Let's Talk about Intermittent Fasting…
On this week's episode of the Lunch and Learn with Dr. Berry I sat down with Dr. Cecily Clark-Ganheart. Following up last week's episode, we have Dr. Cecily's story who like many has had trouble with weight issues after childbirth but found a way to change her lifestyle for the better. In the discussion of healthy dietary change, the topic of Intermittent Fasting has become increasingly popular. With the popularity of a “new” lifestyle, we need expert opinions on what is safe & what isn't so Dr. Cecily has taken the time today to educate the Lunch and Learn Community.
By training Dr. Clark-Ganheart is certified both in Maternal-Fetal Medicine and Obesity Medicine and once she was able to incorporate Intermittent Fasting into her lifestyle and lost over 50 pounds. During the episode, we talked about all of the common misconceptions about intermittent fasting, who would benefit the most & who should stay away from the practice. You also find out how many hours does Dr. Clark-Ganheart fast (you won't believe it).
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- Book Recommendations
- Furmili S. ER, Ramos M., Fung J. Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ Case Rep. 2018.
- Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12(1):146.
- Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. J Diabetes Metab Disord. 2013;12(1):4.
- Dunlop EA T, AR. mTOR and autophagy: a dynamic relationship governed by nutrients and energy. Semin Cell Dev Biol.36:121-9.
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Introduction Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and promotion. This week we are talking about intermittent fasting and have amazing guest, Dr. Cecily Clark-Ganheart, who is Board Certified in Maternal Fetal medicine, Obesity Medicine Specialist. And she's going to talk to us about how to incorporate intermittent fasting in your nutritional lifestyle change. Guys remember the theme for the past few episodes has been about nutrition and making that nutritional transition in your life, to live a longer, healthier life. Because that's always the goal. And I wanted her to come on this podcast because I have a lot of guests who have inquiring about intermittent fasting. Some of the pros, some of the cons, some of the benefits associated with it. So I said, instead of me just telling you what I know from an internist standpoint, let me tell it from someone who's actually in the trenches physically. Actively doing it as we speak and having so much success to the point where she's lost over 50 pounds incorporating the lifestyle of intermittent fasting, low carbs. And guys, she fast for 18 hours a day. So again, first of all, full disclaimer. You do not start going all the way to 18 hours fasting. You have to work to get there and we're going to talk about that mental process and that mental transition of working up to get to the point where you can actually fast for 18 hours a day, lose 50 pounds, still incorporating a great diet. Things going to be another one, things going to be really highly requested because of the amount of gems that gets dropped during this episode. You guys are definitely in for a treat. Of course like always make sure you subscribe to the podcast, especially if this is your first time listening. Again, appreciate you listen to the show today. But if this the first time listening, subscribe to our podcast. Leave five star review. Four star review is okay. With five star review, letting us know how we did about today's episode in our discussion on intermittent fasting. Again, you guys have a great and blessed day. Episode Dr. Berry: Alright, Lunch and Learn community. Just heard another amazing introduction from a guest who I'm actually very interested to talk to, especially for us subject as when we talk about nutrition that we've been doing for the past couple of weeks. I get a lot of questions about fasting and is it safe and what can I do to better my chances. So I say, you know what, let me get someone who, this is what they do. This is the expert. This is their field per se. Let me have them answer it and see if we can get there. So again, Dr. Cecily thank you for joining the podcast and getting ready to enlighten us because I know you're about to do that. Again, I'm excited. Like I said, you've been highly recommended. I just want to say I have had a few people are like, no, no, no, no, you gotta give a passing doctor on the show. That's what it gets. Dr. Cecily Clark-Ganheart: I'm happy. I'm excited to be here. And I love talking all things intermittent fasting and just how it pertains to health. I think it's a tool that people don't really think about and it's highly underutilized and it can make such a big difference in health. Dr. Berry: I love it. So we did a little bit introduction on your bio, but I do have listeners who like to skip passing, get right into the meat and potatoes. For some of who may have read a bio and then they are like, that's great and all that. What is something that may not be necessarily in your bio, but you want people to know about you and your journey? Dr. Cecily Clark-Ganheart: So what's probably not in my bio, my bio does talk about, and I won't rehash, it talks about my own health journey and things of that nature. How I got into intermittent fasting. It was basically the only thing that I hadn't tried before in order to lose weight. And then also combine that with the lower carb approach. And so for me, I found it worth very well. It was the first time that I had long sustaining weight loss without feeling like I was on some strict regimented program where I had to count calories or worry about stuff like that. And so for me, I think just in general there's a lot of misconceptions about intermittent fasting and I'm sure we'll get into some of those later. But it really is easier than I think what a lot of people make it seem like it really isn't that complicated. Other things that I encourage people to do and that I've gotten into myself that's not in my bio, I think you also have to pay attention to the role of gut health. Just overall in our physical health, the gut microbiome. Some people say, our GI tract is like our second brain. There's so many different disease processes and signals and changes that all start in the GI system. So I think doing other like healthy eating habits to support a good micro biome is also important. So for myself, for some examples, I like to do fermentation and I like gardening and I ferment my own stuff at home. One, it's cheaper. Two, it's better than taking a probiotic because the probiotic can't compare to what you're getting in a natural from it for people used to eat all the time. And it's really easy. And I encourage people, once you start refining