Understanding how intermittent fasting may not only help weight loss but have multiple other health benefits including life prolongation, preventing cancer and dementia

1. How our eating affects our health
ASPEC / March 8, 2021 / Robert Miller MD

2. “The only way to keep your health
is to eat what you don't want,
drink what you don't like, and do
what you'd rather not.”
Mark Twain

3. “The second day of a diet is
always easier than the first. By
the second day you're off it.”
Jackie Gleason

4. Obesity Worsens Outcomes from COVID-19
Adults with excess weight are at even greater risk during the COVID-19
pandemic:
•risk of severe illness
• triple the risk of hospitalization
•Obesity is linked to impaired immune function.
•Obesity decreases lung capacity and reserve and can make ventilation more
difficult.
•As BMI increases, the risk of death from COVID-19 increases.
•Obesity may be linked to lower vaccine responses for numerous diseases
(influenza, Hepatitis B, tetanus).
https://www.cdc.gov/obesity/data/obesity-and-covid-19.html

5. https://www.medrxiv.org/content/10.1101/2021.02.24.21251664v1.full.pdf

6. How well did we do to avoid obesity during the
pandemic and social isolation?

7. The Impact of COVID-19 Stay-At-Home Orders on
Health Behaviors in Adults
Obesity 2021 Feb;29(2):438-445
7,753 participants were included; 32.2% of the sample were individuals
with normal weight, 32.1% had overweight, and 34.0% had obesity.
Weight gain was reported in 27.5% of the total sample compared with
33.4% in participants with obesity.
People who gained weight also had the largest declines in physical
activity.
There were some bright spots in the findings. About 17 percent of the
study population actually lost weight during the pandemic; perhaps not
surprisingly, they tended to be people who increased their physical activity

8. Exercise is also a big part of
maintaining good health and
has to be included into our
behavior but our poor eating
habits is a bigger issue and will
be the main point of this
presentation.
My favorite expert on health
and exercise is Daniel
Lieberman,
paleoanthropologist at Harvard
University, where he is the
Edwin M Lerner II Professor of
Biological Sciences, and
Professor in the Department of
Human Evolutionary Biology.

9. The COVID 19 pandemic was a reminder of the risks associated
with our poor eating habits in the US.
1.The continuing rise of obesity and health risks.
2.The real culprit is insulin resistance then metabolic syndrome
3.Increasing popularity of intermittent fasting
A. Is it a logical and safe way to lose excess fat?
B. Are there multiple other systemic health benefits
from fasting?
C. Will fasting increase life expectancy?

10. Important things you may not know
1. Sugar (esp. fructose) is very toxic and the combination of bad science (eat less fat
and eat more carbohydrates) coupled with the profit motive of the food industry
created a public health disaster with obesity and type 2 diabetes. (mechanism is
insulin resistance and metabolic syndrome Robert Lustig.
2. Continuous stimulation of insulin will prevent access to body fat stores, People
who are told to eat frequent small meals throughout the day will almost never
have sustainable weight loss (Jason Fung).
3. Good long-term health requires alternating fed states with fasting states (Mark
Mattson) and this may also increase longevity. (David Sinclair , Valter Longo).
Holding off on microbiome
issues at this time

11. Are we
getting fatter?
71.6% of American
adults are overweight,
and 40% are obese

12. Even rich and famous people
can get fat!
Marlon Brando Elvis Presley

13. US Government recommends eat more carbs

14. https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-
18/obesity-adult.htm
Men
Men
Women

15. Prevalence of Obesity and Severe Obesity Among
Adults: United States, 2017–2018
NCHS Data Brief No. 360, February 2020
https://www.cdc.gov/nchs/products/databriefs/db360.htm

18. Prevalence† of Self-Reported Obesity Among U.S. Adults by State
and Territory, BRFSS, 2019
https://www.cdc.gov/obesity/data/prevalence-maps.html

19. https://www.cdc.gov/

20. https://www.cdc.gov/nutrition/strategies-
guidelines/index.html

21. https://www.myplate.gov/tip-sheet/healthy-eating-older-adults

22. Obesity is a complex disorder involving an
excessive amount of body fat.
Body Mass Index: BMI 25-30 (overweight) BMI
>30 (obese)

23. BMI (Body Mass Index)
body mass
divided by the
square of their
height, units
are Kg/M2
http://www.cdc.gov/healthyweight/assessing/index.html

24. BMI is less than 18.5 = "underweight"
BMI is 18.5 to 24.9 = "normal" or Healthy Weight range.
BMI is 25.0 to 29.9 = "overweight" range.
BMI is 30.0 or higher = "obese" range.

