Leaky Gut - The Case Against Gluten

I've looked into "leaky gut" on multiple occasions during my first year working closely with GI patients. I remember after consulting my 3rd patient that had an extensive list of food allergies/sensitivities, I had to investigate what was going on. WHY are these patients positive for ALL 6 of the common food allergens? And also, why are they not presenting with traditional allergen symptoms (anaphylaxis, itching)? In my investigation, I soon stumbled upon a possible cause: increased intestinal permeability AKA Leaky Gut Syndrome. What I found at that time was that something was causing the tight-junctions between intestinal cells to break down. Without tight-junctions, gaps would form between cells allowing for food particles to enter the bloodstream only to result in immune system response. Immune response to a food = "allergy".

I concluded that I would have to circle around to this conundrum at a later time. But for the time being, I had to recommend the only studied diet for this food allergy/sensitivity condition: The Six Food Elimination Diet. The six food allergens are milk, egg, wheat, soy, fish/shellfish, and peanuts/tree nuts. As you can imagine, compliance with this diet is low.

Besides food allergies/sensitivities, other symptoms of Leaky Gut Syndrome include: 

• Diarrhea
• Malabsorption (which can lead to nutritional deficiencies) 
• Poor immune system
• Fatigue
• Skin Rashes
• Food Cravings 

Fast forward to this past week. After a short discussion with my colleagues about gluten, I revisited the connection between gluten and leaky gut. I've never really taken a side for or against a gluten-free diet (except for celiac patients), until now. 

Remember that something was breaking down the tight-junctions causing "leaky gut"? Well zonulin, an inflammatory protein, is the master regulator of inter-cellular tight-junctions. In other words, it regulates "leakiness" by opening and closing the spaces between intestinal cells. 

The next question I had was: What increases zonulin?

GLUTEN. Gluten stimulates zonulin release! Also, lectins do as well, but we usually cook foods high in lectins, which disables the action of the lectins (please eat your beans!). Another stimulus for zonulin release is bacteria - harmful bacteria. If your digestive tract senses harmful bacteria, zonulin will break down the tight-junctions, allowing water to enter the colon to flush the body of the bacteria. For all of us that have experienced food poisoning knows what I mean... DIARRHEA.

This picture below demonstrates how gluten disrupts intestinal permeability. 
Gluten --> Increases Zonulin --> Zonulin widens the tight-junctions --> flow of food particles enter the blood via the gaps between the intestinal cells --> Autoimmune response to these food molecules (which should normally not be there) --> Inflammation and irritation of the GI tract --> Patient presents positive for food allergies/sensitivities 

So should we all be following a gluten-free diet? No, but a gluten-free diet should be considered for those with GI symptoms such as diarrhea, constipation, and bloating. A therapeutic elimination diet would be beneficial in giving the GI tract a break from the gastric irritant gluten. See below for directions on how to do an elimination diet properly. It's also important to slowly increase prebiotic fiber which will help improve the health of your microbiome (the world of bacteria inside of your GI tract). 

If you suspect leaky gut or some gut imbalance, please see your doctor. Could you benefit from removing gluten from your diet? Yes. Do you need to eliminate gluten forever? No, but you should consume anything processed (such as wheat) in moderation.

Can probiotics help? Possibly! Studies suggest that specific strains may improve tight-junctions. There isn't enough research to solidify this claim, but a high-quality probiotic supplement in combination with increase prebiotic fibers is the best place to start to improve overall gastrointestinal health. Two probiotic supplement brands I trust are Metagenics and Garden of Life. 

Side Note: NSAIDs, such as ibuprofen and aspirin, can also increase intestinal permeability. But that is for another discussion. I highly recommend limiting the use of NSAIDs as they have been shown to damage the gastrointestinal tract.

30-Day Elimination Diet 

Step 1: Remove Gluten for 30 days 

Gluten is found in A LOT of commonly eaten foods. Luckily there are plenty of gluten-free options at the grocery store. Once you understand what foods have gluten (wheat, barley, rye, some oats), adjust your mindset to thinking about what you CAN eat. It will make the process much easier. 

