Fructose, Fatty Liver, and insulin resistance – T2D 28

posted in: Diabetes, Health and Nutrition | 52

Fructose and fatty liver

Fructose is even more strongly linked to obesity and diabetes than glucose. From a nutritional standpoint, neither fructose nor glucose contains essential nutrients. As a sweetener, both are similar. Yet fructose is particularly malevolent to human health compared to glucose due to its unique metabolism within the body.

Glucose and fructose metabolism differ in many significant ways. Whereas almost every cell in the body can use glucose for energy, no cell has the ability to use fructose. Once inside the body, only the liver can metabolize fructose. Where glucose can be dispersed throughout the body for use as energy, fructose is targeted like a guided missile to the liver.

When large quantities of glucose are eaten, it circulates to virtually every cell in the body, helping disperse this load. Body tissue other than the liver metabolizes eighty percent of ingested glucose. Every cell in the body, including the heart, lungs, muscles, brain, and kidneys help themselves to this all-you-can-eat glucose buffet. This only leaves the remaining twenty percent of the incoming glucose load for the liver to mop up. Much of this glucose is converted into glycogen for storage leaving a little glucose as substrate for new fat production.

The same does not hold true for fructose. Large quantities of ingested fructose goes straight to the liver, since no other cells can help utilize or metabolize it, putting significant pressure on the liver. Levels of carbohydrates and insulin may be 10 times higher here than in other parts of the circulation. Thus the liver is exposed to far higher levels of carbohydrates – both fructose and glucose than any other organ.

It is the difference between pressing down with a hammer and pressing down with a needle: all the pressure is directed onto a single point. Sucrose provides equal amounts of glucose and fructose. Where the glucose is metabolized by all 170 pounds of an average person’s tissue, an equal amount of fructose needs to be valiantly metabolized by only 5 pounds of liver. What this means practically is that fructose is likely 20 times more likely to cause fatty liver (the key problem of insulin resistance) compared to glucose alone.  This explains how many primitive societies could tolerate extremely high carbohydrate diets without developing hyperinsulinemia or insulin resistance.

The liver metabolizes fructose into glucose, lactose and glycogen. There are no limitations on this system of metabolism for fructose. The more you eat, the more you metabolize. When the limited glycogen stores are full, the excess fructose is changed directly into liver fat through de novo lipogenesis. Fructose overfeeding can increase DNL five fold, and replacing glucose with a calorically equal amount of fructose increases liver fat by a massive 38% within only eight days. It is precisely this fatty liver is crucial to the development of insulin resistance.

Fructose’s propensity to cause fatty liver is unique among carbohydrates. The fatty liver directly causes insulin resistance setting in motion the vicious cycle of hyperinsulinemia – insulin resistance. Furthermore, this harmful effect of fructose does not require high blood glucose or blood insulin levels to wreak havoc. Further, this fattening effect, because it acts through fatty liver and insulin resistance, cannot be seen in the short term – only in the long term.

The metabolism of ethanol (alcohol) is quite similar to that of fructose. Once ingested, tissues can only metabolize 20% of the alcohol leaving 80% delivered straight to the liver, where it is metabolized to acetaldehyde, which stimulates de novo lipogenesis. The bottom line is that alcohol is easily turned into liver fat.

Excessive ethanol consumption is a well-known cause of fatty liver. Since the fatty liver is a critical step toward insulin resistance, it is no surprise that excessive ethanol use is also a risk factor for the development of metabolic syndrome.

Fructose and insulin resistance

That fructose overfeeding could provoke insulin resistance has been known as far back as 1980. Healthy subjects overfed 1000 calories per day of fructose showed a 25 percent worsening of their insulin sensitivity—after just seven days! Those given an extra 1000 calories per day of glucose did not manifest any similar deterioration.

A more recent 2009 study reinforced how easily fructose induces insulin resistance in healthy volunteers. Subjects were fed 25 percent of their daily calories as Kool-Aid sweetened with either glucose or fructose. While this seems high, many people consume this high proportion of sugar in their diets. The fructose, but not the glucose group, had increased their insulin resistance so much that they would be clinically classified as pre-diabetes. Even more remarkable, this development only needed eight weeks of fructose overconsumption.