your nutrition, I encourage you to look at some other more quote unquote ancestral ways of eating and just see what people did before industrialization because all of the diseases that we are treating now in the medical system really are modern diseases. They're diseases of industrialization. So we used to die of different things before industrialization. (I love it). Now we're dying from a whole host of different things that have just been created by us thinking that we were outsmarting nature. Dr. Berry: Well especially because it's so interesting because first of all Lunch and Learn community, I need you to follow her Instagram because she actually will show you the fermenter process. So this isn't something that she's just talking, she shows you, oh see this is what I do. Now of course when you first look, that's interesting. But when you just listen and understand the process, okay. Because I think that's what always gets people anytime they have to make any type of change transition. Just that newness of it is very difficult for people. So when we talk about just fascinating, and even though like the fermentation and all that, when you hear those words, they're like, what does that mean? You mean I can't eat? That's always a big thing, right? I can't eat. So for a person who says, you know what, maybe I'm thinking about your intermittent fasting, but what is it? What would you say to that person? Dr. Cecily Clark-Ganheart: So the easiest way to describe intermittent fasting is just, it's a period of gut rest. It's a period where you are not intaking any food. You can drink water, but nothing with the caloric content that just allows your system to reset. That's how I like to describe it. Now, there's several different things going on when we say you're resetting your system. But it really is just simply, you just not eating for a period of time and you pick the period of the time. That's the beautiful thing. You decide how long you want to go for without eating. And that's why it's different than starvation because when you're starving, you don't get to choose when you eat again. You’re praying that food comes around so you can eat it. With the intermittent fasting, you can eat whenever you want. You're just making a conscious decision that you know what, for 12 hours, for 16 hours, for 18 hours, whatever you set your schedule to. I'm going to allow my body to actually have time to repair itself, to lower my insulin levels, to do some other beneficial things that my body's not able to do if I'm constantly eating every two to three hours all around the clock. Dr. Berry: What’s interesting, especially when people hear about the intermittent fasting, the time is always one of their biggest markers. It's usually how long I gotta do it and what can I eat when I'm not like or drinking on that process. Do you have any, especially when we talking about the different types of intermittent fasting, is there any pros and cons one way or the other in terms of if someone's a beginner or someone's on late stage? What would you, especially in the beginning stages for sure? Dr. Cecily Clark-Ganheart: Yes. I think if you're just starting off, probably the easiest to do, especially if you are used to a lot of nighttime eating and again, if you're a constant grazer, honestly starting off with just like a sunset to sunrise fast might be the easiest place for you to begin. Because I think it's intimidating for some people to hear that, oh my gosh, I have to go 18 hours without eating. One big thing to keep in mind is that sleep counts is fasting. So sleep! Use that time to not eat. So that's saying that you're going 18 hours starting at 8:00 AM. Do you know what I mean? All while you're working in things, if you stop eating by 7:00 PM and during the summer hours and early fall, it's still going to be light outside. That counts is eating. Getting your last meal in before dark. So if you just did 7:00 PM to 7:00 AM that's 12 hours and you'd be surprised how many of us don't even go 12 hours without eating. That seems that should be natural. But if you are eating at nine, 10, 11 at night or say you ate at 8:00 PM but before you go to sleep you have to drink, name some sugary beverage, that's not fasting. It's your drinks too. If their calories in it or artificial sweeteners, all of that is not counted as fasting. So for a lot of people, if they can just begin with not eating after dark and waiting like even an hour or two after waking up in the morning before eating something, especially if you're changing your nutrition, you're going to see benefits. And so then after that, if you start with that as your foundation, then you just basically start extending after that. So if you ate at 7:00 PM the night before, instead of eating at 7:00 AM the next day you push that back a few hours. That's how you're going to get your 16 hour fasting. And then keep going from there that you can get up to your 18 hours. There's all sorts of different terms. There's one meal a day. There’s people hear about the five two diet, which is just a play on intermittent fasting. There's several different things that you can do, but I would say rather than getting caught up in which method you're doing, just start with 12 hours and then as you noticed, you're not hungry. The next thing I tell people, if you're not hungry, don't eat. So don't eat at 7:00 AM just because it's been 12 hours. Dr. Berry: Because it's like the clock watching and in a second… (Exactly). 7:01, alright I will not going to eat. Dr. Cecily Clark-Ganheart: Exactly. But then I would ask you before you do that, are you hungry? Because if you're not hungry, why are you eating? And that's the whole thing. You have breakfast, lunch, dinner, two snacks and I got to eat on clock. Oh it's time to eat. Whoever told us in nature it was, this position of the sun is time to eat. You ate when you were hungry. So I think by starting just with that concept and getting to know true hunger cues that's going to help you just become a natural, intermittent faster. Dr. Berry: What I love that you talked about is, because I think a lot of times people will say, well I didn't eat anything. But then they'll neglect the fact that drinking soda, I was drinking juice, I was maybe I had a nibble here and there and we don't really realize how much we're actually eating and drinking after seven before seven. So I think sometimes is having that eye opening experience, wow, I'm really eating a lot after the times where I probably really shouldn't need to eat. Because I know a lot of my patients that was always that big, oh, I gotta have something before bed. I gotta have a snack, I gotta have something. It's something that they, quote unquote had to have that we'll tend to get them in trouble. So I love that aspect of