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80: Intermittent Fasting is Kind of Complicated

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80: Intermittent Fasting is Kind of Complicated

Jun 22, 2021

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Dr. Pohl: Are we recording right now?

Scot: Yeah.

Dr. Pohl: Okay.

Troy: We didn't really intro the episode though, Scot, did we?

Scot: I know. But sometimes with new people, Troy, I like to sneak into it, so they feel more comfortable.

Troy: Sorry, Scot.

Scot: Maybe not call attention to the fact that we're actually doing the show.

Troy: Don't let me mess with your technique. Please continue.

Scot: I think it might be too late. I think Dr. Pohl is wise to me at this point.

Troy: I think now she knows what you're doing. So go ahead. Now, I do too.

Scot: You've probably heard of this concept of time-restricted eating. That's where say you eat for 8 hours out of the day and then you don't eat for 16 hours. And it's a way that a lot of people are talking about being able to lose a little extra weight. We've talked to Thunder Jalili, our nutritionist. We have a couple of episodes about it you can listen to. Today, we want to bring in a physician, Dr. Susan Pohl and find out what her take on time-restricted eating is. And if it's right for everybody or if there's some people that it is not going to work out for and what are the impacts it can have on your health. My name is Scot Singpiel. I am the manager of With me, my co-host, Dr. Troy Madsen and Dr. Dr. Susan Pohl. So time-restricted eating, tell me your definition of that.

Dr. Pohl: The concept of it is that the digestive system is more than just a food tube and that one of the key factors in health is digesting your food and getting your nutrients into cells. And that happens with a chemical primarily called insulin. And that insulin is one of the key drivers that helps us use the nutrition from our gut.

So insulin is very important. Obviously, if you know anybody who has diabetes, especially Type 1 diabetes, Type 1 diabetes is the kind that children get. They don't have insulin and they can get very sick. For the more common type of diabetes, which is Type 2, you actually have too much insulin and your body starts to get insulin resistance. And so one theory that has been popularized is that not only do we need the right nutrition, but by timing it with insulin and giving our body a rest from food and a rest from the insulin, we actually can boost health and boost vitality.

Scot: Yeah. That's a little bit of a different take on it that Thunder has. So, when we talk to Thunder, it's primarily more about I think weight management, losing some weight or maintaining your weight. So that's fascinating. It can actually impact your health as well. So is time-restricted eating something that everybody should be doing?

Dr. Pohl: No. The idea behind time-restricted eating from my point of view is primarily around insulin and storing and getting into that storage mode. And when we eat foods that are high in carbohydrates, we tend to secrete insulin and then we go into the storage mode for our nutrition. And the theory behind that, back in high school biology, we learned that the brain was the computer that helped drive the body, we had this nutrition tube to helped us digest food, and that we had fat and fat was a storage vehicle.

What we know now from research is that although those ideas are correct, it's a very simplified model and that there actually are hormones that talk to each other between the brain, the gut, and the fat in our body. So, by doing time-restricted eating, you are decreasing the amount of insulin that your body is being exposed to. But you also are triggering some other hormones like the balance of leptin and adiponectin, which are two other hormones that are secreted by fat. And so for some people, as you start to drive weight down, you actually start to get a decrease in leptin. And you can actually drive the brain to cause some binge eating behaviors.

So the balance between the gut and the brain can become a little bit off. And so I have patients that come to me and say, "I did time-restricted eating and I'm fasting several days a week, but I'm not losing weight," or "I'm not successful in this," or "I do 16/8. So I'll go 16 hours of fasting and 8 hours of eating and I'm not losing weight and I'm not getting more vitality." And I keep reading about this and what may be happening with a lot of those people is that they actually are triggering some bingeing because of the brain's reaction to the fasting.

So it's a tool that works for lots of people, but some people will start to trigger bingeing. And there are certain people who should not be doing time-restricted eating, specifically those that have a history of binge eating disorder or any eating disorder. We don't recommend it for children under 18, which just hasn't been studied. And we know that nutrition is vital for functioning and growth, so children should not be doing time-restricted eating or intermittent fasting and pregnant women because again, nutrition is very important for pregnancy.