It only takes six days of excess fructose to cause insulin resistance. It only takes eight weeks to allow pre-diabetes to establish a beachhead. What happens after decades of high fructose consumption? The result is a diabetes disaster; precisely we are having right now. Fructose overconsumption stimulates fatty liver and leads directly to insulin resistance.

There is definitely something sinister about overconsumption of fructose. Yes, Dr. Robert Lustig is correct. Sugar is a toxin.

Toxicity factors

Fructose is particularly toxic for several reasons. First, metabolism occurs solely within the liver, so virtually all ingested fructose becomes stored as newly created fat. In contrast, all cells can help metabolize glucose.

Secondly, fructose is metabolized without limits. More ingested fructose leads to more hepatic de novo lipogenesis and more liver fat. No natural brakes exist to slow down over production of new fat. Fructose directly stimulates DNL independently of insulin, since dietary fructose has minimal effect on blood glucose or serum insulin levels.

Fructose metabolism is less tightly regulated. Thus, it can overwhelm the export machinery of the liver leading to excessive buildup of fat in the liver. We’ll talk more about how the liver tries to rid itself of the newly created fat in the next chapter.

Thirdly, there is no alternative runoff pathway for fructose. Excess glucose is stored safely and easily in the liver as glycogen. When needed, glycogen is broken back into glucose for easy access to energy. Fructose has no mechanism for easy storage. It is metabolized to fat, which cannot be easily reversed.

While fructose is a natural sugar, and part of the human diet since antiquity, we must always remember the first principle of toxicology. The dose makes the poison. The body has the ability to handle a small amount of fructose. This does not mean it can handle unlimited amounts of it without adverse health consequences.

Conclusions

Fructose was once considered harmless because its low glycemic index. In the short-term, there are few obvious health risks. Instead, fructose exerts its toxicity mainly through long-term effects on fatty liver and insulin resistance. This effect is often measured in decades, leading to considerable debate.

Sucrose or high fructose corn syrup, with roughly equal parts of glucose and fructose, therefore plays a dual role in obesity and type 2 diabetes. These are not simply ‘empty calories’. It is something far more sinister as people are slowly coming to realize.

Glucose is a refined carbohydrate that directly stimulates insulin. However, much of it can be directly burned for energy leaving only smaller amounts to be metabolized at the liver. Nevertheless, very high consumption of glucose may also lead to fatty liver. The effects of glucose are immediately obvious in the blood glucose and insulin responses.

Fructose overconsumption directly produces fatty liver, which in turn directly creates insulin resistance. Fructose is five to ten times more likely than glucose to cause fatty liver. This sets off a vicious cycle. Insulin resistance leads to hyperinsulinemia, to ‘overcome’ this resistance. However, this backfires, as the hyperinsulinemia, made worse by the attendant glucose load, leads to further insulin resistance.

Sucrose therefore stimulates insulin production both in the short term and in the long term. In this way, sucrose is far, far more menacing than starches that contain glucose, such as amylopectin. Looking at the glycemic index, the effect of glucose is obvious, but the effect of fructose is completely hidden. This fact has long misled scientists to downplay the role of sugar in obesity.

The additional fattening effect of insulin resistance festers for years or even decades before it becomes apparent. Short-term feeding studies completely miss this effect. A recent systemic analysis, by analyzing many studies lasting less a week, concluded that fructose shows no special effect outside of its calories. But fructose’s effects, as well as obesity, develop over decades, not weeks. If we were to analyze only short-term studies of smoking, we might make the same mistake and similarly conclude that smoking does not cause lung cancer.

Cutting back on sugars and sweets has always been the first step in weight reduction in virtually all diets throughout history. Sucrose is not simply empty calories or refined carbohydrates. It is far more hazardous, since it stimulates both insulin and insulin resistance simultaneously. Our ancestors have always known this fact, even if they did not know the physiology.

We have tried to deny this during our 50-year obsession with calories. In our effort to blame everything on calories, we have not recognized the inherent danger of fructose overconsumption. But the truth cannot be denied forever, and there was a price for ignorance. We paid for the caloric pied piper with the twin epidemics of type 2 diabetes and obesity. But the uniquely fattening effect of sugar has finally been recognized once again. This was a long repressed truth.

