Moving Your Overton Window on Fasting

The Overton Window is a concept in political science that describes how the range of options from which politicians make policy choices changes over time.

When a new policy idea is introduced it may seem be radical or even unthinkable, but one effect may be that it shifts perceptions of the range of what is considered acceptable or sensible in its direction.

Things that formerly seemed out-of-bounds may seem less crazy in comparison.

While I’m not advocating mandated fasting as a governmental policy prescription, I hope what Lisa and I are doing right now might shift your personal Overton Window in the direction of at least trying a 24-hour fast before Thanksgiving.

Lisa and I are currently in the midst of our periodic #3DayCancerPreventionFast. We’re eating nothing (except Communion at church yesterday) for at least 72 hours. We are putting a small amount of cream in our morning coffee, supplementing magnesium, salt and potassium to make sure our electrolytes stay in balance, and are also drinking mineral water.

I’m just past the 38-hour mark right now. Lisa started a day earlier because on Saturday afternoon when I suggested we do this again she hadn’t eaten since Friday night, and she just decided to keep going.

Once we decide we’re going to do a three-day fast, Lisa wants to get into it and get it done. I wanted to have another bacon-and-eggs meal before I started.

Because I began my fast already having been in a high level of ketosis for a few days, I reached a glucose ketone index (GKI) of less than 1.0 by the end of the first day. Our goal is to be at that highest therapeutic level of GKI ketosis for at least 24 hours.

Lisa will end her fast tonight or wait until Tuesday morning, and I’ll finish tomorrow night or early Wednesday.

Either way, we’ll eat a few small meals to work our way back into eating mode, so we’ll be ready for a sumptuous feast on Thursday.

We’ll be able to eat anything we want without even a trace of guilt or regret.

A three-day fast may seem unthinkable or radical to you right now. It sure did to us originally, but now we’ve done it several times.

Maybe you could start with something shorter, like 24 hours. Or 18.

One person we’ve coached couldn’t imagine g0ing without eating for even eight hours. Yet by limiting carbohydrates and gradually extending her fasting window, she’s now done a 48-hour fast.

So here’s your challenge: after dinner tonight or tomorrow, don’t eat until dinner the following day.

You’ll have a prolonged period of low blood insulin levels, and you’ll be in fat-burning mode for several hours.

Then, if you’re able to have a feast on Thursday you too can enjoy it fully with no guilt or regrets. You will have paid the price in advance.

Your 24-hour fast will make ordinary intermittent fasting or time-restricted eating (fasting for 16 or 18 hours and limiting eating to 6 or 8) seem acceptable, sensible or even something you might adopt as your personal policy.

If you take the #24HourFastingChallenge, I hope you’ll leave a comment below with your thoughts on your experience and what you learned from it.

‘Before diagnosis of Type 2 diabetes there is a long silent scream from the liver’

Dr. David Unwin, a.k.a. @LowCarbGP, is a standout among my Health Sherpas. Over the last 9 years he has revolutionized his National Health Service practice just north of Liverpool, England by encouraging patients with Type 2 diabetes to adopt a low-carbohydrate diet.

More than 100 of these patients have been able to reverse their diabetes and get off their diabetes medications.

Before his low-carb change, he had never seen that happen among his patients.

Not even once.

In the video below, Dr. Unwin shares several of those patient examples, as well as research that supports the assertion of his colleague, Professor Roy Taylor, which is the title of this post and of the video.

Some of Dr. Unwin’s key nuggets:

