First Published in 2016 by Victory Belt Publishing Inc.

Copyright © 2016 Dr. Jason Fung & Jimmy Moore All rights reserved No part of this publication may be reproduced or distributed in any form or by any means, electronic or mechanical, or stored in a database or retrieval system, without prior written permission from the publisher.

ISBN 13: 978-16-28600-01-8

The information included in this book is for educational purposes only. It is not intended or implied to be a substitute for professional medical advice. The reader should always consult his or her health-care provider to determine the appropriateness of the information for his or her own situation or if he or she has any questions regarding a medical condition or treatment plan. Reading the information in this book does not create a physician-patient relationship. Victory Belt ® is a registered trademark of Victory Belt Publishing Inc.

Book design by Justin-Aaron Velasco Illustrations by Justin-Aaron Velasco Food photography (recipes) by Tom Estrera Food preparation and styling by Luzviminda Estrera Printed in Canada TC0116

CONTENTS

Introduction, by Jason Fung, MD Not Just Another F-Word: My Experiments with Fasting, by Jimmy Moore Meet the Fasting All-Stars

PART I: WHAT IS FASTING AND WHY IS IT GOOD FOR YOU? Chapter 1: What Is Fasting? Fasting Success Story: Samantha Chapter 2: A Brief History of Fasting Chapter 3: Busting the Myths of Fasting Chapter 4: The Advantages of Fasting Fasting Success Story: Elizabeth Chapter 5: Fasting for Weight Loss Chapter 6: Fasting for Type 2 Diabetes Fasting Success Story: Megan Chapter 7: Fasting for a Younger, Smarter You Chapter 8: Fasting for Heart Health Chapter 9: What You Need to Know About Hunger Fasting Success Story: Darryl Chapter 10: Who Should Not Fast?

PART II: HOW TO FAST Chapter 11: Kinds of Fasts and Best Practices Chapter 12: Intermittent Fasting Chapter 13: Longer Periods of Fasting Fasting Success Story: Sunny & Cherrie Chapter 14: Extended Fasting Chapter 15: Fasting Tips and FAQs

PART III: RESOURCES Fasting Fluids 24-Hour Fasting Protocol 36-Hour Fasting Protocol 42-Hour Fasting Protocol 7-to 14-Day Fasting Protocol

RECIPES Berry Parfait Bulletproof Coffee Essential Bone Broth Grain-Free Pancakes Mini Frittatas Simple Homemade Bacon Grain-Free Cauliflower Pizza Chicken “Breaded” in Pork Rinds Chicken Drumsticks Wrapped in Bacon Chicken Stuffed Bell Peppers Game Day Wings Homemade Chicken Fingers Steak Fajitas Arugula and Prosciutto Salad Pear and Arugula Salad with Pine Nuts Strawberry and Kale Salad Tomato, Cucumber, and Avocado Salad Avocado Fries Mustard Green Beans Roasted Cauliflower Rice

INTRODUCTION

by Jason Fung, MD

I grew up in Toronto, Canada, and studied biochemistry at the University of Toronto, where I also completed medical school and my residency in internal medicine.

After my residency, I chose to study nephrology (kidney disease) at the University of California, Los Angeles, mostly at Cedars-Sinai Medical Center and West Los Angeles VA Medical Centers (then known as the VA Wadsworth). Each field of internal medicine draws its own personalities, and nephrology has the reputation of being a “thinker’s specialty.” Kidney disease involves intricate fluid and electrolyte problems, and I enjoy these puzzles. In 2001 I returned to Toronto to start my career as a nephrologist.

Type 2 diabetes is far and away the leading cause of kidney disease, and I treat many hundreds of patients with this disease. Most type 2 diabetics also suffer from obesity. By the early 2010s my interest in puzzles, combined with my professional focus on obesity and type 2 diabetes, had led me to focus on diet and nutrition.

How did I go from preaching conventional medicine to prescribing intensive dietary strategies, including fasting? Despite what you might think, nutrition is not a topic covered extensively in medical school. Most schools, including the University of Toronto, spend a bare minimum of time teaching nutrition. There were perhaps a handful of lectures on nutrition in my first year of medical school and virtually no teaching on nutrition throughout the rest of medical school, internship, residency and fellowship. Out of the nine years spent in formal medical education, I would estimate I had four hours of lectures on nutrition.

