Dr. Alan Goldhamer is the founder of TrueNorth Health Center, a state-of-the-art facility that provides medical and chiropractic services, psychotherapy and counseling, as well as massage and body work. He is also director of the Center's groundbreaking residential health education program. After completing his chiropractic education at Western States Chiropractic College in Portland, Oregon, Dr. Goldhamer traveled to Australia, where he became licensed as an osteopathic physician. He is the author of The Health Promoting Cookbook and co-author of The Pleasure Trap: Mastering The Hidden Force That Undermines Health and Happiness.
Articulate, inspiring and energetic, Dr. Goldhamer is one of the most pioneering and dedicated visionaries in health today. An outspoken professional who doesn't shy away from a spirited debate, he is deeply committed to helping people stuck in self-destructive cycles reclaim their ability to change their lives

LEARN MORE AT:

www.healthpromoting.com

www.fasting.org

SHOWNOTES

2:10 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

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6:45 - Dr. Goldhamer's Start

8:50 - Sick People Recovering

9:50 - How Has the Program Evolved Over the Years?

11:00 - what are the fasting lengths of time?

11:20 - Fasting terminology

12:30 - Reduction of Overeating

13:45 - Ratio of visceral fat lost is highest in water only fasting

14:45 - Visceral Fat to Subcutaneous fat and back

16:05 - the fat lost during fasting and the weight gained upon refeeding

17:10 - refeeding on plant based vs meat based or SAD

19:00 - Advice for audience who eats meat

21:25 - excess fat in the diet

22:35 - craving sodium

23:25 - passive overeating

24:55 - the bacteria in our guts

26:45 - diets mimicking the effects of fasting

28:50 - SELF DECODE: Get All Of Your Nutritional Questions Answered With Self Decode's Comprehensive Genetic Reports! Go To MelanieAvalon.Com/Getselfdecode For 10% Off With The Coupon Code Melanieavalon And Don't Miss A Thing By Signing Up For Melanie's Private Email List At MelanieAvalon.Com/EmailList!

31:15 - How long does it take for people to adapt to low salt diet?

33:45 - switching to a low salt diet

34:30 - radical diet changes vs intermittent fasting

37:05 - Studying changes in taste buds

37:40 - emotional eating

40:40 - stress and processed foods

42:45 - meat as a whole food

43:00 - traditional diets and blue zones

45:30 - What is the role of Privilege in the ideal diet?

46:55 - supplementation and deficiencies

49:30 - Whole Food Plant Based Diet and fasting effect on high blood pressure

52:35 - LUMEN: The Lumen Breath Analyzer That Tells Your Body If You're Burning Carbs Or Fat For Energy! You Can Learn More In Melanie's Episodes With The Founder (The Melanie Avalon Biohacking Podcast Episode #43 - Daniel Tal, The Melanie Avalon Biohacking Podcast Episode #63 - Daniel Tal (Lumen)) And Get $25 Off A Lumen Device At melanieavalon.com/lumen With The Code melanieavalon25

54:05 - getting started at True north

56:10 - Fasting with phone coaching, zoom and vimeo

56:45 - how many hours can you fast optimally daily?

57:30 - exercise, glucose need and Gluconeogenesis

59:00 - average weight loss during the program

59:55 - Optional Calorie restriction

1:01:30 - high calorie keto diet + iF

1:02:10 - keto as a short term solution

1:04:20 - being open to new data

1:04:40 - dr. tanner's story

1:05:30 - extended fasting at home

1:06:15 - health promoting fasting intervals

1:07:30 - are you a candidate for long term fasting?

TrueNorth Health Coaching Services

Training For Doctors

1:08:30 - Healing with Fasting

1:09:05 - microbiome changes

1:10:50 - nitrogen balance

1:12:25 - concerns about long fasts

Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting

1:14:20 - metabolism changes

1:15:25 - Hair loss

1:16:25 - Immunological changes and post COVID Syndrome

1:19:50 - fasting while sick?

1:20:20 - lack of supplementation during fasts

1:21:20 - Monitoring during the fast

1:22:10 - the psychology of diet changes

1:25:10 - the Studies

TRANSCRIPT

Melanie Avalon: Hi friends, welcome back to the show. I am so excited about the conversation that I am about to have. Listeners might be a little bit surprised because it's about a topic they might think that I talk about a lot or know a lot about because I am the host of The Intermittent Fasting Podcast as well, but that is something that we actually don't talk about a lot in that show, and that is extended fasting. I'd been dying to do a deep dive into extended fasting and everything surrounding it, and I wanted to get the perfect person for the topic. Who better would be perfect for that than Dr. Alan Goldhamer? He is the founder of TrueNorth Health Center in California. They do extended fasts there. You guys might have seen him, he was recently in the Netflix documentary on Unwell, they featured it, which was really, really amazing. He's also the author of a book called The Pleasure Trap, which I read, and, friends, get this book, there is so much information in there. I'd love to dive deep into it as well. Yeah, I am just so excited. Dr. Goldhamer, thank you so much for being here.

Dr. Alan Goldhamer: It's my pleasure.

Melanie Avalon: To start things off, would you like to tell listeners a little bit about your personal story? What led you to your obsession with fasting and having the center that you have today?

Dr. Alan Goldhamer: Well, sure. I got started as a young kid, actually. I was a frustrated basketball player. My best friend at the time, Doug Lisle, who is currently the psychologist at the TrueNorth Health Center, used to beat me up badly playing basketball and I practice and tried lots of things, but ultimately got desperate enough, I thought maybe if I got physically healthier, it would give me an edge. I started reading and I came across books by people like Herbert Shelton that said that health was the result of healthful living, and that healthful living involve diet, sleep, exercise, and fasting. I thought, “Well, that's interesting.” I started to apply the dietary principles, which is basically a whole plant food diet that's free of chemicals like oil, salt, and sugar. Of course, the results failed, because it turns out, my friend Doug Lisle also adopted the same diet, and he still beats me to this day, we play basketball, I'm 62, and he still beats me badly every time we played, but it did get me interested.

I was also inspired by my overweight uncle who was a medical doctor and knew everything about anything. When I had decided at 16 to pursue alternative health, he became really upset with me. He said that nobody in our family would be going to see any of those alternative health type doctors, let alone becoming one of those. He told me that better I should be a communist spy. My father, who was a very serious guy, he took me aside, he said, “Son, your uncle is a very prominent physician. I don't know anything about this alternative medicine. Anything that makes him that upset and mad, well, it can't be bad. Good luck to you, son, and you stick to your guns.”

Ultimately, I did go to chiropractic college in Oregon, osteopathic college in Australia, where I watched something happen that really wasn't taught in school, and that was that people were getting well. I saw people with high blood pressure, diabetes, autoimmune diseases, certain types of cancer recovering, doing essentially nothing, which was fasting, followed by a whole plant food SOS-free diet. When I came back in 1984, that's a long time ago, 36 years ago, my wife, Dr. Marano, and I opened up the TrueNorth Health Center, which focus was getting sick people well, so we treated patients with fasting, followed by a whole plant food SOS-free diet, and we began to document the results that we were seeing, and eventually formed the TrueNorth Health Foundation, which is a 501(c)(3) nonprofit research-based organization, which operates our facility today, and drives our research, and efforts and it's really amazing how good the body is at healing itself, if you get out of the way.

Melanie Avalon: Yeah, this is so incredible. I'm dying to know, since fasting, it's a lot of not doing things, has the actual program at the center changed much since the very beginning, since basically with fasting, you're not eating? How has it evolved?

Dr. Alan Goldhamer: Well, yeah, there's been a big change in that, we're a whole lot bigger. We went from a facility with 20 beds to what we are today with, where we can accommodate over 70 patients and 20 live-on staff and a total staff of almost 70 people between the operation, the outpatients, and the research. We see 1000 new patient admissions for fasting a year now, and have a research team, which is allowing us to document these changes. Really, for the first time, there really hasn't been a lot of documentation of this prolonged water-only fasting where patients fast from 5 to 40 days in a controlled setting. This is really novel work, and the data that we're getting is really virgin data, because there's not been very many good looks at exactly what happens to the body when it does this prolonged water-only fasting.

Melanie Avalon: Would you consider a short, a moderate, and a long path?

Dr. Alan Goldhamer: Well, we don't fast patients at our clinic routinely over 40 days. Up to 40 days, we consider routine fast. I think the general consensus, a fast of 5 days to 40 days are considered prolonged fasts, less than five days would be considered shorter fasts.

Melanie Avalon: A huge, huge portion of my audience is very, very familiar with intermittent fasting. Maybe we can clarify some of the terminology surrounding intermittent fasting, time-restricted eating, extended fast.

