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.
For the last few months, Lisa and I have been coaching and encouraging some friends who had seen the results of her weight loss journey and mine.
We have a few separate text message threads going with different friends. This enables us to support and advise them, while also creating a shared diary of our experience together.
One couple started about three months ago by cutting sugar, limiting carbs and also adding alternate-day fasting.
They’re doing really well: he’s lost 26.2 pounds and she’s lost 14.4, or 8.8 and 4.8 pounds per month respectively.
It hasn’t always been easy, but she had a pretty amazing and encouraging breakthrough a little over a week ago which showed just how much progress she has made.
Not only or even mainly in weight loss, but in her reorientation toward food.
After hitting something of a plateau, she decided to try going for a longer fast than what has become her customary 24 hours. By waiting to break her fast until the next morning, she could stretch to 36 hours.
But as it turned out, she was busy in the morning and didn’t get to eat until about 2:30 p.m. So her fast ended up being…
47 hours!
Then just a couple of days later, she forgot she had meetings until 8 p.m., and so added an “accidental” 36-hour fast closely following her nearly two-day fast.
Three months ago she would not have believed this was possible.
She also was amazed that at the end of a 36-hour fast she would have such “great clarity and energy.”
The alternate-day fasting, eating dinner to satiety every evening but skipping breakfast and lunch on alternate days, helped her to overcome a habit of unthinking late-night eating.
As she has become fat-adapted and also more mindful of the importance of a narrower eating window, she stumbled into two fasts that were both longer than what she had planned.
At some point, when he and she have reached their goals, we’ll have an online “coming out” party for them, complete with before and after photos and their whole story.
And because we will have their in-the-moment observations from our coaching text thread, they’ll be really encouraging for others who are considering committing to the health journey.
But for now, I’ll just refer to them by their personal pronouns.
If you have questions about keto or fasting, feel free to ask in the comments below or in my social feeds on Twitter, Facebook or LinkedIn.
If you have a story you’re willing to share to help inspire others, send me an email.
Dr. Sarah Hallberg, one of my Health Sherpas, says patients who want to reverse type 2 diabetes have three medically proven options, backed by multiple published studies:
Bariatric Surgery
Very Low Calorie Diet
Low Carbohydrate Diet
Bariatric Surgery works for many people, with 30% or more able to achieve long-term remission. It also has the obvious downsides of surgical risk and expense. But it should be presented as an option, and some people will find it right for them.
A Very Low Calorie Diet, depending on the study, ranges from 300 to 1,800 calories per day. While these work really well in the short term, there is an issue with weight gain after the period of calorie restriction ends. It’s difficult to maintain the weight loss: the faster you lose weight, the faster you tend to regain it, and progress on diabetes can be lost too.
Low Carbohydrate Diets – Dr. Hallberg points to 22 randomized controlled trials (RCTs), 10 meta-analyses and 10 non-randomized trials, including six studies of two years or longer, including the Virta Health/Indiana University Health study she leads.
I think it’s worth watching the video below in its entirety for context, but if you want to skip ahead, she starts describing her results at about the 16:00 mark:
These results are phenomenal: Half of patients maintaining diabetes reversal at two years.
As she says, can you imagine if a drug had that kind of sustained effectiveness?
Here’s how the methods compare in blood sugar control:
Comparison of sleeve gastrectomy, gastric bypass, very low calorie diet and low-carbohydrate diet.
In HbA1c, low carbohydrate is better than sleeve or very low calorie at two years, and equal to bypass.
And here’s how they compare from a weight loss perspective:
As Dr. Hallberg pointed out, the patients in her study (the purple line) started at a higher weight, and the average time with diabetes before the study was 8 years. Shifting the purple line’s starting point down 10 kg would make it pretty similar to either of the surgical options.
I greatly admire Dr. Hallberg and her collaborators, and I think the work Virta Health is doing is outstanding. Their results are great, and I think their intensive coaching intervention is valuable for people adopting this new way of eating.
I would add a fourth approach that I think will be the most effective, however: a combination of a low carbohydrate diet with intermittent fasting.
It conceptually combines the effects of the purple and orange lines in the graphs above.
Dr. Jason Fung calls fasting “medical bariatrics.” It has the benefits of bariatric surgery without the surgical expense and risk. It’s a lot easier to undo, too: You simply resume eating.
In fact, you have unlimited flexibility in adjusting the dosage of fasting. You can start with a 12-hour eating window each day, or you can fast for 16 or 18 hours and only eat from noon to 6 p.m. or noon to 8 p.m.
You can even consider alternate-day fasting, as in the #July4Challenge.
Low carbohydrate eating makes those fasting periods much less difficult, because fat and protein are more satiating than carbohydrates.
It’s kind of magical how these two strategies work together.
One final observation: At about the 23-minute mark of the video, Dr. Hallberg makes a really important point about the misplaced emphasis on randomized controlled trials in gauging efficacy.
RCTs are important when you have a drug intervention, because you’re typically testing a drug vs. a placebo, and the only thing you’re asking of the patients in the study is to just be sure they take whichever pill is assigned.
Diet is different. Motivation matters.
So does belief. If you’re randomly assigned to a diet for purposes of a study, even if you’re really motivated to change, you may not have really bought into the rationale behind the diet.
More on belief in a bit.
Dr. Hallberg in the U.S. and Dr. David Unwin in the U.K. have each demonstrated that a significant portion of patients under their care (as many as half) are able to reverse type 2 diabetes, going off diabetes medications, through a truly low-carb diet.
