012 Dr. Stephanie – AMA#1 – Fasting

00:50 – Introducing today’s inaugural AMA episode


01:03 – Dr. Stephanie introduces her co-host for today’s episode,
Stephanie Major


06:19 – Differentiating between time restrictive eating and
fasting


12:16 – Benefits of fasting


13:28 – Timing your post-workout meal


16:23 – Breaking down PCOS, polycystic ovarian syndrome


18:39 – The important role that hormones play


20:03 – Fasting with PCOS


21:49 – Why Dr. Stephanie never does an extended fast in the week
leading up to her period


26:20 – The incredible differences in a woman’s biology


28:16 – Dr. Stephanie speaks to some recent studies on rodent
fasting


32:27 – HPA Access Dysfunction


35:32 – How fasting can affect thyroid issues, including
Hashimoto’s Disease


40:47 – Fasting and hair loss


41:54 – The three stages of hair growth


43:29 – Supplements to combat hair loss during fasting


44:34 – Best practices for preparing for an extended fast


49:10 – Signs and signals that indicate you should end an
extended fast


52:05 – Breaking a fast


54:30 – Dr. Stephanie discusses fasting while travelling


57:44 – When Dr. Stephanie does longer fasts


58:41 – How to explain fasting to your children


1:04:19 – Who should not be fasting


1:05:37 – Dr. Stephanie announces another upcoming AMA episode


1:07:01 – Where listeners can follow Dr. Stephanie and subscribe
to her newsletter


TWEETABLE QUOTES


“When you allow for the stomach to fully empty, you will have a
better quality sleep.” (09:42)


“When she does eat her next meal, it should have protein in it,
and a minimum of twenty grams. So, a minimum of twenty grams of
good, quality protein to be able to drive that muscle protein
synthesis from her diet.” (16:07)


“Around Day 21 is when we start to see progesterone rising.
Progesterone is a potent stimulator of your appetite. It slows
down your bowels. And it can also affect your mood and it drives
cravings.” (23:05)


“When you are obese, male or female, the data is clear in terms
of fasting and the benefits that it’s going to impart to you. So,
if you are overweight, if you have excess adiposity fasting is
probably the most powerful weight-loss tool on the planet.”
(31:28)


“That’s why I always say females are the original biohackers. We
will do anything to feel better.” (35:24)


“When you start fasting, it is a temporary change you may notice
like clumps of hair falling out, but it tends to return somewhere
between three to six months. You’ll notice that that falling out
stops.” (41:40)


“When you’re thinking about what breaks a fast, you have to be
thinking about what your goal is surrounding the fast.” (52:32)


LINKS MENTIONED


Better! Website


Dr. Stephanie’s Website


Dr. Stephanie’s Twitter – @dr_stephanie


Dr. Stephanie’s Instagram – @dr.stephanie.estima


Dr. Stephanie on LinkedIn


Dr. Stephanie’s Twelve Step Guide to Fasting


RELEVANT STUDIES, COMMENTARY, AND RANDOM BITS FROM MY
PREP NOTES


Time Restrictive Eating (TRE) vs. FASTING


TRE - is restricting the hours in which you
consume calories. This is where 
I start most people off if they have never heard of the concept
of fasting, or they are intimidated by it.


So very basic would be a TRE of 12 hours – 12 hours of fasting,
12 hours of eating starting at 7am - 7pm.


I would quickly move this to a tighter eating window of 8-9 hours
as the baseline for how you eat all the time. If one were so
inclined, and if you’re listening to this podcast, I would also
add in the caveat of making your last meal 3 hours before your
bedtime. This allows the stomach to fully empty, and for our
central and peripheral clock to sync up.


SCN is your central clock. It detects light coming in from the
back of the retina and is the sleep-wake cycle master regulator.


However, we have other clocks in our bodies: the liver, pancreas,
and kidneys, for example. The liver in particular senses intake
of food.


If you have a late meal, there is a sort of homeostatic
dissonance where the brain is saying ‘less light, time for bed,’
but the liver is saying, ‘but we just got a huge bolus of
energy!’ This will affect sleeping quality and quantity. It is
hard to sleep well on a full stomach.


If you listen to Sachin Panda, he will say anything with a
caloric value will start the clock. So, in the strictest sense,
the 5 calorie pre workout drink would start the clock. As far as
I am aware, Mg does not have a caloric value, and neither does
L-theanine.


FASTING is for 24 hours or more and there’s a
myriad of ways to do it: Water only, NC LF, or CR.