Dr. Alan Goldhamer: Our definition is pretty standard because we use intermittent fasting with every patient every day. We believe that people benefit from fasting between 12 and 16 hours every day and limiting the feeding window to between 8 and 12 hours depending on if you're trying to lose weight or gain weight, your individual circumstances. Everybody fasts every night, and they break their fast with breakfast in the morning. It's just a question of when you should stop eating. We believe that people should stop eating at least three hours before they go to sleep at night, not eat through the evening and not eat in the morning until the appropriate time, which would allow them to have, again, between an 8- and 12-hour feeding window. The goal of intermittent fasting under this model is that even that 12 to 16 hours of fasting cumulatively, it's thought to induce changes that are thought to be beneficial. It may also facilitate the reduction of overeating, which is really the main problem you see contributing to metabolic syndrome. Today, two thirds of people are overweight. It's a huge and expanding problem. For people that have waist circumferences over 40 inches for men of 35, or have triglycerides, over 115 milligrams per deciliter, if their blood pressure is elevated or they have excess fasting glucose or reduced HDL, if they have three or more of those things, we call it metabolic syndrome. We know that metabolic syndrome is associated with liver cancer and colorectal cancer and gout and diabetes and stroke and congestive heart failure, myocardial infarction and coronary artery disease and non-alcoholic fatty liver and probably is one of the major contributing factors to increased vulnerability to death from infections, including COVID.

Dealing with metabolic syndrome may be one of the big challenges for our society today. One of the things that we've discovered with prolonged water-only fasting even more so than, say, keto diets or these types of interventions is that water-only fasting preferentially appears to mobilize visceral fat. The ratio of visceral fat lost is highest in water-only fasting compared to any other type of equivalent weight loss approach that we've discovered. In fact, we are just now completing a study, I believe we've completed 25 of the 30 subjects that's going to be enrolled in this study, using a new Hologic DXA scanner that we purchased. We've been able to do very detailed whole body composition assessments, and the changes that occur before during after fasting and actually on follow-up. Again, preliminary evidence suggests that not only is fat mobilized preferentially during fasting, but visceral fat, is mobilized.

For example, a person might lose 20% of their body fat, but 40% to 50% of their visceral fat in a 10-day fast. We will have this data that will come out and we'll know for certain, but it does appear that fasting has a preferential predilection to mobilizing and eliminating visceral fat. Visceral fat is thought to be one of the contributing factors in metabolic syndrome that increases vulnerability to the conditions that I mentioned.

Melanie Avalon: Yeah, this is so incredible. For listeners, if you're not familiar, visceral fat is the fat-- it's more interior surrounding our organs and considered to be pretty inflammatory. I read one study that was looking at fasting, and it found that it created a visceralization of subcutaneous fat so that the subcutaneous fat could then be used as a backup source to the visceral fat and then upon refeeding, that seemed to switch back to subcutaneous fat. Have you seen that study?

Dr. Alan Goldhamer: Well, I'm not sure which study you're talking about. There's literally hundreds of studies that have been coming out now. One thing we do know is that visceral fat probably shouldn't be there. If the body gets to the point where there's no place else to shove it, maybe that's a place that it goes. The bottom line is, we know that it's at least correlated with increased disease and getting rid of it is probably a highly desirable intervention and appears that there's no more efficient way to do that than to do essentially nothing.

Melanie Avalon: Yeah, it's so amazing.

Dr. Alan Goldhamer: The other thing I wanted to mention in water-only fasting. The old wives’ tale that you gain weight, and then you lose weight during fasting, and you gain it back when you recover, is not true. In fact, what we've been able to demonstrate using this new technology, is that the fat that's lost during fasting is both water, fat, glycogen, fiber, and muscle. The weight is regained after fasting when you apply a whole plant food SOS-free diet is strictly water, fiber, glycogen, and muscle. In fact, fat loss continues during recovery, even though weight recovery is taking place. What happens is you're losing fat, but you're also losing water and glycogen, and fiber. So, the fiber in your gut isn't there, the water, there's a natural dehydration that occurs during fasting, and you lose a couple pounds of glycogen that are in your muscles, because you burn that up in the first couple days of fasting before you move into ketosis. But the weight that's regained after fasting is not fat, fat continues to go down, even though the scale weight goes up, because it's a question of rehydration, realimentation, and pumping the muscle cells back up. That's really exciting, so that people used to believe that fat comes off, fat goes back on, and that just turns out not to be the case.

Melanie Avalon: Do you see that only with refeeding on whole foods plant based? What about whole foods including meat, and then a standard American diet?

Dr. Alan Goldhamer: Well, if you go back to greasy, fatty, slimy, dead, decaying flesh and highly processed foods, you're going to gain fat back, that's what made you fat to begin with is the highly processed foods, particularly the oil, the sugar, and the passive overeating that stimulated by eating salt in the diet. One of the keys is not only getting on a whole plant food diet, where caloric density is low, but nutrient density is exceptionally high, but it's getting rid of the chemicalized components that make up 86% or 90% of the calories that most people eating in society, which is salt, oil, and sugar. That's what we talk about a whole plant food SOS-free diet. What's good for short-term weight loss, which would be say a high animal food plant based green vegetable diet, isn't necessarily the best thing for long term health stability from our viewpoint. We want to get people around 10% of calories from protein, we want to see about 15% to 18% of calories from fat, and the balance coming from whole plant food complex carbohydrates.

What we found is that's what works well, not only to get the weight and normalize the blood pressure, normalize the diabetes, but to sustain it over the long run. What we're also seeing now, we're getting our first 35-year follow-ups on patients where we've been tracking people essentially from-- many of these people started at 50, now they're in their mid-80s. What we keep seeing over and over again, the people that eat these whole plant food, SOS-free diets are able to sustain those changes, and sustain their life, avoid the debility. Their friends around them, of course, are falling right and left. Yet they're able to sustain a high degree of vigor. We believe it's in part because of this whole plant food diet that minimizes some of the [unintelligible [00:13:28] gas and exposure to some of the other free radical issues that prematurely age people out.

Melanie Avalon: Yeah, I'd love to expand on that a little bit more, because my audience, a lot of them are in the paleo sphere, the keto sphere. I've had people in the carnivore world and the high protein world on the show, but then I've had like Dr. Douglas Graham, and Cyrus and Robbie, Mastering Diabetes and the plant-based approach. I find that there's a lot of emotional stress and confusion for people because they often feel they're receiving, what seems like science and validated studies and benefits from both of these approaches, these two sides of the coin, I'm always trying to dive deep and try to figure out what's going on there. What would you say to listeners who are following, let's say, a whole-foods, keto-type diet, so including meat, but it's whole foods, so I'm not saying like standard?

Dr. Alan Goldhamer: Let's talk about the things we all agree on. There's general consensus. Number one, refined carbohydrates are a big problem. I don't know if anybody out there arguing for sugar and refined carbohydrates is a helpful thing, the soda pop diet or whatever. Generally, whether you're keto, paleo, Atkins, or a whole plant food, everybody agrees the sugar is a health compromising chemical that's created a mess and we've gotten to where people are eating as much 150 pounds a year or more, it makes people fat, it makes people sick. Let's agree that all of us can agree sugar’s probably not a good thing or refined carbohydrates. This is a problem because most carbohydrates eaten by people in society are refined carbohydrates. People are not eating as their main diet, Hubbard squash, butternut squash, steamed vegetables, that's not what people talking about when they talk about carbs. They're talking about flour, sugar, refined carbohydrates.

Second of all, oil. Most people would agree that the essential fats are critical in the diet, that you can get the Omega-3 fatty acids that you need from whole foods, whether it be animal foods or plant based foods, we can talk about differentiations there, but we don't need to have oil, we don't need to have especially heated oils, fried foods, and which makes another huge percentage of the calories that people are getting, that excess fat in the diet may be a problem, not only because it's highly efficient, nine calories per gram fat eats, the fat you eat is the fat you wear kind of thing but also because it's a highly fractionated process food, doesn't provide the same satiety feedback that whole fats in food would, and there's a peroxidation process that occurs particularly with heat, and the use of highly fractionated products like oil, including olive oil, that may be detrimental. A significant percentage of people would agree that oils and highly processed fats would be detrimental.

The area that we get into more controversy with people is another chemical that's added to food, it's salt. Critically essential nutrient, without which you would die, but all the sodium you need, just like all the carbohydrate you need, and all the protein you need, can be derived healthfully from whole plant foods. You don't need to add thousands of milligrams of sodium a day in order to get the sodium chloride that you need in your diet. The problem with adding salt to food, like the problem with adding any highly refined additive is it creates a mess. One of the messes that sodium addition to the diet creates is high blood pressure. Now, humans are designed to crave salt and to value salt and detect it in very small quantities because it is such an essential nutrient. That's one of the reasons why plants are appealing to people is because they need these minerals that are so critical to their survival. But we began to fractionate and add fractionated sodium to the food because it's such a critical need that brain perceives it as positive. The problem with it includes about a third of the population is extremely sensitive to hold on to sodium in the water that is used to protect the body from it. It increases blood volume and swelling, edema, congestive heart failure, high blood pressure, which leads to stroke and heart attack, etc.