They’re not alone. Dr. Eric Westman at Duke, Dr. Tro and Dr. Brian Lenzkes, Dr. Ken Berry and scores or even hundreds of others are doing the same, although perhaps not quite at the same scale or with rigorous comparative studies.
They’re just helping patients who are motivated to get healthy and lose weight, and who are willing to try a low-carb approach.
For type 2 diabetes reversal (and prevention) and for weight loss, low-carb works.
I believe low carb + periodic fasting works even better.
I can’t “prove” it by the RCT standard, and the people I’ve mentioned above may not all agree with the combination.
They each have their own emphases: Dr. Fung’s is mainly on fasting, while I think some of the others who promote low-carb think it’s most important to eat healthy fat and moderate protein meals to satiety. They say the key is avoiding hunger, which makes compliance easier.
My experience has been that combining both perspectives has led to the best result for Lisa and me.
Now back to what I said about belief.
There’s plenty of evidence that if you will adopt a low-carb eating pattern you can eat until you’re full, rarely feel hungry, improve your metabolic health and lose weight.
But as long as you toy with the idea instead of taking the plunge, you’ll never really know. As one of the great Christian theologians put it in a different context:
“Understanding is the reward of faith. Therefore, seek not to understand that you may believe, but believe that you may understand.”
St. Augustine of Hippo
Give low carb with periodic fasting a try.
Embrace the journey. Take the plunge.
If it doesn’t work for you, you can always have bariatric surgery later.
In the next few days I’ll have a post describing a new free community we’re setting up to support people in making these changes and swimming against the societal dietary currents. I look forward to telling you about it.
Lisa, despite her extra challenges being post-menopausal and with thyroid issues, lost 10.
In alternate-day fasting you still eat dinner every evening.
You just skip breakfast and lunch every other day, and so on alternate days you go from dinner one night until dinner the next without eating.
In that time you’ll burn about half a pound of fat because of your sustained low insulin levels.
Do it two or three times a week and you’ll lose at least a pound a week.
It’s a lot easier if you’re limiting carbohydrates and getting plenty of healthy fats. That prevents cravings that could lead to overeating during your feeding windows.
If you want to add some heavy whipping cream (not half-and-half) to your coffee on the fasting days, that’s OK and you may find it easier. It won’t spike your insulin, and you’ll switch pretty seamlessly between burning your stored fat and the fat in the cream, and then back again.
If you start now and just plug away at it week after week, you won’t believe the progress you’ll see by the time the fireworks fly.
Lisa and I felt fantastic in August 2018, after our 10-week experiment, when we left for a three-week driving tour that took us to throughout the western U.S.
We feel even better now; another 15-20 pounds lighter and even more in control of our eating patterns.
If you’re not yet ready to dive into alternate-day fasting, start with the #BodyBabySteps.
The important thing is to start at some level today. Begin building your momentum. Small steps, repeated consistently, will get you there.
Check out My Health Journey for the full story of our health improvements, and my #BodyBabySteps for an approach to how I would do it if I were starting today, based on what I’ve learned.
As I noted in an update the day after my Stepping Off the Wagon post, I was shocked that after eating a whole pizza and more than one gluten-free beer, I was still able to stay in therapeutic ketosis.
Since Lisa and I concluded our #3DayCancerPreventionFast on January 27, in addition to January 31 we have stepped off the wagon two more times: February 11 and last night.
While Lisa has stopped the daily glucose and ketone measurements between our monthly extended fasts, I have kept them up since then. My readings for the 24 hours after the first excursion are above, and below are those for the period after the February 11:
I technically was out of GKI ketosis on the morning of the 12th, but by fasting as I stepped back on the wagon I was back to moderate ketosis by dinner time.
So because we’ve handled our off-wagon ventures with few negative effects, and because Lisa was away most of the day yesterday, we decide to exchange Valentine’s Day presents a day late. Here was hers to me:
Some in the low-carb/ketogenic community believe it’s essential to always rigorously limit carbs to avoid undoing all of the good of ketosis, and that one step off the wagon will undo weeks of effort.
They say it puts you right back to square one.
I cautiously disagree, at least for myself and for Lisa.
One way it could derail us would be if it became a gateway to ravenous, uncontrolled carbohydrate indulgence.
I’m confident that won’t be the case for us today, because it hasn’t led to this in the past.
We will enjoy our black coffee this morning, and fast until dinner.
The other way it theoretically could cause a problem would be if it reversed the fat-adaptation we had achieved. I think the ketone readings above in my post-pizza periods – all of them 0.5 mmol/L or higher – show that the ketone production is continuing.
That’s a secondary benefit of extended fasting, on top of a generally low-carb eating pattern.
In addition to activating autophagy and apoptosis, an extended fast flips the fat-burning switch to high gear.
The fundamental idea behind ketogenic eating and fasting is to restore metabolic flexibility the ability to use both sugar and fat for fuel.
Unfortunately, the typical American diet has so much sugar and starch in their various forms that it destroys fat-burning capability.
As I finish this post before starting work, and having just taken my morning readings, I’ve seen my ketones dip to 0.4 mmol/L, the first time I’ve been below 0.5 in a month.
So it suggests I probably should wait until after the next #3DayCancerPreventionFast for another pizza night.
Update: I tracked my “day after” glucose and ketones three times today, and here were the readings:
With plenty of carbs in my system from a whole pizza and a couple of gluten-free beers, and with the normal morning rise in glucose levels, I wasn’t too surprised that ketones dipped a bit further even at noon. But with only black coffee in the morning and coffee with cream at noon, I’m now solidly back into GKI ketosis.