Note other names for wheat: durum, einkorn, emmer, kamut, spelt 

Step 2: Think about the foods you CAN eat 

Fresh, whole foods are the way to go. Fruits, vegetables, lentils/beans are a MUST to include because they contain fiber. Fiber is essential to healing the gut and building up a healthful microbiome. Other foods to include are eggs, fish and grass-fed beef, free-range chicken (QUALITY MATTERS when it comes to animal products). It would also be beneficial to include a dietary probiotic such as yogurt or kefir (non-dairy is okay as long as it has the live-cultures). 

What about the carbohydrates?! Well, rice will likely become your friend. And gluten-free oatmeal. Other gluten-free options include quinoa, corn, and millet. 

Step 3: Reinoculate 

It's time to build up that microbiome. It's important to include both prebiotics and probiotics. If you do not like fermented foods, I recommend getting a probiotic supplement. Prebiotic fibers include strawberries, bananas (the greener the better), oats, artichokes, asparagus, garlic, onions, and leeks. 

Step 4: Asses how you are feeling 

If you are still experiencing gastrointestinal issues, I recommend seeing a gastroenterologist so they may rule out any serious GI condition. 

For more information, visit the Mayo Clinic for a good article on Gluten-Free Diet. 

Taylor Swift Themed Birthday Party

So being the big Swiftie I am, after the release of Taylor Swift's new album Lover, I had to throw that in with the mix of my birthday party theme: Boho, iridescent, Lover.

Flower Crown Making Station 

Photo Booth with Polaroid Camera 

Floor Seating Boho 

Lover Album inspired drink menu

Dessert Table

Ultimate Charcuterie Board Table

"Oh, 25 years old"

Want to recreate the drink menu?

Drink Menu Holder - 3 Pack 

I used all three. 1. Alcoholic drink menu 2. Non-alcoholic drink menu 3. Photobooth Sign

A Message to the Body Shamers

A Message to the Body Shamers out there (including healthcare professionals, family, friends, and strangers):

Hi, I'm Tatiana. I'm your [insert relationship: patient/child/friend/spouse]'s dietitian. My patient has told me about you and your comments during our appointment. They expressed feeling hurt, shame, and/or embarrassment about their weight due to your remark. I understand that you are trying to help, perhaps even motivate them. I must inform you that body-shaming does all harm and no good. Weight loss is NOT easy. Healthful, permanent weight loss is a colossal obstacle, especially when my patient is struggling with body image (which is 90% of my patients). 

To The Healthcare Professional: 

My patient was told to lose weight at your medical clinic (likely because their BMI was above 30). The patient brought back the already-known information to our nutrition session. "The doctor said I need to lose weight. I should reduce calories and exercise more." What you didn't know: My patient was too embarrassed to tell you that they are already in the process of making healthful lifestyle changes.

I ask you to change your approach. Before you go on preaching the ineffective calorie-in/calorie-out method for weight loss, ASK your patient what lifestyle changes he/she has already made (don't even bring up their weight). They may ask you for some additional advice, sensing a safe, open environment. If you don't have time to discuss weight loss, ask if they have ever met with a dietitian. If not, write a referral. If yes, don't worry, they are likely in good hands. 

To The Parents:

Never ever, ever use the F-word (fat) in front of my patient. Don't even use that word to describe yourself or another person. You may think it's helpful to remind them about their weight and health, but to be the bearer of bad news, it does not motivate them whatsoever. In fact, it hinders their progress in practicing positive body image. Did you know that positive body image is associated with weight loss? Probably not. We live in a shame-filled society. The least you could do is avoid adding on to that shame. You play a role in my patient's success. Words are powerful. Shame is real and dangerous. I discuss this reality with them during our sessions together, in a safe, non-judgemental environment. Please, do your best to create this same environment at home. Be encouraging and tell them the positive truth: Your daughter/son is making progress and they are enough just the way they are. 