There's another side to salt even for those that aren't particularly sensitive to retaining it, and that's a situation of passive overeating. The way we don't get fat is we eat to satiety. If we eat things like sugar, or oil, we'll eat more than we would helpfully do because it fools our satiety mechanisms because of the high fractionated processing. The same thing is true with salt. Salt stimulates epistatic mechanisms. If you for example, take rats, give them their fill of chow, but you salt it, they'll eat significantly more. Now say, well, yeah, that's because it tastes better. That's true. But the reason it tastes better is because the sodium, just like the sugar and the oil, stimulate dopamine in our brain. Dopamine is the neurochemical associated with pleasure. The more dopamine, the more pleasure, the more we like it. But it's a chemical induction, it's not a natural situation. If you give people, say, whole plant foods like rice, and they just eat their fill, they'll eat a certain amount, but you salt that rice up, they'll consistently eat more, and it will lead to obesity. That's why you will find all fractionated foods have either sugar, oil, or salt added to them because they got to make the stuff taste good. If you take grains and refine them, there's a little flavor left that they've taken out when they turn that, say, brown rice to white rice, you end up having to salt it in order to make it palatable, and the more you salt it, the more possible it is. If you fry it and put some sugar on there too, now everybody's all happy except they get fat and sick. The salt stimulates passive overeating.

Also, think about this you have what five pounds of bacteria living in your gut? Important part of your immune system, important part of your defenses. Yet sodium is what, a preservative. If you salt your meat, it's to keep the bacteria from being able to break it down and spoil it and make you sick. Well, when you put lots of salt into your digestive system, it has a profound effect on your gut microbiome. The shift in the microbiome is part of the problem that's associated with many of the diseases people are vulnerable to today. By the way, that's another problem with meat in general, is people that are meat eaters have a completely different flora than people that are plant eaters. It's thought to be a less desirable flora, and flora that over the long term mean more vulnerable. For example, why do meat eaters have so much heart disease? In part, it may be because of the increased TMA that forms in the intestinal tract of mediators that becomes TMAO and irritates the animal lining of the blood vessels and increases our risk of stroke and heart attack. As we learn more about this, we realize that, for example, though meat eating may be a useful tool combined with vegetables for short-term weight loss, it may not be the best long-term strategy, if your goal is to avoid prostate, breast cancer, heart disease, etc., or if you're trying to reverse those conditions. I know that a lot of the paleo folks want to blame sugar. I don't disagree, it's a major problem, but it's not necessarily the only problem. That's the point we're trying to make.

Anyway, trying to get back to where we agree, I think we can all agree that salt, oil and sugar, at least have some questionable merits in the diet. We can all agree that exercise is a critical component to maintaining health, dissipating the effects of stress, etc. We can all agree that sleep is an important commodity, and that sleep deprivation is associated with all kinds of health-compromising issues, and I think everybody on both sides can agree that fasting appears to have a profound beneficial effect. In fact, what so much of this stuff is trying to do is to mimic the effects of fasting on an ongoing basis, because people don't want to have to face long-term water-only fasting. So, we’re trying to come up with ways of getting the body to make the changes that makes in long-term fasting, but with a more pleasant, easier, more practical, whatever type of intervention. I don't disagree, that you can induce some of those changes short term. What I'm arguing is that if our concern is long-term health, avoiding long-term durability, maximizing both healthy life expectancy and life expectancy, a whole plant food SOS-free diet, I believe has the best support. It's certainly what my experience has been in the last 35 years. The patients that I see that are doing it can prove it with their clinical outcomes. We're trying to prove it with our research.

Now, does that mean that you couldn't do that same whole plant food diet and include some animal foods and be healthy? No, you probably could. The question is how much? What's the ideal amount? The problem today is that the animal foods are available to people, even when they're free range and other, have significant health potential problems. We can talk about that. I believe the data best supports a whole plant food SOS-free diet, if our goal is to avoid long-term debility. If your goal is short term weight loss, you can make lots of different arguments, you can cut your leg off at the hip, and it's 40 pounds overnight.

Melanie Avalon: 500 calories of Twinkies.

Dr. Alan Goldhamer: Yeah, they've got drugs now that will coach your intestinal tract, you can keep eating ice cream, but you just have explosive liquid diarrhea, but you'll lose weight. I don't really care about what's the shortest, fastest way to lose weight. Although honestly, the shortest fastest way to lose weight is water-only fasting. But anyway, the goal is what's the best for long-term health, and that's where my arguments would be. If we can become convinced that the best way to maintain long-term health is to include some animal products in that mix, then we would do that. So far, that has not been my interpretation of my experience or the literature.

Melanie Avalon: Quick question about the salt that we're talking about it. Do you know how long on average-- if a person is on a higher salt diet, and they switch to no added salts, how long it takes aldosterone to adjust?

Dr. Alan Goldhamer: Well, there's two questions here. There's the aldosterone acclimation, because as you know, at first, and particularly if people have conditions like hypoparathyroidism, or something where they have trouble absorbing salt, they can have orthostatic hypotension or other issues when you reduce sodium intake. Probably the more important first question though is how long does it take people to get used to eating a low salt diet. There's literature on this in fact, we did a study here taste adaptation study where we actually detected minimum threshold of salt and sugar, and then did fasting and showed the profound effect on taste that fasting has. It literally changes your perception to sodium and sweetness, and the hedonic effects. The medical literature says that it takes people about 30 days to adapt to a low-salt diet on average. There's a bell curve, though some people it takes longer. That means for about a month, people eating a low salt diet, don't like their food, it's tasteless swell, it's disgusting because they're used to a high salt intake. Once people go on a low-sodium diet for a month, they’re now adapt, and then they can detect that sodium in-- For example, chard becomes very salty, just plain chard. Whereas a person adapted to a high salt, they can't really pick up sodium because their tastes have been desensitized by the higher intake. It takes adaptation, it takes about a month.

If you fast, that can take place in a matter of days in some cases, and so that literally short fast is sometimes enough to get people with a like the taste of healthy foods. They're not dependent on having to put a bunch of salt on their food in order to be able to stimulate their jaded taste sense into function. The natriuretic effect of fasting is very profound too, the excess sodium in the body, natural resources, and that's where you get this massive weight loss initially, where the body flushes out these pounds of fluid that have been held in order to protect the body from the devastating effects of these chemicals in the diet. When the blood volume goes down, the blood pressure goes down, the swelling goes down, the congestive heart failure is just reversed. It's really quite dramatic watching these people transform before your eyes with fasting. The same thing will happen eventually with diet if you control the diet well enough. It's hard to get people to control the diet when the diet and the food tastes like crap initially, because of their addiction.

Melanie Avalon: I wonder for people practicing daily intermittent fasting, if they switch to a low salt, like how long it would take?

Dr. Alan Goldhamer: Well, in our experience, it's probably going to be quicker. But even on a conventional diet, just eating a low sodium diet, it happens in a month. It's not forever. I haven't done a lot of experiment on and quantifying that change because after fasting, I mean, oftentimes, it's just days or a week or two of fasting and people, the good foods taste good. That's one of the great benefits of longer-term fasting. You might be able to get some of the same effects with intermittent fasting, speeding things up, if you kept the diet from being conventional. As you know, even Valter Longo has done such brilliant research. They're really just looking at the effect of intermittent fasting. They really aren't advocating people make radical dietary changes in between fasts. You take their product, you do the fasting, and then you eat whatever you eat. I don't think they have data yet on this particular aspect, or at least not that I'm aware of. Although they're doing massive amounts of research, they have a dozen and a half centers actively working on different projects looking at this intermittent fasting process.

I just want to make a point here. Dr. McDougall, for example, calls us the punishment, calls the TrueNorth Health Center the punishment because he'll send us patients that maybe their blood pressure is still too higher or they're not responding to a more flexible plant-based diet. You'll apologize to him because we restrict sodium and carbohydrates further than he does, which makes it very difficult initially to make the change, it's not easy to make that change initially. His argument is that we need to get the most people eating a plant-based diet as possible to save the planet because as we know, getting out of animal husbandry can have a profound effect on some of the variables that contribute to global warming, etc. His argument is, we need to do this to save the environment, not just for the individual’s health purposes. I'm not arguing with him on that. I'm arguing that all I'm concerned about isn't how to get the most people doing it, it's to help the people that we're dealing with the most. To help the people we're dealing with the most, giving them a more flexible diet to make the transition easier, although it might get more people into it, isn't going to help them sustain health the longest in my opinion.