As a result, I had no more than a passing interest in nutrition until the mid- 2000s. At the time, the Atkins diet, promoting low-carb eating, was in full swing. It was everywhere. Some family members of mine tried it and were ecstatic with the results. However, like most conventionally trained physicians, I believed their arteries would eventually pay the price. I, along with thousands of other physicians, had been taught and certainly believed that low-carbohydrate diets were simply a fad and the low-fat diet would prove to be the best.

Then studies on the low-carb diet started to appear in the most prestigious

medical journal in the world, the New England Journal of Medicine. Randomized controlled trials compared the Atkins diet to the standard low-fat diet that most health-care providers recommended. These studies all came to the same startling conclusion: the low-carb diet was significantly better for weight loss than the low-fat diet. Even more stunning was that all the important risk factors for cardiovascular disease—including cholesterol, blood sugar level, and blood pressure—were also much improved on the low-carb diet. This was a puzzle, a real conundrum. And that was where my journey began.

Figuring Out What Causes Obesity The new studies proved that the low-carb approach was a viable one. But

this didn’t make any sense to me because I was still steeped in the conventional “calories in, calories out” (CICO) approach—the idea that the only way to lose weight is to consume fewer calories than you expend. Diets based on the Atkins methodology, for example, did not necessarily restrict caloric intake, yet people were still losing weight. Something didn’t add up.

One possibility was that the new studies were wrong. However, that was unlikely, given that multiple studies all showed the same result. Furthermore, they confirmed the clinical experience of thousands of patients, who were all reporting weight loss on the Atkins diet.

Logically, accepting that the studies were correct meant the CICO approach had to be wrong. Much as I tried to deny it, there was no saving the CICO hypothesis. It was dead wrong. And if the CICO hypothesis was wrong, then what was right? What caused weight gain? What was the etiology—the underlying cause—of obesity?

Doctors spend almost no time thinking about this question. Why? Because we think we already know the answer. We think that excessive caloric intake causes obesity. And if eating too many calories is the problem, then the solution is eating fewer calories and burning more through an increase in activity. This is the “eat less, move more” approach. But there’s an obvious problem. “Eat less, move more” has been done to death over the past fifty years, and it doesn’t work. For all practical purposes, it doesn’t really matter why it doesn’t work (although we’ll look into that in Chapter 5); the bottom line is that we’ve all done it, and it doesn’t work.

The underlying cause of obesity turns out to be a hormonal, rather than a caloric, imbalance. Insulin is a fat-storage hormone. When we eat, insulin increases, signaling our body to store some of this food energy as fat for later

use. It’s a natural and essential process that has helped humans survive famine for thousands of years, but excessively and persistently high insulin levels result inexorably in obesity. Understanding this leads naturally to a solution: if excessive insulin is causing obesity, then clearly the answer lies in reducing insulin. Both the ketogenic diet (a low-carb, moderate-protein, high-fat diet) and intermittent fasting are excellent methods of reducing high insulin levels.

Insulin and Type 2 Diabetes However, in my work with type 2 diabetics, I realized that there was an

inconsistency between the treatment of obesity and the treatment of type 2 diabetes, two problems that are closely linked. Reducing insulin may be effective in reducing obesity, but doctors like me were prescribing insulin as a cure-all treatment for diabetes, both types 1 and 2. Insulin certainly lowers blood sugars. But just as surely, it causes weight gain. I finally realized that the answer was really quite simple. We were treating the wrong thing.

Type 1 diabetes is an entirely different problem than type 2. In type 1 diabetes, the body’s own immune system destroys the insulin-producing cells in the pancreas. The resulting low insulin level leads to high blood sugar. Therefore, since insulin levels are low to begin with, it makes sense to treat the problem with supplemental insulin. And sure enough, it works.

In type 2 diabetes, however, insulin levels are not low but high. Blood sugar is elevated not because the body can’t make insulin but because it’s become resistant to insulin—it doesn’t let insulin do its job. By prescribing more insulin to treat type 2 diabetes, we were not treating the underlying cause of high blood sugar: insulin resistance. That’s why, over time, patients saw their type 2 diabetes get worse and required higher and higher doses of medications.

But what caused the high insulin resistance in the first place? This was the real question. After all, we didn’t stand a chance of treating the underlying disease if we didn’t know what caused it. As it turns out, insulin causes insulin resistance. The body responds to excessively high levels of any substance by developing resistance to it. If you drink excessive alcohol, the body will develop resistance, up to a point—we often call this “tolerance.” If you take narcotics such as heroin, your body will develop resistance. If you use prescription sleep medications such as benzodiazepines, your body will develop resistance. The same holds true for insulin.