To The Stranger:

Take a moment to think about the pain and hurt you have experienced in your life (if you deny hurt/sadness, then you may be a psychopath or have alexithymia: unable to feel emotions). You are NOT the only one who experiences bad days. Every person you come in contact with is struggling with something (death of a loved one, relationship problems, negative body image, etc.). I would think that judging my patient would be the last thing on your mind. However, sometimes you forget the reality of normal life struggle and embarrass my patient. Perhaps you assumed that my patient doesn't give a flying f**k about their health (which your body language and look gave away). You may have looked at the items in their grocery cart in a disapproving manner. You may have even avoided looking at them in the eye, pretending they weren't there. 

I ask you to treat every person you meet with kindness. Make eye contact and smile. Acknowledge their existence! You do not know what they are going through. Your smile could ignite my patient's will to continue the process of gaining health.

To The Friend:

The type of relationship you have with my patient is crucial to their success. I hope you have an honest, real relationship. I hope he/she can come to you for comfort and reassurance. Allow my patient to talk aloud and honestly about his/her body image. Let them excitedly share their progress on making healthful lifestyle changes. Please, avoid talking about fad diets and losing 10 lbs in a week with him/her. The diet mentality doesn't work. Dieting doesn't work. Calling yourself fat doesn't work. Buying into the billion-dollar industry is just helping the enemy. 

To The Intentional Body Shamers:

I can see right through you without even looking at you. There's insecurity that lives deep within you. I highly recommend looking at yourself before you cast any stones at my patient. My patient has been fixing the damage you've done during our sessions together. If you are interested in bettering yourself so you may be kinder to others, I recommend reading The Gifts of Imperfection by Brene Brown.

We live in a sick, diet-culture. Working closely with weight loss patients has opened my eyes to the psychological component of losing weight. 

From Psychology Today: "80% of U.S. women don’t like the way they look, 50% attribute it to weight and 34% of men are equally dissatisfied with themselves." 

Body shaming is cruel and cheap. Your words have deeply affected my patient and your [insert relationship]. You have created more obstacles on my patient's journey to lose weight. Do your part in making the world a better place by not giving in to the insecure, weak world we live in. Help me take down the diet culture by practicing positive body image and self-love. 

To My Patient:

I'm so sorry that you have experienced body-shaming from family, friends, and strangers. This is not your fault. I know you care about your health; After all, you've sought out help by seeing me. I have hope that you will succeed in making healthful lifestyle changes so that you may return to a natural weight. Do your best to question the diet culture and to loosen the tight chains around your mind. You are worthy now. Love your body now. It's a positive truth that your body has brought you this far in life, so be grateful. You can love your body AND make lifestyle changes at the same time. Respect yourself. And always remember what you CAN control. You may not be able to control the body-shamers. But you can control how you respond. Forgive and remind yourself of the positive truth. 

The Power of Writing

In the middle of a dream, I hear the sound of peaceful music. After about 10 seconds, I realize it’s my alarm 5 feet away, on the dresser. I placed my phone there the night before so I’m forced out of bed to turn off the alarm. I manage to stop the alarm and stumble to the kitchen to turn on the Keurig coffee maker. I get my favorite “It’s F*cking Science” coffee mug and start making my cup of joe. I find my journal and pen, sit on the floor between the couch and coffee table, and open up the journal to the next blank page. Still experiencing sleep inertia, I take a sip of my coffee and figure out the date.  The first thought that enters my mind ends up on the page. I continue writing until I finish 3 pages. I close the journal and continue sipping on my coffee. Let the day begin!

This morning writing routine has become one of the most enjoyable parts of my life. When I started, I had no idea how transformative it would be. It’s an understatement to say that this writing activity has impacted my life.

About 9 months ago, I decided that I would like to write a book one day. I didn’t deny that this was going to be a long road, but I was ready to take the first step. The obvious first step was to start writing. I came across an activity called the “Morning Pages” devised by Julia Cameron, author of The Artist’s Way. The Morning Pages activity takes about 25 minutes of your day. The directions are as followed: Write 3 pages every morning. Don’t worry about grammar or spelling, just write. Write about anything that’s on your mind! If you don’t have anything on your mind, write about that.