just starting when the sun goes down, when the sun goes up, this kind of seat. That way they're not clock watching per se, because again, like I said, that tends to happen. The second they realize 7:01 hits, all of a sudden they're running for a meal. And I asking themselves that question, I wasn't actually hungry or was I eating because I'm quote unquote allowed to eat. Dr. Cecily Clark-Ganheart: Exactly. And so that's the thing. I mean it's about getting used to your true hunger cues. The other problem is because of a lot of the sugary-refined processed carbohydrates our hunger cues are truly off. And so I do this with my kids a lot too. They'll run up and they're like, I'm hungry. I'm like, okay, here I have like the fish that we made and Broccoli, there you go. Oh I don't want that. All right. I guess you’re not hungry. Because if you're hungry, you're getting eat what is in front of you. Right? I know when I'm hungry, maybe I would have preferred a salmon young for dinner. But you know what? That cabbage right there looks good too. And that's what we have. Somebody eat that, you'll eat when you're hungry. And so I think if you can get up or if you're picking at something and you're like, blah, blah, blah, or if the phone rings and now you're distracted for 45 minutes and now you're no longer hungry, you realize that that wasn't a true hunger cue either. And so what I noticed a lot for myself and people that I work with is that when they start intermittent fasting, the thing they say is, I thought I would be starving at the end of my window and I've actually not. And so that's when we start having that conversation. What do you want to go longer? Because if you're not hungry you don't have to break just because it's the time. I'm giving you a time just because a lot of people do better with goals up front. Something very finite, but it's people realizing that once your insulin levels are coming down, once some of these other factors that mediate hunger, like growing, you know, or decreasing and etc. You don't have that urge to constantly snack either. And a lot of people are surprised by that. Dr. Berry: It was interesting, you talked about hunger cues. Does the fasting help modify them or does it, are we able to bring it to light and say, well see, were you actually really hungry or is because you're fasting now as you're hungry. How would you say that the hunger cues are affecting? And we'll even go back a little bit further. For Lunch and Learn community, you may not know, what are hunger cues and what are some of the things that you've seen, especially with the clients that you work with and even self as affected in one way or the other? Dr. Cecily Clark-Ganheart: Yeah, so I think the hunger cues, when we go back and we're talking about the gut, there's a lot of signals and different hormones that originate the gut that then provides feedback back to the brain to mediate hunger or not. I think of the famous experiment with the dog and the bell where it's like every time you were going to feed the dog, you ring the bell. And so then all of a sudden all the same physiologic processes would start happening if you rang the bell but didn't give them food. And that is an example of how our hunger cues can get intertwined with things that are external cues that aren't necessarily your body truly saying, I need to eat right now for nourishment. So it's just time or think about other things like stress. Stress eating is a big thing. But you're not necessarily hungry when you're stressed, but you may eat when you're stressed because it either gives you relief, it either pacifies you with sugary food. Again, stress eating, usually you're not stressed eating out on Brockway, right? You're doing it on high. I mean probably not. You're better than me. That's not what I should say. You're stressed eating on things that are typically poor quality nutrient foods that have a high glycemic index that are very sugary and sugar triggers a reward response in the brain. So this may be getting a little too geeky, but I mean there's a chemical called dopamine. And so if that is stimulated that its makes us feel good, we feel better. So sugar can do that, but then that feeling goes away and I'm stressed again. Okay, now I feel better that I had that piece of cake. Okay. But I'm still stressed, better than I had that extra. And so it can become vicious cycle like that. So there's so many other external stimuli that we are either getting rewarded from or mistaken as hunger. And unfortunately they tend to be the foods that are not the best for us. Then if we're talking about internally, some of the things that intermittent fasting can help do over time. We've already talked about insulin and that's also the same premise behind lower carbohydrate way of living or Keto in general. If you're not having to stimulate your insulin as often, you're going to have lower levels of that in the body. Insulin in itself, it signals storage so you can have a hard time getting rid of that or different things like that. If your insulin levels are chronically high. So with intermittent fasting, if you're not eating, those levels are coming down. In turn, those work with other hormones in your body that when they're high they tend to produce hunger or produced cues to eat. By lowering those, because you're not eating as frequently. That's why we think any way people are not having that constant feeling of hunger because people will tell you the longer they fast, the longer they practice intermittent fasting consistently. Also if they are improving their nutrition, I still think nutrition is important as well in all of this. Over time they're less hungry and that's just uniform around the board. Dr. Berry: It is very interesting because I just recently myself went to a low carb Keto lifestyle type and you hit it right on it because really thought like I would be, because we ate a lot of rice versus everything else. I don't eat that no more. I really thought I'd be starving, but I get that's really not the case. Which is still surprising to me that I'm like wow, I guess I'm not as hungry as I as I though because I would remember the opposite where I'd feel like, oh I didn't have a meal. My meal wasn't quote unquote complete if it didn't have rice, especially rice. I always felt like, oh this meal, I'm not even quote unquote full yet. The fact that I essentially token out away and that felling is in air. That was definitely a very interesting point as well. Because there's always gonna be attracted, right? Regardless of whatever lifestyle change you have. And I'm pretty sure you heard every reason in the book at hand. But I always get people when we talk about anytime we change it, is there any evidence behind it? They don't really read them but they always