So, when Dr. Lustig presented his lecture on a lonely stage in 2009 and declared that sugar was toxic, the world listened with rapt attention. Because this professor of endocrinology was telling us something we already, instinctively knew to be true. Despite all the platitudes and the reassurances that sugar was not a problem, the world already knew, in its heart, the real truth. Sugar is a toxin.

 

52 Responses

  1. I can now see the error in my habit to take in large quantities of fructose in my diet! How do we reverse a fatty liver to become healthy again, and how long will it take to do that? Please help with this question!!

    • sten bjorsell

      Intermittent fasting is the only thing I know to reverse fatty liver soon. Check progress by measuring waist! To be able to fast for 3-5 days in a row one needs to be fat-adapted else hunger makes it very difficult. LCHF first. Search at the top for intermittent fasting to read Dr. Jason’s earlier posts about it.

      • Thank you Sten, I will study all the earlier posts without fail!!!

      • Thomas, I usually use a fat fast for the first couple of days then I switch to a calorie free fast after my body has used up most of the sugar in my body and liver. This helps me ride out the first two days of extreme hunger and into a smoother transition to a pure fast as my body becomes fully fat adapted..

    • Hi Thomas. If you drink the juice of one lemon first thing each morning diluted in warm (not hot) water for three months this will apparently help to cleanse the liver and return it to a healthy state. I have had this advise from a couple of people who are very experienced in natural health matters.

    • Thomas and Sten: avoid PUFAs, too, stick with saturated fats. The studies are on rats, and the offender is actually alcohol, but somebody said fructose and alcohol are the same for the liver (was that Jason?).
      https://www.ncbi.nlm.nih.gov/pubmed/9397995
      http://jpet.aspetjournals.org/content/299/2/638.long

    • Nerida Burton(Sydney, Australia)

      Could someone give me the address of Jason’s website? I am unable to find it

    • S-Adenosylmethionine (SAMe) and choline supplementation, in particular phosphatidylcholine.

    • Thomas, I think that very low carb diet can achieve the same as fasting and is easier to do. read Jeff Volek and Stephen Phinney’s book which tells you how to implement such a diet. If you don’t know what you are doing it is harder to make it work; there are tricks you need to know to remain on a low carb diet long term.

      https://www.amazon.co.uk/Art-Science-Low-Carbohydrate-Living-ebook/dp/B005CVV2AE/ref=sr_1_1?s=books&ie=UTF8&qid=1486772572&sr=1-1&keywords=stephen+phinney

  2. Kristine Marchetti

    I am so frustrated. I have been on a low to no carb, medium protein, high fat diet. I was watching my blood sugar go up in the morning, I fast until noon. Now I read fructose is another and worse culprit and begin to understand why I haven’t been loosing weight and blood sugar although in a normal average range, never goes down. Ok so here it is, lettuce is high in fructose? Zuccinini? What can we eat? So totally frustrated.

    • Hi Kristine. I would not worry about fructose in veggies; not only do they have very little (you can always google it), but the fiber offsets part of its effect. I would limit fruit though, and keep it in season.
      Your morning highs seem to be physiologic insulin resistance associated to your diet. It’s normal, harmless and totally reversible, and part of a mechanism of glucose sparing for the organs that can’t do without glucose. If you measure your postprandial sugars, they’re probably nice and low.

    • Eat less protein at dinner, Kristine. Try moving most of your protein to lunch.

    • Kristine, I wouldn’t be worrying about lettuce. If you’re low in sugar and low or moderate with alcohol, and sensible with fruit, you’re doing well and way better than average. Fasting until noon is good too. I don’t know really know why you’re frustrated because I think you’re doing well. We can eat real food instead of junk, which I think you’re doing. That’s enough for me and I never check my glucose. It’ll go up when I eat, but less than high carbers and for less time due to fasting. Good enough, me thinks.

  3. Everyone is different and I am not sure what medical tests commonly available measure insulin resistance. I estimate about one year to reverse my poor metabolic markers.

    I cut out sugar/sweeteners, fruit, milk, beer, starches, grains, root vegetables, and I fast. Bingo. Clinical fasting BG now is around 89 mg/dL and triglycerides are down to(last 4 over two years) 48, 50, 52, 37 mg/dL. Before BG was over 100 and tri 178.

    My particular way of eating is keto where I limit carbs to those coming from green vegetables, consume about 100 grams of protein per day, and add healthy fats to make up the remainder of my consumption. Each person has to find a way of eating that suits them. Dr Fung has lots of guidance in his books and on this website.