We're doing a study right now looking at it here, it's looking at dietary adherence, what does it take to get people not only healthy, but then how do you get them to stay on a health promoting diet, so they can sustain those results? It is a great challenge, because we live in a society designed to give people what they want, not what they need. What they want is to continue to eat their animal-based richer foods, and not pay the price for it. What they need is to figure out how to get away from the addiction to the highly processed foods and the highly concentrated foods in our opinion, and adopt a plant-based diet that allows them to recover their health and then more importantly, sustain it, so that they don't spend the last 10 years of their life debilitated. They don't want to end up unable to talk or move lying in some nursing home bed, waiting for people to come and change their diapers because they've had a stroke or a heart attack. We know that highly refined foods and excess animal foods are associated with increased risk factors for these diseases, and the data is compelling there.

Melanie Avalon: You did studies on how long it took their taste buds to adjust to both sweet and salty. Did one happen first or was it around the same time as far as the cravings?

Dr. Alan Goldhamer: Ooh, that's a really good question. I don't know the answer to that. I have to go back to the data because we only looked into the fast relatively short, it was about a 10-day fast. That was enough to have the changes. I don't even know if we have-- we had data baseline and a fast and defeating and follow-up, so I don't know if we can answer that with our data set. It's a really good question, but it happens so quickly to both that I don't even know how clinically relevant it is.

Melanie Avalon: A recent episode I just aired we were talking about emotional eating and how some people crave salty, some people crave sweet, I wonder if it would be pretty individual based on that.

Dr. Alan Goldhamer: Let's talk about emotional eating. One of the things that we can't separate is the mind and the body. Some people eat because their brain is telling them that they're dying, and that's what happens when insulin levels go up and blood sugar levels get driven down. Your brain is saying, “Listen, you're not getting enough calories, let's get more calories.” If we want to keep our insulin level stable, there are things like intermittent fasting, like long-term fasting, and like eating a diet that doesn't have a bunch of sugar, oil, and salt in it, that allow insulin levels to normalize. Then, people's blood sugars don't get driven down, and then they don't get these cravings, which sometimes they may interpret as being emotionally driven but sometimes it's just biologically being driven. Your brain is trying to keep you alive but it's getting bad information, or not even bad information, it's misinterpreting what's going on is because blood sugar levels go down, that means you're not getting enough calories in. Unless you're eating so much fat, that you're in ketosis, and then there's a hunger-blunting mechanism associated with fasting. If you get the ketone levels up, it blunts the hunger. When our patients do long-term fasting, there's no hunger after a couple of days. In fact, if they lead in properly, there's no hunger at all. If you lead in with a good-- appropriate lead-in diet, you can minimize even the initial discomfort. Most patients by the end of the second or third day, and they're fully in ketosis don't report hunger, hunger is not part of the problem. Boredom might be or weakness might be, but actual hunger really isn't usually a limiting factor.

The people that are having a lot of hunger, though, are people that are using. For example, when they're on juice faster, they're getting sugar in their blood, insulin levels are still bouncing around, those people are going to have more difficulty with hunger. The people that really have trouble with hunger are people eating refined carbohydrates, because they're constantly going into this kind of rebound effect. The other thing is people, sure, they eat for a lot of reasons, mostly they eat to get out of pain. One of the pain is when their blood sugar levels drop, and they feel hungry. Some people have emotional pain, because they're mad and people tell me, “Oh, they only crave chocolate when they're mad at their husband.” Then, they want to eat chocolate. Now, of course, I tell them, “Listen, make your husband eat the chocolate. If he's making you mad, why should you suffer? It’s his fault.” Yes, if you eat, it can give you a different response or mitigate some of the pain or the sensations you're experiencing. Maybe that's a driving force for people to indulge, but usually they're indulging in not whole natural foods, if you're really hungry, any source of calories will take the edge off the immediate hunger. If it's a special hunger where you have to go out and it has to be peanut brittle or whatever, that's not hunger. That's an appetite and that can be driven by all kinds of things.

Melanie Avalon: I had not come across this study before but in The Pleasure Trap, you talked about a study in rats where stressed rats don't gain weight with normal food. There's this idea that our emotional stress and everything is maybe the root cause of weight gain. But when rats experience this stress, but they have their normal diet, it can potentially protect them from weight gain, compared to when they have a processed food.

Dr. Alan Goldhamer: Emotions can affect the decisions you make about what to eat, but it's what you eat the determines what happens to you. For example, if you're under inordinate stress, but you're on a restricted whole plant food SOS-free diet, you will not be able to maintain obesity. It doesn't mean you couldn't overeat, it doesn't mean you might not lose the weight at the rate that you should. That's certainly true, especially for women who are essentially energy-conserving fat storage devices, biologically speaking, because they have higher levels of estrogen, which is a fat storage hormone. If you inject men with estrogen, the first thing that happens is they get fat. They grow breasts and have hips that enlarge. If you inject women with testosterone, they're going to lose fat, but then they get [unintelligible [00:33:59] cancer and die. It's probably not a good strategy.

The point is a lot of these differences are our biological differences. They're not just emotional differences. Emotional factors affect decisions you make. What you eat determines what happens to your health. My point was, if you take emotionally distraught people with a bunch of emotional scar tissue, but you restrict them to eating a whole plant food SOS-free diet, they will not sustain obesity despite the fact they have-- now, sure, is it easier if you don't have emotional scar tissue? Sure, because you can make better decisions. It also helps if you're educated enough to have clear decisions to make. Now, differentiate animal food from highly processed refined carbohydrates. Animal foods are whole foods. I'm not denying that. They're just very rich foods, and the question is how much of it, if any, should you eat? Especially the animal foods that are available today. That's the debate. Not that they're not whole foods. You don't have the problems with obesity around it, say, eating meat, you have process around how meats process if it's fried, if it's breaded, if it's salted. The problem is plain meat not treated, is necessarily that appealing, but different issue.

Melanie Avalon: I have a question, I mean this completely respectfully, I'm just wondering your opinion on it. In The Blue Zones, for example, in the seven countries that he focuses on. What do you feel about the idea that or the fact that six of them-- all of them have a little bit of animal food with the exception of Loma Linda?

Dr. Alan Goldhamer: Well, everybody's going to use animal food, if they have access to it, especially in a situation where scarcity is an issue. The traditional diets always would have included whatever the most concentrated calories were available to people. If you go back far enough in history, there was no concentrated oils and sugars and salt was so precious, it was considered a means of exchange, that's where your term salary comes from. The idea that people would include those rich foods that stimulate dopamine in the brain isn't surprising. If you go around the world, anywhere where things like cocaine are available, or alcohol is available, they'll certainly use it, it doesn't mean that they're doing well, because they're including animal foods, it may be in spite of it. If they keep small enough quantities of animal foods, you can't tell the difference as far as I can tell, in the epidemiological literature, people eat very small quantities of animal food, and mostly plant based foods and get lots of exercise than people that eat no animal foods. So, I'm not arguing from a health standpoint that people couldn't include small amounts of animal food and still maintain a high degree of health. But just because you can do something, doesn't mean you should do something.

The ideas, we don't have good examples yet of populations that have been strictly plant based. That's why we're doing the research, we're doing is trying to look, how compliant do you need to be doesn't make a difference? I don't say that I have all the answers on that yet, that's what we're doing the research about. My conclusions based on my clinical experience, though, is the less animal food we have in the diet, the better the clinical outcomes are in the conditions that we're treating. Now, granted, we're only treating certain conditions, high blood pressure and cardiovascular disease, diabetes type 2, autoimmune diseases, cancers like lymphoma, obesity. Those conditions, I'm fairly confident clinically, that this is an approach that's highly effective and efficient, it's safe, and appears to work well. It works better than any other data that I've seen. Our effect sizes are off the charts when it looks to treating conditions like blood pressure, etc. If you look at the research on our website, at healthpromoting.com, you can see we've got compelling long-term data that suggests that you can get healthy if you eat healthy.

Melanie Avalon: This might be more of a philosophical question, but a completely plant-based diet with no animal foods, since we don't have examples really of long-lived populations doing that, is it possible that the ideal diet for the human being is a diet that requires some sort of privilege to maintain that we haven't evolutionarily experienced?

Dr. Alan Goldhamer: Well, when you think about it, animal-based foods traditionally were restricted by circumstance, because they tend to be expensive biologically speaking and economically speaking, so disease of kings, it was only the kings that got the gout and all the problems that come, the heart disease and stuff, because they were the ones who could afford to eat the rich foods, particularly the animal foods. I don't think it's a question of-- what do people, the billion and a half people in the world that make less than $5 a day eat? They eat rice and beans, because those are the most cost-effective calories. Animal foods traditionally had been more celebratory foods, and the special occasions and all that because they are very rich and nutritious, and have all kinds of things. Of course, the animal foods that were available then constitutionally we're different than what we're raising today. That's certainly another consideration. Even then, traditionally, foods were used in moderation. Now, we have Christmas for breakfast and Thanksgiving for dinner. Every day, every meal is a holiday treat compared to the world of our ancient ancestors.