MEDITATION
After the first few weeks, I noticed I entered a meditative state after the first page of writing. I was in a state of flow. It was so peaceful. Writing is a meditative practice. The morning pages drain your brain of thoughts that would otherwise be there lingering throughout your day. Meditation is well-known for the ability to quiet the mind, but like yoga, writing is different. You aren’t sitting still getting pissed because you keep thinking about your to-do list.

GROWTH
Recently, I flipped back to read a random page in my journal. It was funny but I thought to myself, “how could I have grown so much in a matter of months?” Writing is a motivational reminder of who you want to be and how each small step makes a difference. Sometimes the morning pages can be for problem-solving. Sometimes it can heal hurt emotions. Sometimes you just write about your dreams. It is so simple, yet powerful.

SELF-RESPECT
To authentically respect yourself, you have to know yourself. Writing shows you who you are. You can decide who you want to be and what you’ll need to do to get there. Self-love and acceptance are not easy, especially for a recovering perfectionist. To watch yourself grow is special.

MANAGING ANXIETY
Sometimes, I’ll write in the evening, after work. I still experience the benefits – occasionally, even more so since I’m usually more anxious after a work-day. It puts the anxiety to rest by helping me work through it. Unfortunately, it’s much easier to numb unwanted feelings/moods by watching TV or scrolling through Facebook or Instagram. Writing helps you work through the mood. Why are you feeling anxious? Why are you sad? Is there anything that is in your control? Write about it – I promise, over time, the anxiety will diminish.

I know one day I'll start writing my book. But for now, I'll keep writing my morning pages and hopefully make a monthly visit on here.

5 Nutrition Guidelines for Increasing Health Span

Would you rather increase your lifespan (the number of years alive and breathing) or "health-span" (the number of years free from disease)? Imagine yourself at age 80. You're dancing and laughing with your great-grandkids. You remember all of their names. You can still do daily activities of living, like brushing your teeth, showering, and getting dressed. Doesn't that sound nice: to be free from diseases of aging?  The topic of anti-aging isn't new, but it has been picking up speed in recent years. I've indulged myself in reading the nutrition research on slowing down the aging process. If you want to be dancing around a living room full of loved ones at age 80, you're reading the right article. There are a few lifestyle behavior changes that can increase health-span, one being nutrition. Here are 5 nutrition guidelines for increasing health-span.

Timing of Meals

At this moment, the timing of meals is the most important piece of nutrition/health advice I can give. When to eat is almost as important as what to eat. According to an ongoing study by Dr. Satchin Panda, the average eating window is 15 hours. This is more than half of the day spent eating, digesting and metabolizing food. Every time we eat, our body produces enzymes and hormones necessary for digestion and metabolism. Unfortunately, our body isn't meant to be metabolizing food for more than 12 hours. Also, as it gets dark outside, our body starts preparing for sleep and digesting food is no longer a priority. 

Intermittent fasting has become a popular topic of discussion over the last few years. Many public figures and intellectuals, such as Joe Rogan, Dr. Rhonda Patrick, Dr. Jason Fung, and Dr. Valter Longo are talking about it. 

Time-restricted eating, a form of intermittent fasting, has been a practice and recommendation of mine over the last year. Time-restricted eating is a daily practice in which a person abstains from eating for at least 12 hours each day. For example, a 12 hour overnight fast can last from 7pm to 7am the following morning. This is the first regimen to adapt if you want to start intermittent fasting. If you are trying to lose weight or increase healthspan, I recommend increasing the fasting period to 14, 16 or 18 hours. I personally fast from 8pm to 12pm for a total of 16 hours of fasting. Occasionally, I’ll eat a little earlier, but I always remain within the 12-hour eating window.  

After about 12 hours of fasting, glycogen stores become depleted (glycogen is stored carbohydrate found in the liver and muscle). After glycogen stores are gone, our body must make new glucose (gluconeogenesis). Fat is the next source of energy for breakdown (a process called lipolysis). 

Fasting is beneficial for overall health because it results in lower fat mass, increased insulin sensitivity, and unnoticeable caloric restriction. Caloric restriction has been found to increase lifespan in many organisms.

Guideline #1: Practice time-restricted eating. Eat all meals within a 12-hour period. If you are trying to lose weight, increase your fasting window by 2-6 hours for a total of 14-18 hours of fasting daily. 