want to know of this type of evidence associated with fasting. I want to talk about your personal journey just in general just so we can kind of get that out the way. Dr. Cecily Clark-Ganheart: In terms of the evidence, so there is a lot of evidence for intermittent fasting. And so when we say intermittent fasting, again the research has looked at different fasting protocols. So for instance, you have animal models. Sometimes people are like, oh that's in rats and I'm not a rat. And I get that you're not a rat. But I mean also you don't necessarily want to start testing out something on six week old infants either. Right? So you got to start in the lab somewhere. I mean it's for human safety. But looking at the animal models, several studies have shown when you do kind of like the Ad Lib Diet basically meaning kind of how most of us prior to intermittent fasting kind of function. Ad Lib meaning you eat whenever you want and what you want as much as you want. And so for some reason you decided to stop. So mice will do the same thing. So if they have chronic access to food, they've looked at their metabolic changes versus when they intentionally restrict the periods of time that the mice can eat. And so that's where they first started seeing some of these improvements in micro neurologic function in terms of rats that were showing maybe some signs of like Parkinson's disease and other neurodegenerative diseases weren't showing it as much as the rats who ate all the time around the clock. Looking at different inflammation markers that are associated with condition called metabolic syndrome, which basically several different conditions. They were showing that those inflammation markers went down, that they were having less visceral fat, which is basically fat around your abdomen. Central obesity as well as what we also call it. Those studies have shown that there are at a cellular level. There is something going on with the intermittent fasting. That's where some of this research and at term or concept called autophagy has come into play, which is a basically a self-healing mechanism that the body uses to remove damaged proteins. Well, the body can only do that when it's not overloaded. But if we're eating all the time, the body is spending all its time in the feed state processing, so you're not able to get those levels. So that's where they think some of the therapeutic benefits of fasting come in. While this is not, I guess, science, if we just look at human culture throughout the ages, every major religion has fasting as a part of their dots. If you're looking at, I'm not gonna promote, tell people one religion versus the other, but I'm just saying if you look at religion in itself, a commonality is fasting and prayer. If you were ill, you needed to fast for a while. We’re now starting to see some of that adamant, you’re a level, why that doctrine actually does make sense to have a period of time. And you'll see people quoted through history, Benjamin Franklin, one of best medicines, rest and fasting. I mean, people would set this off. This is not anything new. It's just we forgot, because we were more sophisticated now, whatever. And we have access to a lot of foods. So then to take it out of using that as a bridge to get into. You have human studies as well. One of my favorite ones, and I'll send you the link for it, talks about intermittent fasting in normal weight people. And so even though you know the clientele I've worked with, my patients are going to be overweight or obese. I like this study because there's this concept that once you hit goal weight or normal weight, whatever that is for you, now you stop fasting. Because if you fast at a normal weight, now all of a sudden you have an eating disorder. But if you're heavy, it's okay because you got to get rid of that fat. But like once your BMI hits normal, why are you fasting? So this study was actually done in people of normal weight or who were just slightly overweight and they did a variation on alternate day fasting and they saw improved metabolic markers still because just because you look a certain way, does it mean that your metabolism and your inflammation markers and all of that are where they should be. It's just manifest it how I might manifest it. So for me, if I go back to eating very high sugary foods, I can put on 30 pounds easily. That would not be difficult for me. Other people just they don't gain weight but they still could drop dead from a heart attack. And you're like why? What happened? Because it doesn't mean that you're metabolically healthy just because you look skinny. Dr. Berry: That’s always so funny because I think a lot of times people are like almost perplexed when they see on the outside looks fit, look skinny, that has all of these other hypertension, diabetes, all these other medical record. For some reason it should be that to the obesity aspect. Oh, that's why you have that. But when a person is an obese, for some reason, I can't explain why. Dr. Cecily Clark-Ganheart: Exactly. And so that showed improvement in health markers for that. If we're looking at diabetes, granted it's only a study of three people, the reason the case series is impressive is because they took people who I belonged standing type two diabetes. So they were on insulin for years. And traditionally a lot of people are like, oh my gosh, what if I get diabetes once I go on insulin? Like that's it. It's just a matter of years before the amputation hits or before whatever hits. It's coming. Dr. Berry: That's so funny. Because I don't know how many times I heard that. That is… Dr. Cecily Clark-Ganheart: Yeah, it's just like people are like, oh well, all right, I gotta take this insulin now. I mean you might have to seek it for a little bit, but come on, let's look at your nutrition. So they did combined a low carbohydrate approach. So they weren't Keto per se, but they reduced their sugary intake. And then they did varying fasting periods and it was like, I think within nine months or something like that, I can't remember the exact time frame. Most of these people were off insulin and they were on high doses. Some on like over a hundred units a day. And they were able to come off insulin using a combination of a lower carb approach and intermittent fasting, which then goes challenged that dogma that once you have, and I'm talking about type two diabetes. Type one diabetes is a different thing that's a whole different mechanism. But, so if we think of a type two diabetes is more of a lifestyle disease. They were able to show through changes in lifestyle that you were able to reverse that. And then there's several other studies that go over again, like autophagy and it's applications and potentially cancer therapy and protecting against some of the adverse