  • Type 2 diabetes, raised triglyceride levels and abnormal liver function are linked to each other and to increased mortality.
  • 24% of the patients in his practice had abnormal liver function (GGT) tests, and 32% had an abnormal triglyceride result.
  • For several years he would watch these lab results with a feeling of helplessness because while he knew these patients were at higher risk of both cardiovascular disease and death, he didn’t really know what to do to help them. Statins, which are often prescribed for high cholesterol levels, don’t really help with triglycerides.
  • High triglyceride levels and low HDL-cholesterol are strong predictors of a poor outcome with COVID-19.
  • 25% of the developed world has Non-alcoholic Fatty Liver Disease.
  • 3.3 million people have died of COVID-19 worldwide in the last 18 months. 4.2 million die of diabetes every year.
  • He then shows the example of a patient with diabetes, high triglycerides and abnormal liver function, and that cutting carbohydrates fixed all three problems. He also details why this works.
  • High carbohydrate diets not only lead to fat accumulation in the liver and pancreas, but even in the tongue, which could be responsible for sleep apnea.
  • Many patients with fatty liver are dismayed to be treated with suspicion by their physicians, who believe the patients must be consuming excessive alcohol. In reality, the fatty liver in these patients is due to an excess of carbs.
  • Dr. Unwin has developed infographics to help patients identify which foods have high carb loads, and what the equivalent teaspoons of table sugar would be in each.
  • Finally, he shares compelling data from his practice, showing the improvements in triglycerides, HDL-c, liver function, weight and HbA1c after patients adopt a low-carbohydrate diet.

Dr. Unwin is unfailingly polite and understated in his delivery, which makes his conclusions all the more compelling.

I believe you’ll find this video well worth your time to watch and listen.

For more of his wisdom, see Dr. David Unwin on Cutting Carbs.

Building on our last few years’ experience and the results of our health journey, my wife Lisa and I are launching a new health-related venture next month, working with a friend who is a family physician. He shares Dr. Unwin’s concern about metabolic syndrome and his passion for equipping patients in making diet and lifestyle changes that can dramatically improve their health.

If you’re interested in learning about it, send me an email and I’ll be in touch to give you a preview.

Addressing underlying causes of disease instead of medicating symptoms

Dr. Jay Wortman is a descendant of one of the aboriginal populations of northern Canada.

Both of his maternal grandparents developed Type 2 diabetes and died from the complications.

All nine of their children developed Type 2 diabetes, cardiovascular disease, or both. At the time of his presentation in the video below, his mother was the only remaining survivor of that generation.

Dr. Wortman and two of his three siblings also have developed Type 2 diabetes.

He diagnosed himself in 2007. He recognized that this would dramatically reduce his life expectancy, so he immediately began investigating what would be the best drug treatment. But to buy time as he was starting that search, he says…

“I knew enough about diabetes to know that when blood sugar is high, that’s not good, and carbohydrates make your blood sugar go up. So I thought, ‘I’ll buy some time by right now, from this moment on, not eating any carbohydrates.’ Now I knew nothing about diet; I had the typical medical education – we get no training on nutrition…and I had no knowledge of the low-carb diet….

“So what happened over the next few days is I had basically a miraculous recovery. All the signs and symptoms went away quickly. My blood sugar normalized, and I started losing about a pound a day of weight, which went on for about a month….So something very dramatic happened, and something I had never encountered in my medical training or in my years of medical practice.”

Dr. Jay Wortman

In the rest of the video, Dr. Wortman describes how that discovery changed both his life and his career trajectory as he works with public health.

He has studied the diets of indigenous populations not only in Canada but also in other parts of the world, and has come to believe that changing from a low-carbohydrate, high-fat diet to an industrialized diet high in carbohydrates (and particularly processed carbs) has massively increased the prevalence of obesity, metabolic syndrome and diabetes.

While I think you would find the whole video enlightening and interesting, I have cued it above to start at the 27:30 mark, where Dr. Wortman makes a compelling case that the various chronic disease epidemics “aren’t a bunch of distinct and different diseases. We’re talking about a problem that is linked together in one huge epidemic of chronic disease…. What we have is a continuum of disease, the underpinning of which appears to be insulin resistance.”

As he says, the point at which diabetes is formally diagnosed is fairly arbitrary. Insulin resistance, which can progress for a decade or more “under the radar,” puts patients on a path to develop a constellation of diseases and conditions.

And of course metabolic syndrome is strongly related to cardiovascular disease, including coronary artery disease, stroke and heart attacks.

Altogether, metabolic syndrome is a cause – if not the cause – of diseases that consume more than 70% of health care spending in the U.S. each year.

As it did for Dr. Wortman, a low-carbohydrate, high-fat diet can help many people significantly improve health and prevent or even reverse many of these diseases and conditions.