Increase Fruit and Vegetable Consumption  

The first recommendation I usually make when consulting with a patient is consuming more fruits and vegetables. Fruits and vegetables provide fiber, vitamins, minerals, and phytochemicals. Many diets tend to focus on restriction, which is not effective in creating a healthful relationship with food. Rather than restricting, think of what you can ADD to your diet (wink, wink: fruits and vegetables). Adding 5 servings of fruits and/or vegetables to your diet will be challenging but easier than a restrictive diet. If you love fruits and vegetables, I recommend having a variety! Try to consume different colors (green, blue, red, orange, yellow).

In regards to increasing longevity, eat more cruciferous vegetables (Brussels sprouts, broccoli, cabbage) as they contain a phytochemical called sulforaphane.

Fruit as a food group is under investigation right now due to the fructose it contains. I don’t think there is an issue with fructose if it’s bound to fiber. It’s not concentrated like high fructose corn syrup. If you are wary about adding fruits into the diet, start with berries. Raspberries and blackberries have the least amount of net carbohydrates. 

Guideline #2: Eat 5 servings of fruits and/or vegetables each day. 1 serving of fruit is 1 medium piece or 1 cup. 1 serving of vegetables is ½ cup cooked or 1 cup raw. 

Increase Healthful Fat Consumption 

I get some fearful responses when I recommend increasing healthy fat consumption. Fat has been demonized for SO long, and I’m pretty tired of it. Fat is not the problem; the COMBINATION of excess fat and excess sugar is. To shorten my rant, WE NEED FAT. A dietitian friend of mine once had her audience hold their right hand in the air and say out loud: “Fat is my friend”. Now, I’m not talking about bacon, sausage and processed fat (hydrogenated oil). I’m pretty against anything processed. I’m talking about plant-based fats such as avocado, coconut, nuts/seeds, olives, and olive oil! Don’t even get me started on the importance of omega 3 fatty acids from fatty fish like salmon and ahi for overall health. Omega-3 fatty acids (ALA, DHA, and EPA) are ESSENTIAL fatty acids. “Essential” means that our body does not make this, and we must get it from food. I have personally started taking fish oil with EPA and DHA daily. A supplement is not necessary, but if you do not eat fish twice a week, I recommend starting a supplement (high quality, of course). 

Fat does have a lot of calories per gram, but it’s satisfying. A high fat, low carbohydrate diet is effective for weight loss. Lowering body fat mass is important in increasing healthspan. Recent studies have shown a ketogenic diet being an effective method for treating the disease of obesity. 

Supplementation with high doses of omega-3 fatty acids has been studied in many disease states. The omega-3 fatty acids are anti-inflammatory, unlike the omega-6 fatty acids found in animal products. Studies supplementing DHA and EPA have found improvements in those with cardiovascular disease, cognitive decline (Alzheimer’s and dementia), depression, inflammatory bowel disease, ADHD and more. All of the diseases above are diseases of aging and/or inflammation. 

My favorite fats: walnuts, almonds, flaxseeds, chia seeds, hemp seeds, cacao nibs, olive oil, coconut (shreds, milk, oil), salmon, and raw ahi tuna. 

Guideline #3: Consume healthful fats daily, especially nuts and seeds. Avoid processed fats and hydrogenated oil. 

Get the Appropriate Amount of Protein 

I’ve switched sides on this macronutrient. I strived to eat protein every 2 hours back in the day when I was weight lifting 6 times a week. I was OBSESSED with protein and gaining muscle. Unfortunately, protein speeds up the aging process. In the discussion of longevity, excess protein is a known nutrient for increasing the risk of aging diseases (cardiovascular disease and cancer). For my mechanism lovers, dietary protein increases mTOR which in turn inhibits autophagy. Autophagy is the recycling of cells and is important in slowing down aging. 

Protein is a necessary nutrient during times of growth: infancy, childhood, pregnancy/lactation, and athletic training. Those older than age 65 also benefit from increasing protein due to increased muscle loss. If you do not fit in any of the groups above, you do not need excess protein. 