Excessive insulin causes obesity, and excessive insulin causes insulin resistance, which is the disease known as type 2 diabetes.

With that understanding, the problem with how doctors treat type 2 diabetes became clear: we were prescribing insulin to treat it, when excessive insulin was the problem in the first place. Instinctively, most patients knew what we were doing was wrong. They would say to me, “Doctor, you have always told me that weight loss is critical in the treatment of type 2 diabetes, yet you have prescribed me insulin, which has made me gain so much weight. How is that good for me?” I never had a good answer for this. Now I knew why. They were absolutely right; it wasn’t good for them. As patients took insulin, they gained weight, and when they did, their type 2 diabetes got worse, demanding more insulin. And the cycle repeated: they took more insulin, they gained more weight, and as they gained more weight, they needed more insulin. It was a classic vicious cycle.

We doctors had been treating type 2 diabetes exactly wrong. With the proper treatment, it is a curable disease. Type 2 diabetes, like obesity, is a disease of too much insulin. The treatment is to lower insulin, not raise it. We were making things worse. We were fighting the fire with gasoline.

I needed to help my obesity and type 2 diabetes patients lower their insulin levels, but what was the best approach? Certainly, there are no medications that do this. There are surgical options that help, such as bariatric surgery (commonly called “stomach stapling”), but they are highly invasive and have many irreversible side effects. The only feasible treatment left was dietary: reducing insulin levels by changing eating habits.

In 2012, I established the Intensive Dietary Management Program, which has a unique focus on diet as a treatment for the twin problems of obesity and type 2 diabetes. At first, I prescribed low and very low carbohydrate diets. Since refined carbohydrates highly stimulate insulin, reducing these carbohydrates should be an effective method of lowering insulin.

I gave my patients lengthy sessions of dietary advice. I reviewed their food diaries. I begged. I pleaded. I cajoled. But the diets just didn’t work. The advice seemed hard to follow; my patients had busy lives and changing their dietary habits was difficult, especially since much of it ran contrary to the standard advice to eat low-fat and low-calorie.

But I couldn’t just give up on them. Their health, and indeed their very lives, depended upon reducing their insulin levels. If they had trouble avoiding certain foods, then why not make it as simple as possible? They could simply eat nothing at all. The solution was, in a word, fasting.

NOT JUST ANOTHER F-WORD: MY EXPERIMENTS WITH FASTING

by Jimmy Moore

In the coming pages, you will read all about the therapeutic uses of fasting and how to implement it in your own life in order to experience its amazing health benefits. But you might be wondering what the experience of fasting actually looks like—perhaps particularly for someone who was extremely skeptical about fasting until he tried it for himself. That’s precisely what I’ll be sharing with you in this chapter. My name is Jimmy Moore, and I’m the internationally bestselling author of The Ketogenic Cookbook, Keto Clarity, and Cholesterol Clarity, as well as the host of the longest-running health podcast, The Livin’ La Vida Low-Carb Show with Jimmy Moore. When I discovered Dr. Jason Fung’s incredible work on fasting, I knew we needed to collaborate to get comprehensive information about fasting into the hands of as many people as possible. But I wasn’t always such an exuberant fan of fasting.

“This Has Got to Be a Joke, Right?” When I first heard about fasting as part of improving your overall health

over a decade ago, it might as well have been described as “the other f-word.” Why in the world would you purposely starve yourself? How could anyone possibly think that deliberately being hungry would ever be a good thing? This has got to be a joke, right? Believe me, I know many of you reading this book have had some of these exact same thoughts. And back in 2006, I didn’t fully comprehend the positive benefits fasting would someday provide me, including its amazing effects on my cholesterol and blood sugar.

I first heard about the concept of intermittent fasting from Dr. Michael Eades, author of the bestselling book Protein Power. In 2006, Dr. Eades began writing about the great success with weight loss and other health benefits he had seen with something called intermittent fasting, or IF. It was a new idea at the time to go periods of time without eating anything at all, on a regular basis, and the way he described it seemed relatively doable: stop eating at 6:00 p.m. and then don’t eat again until 6:00 p.m. the next day. So you still got to eat every single day, but this strategy forced your body to go without food for twenty-four hours at a time.