Melanie Avalon: I guess what I meant by privilege was, if a person were to follow a completely plant-based diet today without animal foods, would it require them to supplement or could they follow that diet?

Dr. Alan Goldhamer: Well, I've done it since I was 16. I'm 62 today. The only supplementation that's required on a plant-based diet is vitamin B12, because the only source of B12 naturally is bacteria. We're so hyper-hygienic in our environment, so we wash, we peel everything because we don't want worms and parasites, we don't get much bacterial contamination unless you eat meat. Of course, meat, if you take ground meat, it's full of feces and all kinds of rich source of bacteria. The one good thing there is you do get plenty of B12 if you're eating animal products. Unless you're eating stuff pulled off the trees and you had insect contamination, etc., you will eventually run into B12 issues on an exclusively plant food diet. We do recommend 1000 micrograms of B12 a day for people that are on what we consider an optimum diet. For people eating meat, meat eaters also develop B12 deficiency, so you still want to do yearly early checks and make sure it's adequate. The other nutrient that sometimes is limiting on both animal based and plant-based diets can be vitamin D. D is fortified in animal foods like milk. But unless you get out in the sun, which is the best and natural source of vitamin D, you live behind plate glass live, very far north, you can develop D deficiency, and it's common, and that's a problem. We test all patients for D. If they're too low, we try to get them out in the sun more. If that doesn't work, we'll supplement them. Supplementation is actually rare and limited. There are a couple other examples. If you live in Minnesota, and you only eat your food grown on your Minnesota soil, you'll develop iodine deficiency. So, we'll either include sea vegetables in that diet or supplemental iodine, or if you're eating animal foods, and you get iodine from your fish and things like that. It's not that there aren't potentially weight-limiting nutrient issues, but they're few and far between.

That's not the reason people are sick in our society. Most people in our society are sick from dietary excess, not deficiency. It's excess fat and protein in particular, and particularly, in our opinion, excess animal fat and animal protein, in addition to refined carbohydrates that are responsible for the problems that we're seeing with heart disease, cancer, diabetes, and the rest. Again, I would challenge anybody, look at the fact of using a whole plant food SOS-free diet in conjunction with fasting on high blood pressure, if nothing else. We have the largest effects that have ever been shown in the scientific literature with an average effect size of 60 points in stage three hypertension. That's not counting the fact that people are often medicated when they start and they're not medicated when they're done.

Melanie Avalon: That's incredible. That's with the fasting and the refeeding period with a plant-based diet?

Dr. Alan Goldhamer: And on follow-up. We’re encouraging people to continue whole plant food diets indefinitely, because the truth is, unlike the problems you run into -- I see patients consistently in the practice that attempt animal rich with limited carbohydrate diets, but they get problems with gallstones, they get problems with digestive issues, they get cancer problems, prostate cancer, they're getting sick when they convert to those diets. All we have to do is basically just pump up the plant foods, get rid of all the refined carbohydrates and they recover. You can see their hemoglobin A1c drop from 13.5 to 5.2. They're able to sustain it indefinitely and they don't get the problems that you see on with some of the Atkins diet type recommendations that have been made. Those diets, I'm not disagreeing, that those diets can be highly effective short term, getting people off for fun carbohydrates, anything you do to do that helps and they lose weight. It's long term that the problems run into. I have the benefit in my practice of tracking patients now for three decades and more.

In fact, I remember my mom when she turned 92, she got started pretty late with this approach. She turned 92, she had outlived all 52 of her friends, every one of her friends were dead. A lot of them used to make fun of her crazy diet and her son's crazy ideas and all that kind of stuff. She said, “Alan, you need to warn your patients. If they're going to do this diet, make younger friends, much younger,” she said because her friends when they-- by the time she got in her 80s, they were all falling apart and dying.

Melanie Avalon: When did you start the diet?

Dr. Alan Goldhamer: She started when she was 58, I believe. She had little over three decades of it. She got started a little bit later, but she did. She survived for a long time and did very well, but [laughs] outlived everybody else. We felt pretty good about that. It's really gratifying to see these people. Again, a guy we had in the practice a few weeks ago, 30 years he's been doing this thing. He's aging out completely differently than everybody he knows. Of course, they tell him, well, he must just have good genes. We're seeing it across the board. I tell him, “Yeah, he's got designer genes. He's taking advantage of not only his genetic strengths, but also the epigenetic strengths.” What's interesting is seeing the people that were sick though, and now we ask, in fact, we require of our cancer patients, they either agree to long-term survival or at least to outlive their oncologist. So, we're asking them to get young oncologists so that they really get the most time out of it.

Melanie Avalon: When patients come to TrueNorth, do they immediately jump into the fast or is there a weaning off of their diet period?

Dr. Alan Goldhamer: It depends on the patient. If it's a healthy patient-- the people that get the most benefit from fasting are healthy people that want to stay that way and they're using it preventatively proactively. These are people that come in, they've prepped well, they've been on a whole plant food SOS-free diet, they're off the caffeine, the alcohol, the other drugs that are so difficult to withdraw from. They can start fasting usually on arrival as soon as we do our exam. We do exam, baseline, history, exam, laboratory baseline. They go on the fast. They fast anywhere from 5 days, 10 days, whatever is appropriate for them and then they recover. People that are sick have to again go through history, exam, and lab, but then sometimes we have to finish getting them off their medications. Some of these patients are working with our doctors through our phone coaching services. Our doctors are available through Zoom and whatnot. They may work with the doctors for a week or a month or longer before they come in so that when they come in, they're ready to go on fasting. We may have already weaned them off their meds and dealt with the dietary changes. It's really important that people prepare properly for the fast. People that come in off animal foods have tremendous difficulties adapting to the fast, but people that come in on a whole plant food SOS-free diet for two days and haven't had caffeine, haven't had alcohol, they usually fast very easily, and they can get into it very quickly.

Once a person stable off medication, because obviously you're not going to fast on medications. They're able to get into the fasting process, go through it. A patient with blood pressure, for example, you fast until the blood pressure's normal, assuming they have the reserves, so they might fast anywhere from 5 to 40 days. Then we recover, it takes half the length of the fast for recovery, progressive refeeding, you have to avoid refeeding syndrome and food shock, you don't want to kill people by too rapid restoration to foods. That's why we require half the length of the fast in a controlled setting to ensure that that gets done right. We really want to have good outcomes because it messes up your data if people have bad outcomes.

Anyway, so they recover, they go home, we ask them to stick to a healthy program that the doctor that they've worked with has set them up, they're able to get ongoing support. We have a Zoom channel, they can watch our videos. We have a Vimeo channel where they can tune in to our live Q&A and lectures each day, twice a day. They can consult through our phone coaching services with their attending doctor that can provide them encouragement, support, intimidation, or advice, whatever's needed. Our goal is to get people to give us long-term follow-up. That means getting them to sustain the diet and lifestyle habits, the exercise, the sleep.

Melanie Avalon: Okay, great, because I asked for listener questions for you, and I got a ton, and you touched on a lot of it just now. Like Christina wanted to know how many hours can you fast before the fast is not deliver any more benefits? Is it about that?

Dr. Alan Goldhamer: Up to 16 hours a day for intermittent fast, we think there's support for-- Dr. Longo says that the data only supports 12 hours, that going to 16 hours is speculative, and I wouldn't disagree with him. He's one of the leading experts in that field. We advocate and we practice 16 hours a day of fasting. We limit our feeding patients at our center to eight hours a day. The problem when you get into the 24-36 hours is you're kicking in that fasting adaptation mechanisms. One of the reasons for example, we don't allow exercise during fasting, we’ll allow stretching and yoga and all that stuff, we don't do exercises because once you've depleted your glycogen stores, if you exercise, that glucose need, or if you get too active mentally, that glucose need can only come from gluconeogenesis. The way that the intermittent fasting folks get around it, is though giving people some protein, giving them 750 calories, to try to minimize the gluconeogenesis. If you're not doing this right, what ends up happening is you mobilize protein reserves and you break down protein and which is exactly what we don't want to do. In fact, we want to mobilize our energy from fasting. The best way to make the most energy derived from fasting is to do water-only fasting in an environment of rest. That's the most effective, efficient way of doing it. We recommend up to 16 hours of fasting, then feed properly, do that every single day. Then occasionally, you take a longer period of time to do the longer fasting, whether it's 5 days or 40 days depends on your circumstances, what's needed for that given individual.

Melanie Avalon: Basically, with intermittent fasting, there is a limit, up to 16 hours. Then, when you are extended fasting, that's when you can keep going.