Troy: And do you find that there's a certain cutoff in this time-restricted eating where it starts to become more problematic? You mentioned the 8-hour eating, 16-hour fast? That seems like a very long fast. Is that just too much or do you just tell people, "Hey, do what works for you and adjust it to your schedule"?

Dr. Pohl: Yeah. I don't think we understand. As we peel the onion, like I said, if we think about the onion and insulin is one of the big layers in there and then we get down into some of the more detailed hormones around leptin and adiponectin and the way that signals and triggers the brain to crave more food. And so everybody has a different reactivity to that. So, again, I think I recommend exactly what you said. You can try those things like 16 and 8.

I have seen some studies that the balance of leptin, adiponectin are not as put into as much imbalance if you do every other day fasting as opposed to everyday fasting. So using it as a tool that maybe you don't do all the time for some people who are being triggered to binge eat or consume more calories during their non-fasting times. And I think it's unconscious. I do think that patients don't . . . People don't quite realize what 100 or 200 calories looks like. And so they'll be recording their food log and say, "I'm only recording 1,500 calories," or, "I'm only recording 1,800 calories." But this trigger for the brain I think gets out of balance.

Troy: That's interesting. Yeah.

Scot: Yeah. It is.

Troy: We've really been on the time-restricted eating bandwagon here. And I worry sometimes this happens with a lot of health things that you see something that has some benefit and we think, "Well, if it's good, if I just do more of it, it's better." We've talked about doing 12 and 12 and maybe increasing that to 14, but then maybe people think, "Well, let's go to 16 and 8." And then potentially as you mentioned, then maybe that just starts to throw things off and you just want to binge eat during that eight hours and it's counterproductive.

Dr. Pohl: Yeah. I see a lot of patients that will do alternate day fasts, eat a norm, regular timing for foods one day and then alternate day, a lower calorie, 16 and 8 or 12 and 12 on alternate days. And I think a lot of people can manage that a little bit more. And some people find that that's a technique that makes it more sustainable.

Scot: I did the 8/16 and I had a lot of success with it. But as I'm listening to you talk, I think I was set up for a little bit more success. First of all, perhaps my body is not having the same chemical reactions that some people do, because bingeing wasn't an issue for me. Second of all, my whole life I've been very aware of what 200 calories looks like. I understand my macros pretty well. So I was eating essentially what I would eat, except for I was just compressing it. And I know how many calories I eat. So I was finding success, but if somebody is not quite sure, it can be really easy. I imagine if that chemical reaction kicks in to just go, "Oh, I need a bag of Reese's Peanut Butter Cups" and you're down that and there's four or 500 calories, now you're eating more than you normally would. The other thing that fasting the reason it worked for me is because I can only eat so much in that period.

So what were you finding when people binge? Are they bingeing on good stuff or bad stuff? Or usually, how does that play out?

Dr, Pohl: So the interesting thing is that if you look at the brain's trigger, we actually think that we have this hedonic pathway. And so during times of stress, we tend to gravitate toward foods that are highly palatable. So speaking in English, you're going to crave . . . If you're given a chocolate cake or a salad, if you are in that craving mode, you're definitely going to go more for the chocolate cake. So I think the other piece of it is when you do break a fast, think about breaking it . . . When your first food that you're eating, I would concentrate on a balanced nutrition profile, so some protein and some fat that'll keep the gut from going into a real fast metabolic rate. So, if you make sure that you have some protein and some fat as you start to break your fast, I think you won't get triggered as much to crave the high sugar, high carbohydrates.

Troy: And you mentioned also you don't recommend this for people who have had a history of eating disorders. Have you seen any cases of people who maybe didn't have a previous diagnosis of anorexia or bulimia or anything like that, but where going to this time-restricted eating maybe triggered some eating disorder tendencies?