Helping people turn back the clock on their health is the focus of what Lisa and I are planning as I start my third career following my retirement from Mayo Clinic. We’ve been doing this informally over the last 11 months, and soon we will be launching a venture that we hope will help many more.

We’re working with a long-time physician friend who has been interested in metabolic syndrome for decades.

Our venture is not a weight-loss program: as Dr. Wortman said, the reason for his personal change was to “buy time” and prevent diabetic damage.

But weight loss is typically a welcome side effect. Dr. Wortman reported losing about a pound a day for a month. Lisa and I have each lost 50 pounds. Your mileage will vary.

We’re developing educational resources, a community support platform and coaching services and expect to launch the new website next month.

If you would like to learn more and get a no-cost preview, send me an email and I’ll be in touch.

Is high LDL-C alone a problem?

As Dave Feldman says, “We don’t know.”

But today I’ve started participation in the process he set up that will help us get the answer.

The standard blood lipid panel includes several measures and calculations that doctors (and particularly cardiologists) use to estimate health and future risk of a heart attack, stroke or some other cardiovascular event.

  • Triglycerides
  • HDL-C
  • LDL-C (calculated)

You’ll also see a Total Cholesterol figure, but almost everyone would agree that it’s practically meaningless.

High Triglycerides (> 150 mg/dL) and low HDL-C (< 40 mg/dL for men and < 50 mg/dL for women) are two of the five elements that go into a diagnosis of metabolic syndrome. Others include:

  • High blood pressure (Systolic > 130 mmHG, Diastolic > 80 mmHg)
  • High Blood Glucose
  • Abdominal Obesity (waist > 40 inches for men or > 35 inches for women. Note that this is the measurement at the belly button, or the natural waist, not the jeans waist size.)

Metabolic syndrome is diagnosed when you meet any three of those five criteria, and the medical community clearly recognizes that metabolic syndrome massively increases your risk of cardiovascular disease, diabetes, many cancers and even Alzheimer’s and other forms of dementia.

What isn’t included in the diagnosis of metabolic syndrome?


It’s not even a factor that’s considered.

And yet it’s the one number which, if elevated, will get you a referral to a cardiologist, even if all of your other factors are optimized.

I know. It happened to me.

In January of this year I had a physical with a new primary care physician, complete with the standard lipid panel.

My Triglycerides? 45 mg/dL. Outstanding.

HDL-C (the “good” cholesterol)? 74 mg/dL. Also excellent.

Blood pressure. In the normal range. So was blood sugar.

I had lost 60 lbs. from my peak and had gotten rid of my abdominal obesity.

Every marker looked great.

Except LDL-C. That was 224 mg/dL.

Most cardiologists want that below 100, and they consider anything above 189 very high.

That’s why I got the call from my new primary care physician and a referral to cardiology, with a suggestion that I might want to consider taking a statin.

As part of that evaluation I got a coronary artery calcium scan, and my score was 0, which indicates low risk. I didn’t take the statin.

But the CAC score only measures the plaques that have calcified, not the newly formed ones. So like Dave, I’m cautiously optimistic that a high LDL level on its own doesn’t increase my heart disease risk. But we really don’t know.

That’s why I’m thrilled to be part of the Lean Mass Hyper-responder study, which will follow 100 people like me for a year. We all have high HDL, low triglycerides and LDL of more than 100.

This morning I’m in Los Angeles, where I had my first coronary CT angiogram with contrast, to measure the current extent of any atherosclerosis.

I’ll be taking blood ketone measurements every day for the next year to demonstrate that I’m staying on a ketogenic diet, and then a year from now will repeat the coronary CT angiogram.

My results, along with the others, will help the researchers understand whether LDL on its own is something to be concerned about, in the absence of other risk factors.

We all owe Dave and the Citizen Science Foundation huge thanks for their perseverance in making this study happen, and in raising the funds for it.

This is information that’s important to know, but Pharma would never pay for it.

And while many of us have been involved in individual n=1 experiments with our own diet and health, pulling together a large cohort like this will hopefully help us get statistically significant data that can help others make informed decisions.

I hope I’m right, and that having elevated LDL-C without other risk factors will be show to not increase atherosclerosis progression.