Animal protein is a great, bio-available source of protein. Unfortunately, it’s TOO nutritious for those of us that are not in a growth state. I recommend eating more plant-based protein to ensure you do not exceed your protein needs. If you strive to increase your health-span, I recommend limiting your protein to 0.8 grams per kilogram of weight. If you REALLY want to calculate the minimum amount of protein you need, instead of using kilograms of total weight, use kilograms of lean body mass. I personally do not eat much meat, maybe once or twice a week. I have incorporated more beans, lentils, nuts/seeds into my diet. All of which are protein, but are less bioavailable, keeping my protein intake to a minimum. 

If you can’t give up eating beef and chicken, I recommend choosing a high-quality source of protein. When reading food labels, be sure to pick up “grass-fed” or “pasture-raised” animal products. For eggs, look for “cage-free” or “omega-3” on the label. Consuming 4 oz of meat (about the size of the palm of your hand) will provide 28 grams of protein.

Guideline #4: If you are not in a “growth” state, limit protein intake. Consume fewer animal products and more plant-based proteins. 

Calculate your protein needs:
You’ll need: current weight, calculator 

 Multiply 0.8 and weight in kilograms (or lean body mass if you know this number).
Example: I weigh 110 lbs. Divide by 2.2 to get kilograms. 110/2.2 = 50kg
50 kg x 0.8 = 40 grams of protein daily

Limit Processed/Simple Sugar 

Sugar is not an essential nutrient. That’s right, our body does not need sugar to survive. Yes, our body prefers to use sugar for energy, but in excess, sugar is harmful. Excess sugar is stored as fat in cells and can cause insulin resistance and inflammation. Sugar also has an impact on our microbiome (the microorganism world that lives inside of us). Excess simple sugar can cause “bad” bacteria to flourish and wreak havoc. Dr. Rhonda Patrick provides a wonderful explanation of the impact a poor diet (high in refined sugar, low in fiber) has on our microbiome, causing inflammation resulting in cardiovascular disease. For my mechanism lovers, here is a short clip of Dr. Patrick explaining endotoxin and cardiovascular disease.

Sugars in the form of sugar-sweetened beverages (juice, soda, coffee, sweet teas) are the WORST food item you can put in your body. Drinking 8 oz of apple or orange juice is easy and contains 15-20 grams of sugar. To put it into perspective, that’s the equivalent of eating 4-6 teaspoons of sugar. Now, imagine eating 4 apples or 4 oranges. Could you do it? If there is one thing to get rid of besides smoking and binge drinking, it’s soda and other sweetened beverages. 

If you are still unsure where you stand in this carbohydrate war, I recommend choosing whole foods for the time being. Choose complex carbohydrates such as beans, lentils, quinoa, millet, buckwheat, oatmeal, fruits, and vegetables. Fiber is a carbohydrate that is necessary for a healthful microbiome. Not all carbohydrates are bad but simple, processed carbohydrates should be limited if you want to increase your healthspan. 

Guideline #5: Limit simple/processed carbohydrates. Avoid all sugar-sweetened beverages.

I understand life is life. Sometimes we will go to Chick-fil-A and order a 3-piece chicken strip with a buffalo, CFA, and ranch sauce. Sometimes we will eat a soft chocolate chip cookie in the work office. It's fine to indulge every once in a while as long as the majority of days are spent eating right and following the guidelines above. I wish you good luck on your health journey. May we all optimize our health by means of nutrition!

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The Truth About Intermittent Fasting - My Journey

A little more than a year ago, I tried intermittent fasting (IF) to prove my husband wrong. During the last year of my nutrition program, I did all my projects on the topic of fasting but came to conclusion that this might not be just another fad diet. One project included trying a diet for 2 weeks. Of course, I decided to finally attempt a type of IF called time restricted eating by following an 18-hour fast with a 6-hour feeding window. 