25. Body Mass Index
Tables from the
NIH, with
“normal” or
healthy should
be 18.5 to 24.9

26. So you’re Fat…What’s the Harm?
…Uh…OK other than COVID 19?

27. Obesity raises the risk of morbidity from:
- hypertension
- dyslipidemia
- type 2 diabetes mellitus (diabetes)
- coronary heart disease (CHD),
- stroke,
- gallbladder disease,
- osteoarthritis,
- sleep apnea and respiratory problems
- some cancers.
Obesity is also associated with increased risk in all-cause and
cardiovascular disease (CVD) mortality.

28. NCI – many
cancers have
been linked to
overweight or
obesity

29. All-cause mortality versus BMI
Normal
18.5 to
25
Male
Female
Body-mass index and cause-
specific mortality in
900 000 adults:
collaborative analyses of 57
prospective studies.
Lancet 2009;373:1083

30. All-cause mortality versus BMI
White Women
Body-Mass Index and Mortality among 1.46 Million White Adults NEJM 2010:363:2211

31. White Men
All-cause mortality versus BMI

32. The Obesity Paradox?
Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index
Categories. A Systematic Review and Meta-analysis
Katherine M. Flegal, PhD / JAMA. 2013;309(1):71-82
BMI Description HR For All Cause Mortality
18.5 – 24.9 Normal 1.00
25 – 29.9 Overweight 0.94
30-34.9 Grade 1 Obesity 0.95
>35 Grade 2,3 Obesity 1.29
Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with
significantly lower all-cause mortality.
Not so bad

33. BMI and all-cause mortality in older adults: a meta-analysis
Am J Clin Nutr 2014 Apr;99(4):875-90
meta-analysis came out in 2014 by Winters et al. looking at BMI and all-cause mortality in adults over age 65
and BMI ranges and the risk of death by any cause meta-analysis looked at 32 different studies and
included 197,940 older adults (ages 65+) with an average follow-up of 12 years.
In Seniors a
higher BMI
in the range
of 27 may be
best

34. https://www.thegeriatricdietitian.com/bmi-in-the-elderly/
Sarcopenia (muscle mass loss) may be more dangerous than obesity, wo if weight loss is desired patient should
take adequate protein and resistance training
Consider this higher
range normal

35. Sarcopenia is a syndrome characterized by the loss of muscle mass, strength, and
performance.
Sarcopenia was identified in 53 to 57 percent of men, and 43 to 60 percent of
women, over the age of 80 in one study
Inactivity exacerbates ongoing muscle loss and increases proportion of body fat
mass
Inadequate protein intake can also contribute to sarcopenia and decreased
function. A prospective cohort study found that adults aged 70 to 79 with protein
intake ≤0.8 g/kg/day (the Recommended Dietary Allowance [RDA]) were at greater
risk of developing mobility limitations
mean upper arm circumference (MUAC) MUAC measures the circumference of the
left upper arm at the mid-point between the tip of the shoulder and the tip of the
elbow MUAC of less than 22 cm for women and 23 cm for men are suggestive of

36. A SYSTEMATIC REVIEW OF THE LITERATURE CONCERNING THE RELATIONSHIP BETWEEN OBESITY AND
MORTALITY IN THE ELDERLY. J Nutr Health Aging. 2012 Jan; 16(1): 89–98.
Mortality Rate per 100,000
Seniors may
be healthier at
higher
weights than
standard BMI
Tables

37. ‘Normal’ weight for Seniors
From Up to Date

38. Important things you may not know
Sugar (esp. fructose) is very toxic and the combination of bad science (eat less fat
and eat more carbohydrates) coupled with the profit motive of the food industry
created a public health disaster with obesity and type 2 diabetes.
Mechanism is Non-alcoholic fatty liver disease is the cause of insulin resistance and
metabolic syndrome
Recommendation: avoid sugar and refined carbohydrates
Robert Lustig

39. Robert Lustig - What is Metabolic Syndrome Anyway?
https://youtu.be/zx-QrilOoSM
Prof. Robert Lustig - 'Sugar, metabolic syndrome, and
cancer’
https://www.youtube.com/watch?v=jpNU72dny2s&ab_cha
nnel=LowCarbDownUnder
Fructose 2.0 | Robert Lustig Website
https://robertlustig.com/fructose2/
Is a Calorie a Calorie? Processed Food, Experiment Gone Wrong
https://www.youtube.com/watch?v=nxyxcTZccsE&ab_channel=StanfordHealthCare
Robert Lustig MD, Pediatric Endocrinologist at UCSF