I have to admit, I had never gone that long without eating in my entire life, and I was extremely skeptical about the whole idea of fasting, even on an intermittent basis. Why? Because I like to eat, as evidenced by the fact that I once weighed in at a whopping 410 pounds. Of course, at that weight I was consuming lots of processed junk food and sugary sodas like there was no tomorrow. Growing up, in college, when I got married in my twenties, and into my early thirties, I had terrible eating habits that contributed to some pretty significant metabolic damage. Thankfully in 2004 I came across information about the low-carb diet, which enabled me to lose 180 pounds in one year and come off of three prescription medications for high cholesterol, high blood pressure, and breathing problems. I had to share about the incredible health success I’d found on that diet with others, and I went on to grow a huge platform online called Livin’ La Vida Low-Carb, which I use to educate, encourage, and inspire others in their own personal health journeys. I write books, give talks around the world, and speak with some of the most influential and intelligent people making waves in nutrition, fitness, and health. It’s been some of the most gratifying work of my entire life, and I’m privileged to be able to do what I do for a living now.

Despite my diet turnaround, though, I didn’t stop enjoying eating! Hence my skepticism about intermittent fasting. I was intrigued by what Dr. Eades had to say about it, though, and I did my homework. One thing I learned in particular made me sit up and take notice. In 2009, I interviewed Boston College biology professor Thomas L. Seyfried, who had been researching alternative treatments for cancer prevention and treatment, including using a calorie-restricted ketogenic diet to treat brain cancer and other cancers. One of the more interesting and memorable nuggets from that half-hour interview came at the very end of our conversation, when Dr. Seyfried made the bold assertion that an annual seven-to ten-day water fast could be a useful tool for preventing cancer. WOW! But as skeptical as I was about intermittent fasting, a one-week fast freaked me out even more. Who could actually do that?

But by that point I’d heard enough to convince me to give fasting a try. Needless to say, I had to get my head around IF before I even dared try a multiple-day fast, and being the nothing’s-too-hard adventurer that I was, I decided to try it. Boy oh boy, what was I getting myself into?!

My First Attempt at Fasting Okay, before we get to the good stuff about fasting, I have to be honest

about the bad stuff, and all I have to say about my first attempt at alternate-day intermittent fasting—fasting for twenty-four hours every other day—is ugh, ugh, and UGH! It lasted exactly four days, nineteen hours, and fifteen minutes. But it felt like an eternity! I did some things wrong that made this attempt much more painful than it should have been, but before I explain what so that you can learn from my mistakes, here’s what I learned about myself during my first, unpleasant experience of attempting IF in 2006:

1. I was pretty addicted to caffeine still. That first day of fasting was painful because I had a massive headache for most of the day. By the second day, though, the headache had subsided.

2. I hadn’t felt truly hungry in a long time. After losing 180 pounds, my philosophy had been to never allow myself to get hungry so I didn’t slip back into those old eating habits. (Ironically, during my low-fat dieting days, all I did was have hunger pangs.) Now, listening to my body is beneficial because I don’t have the same food temptations.

3. Being ravenously hungry made me overeat. At the end of my second fasting day, my wife Christine and I went to Steak & Ale for their all-you-can-eat prime rib special. They were busy, so the steaks took longer to come to the table than they usually do. I was so hungry that I ate a whole plate of salad in minutes, devoured the first prime rib, waited twenty minutes for my second, and killed that one, too. Then my server brought me another one about thirty minutes later (after my food had settled a bit in my stomach) and I started to eat it—but when I got halfway done, whoa Nelly, I was full! Not just full, but really really full! As in, it hurt so much I had to take some Tum-ta-Tum-Tums and lie down for a bit when we got home. I was quite the ravenous beast!

4. Eating enough food to fuel my daily workouts really was important. On day 1 of my fast, I tried to keep up the same resistance and speed on my elliptical workout, but it just didn’t happen. While I usually have a 13 resistance at 8.5 mph, I had to back off to 7 resistance at 7.0 mph to keep my workout as long as usual. Of course, I burned fewer calories as well. What was worse was that even on the days I did eat, the very noticeable lack of energy persisted and did not come back until I ended my IF experiment. It took me several weeks to get back to full strength and endurance.

5. For me at the time, going without food for twenty-four hours was not realistic. On the first day my head was hurting so much from the caffeine withdrawals that I barely noticed how hungry and light-headed I felt. But on my second fasting day, I felt like I

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