Dr. Pohl: I haven't seen it in my practice, but that is a concern. There's another condition called orthorexia. And I don't know if you guys have talked about that at all. So people can go into anorexia where you just don't eat, you never break your fast or adequately break your fast to get enough nutrition. It can trigger bulimia where you're bingeing and then purging. And then orthorexia is, again, a newer diagnosis where patients with anxiety can start to become really obsessed about their food content and it can interfere with other parts of their life so that they can never go off of their food schedule. And so that is a disorder that we're starting to see, some in our practice where I've seen more orthorexia where patients are actually starting to obsess. And it's under the realm of obsessive compulsive disorder where patients will start to spend all their time and energy looking at the food and their food content.

Troy: And I have seen some things as well. Looking at intermittent fasting and time-restricted eating of even some health effects like an increased rate of gall stones, I guess the idea being that the gallbladder isn't working as much because there's no food in there, you don't need that bile secreted. And that bile sitting there increases the rate of gall stones. Are you seeing anything along those lines or any other health effects similar to that?

Dr. Pohl: Yeah. I think if you're weight neutral, I think that the rate of gallstones are less. But with anything that promotes weight loss, you're at risk for gall stones, especially if the weight loss is rapid.

Troy: So a lot of what I'm hearing here is that Scot and I have certainly been on the bandwagon here. With time-restricted eating, we're like, "Hey, this is great." But it sounds like you're telling us yeah, there's maybe a place for it, but there's a whole lot else you should be addressing maybe before even thinking about it. How do you talk to patients when they first come in, in terms of just their general health, weight loss? And when does this come into that conversation?

Dr. Pohl: So most people are very comfortable talking about exercise and nutrition when they're talking about weight and really health. We start to talk more on a global level about things like sleep and mood when patients are having more difficulty and we'll start to talk a little deeper about other issues around health. And if we feel like they're addressing things in a good way around mood and sleep, I might bring up, have they heard of intermittent fasting and what is their experience with it. And we'll talk about time-restricted eating and I'll give them some resources to read about it. I've actually recommended "The Obesity Code" as a book for someone to read and then have them follow up with me and really talk about what that would look like and then support them as long as I know that they're otherwise in a healthy place and have the support that they need to start time-restricted eating.

Troy: So this is not a first-time treatment for obesity, this isn't something you're talking about in your first time, it's like, "Hey, if you've got everything else in place, this is an option as well."

Dr. Pohl: Yeah. I definitely add it after we've maximized nutrition and especially looking at things like carbohydrate content and total exercise, both vigorous exercise and more moderate exercise and making sure they have a balance of all those things.

Scot: So it sounds like if somebody is getting some exercise, they're watching their nutrition, their caloric intake, they're getting good sleep, they've got some good mental health, there's nothing in their life that's causing stress. That tends to work for the most part for people feeling healthy losing a little bit of weight. If somebody hits a plateau, that's when maybe you might pull this one out of the toolbox of intermittent fasting.

Dr. Pohl: Yes. And I make sure that they're following up with me and making sure that we have a good plan for follow-up and just making sure that all their . . . none of those other issues become triggered.

Scot: Yeah.

Troy: So here's the next question for you. Do you practice intermittent fasting?

Dr. Pohl: Yes, I do. Actually, I have found that I maximized exercise and nutrition and felt like I had hit a wall. During the pandemic, actually, I started doing 16 and 8 and I found that it helped break through some issues for me and I was able to have some success that I hadn't previously been able to achieve.

Troy: Wow. And were you doing 16 and 8 every day or every other day like you mentioned?

Dr. Pohl: For me, the issue and it was a little bit, maybe a little bit of that what I talked about earlier, that hedonic drive, but what I found was that I was able to look at my nutrition five days a week. And then on the weekend, I love a piece of chocolate cake or a glass of wine or something like that. And so it was very hard for me, and discouraging for me to do seven days of really good monitoring your nutrition and exercise and then have a weekend of maybe some celebration or something and then lose ground. And so what I found for me was that if I did interment, if I did 16 and 8, during the weekdays, I was able to then let off steam on the weekends a little bit and participate in those fun activities that included some nutrition that maybe I didn't have during the week. And that for me made it sustainable.

