TravelerEastWest

"Chiropractic “science” is a form of alternative medicine with no firm scientific basis to it.  It is a pseudo discipline, and perhaps I'm biased but I have a distaste for most of the chiropractic practiciners I've personally encountered."

I agree that many Chiropractors are shall we politely say questionable. But I don't understand why you keep going back to this as  Dr Goldhammer is a credentialled doctor an Osteopathic doctor which is a level of skill and training basically equal to an MD. Or do you think they are not real licensed doctors in all 50 states?

I doubt he he has been doing anything Chiropratic related for many years. Also I dont see any proof of his unusual profit motive (beyond taking care of his family) as he has a non profit foundation and is putting money into research I somehow doubt Berg is doing the same - is he?

Dr Fung is an MD which is at the same level as an osteopathic doctor yes he has a kidney specialty and Goldhammer has an extended water fast specialty.

I also don't understand why you value lab research at a higher level for the sake of this discussion of is it safe to exercise and go on a long fast? I am not sure what value experiments on yeast and rats etc would have compared to real world experience with thousands of patients if you can explain your point I will be happy to listen.

7 hours ago, WaveHunter said:

Nice post.  It's always going to happen that people will have varying opinions since everybody is different and what works well for one may not work so well for another.  That's why I think the best approach is to take in as much raw information as you can from very well vetted sources BUT then to decide for yourself what YOU feel is the proper course action for YOURSELF, rather than to adopt someone else's opinion.

Do you agree that Dr Goldhammer is not similar to Dr Berg?

And do you agree that he is not selling supplements?

Do you understand that he (and his team which includes MDs) has experience with safely leading many thousands of extended fasts over many years?

If you disagree with the above because of evidence please share it. If you now agree with the above will you at least consider that his proof of exercise not being good for extended fasts (not short ones) is correct? His proof is based on Dexa scans and safe results for all his patients and lots of clinical lab work and other testing. He does not work with rats and yeast etc but others do and we can learn from them - certainly...

What do you think of Dr Gil Carvalho? Who is a MD and research Phd?

"what works well for one may not work so well for another'  Good point.

" then to decide for yourself what YOU feel is the proper course action for YOURSELF," Agreed 100%.

I still feel that very few average people are qualified to understand the science because you need a high level of skill with statistics and a deep understanding of how the body works. I accept that you may disagree... smiling.

5 hours ago, The Hammer2021 said:

The photo you showed looks like very old technology used for selecting a lense. First they test your eyes. I reiterate  my doubt that the  Bangkok  Hospital wouldn't  have the  best most modern equipment. Are you from England? If so  that might explain that you're  not used to seeing really modern equipment. BTW I have an astigmatism in both eyes and have had eye tests in England,  Thailand,  Vietnam, Kuwait  and Saudi.  Here in Thailand  you get the  best International  modern quality treatment far better than UK. Certainly just as good. Many British  people have never experienced top quality medical  treatment so when they get  it  as you did  in the Bangkok  Hospital its confusing  for them.

Sounds correct.

Going to a chain the person doing the measurements is a non professional.

You need at least a trained optometrist and better yet an ophthalmologist who can check if you have undiagnosed diseases.

5 hours ago, jerrymahoney said:

Well that's the thing for Americans with Medicare -- You have to be well enough to make  the 20+ hour trip back to USofA when you might not be well enough to make the trip to Bangkok.

You correct.

Most of the time I will be able too make it back to America and for the time when I can't I will simply have to pay for the procedure here.

I can't get insurance here due to age and pre existing conditions - so the choice is move back to America or self Insure... I choose to stay here. I think the odds are that an expensive illness such as cancer won't happen overnight- I am not worried about heart disease. An accident is certainly possible...!

3 hours ago, internationalism said:

from thai insurers only pacific cross has up to 300k deductible, Luma up to 192k, April up to 200k, LMG up to 200k.

The PC gives 50% discount for 300k deductible. Also up to 20% discount for not claiming. So up to 70% total.

 

Problem, they will exclude your pre-existing - or refuse policy.

 

Bangkok hospital is private, one of the more expensive. They have offered you 50% for bed, but charge for treatments, medicines, care, tests etc. 

Cost of bed is insignificant in comparison to every else they will skim you.

Do count in the governmental hospitals, this 850b for bed on a common ward or 2500b at single occupancy is much less than your 50%, which still might come around 5k.