41. Not fat here
Visceral fat
here

42. Non-alcoholic fatty liver disease is the cause of insulin resistance and metabolic syndrome

44. Evidence Summary
Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions
September 18, 2018
A total of 122 RCTs (N = 62,533) and 2 observational studies (N = 209,993) were
identified. Compared with controls, participants in behavior-based interventions had
greater mean weight loss at 12 to 18 months (−2.39 kg) and less weight regain (−1.59
kg)
Participants with prediabetes in weight loss interventions had a lower risk of
developing diabetes compared with controls (relative risk, 0.67. There was no
evidence of other benefits,
No evidence of harm such as cardiovascular disease from behavior-based
interventions; higher rates of adverse events were associated with higher dropout
‘Evidence’ Based Guidelines

45. Important things you may not know
Continuous stimulation of insulin will prevent access to body fat stores, People who
are told to eat frequent small meals throughout the day will almost never have
sustainable weight loss (Jason Fung)
Recommendation: Consider Fasting

46. Dr. Jason Fung, MD
Dr Jason Fung is a doctor, author and researcher. His science-based books about
diabetes and obesity, The Diabetes Code, The Obesity Code and The Complete Guide
to Fasting have sold hundreds of thousands of copies.
Dr Fung is also the co-founder of the Intensive Dietary Management Program, to help
people lose weight and reverse Type 2 Diabetes naturally with fasting. His work on
fasting has been cited by the Daily Mail, Telegraph, CNN, TIME, the Atlantic, Forbes and
many other media outlets.

47. “I fast for greater
mental and
physical
efficiency”
Plato
"Fasting is the greatest remedy-- the
physician within.“
Philippus Paracelsus, one of the three fathers of
Western medicine
"The best of all
medicines is
resting and
fasting."
Benjamin Franklin

48. Traditional
way of
thinking about
weight loss
diet, reduce
calories and
increase
exercise
When the
patients fails to
have
sustainable
weight loss,
‘blame’ the
patient

49. Why Conventional Diets Fail
1. Every time you eat (esp with carbs and sugar) your pancreas see the rise in
glucose and produces insulin
2. Insulin lowers your sugar (so you get hungry in a few hours) and prevents
lipolysis (won’t let you release fat storage for energy)
3. If you just reduce calorie input but still eat frequent small meals your body sees
the calorie reduction and tries to ‘help’ by lowering metabolism (to reduce energy
consumption) and raising ghrelin (hunger hormone to motivate you to search for
food)
4. If you fast (at least 12 hours a day) once your body has consumed blood glucose
and then stored glycogen (4 – 12 hours) then the pancreas secretes glucagon and
you release fat storage, you have more energy and you suppress hunger (once it has
access to all the energy in fat storage you no longer feel starvation)

50. Typical
results from
large long-
term
studies
utilizing
reduced
calorie
intake with
increase
exercise
Women’s Health
Initiative Trial,
JAMA
2006:295:39
Change in weight over 9 Years

53. Conventional Diet will be Resisted by the Body Set
Weight
1. Reduce body energy expenditure
2. Increase your hunger
Long-Term Weight Loss
1. Keep Basal Metabolic Rate (BMR) Stable
2. Stop hunger signaling
Control Insulin. Fasting

54. All the other
health benefits
from fasting
Jason Fung
Eat during a 6 to 8 hour window

55. Besides losing weight
(unwanted fat not lean
body mass or muscle)
there are other
significant health
benefits from fasting

56. Important things you may not know
Good long-term health requires alternating fed
states with fasting states (Mark Mattson) and may
also increase longevity. (David Sinclair).

57. Mark P. Mattson is a Professor of
Neuroscience at Johns Hopkins
University.He is the former Chief of the
Laboratory of Neurosciences at the
National Institute on Aging Intramural
Research Program of the National Institute
on Aging.
Mattson has done research on intermittent
fasting. The National Institute of Health
considers him "one of the world’s top
experts on the potential cognitive and
physical health benefits of intermittent
fasting

58. Hormesis
Low levels of
stress are good
for you.
What doesn’t kill you makes you stronger.
Friedrich Nietzsche

61. Exercise, fasting,
neurostimulation
will increase
glutamate and BDNF
(brain derived
neurotrophic factor
in hippocampus also
causing stem cells to
form new nerve cells

64. Professor in the Department of Genetics and co-Director
of the Paul F. Glenn Center for the Biology of Aging at
Harvard Medical School. He is best known for his work on
understanding why we age and how to slow its effects.
He obtained his Ph.D. in Molecular Genetics at the
University of New South Wales, Sydney in 1995. He
worked as a postdoctoral researcher at M.I.T. with Dr.
Leonard Guarente where he co discovered a cause of
aging for yeast as well as the role of Sir2 in epigenetic
changes driven by genome instability.