The beginning was brutal. I was a breakfast person! I loved making overnight oats, eggs and don’t even get me started on pancakes, waffles and cereal. The first 2 days of the time-restricted eating regimen were terrible. I binge ate both nights. I decided to switch my feeding window from 6 hours to 8 hours to make it a little easier on myself. After a few days, my body started getting used to eating at 11am. I wasn’t as ravenously hungry as I used to be in the mornings. I was able to drink my black coffee and plenty of water until my feeding window began. A small confession here; I am usually running late to everything. About a week into IF, I realized that the new regimen was convenient for me! I didn’t have to spend any time in the mornings making breakfast or eating! That saved me 20 minutes each day (and helped with my time management). Not only was I saving time in the morning by not eating breakfast, but I was also more productive! About a month in, I noticed a difference in my mental clarity. I was able to concentrate more in the mornings up until after lunch. I clearly noticed a difference in my ability to process information. It was like night and day! At that time, I did not know that this was the start of a life-long endeavor. 

Before I started working as a dietitian, I used to exercise 5-6 days a week which helped maintain my weight at 112-115 lbs. After starting IF, I lost 8 lbs and now my set point weight ranges from 108-110 lbs WITHOUT exercise (I couldn’t find much time for it once I started working full-time plus commuting). Back in the day when I was eating 3 meals and 2 snacks, I would gain weight pretty quickly if I didn’t exercise. Daily fasting became my “metabolic exercise”. I was reaping some of the benefits of exercise through fasting without actually exercising. In Dr. Jason Fung’s book, Obesity Code, he explains that IF drops your set point weight where as other fad diets do not. There's a hormonal change that occurs during fasting that other calorie restriction diets do not do. 

Now, let’s fast forward 7 months to when I started working with weight loss patients. The dietitian before me recommended books to read, one being the Ultimate Guide to Fasting (by my favorite MD at the time, Jason Fung). I didn’t know that dietitians could recommend a fasting regimen, but I quickly reminded myself that I am an evidenced-based dietitian. The science and mechanisms were clearly there and I didn’t understand why the Academy of Nutrition and Dietetics (AND) wasn’t making this a standard of care for those with type 2 diabetes, obesity and metabolic syndrome. That’s when the reading started. I was commuting 2-4 hours a day to my work, which left a lot of time-opportunity for audiobooks. At first, it was difficult but after a few months, my brain was able to listen to audiobooks on 1.75 speed and absorb more than 75% of what was being said. I also began reading science literature on fasting to better understand mechanisms.

When I started seeing weight loss patients, I decided quickly that fasting may not be for everyone, but 6 months later, I’d take that back.  Seeing my patients follow a time-restricted eating regimen daily and lose weight with ease was very satisfying and only solidified my belief in fasting even more. I started sharing this information with my dietitian friends but not everyone was convinced. I kept reading and bringing more evidence back to them only to receive more doubts and counterarguments. Of course, I am grateful that they were skeptical as it has only made me a more informed dietitian on the subject of fasting. 

I concluded that IF was the perfect “diet” for weight loss. I don’t like to call it a “diet” because there are no requirements on what to eat; IF is focused on the timing of meals. Of course, eating a healthful diet in combination with a fasting regimen is ideal but that’s a topic for another blog post. 

In my reading, I have come across some people that should not do a prolonged overnight fast (more than 12 hours). This includes children, pregnant/lactating women, type 2 diabetics on insulin, and those with an eating disorder, low BMI (<18) or gallbladder disease. If you are one of the above, I recommend talking with your doctor before starting any fasting regimen. 

That leaves everyone else! If you are wondering if you could do it, even though you aren’t trying to lose weight, I highly suggest starting with an overnight 12 hour fast daily. Most people think they already do this; however, an ongoing research study suggests that the average “feeding” window is 15 hours. This exhausts our digestive system. Every time we eat, our bodies have to produce hormones and digestive enzymes. Towards the end of the day, especially as it gets dark outside, our metabolism does not work as efficiently. It slows down in preparation for sleep. Humans are not meant to be eating all day and all night, just like we aren’t meant to be awake all day and all night. This is where I bring in a concept called circadian rhythm. This is usually associated with our sleep and wake cycle. We are diurnal creatures! What most people don’t realize is that our digestive system is also on a biological clock. If we eat at 8am every day, our body will eventually get used to receiving food at 8am. That is why it may be difficult initiating a time-restricted eating regimen initially. When you change the time of your meals, your body will be confused so it’s best to eat your meals at the same times every day. This is why it was difficult for me and many others to start IF. Our circadian clock gives us cues (hunger/ghrelin) that it's time to eat; However, your body can get used to eating at 11am or even once a day with minimal hunger after some time and consistency. 