    • sten bjorsell

      Seems as if you are doing the perfect things! The fasting has emptied your liver from fats and if you are young enough the metabolic syndrome can well be permanently gone. It seems the older one is, or the more stress and high-carb years one has clocked up, the more fasting is required to empty liver and probably some other organs too from fat.

    • What do you eat and drink?

  4. I gave myself fatty liver a couple years ago with daily energy drink consumption. Confirmed it with an ultrasound, and my naturopath decided it was a good idea to put me on choline therapy. For those of you who don’t know what choline is, it’s mainly found in eggs but it’s excellent at ridding the liver of fat. I havn’t had an ultrasound since, but since then I had gone paleo, but moved more keto, and I’ve started incorporating longer fasting periods.

    I assume Dr Fung will go over ways to rid the liver of fat though I’m sure it will be the same advice, LCHF/Keto + fasting, which works for me!

  5. https://www.sciencedaily.com/releases/2016/06/160621111547.htm

    I don’t think Dr. Fung approves of this drug, but I remembered that it does halt fatty liver.

    • Ha-ha, indeed he doesn’t. Besides, it looks like pioglitazone increases the risk of cancer, and it’s banned in India. I think I’ll stick to fasting…

  6. An Australian documentary that really illustrates this post perfectly can be found here, http://thatsugarfilm.com/. Fructose can turn an otherwise healthy individual into a pre-diabetic in a very short period of time. Note that the producer of this movie was counting his calories, exercising as before, and developed fatty liver as he gained ten pounds. This further illustrates that sugar is at least as bad as tobacco, and maybe worse in terms of its association with a long list of chronic diseases.

  7. So I’m throwing this out there for the followers. If you were going to eat some form of sugar what do you think is the least harmful? (And I already know none is the best answer.) But if forced to eat some, what would you use. Honey? Maple syrup? Sugar? Artificial Sugar? Just curious about what you all think is the less of the evils? We rarely eat sugar but sometimes we do like to have a treat or a recipe calls for some. At this point we use erythritol. Thanks in advance.

    • sten bjorsell

      Dextrose is pure glucose only. Probably a few other commercial names on glucose only.

    • Sue, I’d stick with erythritol, stevia, and xylitol. You’re on the right track.

    • Honey has a lot more fructose than table sugar (sucrose). Honey should be avoided. Maple sugar is about 66% sucrose, the rest being mostly water. Its benefit is that one might use less maple sugar because it’s so satisfying…

      If you read Dr Fung’s “The Obesity Code,” you will see that he is against artificial sweeteners, as these products also stimulate the insulin response.

    • If it’s on rare occasion, I don’t think you have to worry about it… The problem with fructose is overconsumption, daily.

    • I prefer to avoid encouraging my now dormant sweet tooth, but if forced I’d go for stevia, which comes from a plant and I understand doesn’t raise glucose. Xylitol is also considered natural.

  8. For those who need to know fructose content of foods (based on 200Kcal)

    http://nutritiondata.self.com/foods-000011000000000000000.html

    Thinking about all those years when I was eating several apples a day “to be healthy”, I can see the error of my ways. But, having taken my weight down to an optimal BMI with a LCHF/IF diet, I can see that beans, roots and potatoes can fit in a maintenance diet (due to their near zero fructose). And the results say that yes, you do not gain weight if you eat those things for a starch-rich dinner.

  9. J L De Foa, MD

    “Every cell in the body, including the heart, lungs, muscles, brain, and kidneys help themselves to this all-you-can-eat glucose buffet.”

    While this is indeed true, striated muscle, both cardiac and skeletal, actually prefer to burn fatty acids. When the heart is made to burn glucose it doesn’t work so well, exhibiting “diabetic cardiomyopathy”. Though skeletal muscle will use stored glycogen for bursts of activity, like trying to beat Usain Bolt or run from a bear, when it is at rest like it is for most of us most of the time, it prefers to burn fatty acids.