effects of chemotherapy. So there's a lot of work in this area. And so I think to, for people who are referring to it, just as a fad. One, you haven't looked into it because it's not. There’s actually evidence behind it. Dr. Berry: What led you on the journey where you realize that you know what, intermittent fasting is for me or that's a way I want to go? And let's talk a little bit about your regimen. Because when I had Dr. Lisa Folden, she's been on the meal prep. And when I asked her, what are the issue that thing happens with meal prep. Is people, they Google and they see these images. Or they Google and they read stuff and they're like, oh, I can't do that. And that's always a big thing. Oh, I can't make my foods look like that. Oh, I can't stop eating for 12 hours. What was some of the events that led you on that path? What's your day to day now with that process? Dr. Cecily Clark-Ganheart: So what led me down that path was, when I had my second son in 2014. At the time of delivery, I was around like 260, 264 pounds when I had him. And so I was like, okay, I had been diagnosed with metabolic syndrome after all of that. And so I was like, all right, well I need to do something differently. Okay, I'm pre-diabetic. So we already know where this goes. Dr. Berry: Insulin, amputation. Dr. Cecily Clark-Ganheart: So I was like, okay, that's where I'm going. So I need to, I'm only pre-diabetic right now so I can get a hold on it. So that's what led me realizing I needed to make a lifestyle change. The problem was after that I did more of the same thing because I really hadn't heard of intermittent fasting yet at that point. So I mean, I did lose weight. I started like your traditional calorie counting, working out, running all of these things. And so gradually I was able to get down to just around 200 pounds and then the weight just started coming back. And so I was like, I was doing everything that I thought I was supposed to be doing and then I'm gaining weight again. And then I was like, well, if I'm just gaining weight then why am I even doing this? I gained more weight. So around that time in 2017 though, I was like, okay, really though I need to figure this out. And on the chat board actually is where I heard about a book called Obesity Code and that's by Dr. Jason Fung. So I pick that up and read it and it actually made sense as to what he was talking about. And so I said, okay, well I'm just going to give that a try. And in his book, it's not his focus really. He talks about nutrition a little bit. That's not the main focus. It's to get you to understand the mechanisms of intermittent fasting. So I started with that, but then subsequently read a book called Deep Nutrition by Dr. Cate Shanahan that discusses more ancestral ways of eating. And so in a more ancestral approach is going to be lower and refined carbohydrates. So it kind of all still goes together. So that's what led me to it. And then I was seeing results. For me, my typical regimen is closer to like an 18 hour fast each day. But sometimes I go longer or sometimes I go shorter. But that's typically what my period looks like. And then during my eating window though, I also don't snack or keep snacking to a minimum. So can I say I never have a snack? No, I can't say that, but I certainly make a conscious effort then if that day's going to include eating lunch and dinner to really mainly just eat a good lunch and a good dinner and not stack in between that. Because what we're thinking is if we're thinking that insulin has a role in obesity, and obviously there are other hormones, nothing's like that simple where it's X plus Y, you know? I definitely admit that we're probably over simplifying some of the explanation. But at the end of the day, this is the premise of it. Every time you eat, you spike insulin. So insulin in itself, the insulin you make in your body is not a bad thing. It's just when you have it in excess. Because we need insulin to live. If not, that's where you start getting type one diabetes, right? So I mean, you do need it. But the problem is when you're needing it and increasing amounts, increasing amounts, and if you keep stimulating it all the time with frequent snacking, without doing gut rest, this leads to just higher baseline levels of insulin even when you're not eating. And so insulin signal storage, so signals fat storage, but it also can play into other signaling for inflammation. And then your high blood pressure or polycystic ovarian syndrome. I think of that as a disease of androgen. Excess meaning too many like meal steroid type hormones, which yes, but also insulin excesses at a key in that as well. So there's so many other things that insulin influences where it works in perfect harmony when your insulin levels are regulated and normal. But in excess, anything can be bad. Why? I still try not to snack during my eating window per se because I don't just want to keep. I don't want to do that. Dr. Berry: Is there any issue during your period as far as foods you try to stay away from, during that period as well too? Or is it because it's my period and I can go and I can go in blank? Dr. Cecily Clark-Ganheart: Agree. I still try to stay away from refined carbohydrates during my eating windows. So things that I'm going to eat are pretty much stuff that either grew from somewhere, or it's an animal, something like that. I've really tried to stay away from package food. And also I think a big misconception is that, diet pop is fine. No, those artificial sweeteners we see can stimulate worse than what just regular sugar would do. So it's not been saying, well I'm not eating. Because it says zero calories, but it still has that very sweet taste. I try to stay away from juices. I am not at my brother and I go back and forth on this all the time because he just lost his eyes at me. But I am not a fan of smoothies that you can tell me you make them however any kind of way. Especially if you're buying them at a juice bar or something like that. Have you ever just blended pure Kale doesn't taste good. If that taste good, they have put something. I mean this is the thing or what I tell people is, think about an apple. So I don't know if you're having like a green apple smoothie or something like that. In a day, it is probably very difficult for any one person to eat five or six apples in a day. I eat one apple. But it's going to be difficult just for you to sit there and say, I'm gonna eat five apples. You could easily have apples in a smoothie. So again, I think there's a misconception that just because the sugar is natural, that it's fine. I think when we're eating fruit in its whole form, there's only so much of it that you're going to be able to eat. So you're still naturally limiting how much sugar you're taking in in a day. If