Benefits are similar and, like anything, has a bell shaped curve:


drops in insulin

activation of sirtuins

Autophagy - cellular cleaning up of debris

BDNF

improve lipid profiles ( HDL: LDL ratio, TG levels)

allow for rest and repair of gut

FFA & ketone production / alternative substrate

mental clarity and focus

amps up GH

changes in gene expression upping longevity / FOXO

cardioprotective benefits

Powerful weight loss tool



On Refeeding Within 15-30 Minutes Of Exercise:


There has been considerable work undertaken to determine the
optimal timing of nutritional intake in order to maximize
post-exercise MPS and ensuing adaptations to training (Cribb
& Hayes, 2006; Hoffman et al. 2009). In general, it is
largely irrelevant whether the feed is given pre-, during or
post-exercise. This is because the delaying of the muscle-full
response appears to last at least 24 hours (Burd et al. 2011)
after a single bout of exercise, which may help explain
adaptations likehypertrophy/remodelling of muscle over time,
which is independent of proximity-dependent feeding patterns.


Types of Exercise:


Endurance-type exercise such as running or cycling is associated
with increased synthesis of mixed muscle proteins. However, these
acute responses are not associated with significant changes in
muscle mass (i.e. hypertrophy observed with resistance exercise).


The same individuals performed a 10-week resistance
(weight-lifting) programm in one leg and a 10-week endurance
(cycling) programm in the other. After training, post-exercise
myofibrillar not mitochondrial protein synthesis increased with
resistance exercise (Wilkinson et al. 2008). Conversely, after
training mitochondrial protein synthesis increased only in the
endurance-trained leg, whereas myofibrillar did not. These data
seem to suggest a ‘matching’ between MPS responses and phenotypic
changes, i.e. muscle hypertrophy in resistance training versus
mitochondrial biogenesis in endurance training.


I have a general disdain for traditional cardio machines and feel
like I am on a hamster wheel. I have retrofitted my outdoor bike
with a TacX and use an app called ZWIFT so I can have some sort
of indoor cardio in the winter months. I love to climb hills,
have a psychological and physical resistance to sprints. I have
to pump myself up mentally and physically when I know I’m
sprinting, but generally I hate them. If I were to guess, I have
way more type 2a mm fibres than 2b, because I despise sprints. It
feels like I peter out and need a much longer recovery. This may
be due to my years as a step instructor and being an endurance
runner.


Best practices:


Vary workload and intensity

Aim for at least 20g of good quality protein per meal(this
can change as we age, necessitating the need for more protein to
continue to stim MPS)



A few more studies should one want to read up further:


No effect on protein supplement timing:


https://www.ncbi.nlm.nih.gov/pubmed/19478342/


24h window for refeed:


https://www.ncbi.nlm.nih.gov/pubmed/21289204/


20g for MPS:


https://www.ncbi.nlm.nih.gov/pubmed/19056590/


PCOS & Fasting:


Insulin levels elevated:

inverse relationship to SHBG (high insulin, low SHBG, more
free T)

direct relationship with LH (high insulin, higher LH, lower
relative surge before ov)



Insulin is a nutrient sensor. You eat carbohydrates or proteins,
and insulin goes up. This signals to the body that there is
sufficient food to drive growth. (There are other nutrient
sensors involved - mTOR and sirtuins, but let’s stick right now
to insulin and its role in PCOS)


High insulin levels drives growth. For women of reproductive age,
the ovaries are the queen of cells. They have 100-600K
mitochondria in them, and are the most rapidly growing cells in
the body.


The other issue excess insulin has on a reproductive female is is
drives up LH. LH levels should only surge right before ovulation,
to help the mature follicle release the viable egg. If LH levels
are higher throughout your cycle, the egg cannot be released. I
always liken LH to that uncle that comes over for dinner, slaps
you on the back so hard to make you spit out your food. That is
basically what LH is doing to your follicle.


Insulin has an inverse relationship the shbg. Shbg will, like its
name suggests, bind sex hormones, like testosterone. Sex steroids
and thyroxine are shbg regulators, but so is insulin. More
insulin, less shbg, meaning more testosterone is free and able to
exhibit its masculinizing effects.


So when we are fasting, we are not stimulating insulin to rise,
and therefore will see a lowering of LH throughout the cycle, and
an increase in shbg, which will lower free T.


With PCOS patients, fasting is a powerful tool to help regulate
this hormonal derangement. At the very least, depending on the
severity of symptoms and the patient’s goals, a TRE of 8 hours. I
would also be strongly inclined to throw in several OMADS, and
potentially a monthly or quarterly long fast in there as well if
there was excess adiposity.


I would also be looking at other lifestyle changes, like weight
lifting with a focus to increasing lean mm to assist in further
insulin regulation and glucose disposal.


On Females & Fasting:


Fasting for women is different for men and women. We do see some
gender specific differences. For obesity, whether male or female,
the benefits are largely ubiquitous. It is when you get closer to
normal BMIs that the data begins to differ. Some rodent studies
have demonstrated deleterious effects on females and either
alternate day fasting or prolonged CR.