 

Check

https://misterprakan.com/th/health/plans?gender=Male&age=62&lg=en&ipd=1&opdf=0&leadid=348157

but only expensive policies have deductibles, no need for them at cheap ones.

 

Also Thai Health Insurance PCL has deductible up to 200k

https://www.aainsure.net/thai-health/

I agree with you that with my discount the room rate with nursing fees will be around 5 or 6,000 per day. The rooms are very comfortable though - smiling...

Actually I don't mind a shared room at all and it might be better at times. But Thai public hospitals from what I have seen are not very good - can be very crowded with very poor service - sure there are exceptions some special private/public clinics etc... Actually i got a COVId booster at a ;are public hospital with a private wing it was very good service.

Thank you for the insurance examples! seems like there still are no ,local Thai options where I pay the "wholesale" insurer price for the deductible like I used to do in America.

In three years at 65 I will qualify for Medicare so that might be the best way to go for any serious cancer/heart attack type problems.

Meanwhile I will eat well and exercise a lot.

Thanks again for your help!

Does anyone know how to get a very high deductible insurance plan where I pay my deductible at the insurance company's lower rate (than the normal public rate)?

I am 62 and have pre existing conditions...

Thank you!

Note I spoke to a Thai insurance broker in the past but was told that type of insurance does not exist in Thailand.

Currently I have a Bangkok hospital plan where with their hospitals I get a discounted rate on their platinum plan. So let say I pay 50% of the room rate half is discounted and half I pay out of pocket. So sort of a middle path plan...

23 hours ago, SteveBull said:

 

 

In Hua Hin's main hospital they have a VIP option 250 baht I think it is - if you don't pay it you've got a hefty wait in the busiest hospital in stifling conditions, if you do pay it you are taken to a different area and seen within the hour. They could put another zero on the end of that and given the options I would still pay it personally.

Agreed 100% for an extra charge to get great service is worth it...

"I don't mean to come down on True North or Goldhammer, but quite frankly, he is a chiropractor (just like Dr, Berg).  I don't consider his credential to be suitable for me to consider him an authority on the metabolic sciences."

Actually I think you may be thinking about someone else as Dr Goldhammer is both a chiropractor and an Osteopath; not just a chiropractor like Dr Berg - who from what I understand doesn't even have a current license as chiropractor. So very different. Osteopath go through almost the same training as MDs and can prescribe medicine - so again nothing even similar to Dr Berg. And Dr Goldhammer is not running a supplement business only a medical clinic like many doctors.

Also Dr Goldhammer as I have mentioned has lots of real world experience in the field of extended water fasting more than most doctors of any type and he is very active in advancing the science in the field through clinical work - lab work is something different and not his focus. He is very active in his nonprofit foundation and they are building a collection of peer reviewed articles - again nothing similar to Dr Berg.

I write the above as comparing him to Berg is shall we politely say not very kind...

Also I have read many of your suggestions in the past and to date I have found nothing more on point to the issue of exercise and extended fasting than Dr Goldhammers's work.

You seem very sincere and open minded so you may want to spend some more time reading his articles and watching his videos - just a thought.... feel free to ignore my suggestion if you have made up your mind...

An interview with Dr Carvalho where talks about how to look at studies and think about health.

He seems calm, smart, trained in research and a good communicator - he does real research at USC.

https://theproof.com/making-sense-of-nutrition-with-gil-carvalho-md/

My goals for fasting are varied but improved insulin resistance is probably the most important as I have had type 2 diabetes for a very long time.

I went from being very sick with mega doses of insulin daily to only being moderately sick with much lower doses of insulin after doing 15 and 16 day fasts without electrolytes or other supplements. But it is difficult to say exactly what role extended water fasting played in my improvement as I also have been doing daily walks, weights and eating well. although I did see quick results after extended fasts. I think I will try a longer fast with the long shot of pancreas improvement.

Again I am a N of 1 so nothing to be relied on but maybe something o add to the range of ideas that you rely on?

I also like developing will power to not be attached to food but that is a bit off our topic.

Losing visceral fat is also a good result of extended fasting.

I still agree with about 80% of what you have written which is pretty good I think - smiling.

We will have to agree to disagree on about 20% of what you say.