Dr. Alan Goldhamer: You can keep going. But if you're going to do the 16 hours, but not do water-only fasting, you're not going to restrict your activities, then you do your caloric restriction. For example, if people are getting somewhere between 600 and 800 calories, where if you use the programs, you get enough calories to minimize gluconeogenesis. I think you still should be resting, but that's a different issue. They talk about one or two days a week of restricted calories to facilitate additional weight loss. Here's the thing, I don't think you need to necessarily facilitate additional weight loss if you're eating a a whole plant food SOS-free diet. We know average weight loss for females is two pounds a week and average weight loss for males is three pounds a week. Interesting that males lose 50% more weight per week on average, because of the testosterone. They say women have to work a lot harder to get the same effect and it's probably true. Actually, some of my patients say if they walk by the buffet table, they don’t even have to eat it, they gain weight. A bad dream, it's [unintelligible [00:50:20] and it's probably true. Women lose, have to work harder and this and everything else, too, isn't it?

Melanie Avalon: I want to clarify some things you said because I know listeners, they're very much immersed in the intermittent fasting world, so probably their ears are perked up with this. You're saying with the calorie restriction, is that calorie restriction paired with intermittent fasting, time-restricted eating, or calorie restriction throughout the day?

Dr. Alan Goldhamer: Well, I think what we always do 16 hours of fasting, and then during that other eight hours, some people will limit the calories during that eight hours to 750 calories. Whether they're doing a ProLon type program, or whether they're doing a fruit and vegetable or other type of product or a higher vegetable fat. Some people use nuts, avocado. I think the ProLon basis, probably macadamia nut powder or something. If something where it's high fat, low carbohydrate, but there's still calories coming in to minimize the amount of gluconeogenesis that has to take place.

Melanie Avalon: Is this comparing it to mimicking an extended fast or--?

Dr. Alan Goldhamer: Again, you'd have to talk to the fasting mimicking people to get the details. This is not something I practice. Here's what I know about, here's what I have experienced with it, keep everybody fasting 16 hours a day, feed them 8 hours a day, feed them a whole plant food SOS free-diet, that's about 10% of calories from protein, 12-- well, 15% to 18% of calories from fat and the balance from complex carbohydrates, and then occasionally do long term water only fasting, where they've had a history exam lab, and they're monitored twice a day in a controlled setting. That's the only thing I have professional experience doing. In terms of using these programs to do intermittent fasting for weight loss and whatnot, talk to the people that do that. That's not me.

Melanie Avalon: A lot of people will combine a high-calorie ketogenic diet with intermittent fasting.

Dr. Alan Goldhamer: Yes, I don't have expertise in that. I have some philosophical concerns from a health standpoint. Again, what's good for short-term weight loss isn't necessarily for good for long-term health. I want patients doing things every day that they can do forever. That's my preference if you can do it that way. Otherwise, you're talking about a short-term therapeutic intervention. That may be appropriate like fasting as an intervention but preference, put them on a diet that is good for them every single day for the rest of their life, and one that will not only increase their life expectancy, but their healthy life expectancy, even more so.

Melanie Avalon: Yeah, that's definitely one thing I've seen a lot in the keto sphere is, I have seen some people who seem to-- it seems like they can stay on it for life, they don't have these problems. So many people seem to do a keto diet, and it seems to work really, really well for a short amount of time, and then something happens, and they just feel like this need to binge or this--

Dr. Alan Goldhamer: There is no data showing populations of long-term ketogenic diet adherence, what the long-term effects are. I've seen what happens to people that were successful with it short term. When patients do whole plant food SOS-free diets, I've seen them now 35 years in, you show me people that have been doing it the other way. I'd like to see that data. That would be compelling.

Melanie Avalon: The Inuit been doing it and the Poles, the Inuit populations. I think their long term, like meat eating diet.

Dr. Alan Goldhamer: Yeah. I know some of the Alaskan tribes had significant coronary artery disease problems.

Melanie Avalon: Yeah, I think it happened when they started eating processed foods, though.

Dr. Alan Goldhamer: Well, that may be, which and also some of the populations have-- you also want to find people that have long term life expectancies. You can argue that predation and other issues are responsible for that. Again, not an expert in that area, I would defer to the people that are, as far as discussing that population, if there's actually compelling data, the stuff that I've seen was really weak in terms of making the case for long-term compliance. It's also very difficult to talk about populations that were have high levels of, disproportionately high levels of physical activity and other things that might allow people to compensate, and it might be in spite of not necessarily, because of-- The point is, [unintelligible [00:54:31] people of all kinds of races here, and we see consistent predictable clinical results when they adopt the whole plant food SOS-free diet, in terms of dealing with their disease conditions.

Melanie Avalon: Okay, awesome. I really appreciate you talking about all this. I just know, like, these are the questions my listeners are going to be--

Dr. Alan Goldhamer: It doesn't mean this is the only way to do it. There may well be other ways to do it. If there's ways to do it, that's better than what our data is showing, I'd be more than interested in adjusting what we're doing to make it work better. If your listeners out there believe that there's a better approach and I'm just ignorant because I don't know about this or that, I'm totally open to getting educated. All I can tell you is for 35 years I've been using this approach because it seemed like the most logical one to me, with whatever limitations I had in interpreting the literature, and I'm getting the data. So, if I can get better data, I'd love to know about it.

Melanie Avalon: It's really, truly incredible. The story I love that you talk about The Pleasure Trap, if you'd like to tell it was, the one about, is it Dr. Tanner, who wanted to kill himself?

Dr. Alan Goldhamer: Well, I'll give you a quick summary. The guy was so riddled with arthritis and debilitating health conditions that he decided that life wasn't worth living. He didn't believe in suicide because of religious reasons, so he decided he would just starve himself to death. He started fasting, to make a long story short, after about a month, he was completely well, went back to feeding and spent the rest of his career encouraging people to do fasting and diet.

Melanie Avalon: It's incredible. I love that story so much.

Dr. Alan Goldhamer: Yeah, it is pretty well documented, so I think we're on solid ground citing.

Melanie Avalon: I love it. Some more questions about the extended fasting. Can people do extended fasting at home, like a three-day fast? Or, is that not recommended?

Dr. Alan Goldhamer: Well, I'm not sure three-day fasts are particularly good. I'd rather see them doing 16 hours every single day. Then, when the time to do it longer fast is to do in a controlled setting. In order to do a longer fast safely, you need to first of all, make sure you're a good candidate. Medication complications are certainly an issue metabolic issues are there, so you do a history, exam, and baseline lab, and then we know that the person is a good candidate for fasting. It's also important that people realize that three days isn't going to necessarily get you where you need to go to resolve problems. If you had a problem that can be resolved in a three-day fast, you'll resolve it just with 16 hours of fasting every day in careful diet over time. The people that we're seeing, unless you're talking about doing it just from a health promotion standpoint, and that we believe requires probably a little bit longer than that. We don't know for sure, because that's an area we're researching right now. How long does it take to induce the changes we think are associated with health promotion, and life extension benefits? We believe though that these changes take longer periods of fasting to induce those. If you're going to do something shorter, you may be able to do the fasting mimicking programs. I wouldn't recommend water-only fasting other than 16 hours a day, and then longer fasting would be 5 to 40 days. That is, in my opinion, better done, at least working with a doctor that that knows about fasting so that you can get a proper history exam and lab advice. We're not the only place that does that. There's a place in Ohio, there's a place in Florida, his place in Texas is a place in Southern California, we're training doctors that are opening up places to be lots of places to do that. It's really better-- people really muck it up. It can actually be very dangerous. Long-term fasting with inappropriate refeeding can result in refeeding syndrome and can result in very significant post-fasting edema or other complications. We don't recommend that. People that shouldn't be fasting can end up really in trouble because of their medication complications.

We do offer a service though, that cost nothing. If they want to go to our website, complete the registration forms, that gets me their medical history, I will do a phone conversation with them, at no cost to tell them are they a candidate for fasting and direct them to the places closest to them that can guide them to do that safely and effectively. For listeners that want to know more about that, I'm happy to talk to them about it. We also have another service. If their doctor wants to help them do a home fast, we will help their doctor, no cost, get them the information they need. What they need to do as far as baseline exam, lab, and if they're willing to provide the monitoring, and the responsibility for that, we will help that doctor at no cost. If that doctor wants to do something worthwhile with their life and go to heaven instead of hell, then come and do a rotation or internship with us at the TrueNorth Health Center which also will cost them nothing because we train them for free and we provide them housing and take care of them so that they can really learn how to use this approach healthfully.

Melanie Avalon: That is incredible. For listeners, I'll put links to all of that in the show notes. Again, the show notes will be at melanieavalon.com/truenorth. Quick question about things that are being healed. One of the things I've been fascinated by with healing is so many of my listeners and myself included often have digestive issues and they say our intestinal cells are replaced every three days, yet it seems that for healing leaky gut or all these things that it takes months and months.