    So the fact that resting skeletal muscle replete with stored glycogen doesn’t want to take up even more glucose doesn’t mean it is “insulin resistant”, it is just behaving physiologically, and it is full. FRUCTOSE driven Foie Gras certainly plays a role in hepatic insulin resistance, but peripheral insulin resistance may simply be muscle and adipose tissue behaving physiologically against our misguided desires. We throw excess glucose at our storage sites, and they say they are full, leaving an additional sugar cube worth of glucose in our 6 L of blood. MDs who have forgotten their physiology (if they ever connected the dots) try to lower that by throwing more insulin in, and of course it doesn’t really work.

    When IS skeletal muscle NOT insulin resistant? Well, right after exercise has depleted glycogen stores and they need to be replenished. So “carb loading” before may be of little value, but if one is lean that post exercise chocolate milk may not be such a bad idea.

    • That could be true regarding having the post-exercise chocolate milk, for lean people. But there is more evidence emerging that even lean people can use fat for fuel for long distance-type exercises. And, given that most people who read this site have insulin issues, throwing carbs at us is a bad idea. Personally, I was using a technique from a book called Slow Burn, where you only lift weights once per week, and I was easily able to gain muscle mass and strength while fasting a ton and eating a low carb, high fat diet. I had no problems, even if I fasted for 4-5.5 days. Now, I am not lean, and I was only exercising 3 days per week (1 hour each time, one lifting, two aerobics). But I had no trouble doing so. Oh, and I lost weight while gaining strength (and I’ve been lifting since I was 15 or 16 and I’m over 50 now).

      Sadly, I had to have shoulder surgery, and that caused my exercise to be stopped for a while. Additionally, swimming caused both shoulders to hurt to the extent that I had to stop lifting for most of my upper body (any pushing exercises). Verdict: degenerative rotator cuff tears.

      Now, I’m finally getting back to lifting and using a slightly different technique from a book called Body by Science. This is also a one-day-per-week weight lifting regimen, but it places more emphasis (I believe; I’d have to re-read Slow Burn to be sure) on training to failure. I have had no problems lifting while on a ketogenic diet and also fasting two times per week of 40 hours and one time of 24 hours (with a small meal at dinner that day). Again, I don’t eat before or after the workout, as I workout in the morning and no longer eat breakfast. I was originally working out after about 36 hours of fasting, with no problems. Now, I’ve changed the date of my strength workout to where I’ll workout after about only 12 hours of fasting, but I’m sure I’ll have no problems.

      So, I believe many people could workout with a total lack of carbs afterward or even eating at all and have no ill effects. Of course, you might have to eat if you’re exercising a ton, as you need to get calories into you.

      • Bob, the way to preserve your rotator cuffs as long as you can is massive doses of cartilage. I do eat most of the cartilage in my chickens, and use the rest for bone broth. Bone broth, gelatin and chicken skin are second best, or any animal that you can eat whole (insects?). I do not eat roast chicken every day, but I do have bone broth with gelatin every night.

      • Been doing BBS off and on now for about 4 years and don’t have any performance issues even if a am in a VLC phase (I tend to cycle between VLC to about 100 g of carbs and fast whenever I am in the mood. However, I find that I like to do heavier and more explosive lifting, running etc and I find I do have to up my carbs.

  10. I’m looking for a link with good details about the 80% liver and 20% muscular metabolism of alcohol.

  11. I’m getting to the point where I’m convinced avoiding processed sucrose, is critical to long-term success. I’m still not totally convinced on the dangers of eating whole fruit, or other plants containing Fructooligosaccharides/fructans (e.g. onions, garlic, asparagus, and many others).
    Is there a study out there that compares fructose consumed as table sugar vs the same amount consumed as whole food?

    I’ve seen a lot of anecdotal evidence over the years that low-carb dieters have to be careful when including onions and garlic in their recipes.

    I would be interested to see if there are differences in weight loss, liver fat, and other diabesity related markers.

    • Hi Stevo74,
      Dr. Fung is here elaborating on the research by Dr. Lustig.
      Dr. Lustig says that fruits are not a problem because the fructose in them is package together with fiber. Fiber slows down the digestion of fructose and therefore avoids the bad effects of it.
      That said, he recommends never drink fruit juice of smoothies because the insoluble fiber is destroyed in the process.