Troy: And it seems that if you do 16 and 8, you're essentially skipping a meal during the day, and I've heard breakfast is the easiest. That seems to work for me. Did you do that or did you approach it a little differently?

Dr. Pohl: No. That's exactly what I did. Again, because I do have a family, I just moved my lunch to about 1:00 and then made sure that I was finished up with dinner before 6 or 7. And then that was a really easy transition because I was able to have dinner with my family.

Troy: Yeah. That makes sense. Yeah. That's what works for me. For me, the balance seems to be 12 and 12, and then sometimes that 12 stretches to 14 where I don't eat after 8, then I may not eat until 10 a.m. the next morning. But 16 and 8 sure sounds tough. I have not tried that. That seems tough to sustain, but it seems like you had some pretty good balance there.

Dr. Pohl: Yeah.

Scot: Shockingly, so I flip flop it. Breakfast is too important to me. So I usually have my breakfast, and then I'd wrap up at about 3:00 or 4:00 in the afternoon. And my concern was, I think what Dr. Pohl speaks to a little bit is then that time between 4 and bedtime, right? You get into that no man's land where maybe you're going to start making some bad decisions. I just upped my water intake, and a lot of times that took care of the problem. So that worked for me. I don't know if it would work for everybody or not, but . . .

Troy: I guess it depends how many times you want to get up to pee at night, Scot. I don't know if that was an issue for you.

Scot: Well, this is the shocking thing. No. This is a shocking thing. I didn't.

Troy: You didn't?

Scot: It didn't have to get up and go anymore.

Troy: You just like chugging water and . . .

Scot: Which is bizarre because I used to have to. So I don't know if it's related to this or what it was, but . . .

Troy: Huh, interesting.

Scot: Dr. Pohl, what about intermittent fasting for somebody that's trying to manage their blood sugar levels if that's been a challenge? Is that a good strategy? Are there other better strategies, much like we talked about with weight loss?

Dr. Pohl: So, again, if you do have diabetes, I would definitely make sure that you're working with your doctor about this and that you are monitoring your blood sugar. And if you're on medications for diabetes, you need to be adjusting those based on fasting. So, for patients that have pre-diabetes, which is a condition where your blood sugar tends to run high after eating, I think that this is a tool that you can use to help control that. If you already are on medications for blood sugar and diabetes, then you definitely only want to do this under a doctor's supervision.

Troy: So definitely not a first line. But Scot, I know you've had this question. You've asked and maybe you can ask it. I don't want to necessarily reveal your health information, but you've talked about it on the podcast that you said you were borderline on your blood sugar, on your fasting glucose. And I don't know, maybe you can tell us a little bit more about that.

Scot: Yeah. So I come in around 97 to 99 and that pre-diabetes is 100. So I'm right underneath there. And I don't know if that's been just the way I've been my whole life because I don't have enough history of those numbers to be able to tell you if that's always where I've been. I used to subscribe to the Zone diet, which one of their tenants is that you have a little snack before bedtime. So, really, my time eating would be from 6 a.m. until 10 p.m. because it would be like cottage cheese and nuts and fruit. It would be healthy. I don't know. Troy, what question did you want me to ask? What question are you asking for me?

Troy: The question I'm asking on your behalf, Scot. For someone like Scot, is time-restricted fasting . . . because he tried everything. Is this some way to then maybe help a little bit more to move someone out of that pre-diabetes range? Is there any benefit there?

Dr. Pohl: Yeah. So the theory behind pre-diabetes is that you're constantly bombarding your body with insulin. And so by constantly having carbohydrates throughout the day, you're constantly having insulin in your body throughout the day. So, with time-restricted eating, what you're doing is giving your body a break from that insulin and you're saying, "Okay. I'm not going to expose the body to carbohydrates and insulin during a certain time period of the day." And that's a way that in the pre-diabetes when you have this tendency toward that borderline, you can actually pull that back a little bit. And so, Scot, were you successful or did that change your . . . What's your fasting glucose now? Do you actually monitor that?