Males


improved insulin sensitivity

waking and sleep patterns were uninterrupted,

they were more fertile (gonadal transcription factors),

Improved lipid profile



Female rats ‘masculinize’ - meaning their ovaries shrunk,


With 20 CR:


irregular cycling patterns



With 40% CR:


they ceased ovulation and menstruating altogether

became hyper alert,

learning and memory went up,

sleep patterns were disrupted,

heightened stress response,

Upregulated BDNF

Increased adrenal size



In human females


ADF showed poor glucose tolerance and no change in insulin
sensitivity in non-obese women

did not see this negative effect with men, and only the men
showed improvement in TG levels



So what do we as women do?


So if you are overweight, fasting is going to be a good option
for you to reduce adiposity, and to help regulate metabolic
hormones. Most of the studies I have looked at that detail
fasting interventions report positive outcomes in cardio
metabolic parameters.


It is when we trench into waters of hormonal issues, and also
fasting with women who are not obese, where things can get murky.
Even women with the same condition are going to be different. You
are not the same hormonal each day of your cycle. We are just
extra like that.


Must consider:


HPA Axis Dysfunction


chronic low grade stress (physical, chemical, emotional)

pro -inflammatory - pro cytokines

long term fasting is a stress, and may contribute to the
allostatic load

short term fasting like TRE is appropriate

most women have some sort of HPA derangement until proven
otherwise

pregnant, delivered a child, sleepless nights associated with
kids, and then if you work...good luck



PCOS


in this condition, our bodies behave more male

fasting, especially longer term fasting on a monthly or
quarterly basis is great

allows for the drop in insulin, and can lend to better T
regulation



For women like myself who are not obese, do not have hormonal
issues, what do we do?


The truth is the jury is completely out, and we do not have
enough literature to really tell us either way. I think there are
measurements you can watch: ketone levels, glucose levels, and
subjective observations that can help you monitor your fast. But,
I would definitely seek counsel in a trusted primary care
physician so you can be monitored while doing it.


I personally TRE everyday - it is around 4-5 hour eating window
when I eat. While I love eating, I find it incredibly distracting
and annoying to getting into my work, so I will have a large meal
around 11am, and then a snack with the kids when they get home.
Usually no dinner.


For women of reproductive age, there is no wrong time to fast,
but there are decidedly easier and more difficult times


Again, talking in depth about gaming your menstrual cycle for
metabolic and body comp gains soon, but the first week of your
period - when P and E are low is much easier than the week
leading up to the bleed.


Reproductive Function in Response To Fasting


https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0002398


https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0004146


Alternate Day Fasting in Humans


https://www.ncbi.nlm.nih.gov/pubmed/15833943?dopt=Abstract


https://academic.oup.com/ajcn/article/81/1/69/4607679


Sex Differences


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200169/?tool=pubmed


https://academic.oup.com/ajcn/article/85/4/981/4648934


Obese Females & Fasting


https://www.ncbi.nlm.nih.gov/pubmed/23171320


https://www.ncbi.nlm.nih.gov/pubmed/29534545


On Autoimmunity & Fasting


https://www.ncbi.nlm.nih.gov/pubmed/27239035


On Fasting & Hair Loss


3 Distinct Phases of Hair Growth


Anagen Phase is the active growth phase. It lasts anywhere from
2-6 years and is largely genetic in terms what your window is. It
could be up to 1 cm every 28 days.


Catagen Phase - follows the anagen growth phase


transitional stage where growth stops, somewhere around 2-3
weeks

follicle stops producing fiber



Telogen Phase


resting phase

When the body is subjected to extreme stress, as much as 70
percent of hair can prematurely enter the telogen phase and begin
to fall, causing a noticeable loss of hair

3 months in length



Reasons for Hair Loss


It’s not the fasting per se, but the large, sudden change in
calories. The body repurposes energy for vital function (brain
> hair). It can also be caused by vitamin & mineral
deficiency. Zinc has been shown to be a cause of hair thinning.
As you use up glycogen stores, your kidneys excrete excess water,
Na, zinc, Mg, K.


Hair loss can also be affected by the supplement or foods once
you resume eating (ex. beef, lamb, chicken, mushrooms). It can be
caused by not getting enough protein in your diet (aim for 20-30g
good quality protein per meal). When you do start eating again,
making sure you are getting adequate biotin, which is known to
increase hair thickness.


Foods with biotin


eggs w yolk

avocadoes

salmon

spinach



MSM - methylsufonylmethane - forms the structural links in things
like skin, hair, and nails and strengthens cartilage and tissue


found in animals & animal proteins



Collagen - (from bone broth or supplementation)


Lack of collagen has been linked to early hair loss, hair
thinning, hair graying, and spine degeneration.


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