IF is not just for weight loss, though. The main reason why I continue doing it is for longevity. The science of aging and increasing health span is picking up speed. I’ve recently gotten into the research on fasting and increased longevity. Caloric restriction increases longevity in many animals. Even the Japanese people in Okinawa (one of the blue zones) believe that one should eat until they are 80% full. This is caloric restriction. Obviously, when we restrict calories, we need to ensure we get enough nutrients to avoid malnutrition. There are no benefits to being malnourished. A slight reduction in calories DOES, though. I’ll explain the mechanisms. 

1.    Insulin – keeping insulin levels low and insulin-like growth factor low has been shown to increase life span not only animals, but also humans. Loran Dwarfs lack IGF-1 (there is a defect in the receptor). Despite eating the same diet as their relatives, those that did not have the syndrome, had 20% rate of cancer. Remember, cancer is a leading cause of death in the USA. 

2.    mTOR – dietary protein activates this guy. Decreased intake of protein increases life span. Increased mTOR turns off autophagy, a very important recycling process in the body. As we age, autophagy decreases. Autophagy is a very important component in increasing health span and preventing diseases such as cancer.

3.    AMPK – increases when we have low ATP (energy). AMPK increases glucose uptake into the cell, increases autophagy and increases lipid metabolism. 

I could go on and on about mechanisms, but I want to keep this article simple. 

How to start IF: 

1.    Start with a 12 hour fast daily. For example, abstain from eating between 7pm to 7am. Follow this strictly for a couple weeks.  

2.    Start shortening your “feeding” window by an hour each week. Bring breakfast up to 8am or finish dinner by 6pm. 

3.    If you find this easy after a couple weeks, you can attempt a 16 hour daily fasting regimen. Most people follow a 11-7pm feeding window regimen while other follow 12-8pm. Some even have breakfast and follow a 9-5pm feeding window. Customize to your lifestyle and schedule. 

4.    Continue this for as long as you’d like. Most people adopt IF as a lifestyle. I, for example, rarely eat breakfast and feel great without eating until 12pm.

5.    If you still have difficulty, make an appointment with a registered dietitian to help. I see patients in Irvine, Ca. 

Dietitians/Nutritionists/Doctors are too focused on macronutrients (fat, protein, and carbohydrate) and calories. I think it's the timing of our meals that is MOST important in overall health. Eating multiple meals, multiple snacks and the elongated "feeding" window (12+ hours) is not the answer. Obviously, fiber intake and healthful fat intake are both very important nutrients in preventing many diseases but timing is right up there with basic general healthful nutrition guidelines.

I predict that fasting will become standard of care within the next couple decades. Whether it’s a 12 hour overnight fast, a 24 hour fast once a week, or a Fasting Mimicking Diet, I say with confidence, this is the solution to our obesity epidemic. Fasting increases insulin sensitivity so it can be used as a treatment method for those with type 2 diabetes. Fasting helps reduce caloric intake (in a much easier way) which can be used to treat obese people. Fasting even lowers triglycerides and inflammation which lowers cardiovascular disease risk! There needs to be more research published, I know, to officially become standard of care. It’s coming, though. 

Disclaimer: This article was written off the top of my head but there is evidence for every single claim I make in this article. I've been wanting to write an article for months now but I have limited time. I will eventually be adding references to this article but I would be more than happy to send you specific articles if you need me to do so. 

Who I follow for new evidenced-based fasting information:

1. Dr. Rhonda Patrick 

2. Dr. Satchin Panda

3. Dr. Valter Longo

4. Dr. Peter Attia 

If you feel at all skeptical, please go to the "Research" tab in the upper left side of the page. Feel free to leave questions below. 

Tatiana Keay, MS, RD