  12. charles grashow

    https://well.blogs.nytimes.com/2014/02/19/learning-to-cut-the-sugar/

    Q. A lot of the recipes in your book use fruit to add sweet flavors. Was this a way to limit refined sugar?

    A. Exactly. People always say to me, “What about fruit? It has sugar.” But I have nothing against fruit, because it comes with its inherent fiber, and fiber mitigates the negative effects. The way God made it, however much sugar is in a piece of fruit, there’s an equal amount of fiber to offset it.

    There’s only one notable exception: grapes. Grapes are just little bags of sugar. They don’t have enough fiber for the amount of sugar that’s in them. But I have nothing against real food, and that includes real fruit. Eat all the fruit you want. It’s only when you turn it into juice that I have a problem with it, because then it loses its fiber.

    Dr. Robert Lustig – “Eat all the fruit you want. It’s only when you turn it into juice that I have a problem with it, because then it loses its fiber.”

  13. How harmful is a bowl full of low sugar cereal like life and whole milk on occasion?

    • Stephen Town

      Lynn, Just drink the milk. The cereal is mostly glucose and the added sugar is half glucose and half fructose. It will cause your insulin to rise and when it drops, you’ll feel hungry. This is why these type of ‘breakfasts’ don’t fill people up. Frankly, it’s processed rubbish, but I accept that some of them are tempting. I don’t keep cereals in the house and much prefer a late breakfast that keeps me satisfied until mid afternoon. Full fat yoghurt, eggs, bacon, fish and salad. That sort of thing. Real food and pretty easy to make.

      How harmful is this type of breakfast? Well, if you have it once a month I don’t suppose you’d notice much difference, but the problem is that most people eat this stuff every day.

  14. DrunkCalvin

    Hello Jason,

    Big fan of your work, thanks so much for the insights you provide.

    Every now & then i get confused about dietary advise i receive.
    From this current post its clear that Fructose & Alcohol are processed/digested by Liver only
    so more of it i consume heavier the load will be on the Liver.
    I go to DietDoctor.com – How to lose weight section – it clearly says “Men – don’t drink beer” & spirits like
    Whiskey, Vodka, Rum etc are recommended over Beer.
    Beer clearly has lesser Alcohol when compared to these spirits (Whiskey, Vodka etc) so would be lighter on the Liver!
    So, shouldn’t beer be a better drink for weight loss (it does contain some maltose which is no additional load on the liver i believe). Shouldn’t all drinkers be advised to drink beer just for the lighter alcohol load? please help me understand this better.

    • Stephen Town

      Drunk Calvin, I used to love beer, but it’s decribed as “liquid toast” because it’s full of sugar and wheat. In short, lots of carbs. And alcohol and fructose for the liver to deal with. I assume that’s why DietDoctor recommends spirits, but clearly not too much.

      After I went low carb, I had increasing difficulty drinking my favourite beers. It just wasn’t going down at all. I reached a point where i just couldn’t drink beer. I spoke, via email, to Zoe Harcombe, a top low-carb nutritionist in the UK, and she said that my body was probably reacting to the sugar and wheat which I no longer ate. This doesn’t affect everybody.

      I’ve moved onto red wine.

      • DrunkCalvin

        Thanks for the reply Stephen, appreciate it.
        So in theory, Beer = 8-12% alcohol + maltose (mostly glucose – none of the bad stuff fructose!)
        Spirits = 30-50% alcohol + In case you drink this with Coke or Juice (all fructose)

        In theory, Beer looks like a better deal to me 🙂

    • Alcohol

      Alcohol provokes many of the same damaging metabolic effects as does sugar.  For example, there is only one more powerful way to elevate triglycerides and contribute to metabolic syndrome (insulin resistance, abdominal weight gain, rising blood pressure, along with the rising triglycerides and diabetes) and that is with alcohol.  

      Gin & tonic and mixed drinks?  — Rum and coke?  Vodka and orange juice?  Gin and tonic?  Whiskey sour?  Manhattan?  Martini?

      If someone is going to drink regularly, he/she needs to just consider each alcoholic beverage is the equivalent of a large Pepsi, and to compensate make a huge cut in the carbohydrate foods at that meal.  In other words, if meals frequently include alcohol, those meals should consist of nothing more than meat/fish/poultry/eggs plus non-starchy vegetables along with the booze.  

      Also, they like to totally ignore the carb effect of the alcohol in wine.

      — Face it — frequent alcohol consumption is not compatible with optimizing health.