I found someone on YouTube Dr Gil Carvalho who is well qualified (MD and Phd) calm and seems to be honest not sure, but you might like him and perhaps have already watched some of his videos..

https://www.youtube.com/hashtag/nutritionmadesimple

Finally - I love exercise and really hope that in the future it is proven that exercise and extended fasting go together well thank you for all your ideas - and I am still in awe of your notebooks! You are very organized!

47 minutes ago, WaveHunter said:

My point is actually very simple.  There are no studies currently that empirically confirm that exercising while fasting is beneficial.  There are no studies that empirically confirm that being sedentary while fasting is beneficial.  Much about fasting, autophagy, and metabolic sciences in general are still largely unexplored territory with mostly unproven concepts.  Therefore, as a lay person interested in practising optimal health, we have several options to pick from:

1. Take no action and wait for science to confirm the truth
2. Listen to proponents of one side vs the other side, and take action based on which one you believe in more.
3. Listen to proponents of BOTH sides, and then use their views to go on and do your own research of all the well-vetted studies. and then, after digesting as much information as you need, do a bio-hack on yourself, and then use the result of that to decide which view is the one to believe in

I prefer #3.  This is clearly the most difficult track to take.  It's very hard to try and stay unbiased as you look at both sides of the question, and it takes a lot of time and effort, but I prefer it to the other two.  

 

It's like if you have ever watched a trial proceedings.  You have the prosecutor laying out his/her version of what happened, and his presentation is very compelling.  But then you hear the Defence's version of what happened and it is also compelling.  You, as the jury, then have to decide which version YOU believe is correct.  You may choose wisely, or you may make a mistake, but in the final analysis, you MUST make a decision that you feel best defines the truth.

 

You can look at any / all scientific studies in the field of metabolic science and find things you believe are correct and things you disagree with,  No single study can prove or disprove a concept when that concept has yet to be proven by peer review, so as a lay person who wants to optimize their health by fasting, you have to look at all the available and make that decision for yourself.

 

That's really all that I am saying. I have a whole library of notebooks I've amassed over the twenty years, going back to when I first became curious about the metabolic sciences.  I have explored and bio-hacked so many different concepts, I can't even keep track...Whole food, Veganism, Carnevor, Low Carb, OMAD, Water Fasting, Autophagy.  Here's an example of just one of my Fasting / Keto notebooks for 2021:

 

 

What I'm trying to say is that you really have to be your very own researcher when it comes to topics such as fasting and exercise. 

 

Nobody can tell you definitely whether dieting and exercise go together.  You have to piece it together all on your own.  So, when I say that I believe that exercise is important (even vital) for a successful fast, it is only MY opinion because almost all of the well vetted scientific research I've seen supports that view, even though there is no single study that I know of that makes that makes such a bold claim.

 

More importantly, I believe it because it has worked well for me in practice, where a sedentary approach to fasting was a disaster.

 

I mean, I guess it all depends on what you expect from a Fast.  The majority of people's only goal is to drop some excess weight.  To me, that is a dumb idea.

 

"Water fasting" is just a nasty little catch-phrase used by YouTube gurus.  In reality it should not be considered a weight-loss diet.  The real goal of fasting should be to induce accelerated autophagy.

 

Autophagy goes on in the human body 24/7 but when a person has a history of over-consuming carbs and heavily processed foods, the regular autophagic response can not keep up with the intra-cellular damage that occurs from poor nutrition.  Intracellular proteins become irreparably damaged and began to accumulate.

 

The goal of fast should very simply be to accelerate the autophagic response (which Ohsumi proved in his Nobel prize winning research).  He proved that any type of metabolic stressors such as deprivation of food, or increased physical stress (i.e.: exercise) have a direct effect on the autophagic response.

 

So, when you fast, and when you exercise, you increase this autophagic response.  The big picture of fasting is simply this:  Fasting and exercise induce accelerated autophagy, which is able to sequester those damaged intracellular proteins caused in part by poor nutrition, and pass them outside the cell membrane so that they can be broken down to amino acids.

 

Then, when fasting ends and you resume eating, new intracellular proteins can replace the old, damaged ones, allowing the body to return to a more homeostatic state.

 

That's it in a nutshell IMHO.  The goal with a fst is to induce accelerated autophagy and nothing more.  When the human body is in an optimal homeostatic state, there no need to go on a diet to lose weight.  The body will take care of that all on its' own provided sound nutrition is practiced and one does not resume poor nutritional habits after the fast.