you're eating it, you have to process all the refuge with it. You know you're going to get cool. But once you blend something, you can easily have two smoothies. Well how much went into that? Again, I'm not saying have I not ever had a sweetened beverage, have I never had a pop since I've started intermittent fasting? No, that's not true. But I can tell you prior to intermittent fasting and changing my nutrition, it would have been nothing for me to have three or four diet drinks in a day. Thinking I was doing well because I was only having a diet drink and all of that stuff messes with your insulin. So on a day to day basis I try to stick with water, plain tea or coffee as the beverages I drink. I do brew my own Kombucha at home so I may have like a little bit of that here or there. I try to stick with real natural foods stuff not made out of a factory or plants. Dr. Berry: I love it. Because I think you answered my next question as far as different types of lifestyle adaptions you can also apply while on the intermittent fasting. Because I would assume especially with the clientele you work with, when they initially start it's the time factor. The hurdle that they go over. I'm pretty sure you probably do just as much as education when it's time to go when it actually is time for them to eat. Okay. That is time for eat. I need you to kind of look at the type of foods you're eating as well too. I'm not sure if saying it would offset their fasting is correct. I guess that's probably a good question. Can you have a bad faster who may go 12 hours, 14 hours, but because of what they do with the rest of the time, it offsets some of the benefits? Dr. Cecily Clark-Ganheart: So I think initially you'll probably see some improvement even if you don't change your diet right away because you're going to eat less of those sugary process carbohydrate foods. Usually if you're increasing the time between meals. So you may start to see an initial benefit. But I think we're, a lot of people hit plateaus from, because they aren't realizing, okay, now I need to focus on my nutrition. The other thing is because I see a lot of people who are hoping to become pregnant, we don't recommend intermittent fasting during pregnancy. So my thing is you gotta get your nutrition down because when you're pregnant, your nutrition is all that you have to control how much weight you're going to gain during pregnancy. Contrary to popular belief, we're all not supposed to gain 60 to 80 pounds when we're pregnant. You’re having a seven pound, eight pound baby, where did 70 pounds go? I was like that too. I gained like 60 pounds with my son who was only seven pounds, two ounces. Like, okay. Clearly he didn't use all of that 60 pounds that I gained. So the thing is, I think we need to also focus on nutrition because that there's so many other benefits to having a nutritious diet rather than thinking of intermittent fasting as a mechanism that you can eat whatever you want. Honestly, I don't even have people do extremely strict carbohydrate moderation. I think people automatically assume, because I'm seeing lowering your carbs. I'm saying, you can never have another carb again. And I'm like, that's not what I'm saying. I have people who do fantastic on 20 grams or less of carbs a day. And they might love it and they feel great. I have other people who come to me and the first time I see them, they're eating 400 plus grams of carbs a day. I am not going to get someone in a week to go from and sustain because again, this is about sustainability. I'm not going to be able to get them to go from 400 to 20 grams all in a week's period. So what I find is that even just gradually reducing it and people, a lot of people are shocked. They're like, oh, you have people who really eat, a hundred, 150 grams of carbs a day and you add intermittent fasting and they lose weight. I'm like, yes. And they're like, but you have to do, I’m like, we took away a lot of the processed stuff they were eating and now we added periods of gut rest. You would be surprised. The next thing I'll hear people say is, well, they possibly can't be in ketosis if they eat a hundred grams of carbs a day. Well, if you're 400 pounds and you add intermittent fasting and you're eating a hundred grams of carbs a day, I can pretty much guarantee you are in Ketosis, right? Because it's this state relative to each. By everyone body compass. So I think we get into a lot of things and that intimidates people where it's all of these rules. And I just go back to, if we kind of simplify it, I tell them they can still have carbs, but I want their carbs primarily to come from vegetables that are in low glycemic index. Then I want their dessert now to be fruits. So think of fruit as dessert. To me, dessert is not something you have to have every day. That's just me. So if fruit is now becoming your dessert, you can still have it, but you're not doing that every day. And then you're adding a period of gut rest, which is forcing you to mobilize your own fat stores. And I think just doing those different things, people actually see a lot of difference and they're surprised that how much a change they can note without feeling like restricted. Dr. Berry: Especially with some of the clients that you worked with, I think when you Google you hear some of the common questions and even better misconceptions and we've talked about a lot of them, but are there any others that you hear questions even sometimes bother your mind like huh? Dr. Cecily Clark-Ganheart: I know. So we already talked about the starving misconception. The thing that I find most interesting is the conception or question I get all the time. Can women fast? Women’s shouldn't fast? (Interesting). I don't get that. But yeah, men fast and, but then women can't fast. And I said, well that's very nice that in caveman days the men would give all their foods to the wife. Probably not. I'm sure they were both not eating together, but women can fast. I think the issue is that we are equating fasting to an actual state like Anorexia where we see when people have true Anorexia, you can have irregular cycles. It's the same question I've heard people say, well can women do Keto? Because don't women need carbs in order for their cycles to… So people will ask that too. No. Again, people are thinking that you're taking something, you're mistaking fasting with a medical condition and they're different. So there may be, you'll see people who do intermittent fasting along with a more real foods, whole foods diet approach, who talk about this is the first time in my life that had normal cycles. Because they're self-healing their self correcting some of those issues. I think as with anything, and I don't think fasting is not any difference. If you take fasting too far to