  15. I like this explanation for why fructose has this effect in our evolutionary context:

    Fructose was available only in late summer, when fruits were ripe.
    The fructose leads to insulin resistance, which leads to massive hunger and energy storage (you get fat).
    Winter comes.
    There are zero carbs available in the winter (no fruits or veggies growing) = keto diet.
    Other foods (like meat) are available only when you get lucky catching an animal = Fasting.

    Keto and fasting reverse insulin resistance and you start burning your body-fat for energy.

  16. I have been doing 48 hours fast per week and OMAD on the other days for the past year. I got off track at Christmas and when I went back to it a month ago I am finding that I have explosive diarrhea about 3 days per week now. After each meal-dinner about an hour later I am in the bathroom. All I can find on this is gastric dumping after gastric surgery but I have not had any surgery. I cannot figure out why this is happening now.

    • Steve, how has that worked for you?

      I do a 48 hour fast 2X per week. OMAD on the other days. And I don’t feast. Just real/unprocessed food. Eggs from scratch hens. A little meat in a panado, which is a vegetable soup with a little tomato in a freshly made chicken broth. Weight stays at a solid 170. Height is 6 feet. Washboard abs. Lean. lithe and sculpted. Effortless.

      Exercise: 14,000 strict push ups per month.

  17. CptAhnungslos

    Fasting sucks! Due to fasting, I lost so much weight, that I had to buy new, smaller clothes.
    And I’m bored to the bone, I don’t know what to do with all the free time I have because eating isn’t my main pastime anymore 🙁

    • Stephen Town

      Cpt, I sympathise. It’ll never catch on.

      We couldn’t do with a country where slim people are common and don’t need drugs.

  18. […] that fructose is something like 20 times more fattening than glucose (starches), as we discussed last week. So it is not really true when somebody says that eating a bowl of rice is the same as eating a […]

  19. Dr Fung, do you think fatigue and sleepiness after meals is a sign of hyperinsulinemia? Starting the last 3 years or so I have made the effort to eat healthier, beginning from just eliminating processed foods into low carb higher fat recently. I’ve struggled to get regular exercise in and have been inconsistent there though I am doing better than before, I like to think. I’ve gone from borderline overweight BMI to regular BMI. While I did completely eliminate sugar I’ve incorporated honey/maple syrup and increased my intake of fruits…. the honey and maple syrup is very occasional, while the fruit intake has been almost daily! I do have hypoglycemia. I’ve passed out several times in the morning from it. I’ve been thinking my current problems have been adrenal fatigue, but now reading your blog I wonder if hyperinsulinemia is something I have, probably had for a long time. I would like to fast, but I’ve been told this is not good for adrenal fatigue(I am female also).

    • ok I looked up more information and I think reactive hypoglycemia fits my condition more, but doesn’t that overlap with hyperinsulinemia? I think I am prediabetic….wow. and with fatty liver, adrenal fatigue and subclinical hypothyroidism. I would I have to fix this before fasting? would fasting aid in healing any of the above conditions?

  20. Type 2 on oral meds, met and 1 mg glymeperide. a1cs alway under 6.1. 70 years old, 5’10”, 200 lbs. If i go on a 16/8 IF and watch carbs, any guess how long it would take to get fats out of liver to a healthy level? Months, years? I can lose 1 lb a week easily with exercise. Thanks

  21. SimpsonsFan

    Hi, all. I’m new here and have just begun reading some of the materials provided here, to augment what I’ve already read elsewhere.

    I’m just rambling. Feel free to skip.

    I’m trying to stay positive, but I’ve tried many strategies to lose fat, and all have failed (short of legit starvation…which isn’t sustainable). I started intermittent fasting 2 weeks ago. Yesterday, I was back at my starting weight, and today I’m now a 1/2lb heavier than my starting weight. My waist is getting bigger and my clothes are tighter. It’s pretty demoralizing.

    To be clear, it has only been 2 weeks, but I just keep gaining and losing the same 1-2 lbs, from day to day.

    (In case you’re wondering what I ate yesterday, to gain that 1/2 lb, well… Yesterday was a weights day. I do weight training every other day. That was good. I felt fine. For my meal, I made a stirfry with 1 stalk of broccoli florets, 1/4 of a green and yellow pepper, 6 small green onions, about 4 cups of spinach/kale blend, 1 Tbsp of minced garlic & ginger, a splash of lime juice, and a tsp of oil. About 2 hours later I had 2 dark choc.-covered Brazil nuts. About a half hour before the end of my eating period, I had a handful of unsalted peanuts.)