67. Three main defense systems you need to turn on
for prolonged health (to live longer) genes are
hormesis sensers and will respond to stress by
turning on a protecting you
mTOR – senses protein (avoid too much meat)
AMPK – take Metformin and also responds to
hunger
Sirtuins need NAD energy / you can use raise
NAD by exercise or fasting (being hungry) or
molecules like NMN or Resveratrol

68. David Sinclair

69. Valter D. Longo
is an biogerontologist and cell biologist known for
his studies on the role of fasting and nutrient
response genes on cellular protection aging and
diseases and for proposing that longevity is
regulated by similar genes and mechanisms in
many eukaryotes
He is currently a professor at the USC Davis
School of Gerontology with a joint appointment in
the department of Biological Sciences as well as
serving as the director of the USC Longevity
Institute

70. Longevity Diet
for Adults
1.Eat mostly vegan, plus a little fish, limiting meals with fish to a maximum of
two or three per week..
2.Over age 65, you should slightly increase protein intake but also increase
consumption of fish, eggs, white meat, and products derived from goats and
sheep to preserve muscle mass. Consume beans, chickpeas, green peas, and
other legumes as your main source of protein.
3.Minimize saturated fats from animal and vegetable sources (meat, cheese)
and sugar, and maximize good fats and complex carbs. Eat whole grains and
high quantities of vegetables (tomatoes, broccoli, carrots, legumes, etc.) with
generous amounts of olive oil (3 tablespoons per day) and nuts (1 ounce per
day).
4.Follow a diet with high vitamin and mineral content, supplemented with a
multivitamin buffer every three days.
5.Select ingredients among those discussed in this book that your ancestors
would have eaten.
6.If you are overweight or tend to gain weight easily, consume two meals a day:
breakfast and either lunch or dinner, plus two low-sugar (less than 5 grams)
snacks with fewer than 100 calories each. If you are already at a normal
weight, or if you tend to lose weight easily or are over 65 and of normal weight,
eat three meals a day and one low-sugar (less than 3 to 5 grams) snack with
fewer than 100 calories.
7.Confine all eating to within a twelve-hour period; for example, start after 8
a.m. and end before 8 p.m. Don’t eat anything within three to four hours of
bedtime.

71. Can Seniors Do Intermittent Fasting?
1. Goal is to eat healthy food, avoid sugar and refined carbohydrates
and limit eating window to an 8 hour period (or less)
2. Stop eating by 6 pm then at 6am already have completed a 12 hour
fast, wait till 10am (16 hours) and if you can wait till noon (18
hours)
3. Drink lots of black coffee (green tea would probably be better) till
noon
4. Exercise in the morning (power walks at 6am / 5.5mi / 15-16 min
per mile) 5 days a week plus barbells for 20 minutes 4 times a week
5. Lunch – oatmeal or fiber one or yogurt with fruit (raspberries/
blackberries) plus an apple or a hard-boiled egg
6. Dinner at 4 to 5:30 – huge salad or healthy meat (chicken or fish) or
even Healthy Choice plus vegetables
7. Occasional alcohol , red wine would be best but lite beer or Scotch
178 pounds 128 pounds
BMI 28.7 BMI 20.7
All the junk food you miss (breads and deserts) only occasionally

72. Evolutionary biology and
evolutionary psychology
Hunger signal: “I must eat”!
Can you train yourself to respond
differently?
“Great, the signal tells me I’m now
switching over to stored fat as fuel and
allowing my body to restore itself.”
Do you eat to live…
or live to eat?

73. Along with making smarter food choices should you
consider timing … Advice as of March 2021
Shelf life of any medical advice is getting shorter and shorter with the pace of new information flooding in
Pretty solid evidence that our health requires regular stressors in moderation for optimal health and longevity.
To allow the body and brain to properly maintain itself we should alternate between fed states and fasting states
and most people could probably go 12 hours between each
If someone has been unsuccessful with losing excessive body fat, they may want to reduce the feeding interval
down to 6 or 8 hours on most days but should consult with their own physician and review the best advice (Jason
Fung)

74. 75% of weight is
genetic