where you are now nutrient deprived. But again, most people, if you're still eating two meals a day, especially in the U.S. you're not going to be lacking calories. That's why I think we have to, we're not in the desert, you still have food. So you really don't, in my opinion, have to worry that you're not getting nutrients if you're really just cutting down from three meals a day to two meals a day. There are now hopefully better nutrition quality than what you were eating before. Your nutrients should be fine. But yeah, if you take fasting too long and you're doing regularly 20 day fast or something of that nature, yeah, you probably will see a change in your menstrual cycles after doing that chronically. But with 16 hours of fasting a day, 18 hours, even one meal a day. If you're eating nutritiously during those periods, it really shouldn't be an issue for most women. So yes, women can do intermittent fasting. Women can do low carb. You can do both eating before you work out. So there's this concept that you have to have that free nutrition, before you go lift weights or run or if you work out in a fasted state. You will be surprised at how much better you feel and the results that you've noticed actually. Bodybuilders tapped into this a while ago. Think Terry Crews. He lifts fast and when you are in the fasted state actually working out, you have the higher levels of growth hormone, which not to a point where it's going to be detrimental, but it actually preserves that muscle and makes it more receptive to during that recovery time period. Within, you may go and have your meals so you don't have to eat before you work out. Remember there's something called like fight or flight or adrenal access. So if your body is sitting there trying to process food while you're trying to divert. You're having competing processes going on. So you can work out fast and a lot of people, I prefer to work out fasted and I just feel better when I do it. Other people say fasting will slow your metabolism. It doesn't slow your metabolism either. Just think about it again, fasting, we're now using it for therapeutic purposes or for weight loss. The fasting was just a period of people's lives because again, they stopped eating after dark. And then when they got up in the morning, they were either tending to work outside or doing something like they didn't eat as soon as they got up. So just by virtue they were fasting. If you go 12-hours without a meal and all of a sudden your body starts to shut down and go into some hybernation state, the human race would not be here. All of these things that we think need to happen for survival. We've been surviving for years without doing all of these things that now all of a sudden (Feel we have to do) every two to three hours. So I think those are the biggest misconceptions that I see. And I think people really just have to realize, you will not die if you don't eat for 12 hours. You really well. Dr. Berry: I know you talked about pregnant women avoiding intermittent fasting. Is there anybody else who should maybe stay away from this type of? Dr. Cecily Clark-Ganheart: I would say during pregnancy we already touched on stuff. The time also with breastfeeding, that's not the time to try to do 16 hour fast or anything like that. Eating disorders. So if you have a history of eating disorders, you really want to work with your physician prior to doing that to make sure your issues surrounding that have resolved. Because again, especially if you may have had like anorexia or something like that in the past, we don't necessarily have data either way to say that it's going to make that condition worse or it's going to make it better. But I think you need to make sure you're being monitored by someone so that if they see that you're starting to develop those habits again, they can help get you into therapy or whatnot. So I personally wouldn't recommend it for people with a history eating disorders. We talked about the case reports with diabetes and how it's used as a treatment. So it's not that she can't fast if you have diabetes. But again, you need to be monitored by a physician if you're doing that because you probably need medications adjusted. You don't want to go hypoglycemic. So the interesting thing is, and this concept I find interesting because when you do have studies of people who do prolonged fasting and maybe like an extended fast for like 48 hours or you know, whatever. If you look at their glucose levels, they actually are pretty low. Where if you were getting a lab result back, it probably would deem it as a critical lab value that their blood sugar is hypoglycemic. But you don't have symptoms of hypoglycemia because your insulin levels are low. So if the insulin is low and your blood sugar is low and you're producing ketones, your body runs off of the ketones. This is also why a lot of people who are strict Keto will notice that they have natural low blood sugar levels because your body is using the ketones. So the same thing with fasting. So you're not going to be hypoglycemic or have symptoms in someone who is adapted like that. The problem is with intermittent fasting and a diabetic who has not adapted to having low insulin levels is now all of a sudden you think, okay, well I'm going to fast, but I'm still taking my same dose as the insulin. Now you have low blood sugar, high insulin, that's a different state. Your problem. Now you have symptoms of hypoglycemia, so you really do need to work with your doctor. It's the same way though, like when you start reducing your carbohydrates. I tell my patients, especially during pregnancy, if they're on insulin, I'm like, hey, if you have a change in your diet, I need to know that because I need to change your insulin. Your insulin prescription is based on your diet, so this is why we really shouldn't be surprised that changing your diet can read your need of insulin because I am prescribing you insulin based on what you’re telling to eat. Dr. Berry: A lot of time, I think especially my diabetic patients, they know sometimes we have to get on them. That a lot of times I'm not even necessarily prescribing it for the weight base, which is should be. When I'm prescribing it because what you eat and I got to come back your mouth and that's why you're on the dose that you're on. Dr. Cecily Clark-Ganheart: Correct. And so it's one of those things, it's like, well if you are going to start, I would say the same thing with low carb. If you are on hundreds of units of insulin and now all of a sudden you're like, okay, I'm going to go low carb. I'm not saying you shouldn't go lower carb. You need to call your doctor because that same insulin dose now is going to be probably not appropriate because now you've made a lifestyle change. So that's what you