    A bit about me… I am a woman in my 50s, 5’3″, and currently have a BMI of 25.5. I am healthy, but I do have (almost irrelevant to me) PCOS, am in the middle of perimenopause (thus I’m estrogen dominant), and was recently diagnosed with a fatty liver.

    Just so you know, I was always the super-thin sub-type of PCOS-er, until my 40s. (From my late teens to my 30s, my BMI always stayed between 15.3-16.2. In fact, I didn’t break the 100lb mark until somewhere in my 30s. I didn’t watch what I ate and didn’t exercise.) I really started to gain fat as I entered my 40s and/or perimenopause.

    I lost a bunch of the visceral fat I’d gained, once I learned how cinnamon is a natural insulin sensitizer and then added it to my diet. Unfortunately, that effect eventually plateaued. Funny enough, though, despite seeing the scale go down every day I ate 3g of cinnamon for that first few months, my outward appearance didn’t change. My clothes were just as tight. The reason I’m convinced it was just visceral fat is because I’d noticed a kind of harder fat in my belly, in cettain yoga moves. After I started taking cinnamon and my weight dropped significantly, that weird, hard sensation in my belly went away, even though the sub.cu. belly fat was still there in all its glory. I lost all that weight from somewhere, and it sure wasn’t my beliy or my butt!

    I do exercise regularly, although it tends to be in clusters. Like, I’ll exercise like a maniac for 2 months, only to gain a pound or two, look exactly the same as when I started, give up, go back to moderate exercise or exercising every other day for a few months, then get motivated to kill it in the gym again, only to get demoralized when I, again, don’t lose a single pound, etc., etc.

    For about 15 years, I’ve been eating a plant-based diet of mostly whole foods. I rarely eat fruit or juice. I eat mostly greens & vegetables, plus nuts, seeds, and some beans, too. I now eat according to the newer Insulin Index (after many years eating low GL). I focus on lots of fibre for my microbiome. I’ve recently been trying to go oil-free, or at least significantly oil-reduced.

    Most of my adult life, I was essentially intermittent fasting; it just wasn’t called that. I don’t really care about food beyond the nutrients it provides, and I have long joked that I must have very little ghrelin, given that I am never hungry. So, a single meal and a snack or two, later in the day, was my normal routine for all the years I was skinny. I’m doing 19/5, since that fits my schedule best. (I eat between 1PM & 6PM.) I suspect that is partly why I can stick to such a healthy diet. I find most people are somewhat slaves to their tastes buds. My husband (who IS a slave to his taste buds) and I often joke about the fact probably 30% of my diet is made up of things I don’t even like, but consume for the nutrients. (Dulse comes to mind. Blech!)

    Long story short, I eat a seemingly very healthy, plant-based diet that is low in sugar and processed oil, and high in nutrients, given that the volume of food I consume is fairly small.

    The more I’ve read, it seemed more likely that the “healthy” lifestyle I adopted in my mid-30s…of eating 3 meals a day, plus snacks, focusing on extra protein…may have been the biggest part of what led to my fat gain. (Because PCOS makes me insulin resistant, and perimonpausal stress can increase cortisol, as does excessive exercise…) For many years, now, people would talk about eating lots of small meals per day, yadda, yadda, yadda, and all I could think was ‘for 2 decades, I ate maybe once a day, never watched what I ate and never exercised, and was thinner than you’ll ever be.’ It was truly confounding. Following popular conventions has only led to weight gain for me. (I did that ‘Insanity’ program, for example. I gained 2 lbs!)

    I was REALLY hoping that creating a structured, intermittent fasting schedule would be the thing that finally works to shed the excess fat, because it so closely mimics my normal lifestyle, for those decades where I was effortlessly-thin. Sadly, it’s not getting off to a miraculous start. I dare say, had I eaten whatever I wanted and whenever I wanted, over the past 2 weeks, I’d be in exactly the same circumstances as I am today. So far, no benefit to intermittent fasting. But I’ll hang in there for another couple of weeks, and see what happens. “Pray. For. Mojo.”

Leave a Reply