 

Autophagy is now coming to the forefront of many prominent researchers such as Dr. Valter Longo, and Verhoeven (who I mentioned yesterday, and who's research work is laser focused specifically on autophagy).   And of course there is Dr. Yoshinori Ohsumi's ongoing work, for which he was awarded the Nobel prize in 2016.

 

Anyway, as usual, I have gotten carried away in my writing.  Sorry for being so verbose, but I hope it has some meaning for you ????

 

 

 

 

"Anyway, as usual, I have gotten carried away in my writing.  Sorry for being so verbose, but I hope it has some meaning for you ????"

I like your posts and was looking forward to reading this one!

I agree with perhaps 80% of what you write.

"Listen to proponents of one side vs the other side, and take action based on which one you believe in more.'

I follow your second choice as I don't feel it is normally possible (99%+ of the time) to read and understand actual research unless you are trained in the field. The level of statistics that you need to understand is very high. As is the biochemistry.

Verhoeven - unless I am mixing him up with someone else has little to no credentials and is not a good source for me He is not an MD or Phd and is only a student. The article link that you posted is interesting but he does not appear to be the main researcher. 

Dr Goldhammer and his team seem to be partially or mostly non profit and are not focused on sponsoring others. His team also has extensive real world experience in the field literally thousands of medically supervised long water fasts over many years and in his research exercise is not included as a safety measure. I trust that more likely than not he is correct. So far you have shown zero evidence to contradict this position, and I am very open to hearing about a doctor or researcher with equivalent experience who has had good measured results with extended water fasts and exercise...

When you say exercise helps with autophagy I agree with you - but doing an extended water fast and exercise together have not been shown to be something good (at least I have not heard about it and you have not posted any facts to support this idea - you do not have extensive experience with extended water fasts (not intending to be rude but going with what you wrote:

("More importantly, I believe it because it has worked well for me in practice, where a sedentary approach to fasting was a disaster.")

I am not sure how you can say that with your limited experience with extended water fasting exercise while doing an extended water fast it is a good idea. Perhaps a gentle walk or light yoga might be OK with an extended water fast - but maybe not.

"it is only MY opinion because almost all of the well vetted scientific research I've seen supports that view, "

Not sure what you mean so far as you have not posted any research showing that extended water fasts and exercise are a good idea.

"There are no studies that empirically confirm that being sedentary while fasting is beneficial."

Dr Goldhammer has written about his research and he uses a Dexa scanner to show visceral fat going away and very little muscle being used during long fasts with no exercise. This to me is very good evidence supporting the no exercise with extended water fasting theory. Now if many other doctors could do the same Dexa scans after  an extended water fast this would be much better of course, but for now it seems taht more likely than not no exercise with extended water fasts is best for your health. Remember I am talking about long water fasts not short ones... 

Remember Dr Goldhammer is doing extended water fasts up to around 40 days which is very, very different from 7 to 10 day water fasts...

Thank you for sharing an example of your notebooks - you clearly are well organized - my notes are very unorganized as in using scarps of paper and piling them up... not a good system at all!

2 hours ago, WaveHunter said:

One thing I forgot to mention is that while exercise is good for an extended fast, it is not so good for the initial few days of starting a fast.  During this time, until ketogenesis ramps up, the body has no alternative but to catabolize proteins, and exercise will only cause more catabolizing to occur.  Not only that, but until there is adequate ketones bodies being released, the body will go into survival mode by decreasing the basal metabolic rate.  So, the first 3 days of a prolonged fast, I take a brisk 30 minute walk daily, but that's about it until day 3.

 

Regarding Goldhammer, I'm sure their clinic has helped many people but the research that comes from them is really as a sponsor of others' research, and that leads me to believe it may be a bit biased. What's more, the type of research papers that result are more related to clinical statistics as opposed to fundamental biochemistry and physiology.

 

The only reason I mention Cahill is because his research provided the foundation for truly understanding metabolic biochemistry and how the body reacts to food deprivations, and their findings are as true today as they were when first published.

 

You really do not need an academic understanding of biochemistry to understand Cahill's work, or any of the current research that's being done.  You may need to familiarize yourself with real basic biochemistry; things like the Krebs cycle, for instance, but YouTUbe is actually your friend with this since there are plenty of really good videos that you can actually trust, written by academics.