Scot: I have not been doing it long enough to really check.

Dr. Pohl: Yeah.

Scot: So I started doing it right before the pandemic hit. And since then, all bets for me. Troy's doubled down on everything in his life, meaning he runs further and he eats healthier. And I've gone it completely the opposite way.

Troy: I don't know about that, but . . .

Scot: I do. So I haven't tried it yet. Is there any research on that, Dr. Pohl? Is there any expectation I could have? Because I did exercise. I was eating healthy. I was just eating throughout the day. So I wonder if my eating throughout the day and never giving me my break is what started developing that pre-diabetes. There again, I don't know, maybe I've always had high blood sugar resting. I don't know.

Dr. Pohl: Yeah. Well, it's interesting to see what your weight was before and what your weight is now. But the balance between your fat and your sugar and that trigger of the insulin, I would expect your fasting blood sugars to now be a little bit lower, more like 90 or 85. But it'd be interesting to see how your body responded. Again, it's a really complex system and that insulin is that big part of the onion. But as we drill down into the other hormones in your body, those could be affected as well. So we would only know by checking.

Troy: I think we got to check, Scot.

Scot: Yeah.

Troy: I think you are our case study because you've talked about it and I know you were struggling just to get that number down and definitely concerned. So I'd love to see where it is after doing some intermittent fasting.

Scot: So I'll do a 12 on, 12 off and I'll see how that works. How long would I need to maintain that, Dr. Pohl, before I'd want to get my blood sugar tested again, which I haven't done in two years, by the way?

Dr. Pohl: Yeah. What's your eating style right now? Are you not doing any time-restricted eating?

Scot: I do try to do 12 on, 12 off. I do try to wrap up. I start at 6 and I try to wrap up at 6.

Dr. Pohl: Yeah. So I would test it now and see where you're at. If that's what you're doing.

Scot: Oh, really doing?

Dr. Pohl: Yeah.

Scot: So that soon?

Dr. Pohl: Uh-hmm.

Scot: Okay.

Troy: Let's do it. Yeah. Let's do it.

Scot: All right.

Troy: This will be our next episode, Scot. We're going to do the reveal with you. You get your blood sugar drawn, we'll do the reveal and find out what it is, if you're willing to share it.

Scot: That'll be a lot of fun for our listeners . . .

Troy: Drama.

Scot: I'm sure. Yeah. I'm sure there's nothing more . . .

Troy: Radio drama.

Scot: . . . intriguing to podcast listeners than hearing a guy's blood sugar revealed live on the air. That seems solid.

Troy: Here is the number.

Scot: Now, I know why you're the doctor and I'm the professional broadcaster.

Troy: Exactly. That's right. Not my area of expertise, but I'm intrigued.

Dr. Pohl: I want to know too.

Scot: All right. Well, the doctors in the room want to know. That's fine.

Troy: Yeah. We want to know. We'll listen to that episode.

Scot: All right. Dr. Pohl, so it sounds like just to summarize. Time-restricted eating is something that somebody could try, but there are some caveats. It can cause overeating, some bingeing, you might end up going the opposite direction. Better to check in with some of those basics first like, how does your nutrition look, what you're eating, how does your activity look, your stress, your sleep. This could be a tool that maybe if somebody has hit a plateau they want to try. And then there are some medical conditions, you might want to talk to your doctor first before thinking about time-restricted eating. Did I sum that up fairly well?

Dr. Pohl: That's a great summary.

Scot: Okay. Great. This was a great conversation because I think I get excited about something like this and I forget that everybody is going to react to something like this differently. I was blown away when you said that some people would binge because I didn't experience that. So, of course, that's the way everybody would experience it. That's what we think, but that's not necessarily the truth. So great conversation. Thank you for being on the podcast and thanks for caring about men's health.

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