Dr. Alan Goldhamer: Ooh. Yeah, but it's not just the cells, the lining cells, it's actually the microbiome. Five pounds of bacteria in your gut right now living creatures, eating, drinking, and defecating inside you right now. what your bacteria poo and you, can either be fertilizer vitamin K and nutrients you need or it can be things like TMA, and we know that people that eat animal-based diets have a different bacterial flora and a much higher production of TMA. That's one of the arguments against too much animal food in the diet, is you get not just trimethylamine oxidase formed, but other products that are thought to be health compromised. This is relatively virgin research, especially when it comes to fasting. In fact, we've done the first study that I know of with long-term fasting and changes in the gut microbiome. I don't even have the data back from that yet. We did that with Luigi Fontana at Washington University. That's a very active area of interest in research where we'll be able to find out of the thousand strain of bacteria, which ones support long-term health, and which ones can we control their defecation, or their elimination of products in a health promoting way. That may be why gut leakage is so hard to heal, and just taking probiotics and stuff doesn't get the job done.

Fasting has a profound effect on the gut microbiome. We know that's true. We believe that what happens is a complete rebooting of the environment that allows healthier bacteria recovery. We see these patients with gut leakage healing, and the products that you measure of gut leakage healing, but it doesn't just take three days. This idea of rapid turnover of cells in the gut is I'm sure true, but it's not that simple. This is a much more complex, immunologically driven process. It's about creating the right environment, and then putting the right diet in.

Melanie Avalon: I recently interviewed Joel Greene on the show, and he wrote a book called The immunity Code and his theory about fasting and the gut microbiome is that fasting limits internal/external nitrogen production. That that was the key thing, changing the microbiome. Have you done any tests on the nitrogen balance?

Dr. Alan Goldhamer: I'd have to check with our Director of Research. I'm a clinician, we have Dr. Toshia Myers, who's a brilliant PhD postdoc from Columbia that does our actual research design. I have to ask her, if that's one of the variables that has been already assessed. It sounds very interesting. I have no idea if it's true or not.

Melanie Avalon: It was the first time I seen a lot of--

Dr. Alan Goldhamer: What was his name?

Melanie Avalon: Joel Greene.

Dr. Alan Goldhamer: Is he published a paper on this?

Melanie Avalon: He wrote a book. No, he doesn't do studies.

Dr. Alan Goldhamer: Well, maybe he cites studies, because I'd love to find an actual-- I'll look him up, I appreciate the tip on that.

Melanie Avalon: Yeah, sure. I can connect you too. He's so nice, he'd love to talk to you.

Dr. Alan Goldhamer: That'd be great. Yeah, because we're just formulating some of our studies now, for next year, we're looking at not only long-term adherence, but we also want to assess how much how long to get off in return. We're looking for non-invasive biomarkers that we can use, that are going to help us really answer these questions, because we clearly don't pretend to have all the answers. All we can describe is what we've been doing clinically and what the results are. It doesn't mean that we understand exactly how it's working yet.

Melanie Avalon: Awesome. Yeah, I'll connect you guys, and you can go down that rabbit hole.

Dr. Alan Goldhamer: That'll be great.

Melanie Avalon: Yeah, when I asked listeners for questions, I got a lot of concerns about things that might happen with extended fasting, just like rapid fire ones.

Dr. Alan Goldhamer: Well, those that want to know, just whatever we don't answer right now, we have an actual fasting safety study that's been published in the peer-reviewed literature that looks at five years all the patients, consecutive patients, over I think, 600 people in this study, they looked at adverse events. Stage one, two, three, four, five, using the [unintelligible [01:03:27] criterias. It's well done, it's exhaustive and it gives you a really clear picture of exactly what the risk factors are associate with fasting. The conclusion was there was no deaths, there was only one category 4 event, which was a single incidence of natriuresis that was easily corrected. Most of the stage three adverse events were what are called hypertensive crises, and those were in established hypertensive patients, whose blood pressure was coming down. For example, if a person starts at 200/100, and then next day, they're 190 and the next day they're 180 and the next they're 170, each of those days is considered an adverse event, because any day you have a systolic pressure over 160 is reportable, but 100 of our 300 events were those people whose pressure was actually correcting.

The fact is, we show that fasting when it's done according to the protocol that's used at the TrueNorth Health Center is in fact a safe system. Not only safe for young people. Up till that time, nobody would approve studies in patients over 65, but we showed there was no increased severity of complications in people that were older, so that people 75 can also fast. So, it's a really important initial fasting safety study and it's one that allows human [unintelligible [01:04:41], for anybody to be able to have a protocol that can be used and prolonged fasting can be done safely.

Melanie Avalon: Okay, so I will definitely put a link to that in the show notes. The concerns that I got, I don't know if it looked at these things. It was things, like Laura said, adrenal fatigue. Karan wants to know about if it slowed the metabolism.

Dr. Alan Goldhamer: Let's talk about metabolism. It's an old wives’ tale that you fast and metabolism slows down and it stays down. We've had people with colorimetry machines here actually testing this. Metabolism does slow down while you're fasting, obviously, the body's trying to conserve your resources. By the end of the refeeding period, that is half the length of the fasting, your metabolic rate is back at the same rate that it was before unless it was elevated, and then it's normalized. So, this idea that fasting permanently changes things is just nonsense, not true. There is no permanency to that normalization that actually occurs. People mistakenly believe though that they gain weight easily after a fast, but they're not differentiating weight from fat versus muscle, etc. Now, we have the Hologic’s DXA scanner that allows us to actually accurately differentiate what the body composition components are. As I said, we've already done a preliminary study, we're finishing a major study right now. It's clear that in fact, just as you'd expect, it's fat that's primarily mobilized, and the weight that's regained after fasting is muscle.

Melanie Avalon: Ritu was wondering about hair loss, do you ever see hair loss?

Dr. Alan Goldhamer: Hair loss happens anytime there's rapid weight loss, whether it's in pregnancy, with hormonal shifting, or any kind of where people lose large amounts of weight rapidly. The month following that experience, hair follicles may mature, you don't actually lose any hair follicles, but it all comes out together for a few days. It's because the body shuts off, that whole protein catabolism is modified in terms of how carotenes form. So, the hair tends to mature at the same time, so it comes out, it looks like it is, you do get some thinning and then it recovers. We don't see permanent changes unless there's other issues, thyroid issues, or other kind of problems. There is a startling response that occurs, again, with hormonal issues or with any time people lose a whole bunch of body fat as the body goes into conservation mode, but it's not a permanent or issue that’s something we warn everybody about occurs in a small percentage of patient, but definitely is associated with rapid weight loss.

Melanie Avalon: Okay, and you touched on this earlier, it's a hot topic right now. Kim wanted to know how fasting would affect immunity.

Dr. Alan Goldhamer: Well, we do not have a study done on active COVID-19, for example. We don't treat COVID-19 at TrueNorth Health Center right now, we actually screen to avoid it. But what we are treating a lot of now is post-COVID syndrome. They've recovered from COVID, but they have residual loss of smell or taste, they have persistent fatigue.

Melanie Avalon: Our assistant has this.

Dr. Alan Goldhamer: Yeah, this is very common. It's responded so far-- we have not done a study on this. I'm just talking anecdotally. The limited number of patients we've had so far, we fasted them for post COVID syndrome, have done remarkably well. We're very excited, we are proposing to do a study because there's going to be this avalanche of people that have post-COVID syndrome, and then there's going to be another syndrome that's about to come up that will be the consequence of immunization. There's a lot of postvaccine problems that people get. Undoubtedly, the vaccines they’ll be pushing forward for COVID will also have some of these sequelae, consequences. For those that are persistent, we hope that fasting will prove to be helpful as it has in post-COVID syndrome in terms of the loss of smell and taste. We don't know the mechanisms yet. We've only had a few patients to date, we need to obviously do a proper study, we'll get there. Let's take a look at-- why do people die from COVID? What do we know about the people that-- some people most people get COVID, they even don't have a habit or they recover, it's not-- Some people get really sick, and some people die.

Well, we know that one of the big risk factors for having bad reaction to COVID is metabolic syndrome. It's particularly compounded by age, but being 80 itself may not be the problem, but the cumulative use and abuse that occurs when you are 80. Let's be clear, a lot of the people that are dying are people that were in nursing homes, many of which were hospice patients. They had high expectation of mortality in relatively short period of time. It doesn't mean the COVID wasn't devastating and terrible. It doesn't mean that everybody is at the same risk for devastating and terrible. The question is, what can you do to try to be one of those people, whether you're old or not, that would be less vulnerable when you do get exposed to COVID, from dying from it? Well, good advice might be, well avoid it. Wash your hands, wear your mask, do your distancing, and all that stuff. Maybe even more importantly, get rid of the excess weight, get rid of the diabetes, get rid of the high blood pressure and the medications that are necessary to manage it. Get rid of the metabolic syndrome. And then, perhaps you will be less vulnerable should you get sick from having devastating, long-term consequences. We're not doing that as a society. We're emphasizing right now the hand washing and the distancing and the masks and stuff, but we're not telling people-- you never hear people talk about the relationship to obesity, to higher vulnerability to negative effects during COVID, do you?