 

Actually one guy I religiously follow on YouTube is Nicolas Verhoeven.  He is PhD Candidate in Molecular Medicine and a researcher in a molecular biology lab that is researching cell biology related to autophagy, and really is on the cutting edge of this, which is intimately related to water fasting.

 

Though incredibly difficult to read for the lay person (me), here is his latest research paper, and I only link here so you can see this guy really knows what he's talking about:

 

https://www.researchgate.net/publication/350870898_Parkin-independent_mitophagy_via_Drp1-mediated_outer_membrane_severing_and_inner_membrane_ubiquitination

 

My point is that in order to understand the link between fasting and exercise, the answers are not in a research paper but in understanding the metabolic processes that underlie both fasting and exercise, and people like Attia and Verhoeven provide the link between very difficult to understand research and the truth.

 

I'm not saying their viewpoint is right or wrong, but what they have to say gives you a starting point that is firmly rooted in science so that you can further explore the topic on your own, and then have your very own viewpoint on it, instead of having to rely on others opinions.

 

Verhoeven's YouTube channel is called Physionics (https://www.youtube.com/c/Physionic/videos), and he discusses a wide variety of topics related to his research, and many focus specifically on water fasting, all strictly from a scientific perspective. He also describes complex physiological and biochemistry processes in a way that anyone can easily understand.

 

What's more, he provides very detailed "translation" of whatever scientific papers he happens to discuss in easy to understand language in his written "video notes" of his channel.  I've gotten a working knowledge of some very complex biochemical processes through his simplified (but not misleading) explanations.

2 hours ago, WaveHunter said:

 

He discusses water fasting as well as critiquing many f the proponents and that includes Goldhammer, Fung, including Valter Longo and his Fasting Mimicking Diet (which is very in-depth and fascinating).  He also critiques (in a fair impartial way) people like Berg, Fung, etc... .

 

He is literally a gold-mine of incredibly reliable and accurate information!

 

Regarding refeeding, all the guidelines [put out by health gurus) is overkill IMO.  I've used a simple protocol to end a fast and it has never caused me issues. 

 

Throughout the fast I take psyllium daily just to keep something running through my digestive tract (and that will not interfere with ketosis or autophagy), and water water mixed with electrolytes (Sodium, potassium, and magnesium). 

 

The electrolytes are not just to stave off headaches and "keto flue", but because those three electrolytes are seriously depleted in in a 72 hour fast.  You might not feel any negative repercussions during your fast, but you could in a serious way afterwards. (Verhoeven did an excellent video on this on his YouTube channel BTW)

 

On a 7 day fast, I do a 3 day refeed.  I continue with the psyllium, and on Day one of the refeed I have one meal only, consisting only of soup (I like Minestrone best), and consume it very slowly over a one hour period, along with natural vegetable juices (not processed or with added sugar)

 

On Day 2, the same thing, but two meals of soup plus a simple salad.  On Day 3, I just go back to OMAD (one meal a day), keeping it light and low in carbs, and difficult to digest proteins.  By day 4, I'm pretty much back to eating the way I normally would, and just being careful not to binge.

 

The whole idea is simply to avoid shocking your metabolic system which is now fat-centric, no longer carb-centric, and it is really as simple as that.  Bone broth and all the other things that health guru's suggest are fine if that's your thing, but they are certainly not necessary.  All that's necessary is good common sense IMO.

 

Regarding the duration of a water fast, I never go beyond 7 days.  I did once as a bio-hack but really, form everything I have read, there is no point in going beyond 7 days.  I only go for 7 days because of the effect it may have on autophagy, and even possible stem cells, but those are still very gray areas to me (which again is why I really like Verhoeven's videos since his research is specifically to do with these things.

 

As for research I can point you to, again I have to say that I can not think of any specific papers I can suggest that support the link between exercise and fasting except the basic biochemistry concepts that come into play with the two.  Attia and Verhoeven are my two "go-to" starting points I can suggest though.

Again thank you for your thoughtful post and I respect your thoughts and observations!

But I don't see quite what you do:

1) As you mention in the end of your post you have not read direct studies or heard of them by experienced researchers that support the idea that exercise while doing an extended fast is a good idea. This matches my research.

2) I have watched a number of Verhoeven's videos and he does have a calm voice and some nice graphics and interesting information but he is not in the league of experienced and well educated researchers - also I don't like his attitude at times... (but that is a subjective comment). He is basically an exercise trainer who is now a Phd student - he has not graduated nor does he run his own research studies - so he is not authority to be relied on.