have to be careful about. And then especially type one diabetics because type one we've already discussed, you need insulin as a type one diabetic. You don't make it. So you really have to be cautious. That needs to work with the healthcare provider on that. And never would say anyone who's taking just general medication stuff. Sometimes we don't think about blood pressure medications, but there's some several different classes of blood pressure medications and some of them, not all of them, but work with making you urinate more, go to the bathroom more because you get rid of excess fluid. When your insulin levels lower, that acts as a natural diuretic as well. You will notice lots of people who do intermittent fasting initially because eventually it equals out. But who lose a lot of water weight. They’re diuresing extra water. So again, your health care provider needs to be involved in this because they may need to adjust doses of medication. They may need to do different things. So it's not that you can't fast per se. And I know a lot of people are like, oh, I don't want to talk to my doctor about it because they'll tell me not to do it. But I mean go talk to them. Because the thing is, they may tell you not to do it, but if you tell them you are doing it, then they will adjust. They'll document all in the chart and you know, whatever. But at the end of the day, you need someone to manage your medications. The other thing I would say is that this goes back into misconception time. But people get so worried about, oh my gosh, I'm taking my medication. Is that breaking my fast? If you are prescribed a medication, assuming that it doesn't say don't take on an empty stomach because you do have some medications which should not be taken on an empty stomach. Ibuprofen should not take in state on an empty stomach. Regularly you're going to have a GI bleed. So there there's some things that shouldn't be taken but I wouldn't worry about unless you're drinking your medication with a smoothie about your medication breaking fast. Dr. Berry: Good old green apples smoothie. Dr. Cecily Clark-Ganheart: Because eventually I'm never going to have a smoothie company endorsement. Losing my endorsement potential. But there a water company. That's what I need to find. I think a water company. That's something too, again, before you are playing around with your medications and not taking something or doing this or the other. You you really need to talk to your healthcare provider because that in itself can be dangerous not because of the fasting. It's because you're self-adjusting medication. And so that's something you need. And obviously this is not medical advice for you to go start doing anything. You should talk with your healthcare provider, but these are just some cautions that you should keep in mind. Dr. Berry: Always talk to your doctor. Especially I think in this day and age where there's so much information out there that could have some good effects or also some bad effects. Always want to make sure you're talking to a professional to make sure you get yourself in order before causing any problems. Before we go, I do love the aspect of highlighting my guests and all of the amazing things that they do. First of all, congratulations. I know you recently, just got certify Obesity Medicine Specialist. Definitely congratulations on that aspect as well. I like to call this like the Promo period where any books, any courses, any clienteles or anything that you wanted like say, hey like this is what I'm doing right now. Please feel free. Because I think when people hear this and they get enamored by the guests and sometimes they want to follow up and see what else guests can all kind of offer them. Dr. Cecily Clark-Ganheart: I think the easiest way to find me is my handles the same. My websites the same just across all platforms. So if you go to my website, it's www.thefastingdoctor.com. I'm also thefastingdoctor on Instagram and thefastingdoctor on Facebook. And I have a Facebook group and a newsletter so you could sign up for either, or. I'm going to this fall actually start launching two different programs. One's going to be like small group coaching for people who feel like they want a more personalized kind of approach. But also just a large group forum where we'll have basking schedules available and then host weekly Q and A's. So if you sign up for my newsletter or follow me on Instagram or on Facebook, any of those sites, once that's available, all the information will be there. Dr. Berry: Before I get you out of here, I always ask my guess this, how is what you're doing helping others to take better control their health? Dr. Cecily Clark-Ganheart: So I think how it helps it just realizes or helps people recognize that the weight loss and being healthy says it's really not some magic kind of thing where you, you need something super complicated to do. I think if you just focus on periods of gut breasts and trying to eat whole foods, things that are not in a package, I think those are the easiest places to start. And then in terms of adding physical activity, it could be as something like walking 30 minutes a day. You don't have to join a gym. I mean, not saying you shouldn't, I'm just saying though that people will have all these reasons like well they are able to lift weights five times a week, they have access to a trainer and they have access to this. And it's like you don't need access really to any of that. You need access to quality foods and you need to give your gut a rest. And while quality food can be expensive, if you save the money from that one meal that you skipped, you probably then have more money available to buy more nutritious foods. So I think that's the take home. That is my message. I just want to realize and empower people to know that health isn't just for a certain group of people who have access to wealth or whatever. Health really can be for anyone. And probably some of the most healthiest people in the world are the people who actually have access to police. Dr. Berry: Very good point. I love it. I want to say thank you for joining podcast and really helping to enlighten on a subject that is gaining, I guess traction per say in just the everyday talk when people are making the transformation, transition to one, be more nutritious and they want to think of different ways to do it. This is definitely one of them. Again, thank you for taking the time out and much appreciated. Like I said, we will definitely be looking out for the program, for the groups. And again, remember Lunch and Learn community, all, every book, everything, every link she noted. We'll make sure it's in the show note so you don't have to write anything now. We'll make sure we get that to you. Dr. Cecily Clark-Ganheart: Thank you.