Melanie Avalon: Right.

Dr. Alan Goldhamer: Well, because two-thirds of people are overweight and obese, and they think there's nothing can be done, it's helpless and hopeless. We were fighting to keep the meat industry functioning fully. We need to, I think in my opinion, shift to people's attention to saying, let's do all those things they're asking us to do, but let's also get healthy.

Melanie Avalon: People practicing normal, time restricted eating daily fasting, if they do get sick, not necessarily COVID, and you talk about this in The Pleasure Trap, what are your thoughts on the natural anorectic response like people losing their appetite when they're sick?

Dr. Alan Goldhamer: Almost like the body's trying to get them to do a fasting naturally. Like animals do when they get sick, they naturally fast. What I recommend is that they consult with their doctor if they have a doctor that's not an idiot. Or go to our phone coaching service and consult with one of our clinicians, what advice for them specifically would be best in their condition. If fasting is appropriate or modified fasting or intermittent fasting, then certainly our doctors will give them that advice.

Melanie Avalon: One more question about patients at TrueNorth. When it's a water fast, do you supplement anything at all, electrolytes, anything?

Dr. Alan Goldhamer: No. There are some cases where if people develop some clinical challenges, we make a vegetable broth, it’s called a therapeutic broth. There are things that we'll do to make it easier on people symptomatically, but there's no supplemental. In fact, there's explicitly no supplementation because we want those limiting nutrients to be the limiting nutrients so that we don't supplement them, say potassium, and then end up getting myocardial fibril breakdown, because we let our arrogance exceed our ignorance. If you're not able to stabilize the fast, then you need to be in a modified fast where you're getting 600 calories of controlled nutrients. We do that. Some people are not candidates for water-only fasting. We’ll do modified fast or juice fast. There's other things that we do, we don't just have-- it's not just a one-trick pony there.

Melanie Avalon: What do you monitor with the patients during the fast as far as blood tests?

Dr. Alan Goldhamer: They're seeing twice a day by a staff doctor where we check their vitals or all your standard blood pressure and pulse and temperature and oximetry, etc. We're looking at variables in the urine, we're looking at variables in the blood. We have noninvasive diagnostic EKG, etc. We do whatever we need to do to be able to clinically monitor the patient. The point is, they have an exam twice a day with the staff doctor.

Melanie Avalon: Okay. Then, one thing I found really, really helpful and practical in The Pleasure Trap was you have a chapter on dealing with social pressure and all of that. The [unintelligible [01:12:34] strategy.

Dr. Alan Goldhamer: Ah, that's [unintelligible [01:12:37] strategy. He is really brilliant. He's got to be one of the smartest people I've ever met Dr. Lisle. He's really the best person to talk about psychology, that's not my area of expertise. What he's explaining is that you don't want to be shoving things down people's throats that they're not interested in, because it's just going to create stress for you. When you go out there, and you start eating a healthy diet, and you start losing weight, you start pissing people off. They get cognitive dissonance. They get real psychological pain, you and your thin body and your perky smile and your thin clothes. You’re going to start to piss people off, even if you don't say anything, and you start opening up your mouth and say, “Oh my God, you're not going to eat that dead, decaying flesh, I can hear your vessels thickening from over here.” They're not going to like it. If you have an alcoholic friend, and you go up to him, and say, “Oh, you know how your life sucks? It's because you're a drunk. You should quit drinking.” They're not going to go, “Oh, it's the alcohol, I had no idea. Oh, thank you so much. I just won't drink anymore.” You're not going to be effective at helping people maybe learn what you think is important, except by keeping your mouth shut and setting an example.

So, Dr. Lisle provides a lot of techniques that you can use to eat your diet, but not piss everybody else off, how you can go along and get along without becoming socially alienated. You can still maintain your life and not upset people, especially as you become successful. There's a lot of people out there I call them energy vampires. They're people that do what they do best, and that's making other people sick and miserable as they are. By comparison, they don't have to feel so bad. You ask any woman that loses 50 pounds at TrueNorth Health and then goes to work, the other women are not all happy and supportive. They go, “Oh, did you adopt the whole plant food diet? You look so wonderful. What can we do to be helpful?” It's quite the opposite. They're going to do everything they can to undermine your success. They're going to bring you cupcakes and ask you where you’re going to get your protein from and it's terrible. I have women telling me they have to modify their behavior just to avoid pissing everybody off.

It's interesting, men, don't have quite as much problems. If men lose 50 pounds and they go to work, while the other men, they don't notice, so it doesn't really matter. If they do notice, they don't care. It's a little bit again, easier for the men than the women in general. I know this is a generalization, but it's true. That's why generalizations are generalizations. Because women oftentimes have a lot more pressures, both on the negative and the positive when it comes to weight loss. Men, more or less, they leave us alone. A little bit easier to be men in my opinion.

There's a book called by Farrell called Why Men Are the Way They Are, which in my opinion, is more about why women are the way they are, but it's an interesting read. He is a psychologist, he talks about a lot of this. Honestly, though, if your readers want to learn about this, they shouldn't be listening to me, they should be reading The Pleasure Trap, or if they don't want to read it, they should listen to the audio version by a Chef AJ who did a great job putting it into an audio format. It's a disturbing book that will bend your mind because it doesn't tell you what you want to hear, but it does tell you what you need to know, in my opinion, to get and stay healthy.

Melanie Avalon: Yeah, it was really great. For listeners, definitely check it out, really, really invaluable. I'll put a link to it in the show notes. Well, this has been absolutely wonderful. Oh, I want to throw one thing by you since you're doing so many studies, I think I've come up with a way that you could account for the placebo effect with intermittent fasting. I think they should do a study where they give you a pill, and I realized that you would be taking the pill, so maybe you won't be fasting. But the instructions for the pill would be that it has to be taken on an empty stomach and you can't eat for a certain amount of time before or after.

Dr. Alan Goldhamer: That's a really good idea. Why don't we do that? We'll charge $10,000 for a pill, tell them in order to activate it, you have to fast for two weeks, and then stick to a whole plant food SOS-free diet, and we guarantee it'll resolve your high blood pressure or double your money back.

Melanie Avalon: I tell you, there could be a lot of studies with this placebo pill, just take this pill with water and no food for this amount of hours before or after. People would think that they were testing the pill, but really, it's the fasting.

Dr. Alan Goldhamer: There you go.

Melanie Avalon: I think this should be done. I'm just putting it out to the universe. Well, this has been absolutely amazing. Thank you for all that you're doing. I know my listeners are going to love this. If listeners want to learn more information, I'll put all the information in the show notes, is it all on the TrueNorth website?

Dr. Alan Goldhamer: Everything they would want, I think, will be on the TrueNorth website or on the Foundation's website, fasting.org. That's where a lot of the studies are posted on fasting.org. All of the other information, the phone coaching, the website, all of the lay articles are on healthpromoting.com.

Melanie Avalon: Awesome. Well, I will put all of that in the show notes. That brings us to the last question that I ask every single guest on this podcast. It's just because I realized more and more each day, how important mindset is surrounding everything. What is something that you're grateful for?

Dr. Alan Goldhamer: Well, I'm really grateful that I was able to discover the benefits of fasting at an early enough age that I could make it my career, that every day, all I have to do is allow the body to heal itself and the patients and then try to take credit for the good results.

Melanie Avalon: That's incredible. Well, thank you so much. I'm so grateful for what you're doing. It's really, really revolutionary. I hope that it just continues to grow and gets more out there in the popular sphere. This has been absolutely amazing. I'm in Atlanta right now, but I plan to move back to California. When I do, I'm going to have to check out TrueNorth Health Center.

Dr. Alan Goldhamer: Excellent. Let us give you the tour.

Melanie Avalon: Yes, that'd be amazing.

Dr. Alan Goldhamer: Very good. We'll look forward to seeing you, and maybe you can do a show as you experience fasting yourself.

Melanie Avalon: Oh, my goodness, because I've actually never done an extended fast [unintelligible [01:18:33] my listeners.

Dr. Alan Goldhamer: Well, come on out, and maybe that'll be a way of really experiencing what we're doing.

Melanie Avalon: That'd be incredible. Okay, I'm doing it while I'm doing it. Perfect. All right. Well, thank you so much, and I'll talk to you soon.

Dr. Alan Goldhamer: My pleasure.

Melanie Avalon: Bye.