbage if I attempt to fast for any more than 6 hours or so, and I have been this way ever since I was a little kid…I can’t think straight, I’m grumpy as hell, I don’t feel good, etc etc. The folks who fast for Ramadan, Jewish holidays etc…more power to them, but I would not be a functional physician or human being if I had to do that. I hear all this noise about life extension etc from fasting…again, more power to the people who do that, but if I shave a few years off my life so as to not be a miserable grumpy hungry brain fogged loon for big portions of my life, I’ll take that deal.

That said, my point is that I do not think fasting is necessary to achieve big progress in terms of one’s health and wellness. Just reasonable portions, clean eating, ditching the carb excess that often characterizes the American diet, and decent amounts of exercise.

yep its way too easy to go into a calorie surplus when eating those items and gaining adipose

however, those people who work out a ton, lifting heavy weights and burning up calories with other aerobic activity can subsist just fine eat that way and be in good shape

but most people are "too busy" with work to work out like that so it's generally not a good idea to eat all that animal protein and high fat as its not easy to maintain calorie deficit without working


the message shuld be if eating bigger portions, gotta work out / labor / burn it off

anyway try doing what I do. I wear scrubs with side scrub cargo pockets. i put two pedometers one on each side (because I have noticed I have right leg dominant and take "bigger strides with the right leg so I need to balance both sides) and begin to "walk in place" all day long while in front of the computer as I am doing. working 12-16 hours a day (not all patient care but definitely in front of a computer...) while doing this is the best passive calorie burn that lets me truly multitask. i once got 77,000 steps this way (again its somewhat lower intensity steps compared to going outside but hey I got 16 hours of computer work in as well. multitask FTW)

 

[TooMuchResearch]

I am an anesthesiologist so I’m looking for insight from my IM colleagues, especially endocrine.

My golf buddy claims that he occasionally gets hypoglycemia late in the morning when intermittent fasting. Totally healthy, non overweight 45 year old. No meds. Fasts from 6 pm to 10 am. Says he gets visual disturbances that sound like scotoma, maybe some lightheadedness. Reverses with food. Worse if exercise before food.

Seems like healthy pancreas/glucogon would prevent this, am I wrong?

You can go many days without food and maintain a normal blood sugar, unless I suppose you're used to an elevated blood sugar and feel off when it's low normal range.

 

[InternistDO]

Absent some metabolic disorder (or meds) the idea of getting significantly hypoglycemic with fasting doesn't pass the sniff test. Humans can survive for many days to even weeks without food, and while you may initially have some transient "lows" of 50-60 as you deplete your glycogen stores, the slower gluconeogenesis pathways will kick in and you will maintain a normal blood sugar.

99.99% of people saying they have low blood sugar when they don't eat are simply feeling the (unpleasant) effects of hunger that will pass if left alone.

 

[NewYorkDoctors]

meh this patient was totally fine and asymptomatic. for real....






















this SST tube was not centrifuged...

 

[mszzeta]

I am an anesthesiologist so I’m looking for insight from my IM colleagues, especially endocrine.

My golf buddy claims that he occasionally gets hypoglycemia late in the morning when intermittent fasting. Totally healthy, non overweight 45 year old. No meds. Fasts from 6 pm to 10 am. Says he gets visual disturbances that sound like scotoma, maybe some lightheadedness. Reverses with food. Worse if exercise before food.

Seems like healthy pancreas/glucogon would prevent this, am I wrong?

Not an endocrinologist. IM trained.

I know the textbook says a healthy person with DM should not get hypoglycemia in their regular life. And the only way to know if one has hypoglycemia is to measure glucose level while asymptomatic.

My personal experience is that, I do feel sometimes symptoms of hypoglycemia when eating too little for my last meal (not even fasting), especially when I also exercise. These symptoms would get better after I ate sugars. I never checked by glucose levels during these times

Maybe it was just symptoms triggered by hunger, as other people have suggested