But if that turns out to not be the case, that’s important information to have as well, and could lead to treatment modifications.

I’m confident that I’m in much better health than I was five years ago.

Whatever the outcome of this study, within the next couple of years I’ll have better data to guide future decisions.

In China in 2016 vs. earlier this year with three 20-lb. jugs of kitty litter illustrating weight lost.

Optimizing Health through Diet

In this video from our friends on the Low Carb Down Under channel, Dr. Paul Mason , one of my Health Sherpas, covers many interesting points. Some of the highlights:

  • His personal experience with developing metabolic syndrome, and the relative lack of dietary teachings he received in medical school.
  • How medical school teaches doctors to prescribe medications, but not how to de-prescribe medications when patients begin to reverse metabolic syndrome.
  • The vegan vs. carnivore dietary controversy, and the relative strengths and drawbacks of each. Both are superior to the standard Australian (or American) diet – or SAD.
  • Limitations of nutritional research, including food frequency questionnaires that rely on faulty memories, the healthy user bias and misclassification of pizza, for example, as “red meat.”
  • Giving children in Ecuador one egg a day prevented stunted growth. Red meat, dairy and eggs provide the fat needed for brain development in children.
  • The strongest experimental design is a blinded randomized control trial (RCT). A meta-analysis gathers related RCTs and re-analyzes them as if they were one larger study. If you see the words epidemiology, association or correlation in the discussion of a study, you should be hesitant to rely too firmly on the results because of possible confounding factors.
  • At about the 24:00 mark in the video Dr. Mason discusses environmental issues related to plant and animal-based agriculture, and how grazing animals replenish the soil.
  • Cholesterol is essential to human life and is part of all cells. Lipoproteins, e.g. Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) transport cholesterol through the blood. Starting at about the 40:00 mark, Dr. Mason discusses the bad science behind the saturated fat/LDL hypothesis, and a meta-analysis that showed LDL levels had an inverse relationship to all-cause mortality: the higher your LDL levels, the longer you lived.
  • Damaged LDL is the the kind that leads to atherosclerosis, and this damage occurs in two ways: glycation (due to high blood sugar levels, which come from too much sugar and carbohydrates), and oxidation. Vegetable and seed oils are more likely to become oxidized, particularly at lower temperatures.
  • The Triglyceride/HDL ratio is a good gauge of whether you have small dense LDL (the dangerous kind, which is called Pattern B), or big, fluffy LDL (Pattern A). This ratio, which you can calculate from a standard lipid panel, is a far better predictor of heart attack risk than LDL cholesterol alone.
  • The problem with laboratory test reference ranges is that they reflect results that encompass 95% of the population, so just because your lab results are in the “normal” range doesn’t mean they’re in a healthy range. Much of the population is not healthy.
  • High protein and Vitamin D are keys to bone density, and in a study of post-menopausal women and men over 65 those with the highest protein intake actually reversed bone loss.
  • Fasting or time-restricted eating are especially helpful for people who are metabolically unhealthy. Even without changing what you eat, you can improve your health by limiting when you eat. (I would add that limiting carbs and becoming fat-adapted makes it easier to limit eating windows.)

There’s lots more, so as you have time I’d encourage you to watch it all. In addition to the points I’ve highlighted above, you’ll hear him drop some truth bombs that you might find jarring because they directly challenge the low-fat, high-carbohydrate orthodoxy promoted by the U.S. government and various medical societies.

An orthodoxy for which the scientific evidence is seriously lacking.

Along with my other Health Sherpas, Dr. Mason’s perspective has helped to reorient my thinking on what is a healthy diet as Lisa and I have been on our health journey over the last few years.

We’ve each lost more than 50 lbs. and have been informally coaching others who have massively improved their health, energy and vitality, with significant weight loss as a welcome side effect.

Based on that experience, I retired in August to launch a new venture we’re developing together with a long-time friend and primary care physician who has had an interest in metabolic syndrome for decades.

We’ll be providing education, community support and coaching to people looking to turn back the clock on their health. Some also will be eligible to take advantage of a direct primary care option.

If you’re interested in learning more, send me an email and I’ll be in touch to give you opportunities for a preview.