3) We have a different view of what an extended fast is - seven days is a fairly short fast... so your actual experience is quite limited (mine is also fairly limited I don't count 15 or 16 days as a long fast - normally 21 days is where you start to hear about great results)

4) "understanding the metabolic processes that underlie both fasting and exercise, and people like Attia and Verhoeven provide the link between very difficult to understand research and the truth..." as mentioned above Verhoeven is not qualified to rely on as a resource at least not in my opinion and I am not a scientist or MD so my opinion is not that valuable... But I have those I know with the education and experience to know what they are talking about who agree with my thought about who is qualified.

"Regarding Goldhammer, I'm sure their clinic has helped many people but the research that comes from them is really as a sponsor of others' research, and that leads me to believe it may be a bit biased. What's more, the type of research papers that result are more related to clinical statistics as opposed to fundamental biochemistry and physiology."

I was not aware that they are really a sponsor of other's research I thought they are doing  research both on their own and in collaboration with others. Can you show proof of your comment please? To some extent everyone is biased which is why they are publishing articles so that others can comment on their results. Not sure why clinical statistics of real life results would not be really good information as opposed to only theory? Can you explain why you say that please?

5) Dr Attia is clearly very smart and very interesting and a man who is not afraid to reverse his option I respect him. But I have not heard him comment in his videos about the advantage of long fasts and exercising so unless I missed something - always very possible - lets assume he doesn't agree with extended fasting and exercise as I don't want to speak for him.

6) Dr Cahill clearly did some very important research and is indeed someone to respect. I have read his explanation of what happens to the body during the fasting process and again I may have missed it but I don't see anywhere  - where he suggests extended fasts should include exercising. If I missed this please let me know.

7) "instead of having to rely on others opinions." Here we will have to agree to disagree I have studied statistics in graduate school but only up to a masters degree not a Phd and I clearly don't have the knowledge or experience to judge the quality of scientific research papers. You must be much smarter than I am and I accept that (note not being sarcastic). A month ago I was talking on the phone with William a retired doctor about a conference he had gone to with various research appears being presented. One paper in particular he remembered as the static were simply wrong - my point being statistics are very difficult to understand even with a great deal of education and experience...

???? "those three electrolytes are seriously depleted in in a 72 hour fast." I have not heard that this is typically a problem with short three day fasts - any information to back that up? During long water only fasts normally it is not a problem but it could be. which is why experienced researchers and doctors such as Dr Longo and Dr Goldhammer  and others always suggest Doctor supervised long fasts. i am in Thailand so i can't go easily to somewhere like True North where they supervise your fast. So instead I read very carefully and slowly increase my fast lengths and if I have any problems I will stop.

9) Sounds like you have a good refeeding program. For a longer fast - two weeks or longer I would probably follow the advice of having light fruit to break your fast.

Thanks again for your thoughtful response - we agree in many things - but not everything - which is OK...

2 hours ago, WaveHunter said:

I am familiar with Goldhammer and True North, as well as the clinic in Germany I think you are referring to which is the Buchinger Wilhelmi Clinic. 

 

The problem I have with such clinics is that they are obviously "for profit" institutions, and while I've never heard anything negative about either clinic, most of their PR efforts that you see on YouTube are seriously lacking in science-based information and they emphasize anecdotal information that celebrates the virtues of fasting. 

 

I particularly dislike the way they discuss prolonged fasting as a panacea for everything under the sun, stressing that that your protocol MUST be done under the direct supervision of an MD trained specifically in fasting protocols, which is just nonsense, and shameless self-promotion.

 

I prefer to educate myself ONLY from science-based sources with no bias based on financial gain.  My belief that "moderate" exercise while in a fasted state is based not only on such information, but it is backed up by personal experience.

 

My first attempt at a prolonged fast (7 days) was a failure because I followed the common notion that being sedentary during the fast was a very important element of fasting.  As a result, I had a horrible time of it.  I felt lethargic which is a normal component of fasting BUT that should only occur until ketone body production begins to ramp up (i.e.: 72 hours into the fast).  However, for me it continued until day 5 when I finally gave up.

 

Worse, I didn't recover after I began eating again.  My workouts (both resistance training and cardio) took about 3 weeks before before they were back to where they were before the fast.  It was obvious to me that something was seriously wrong. 

 

That's when I got more serious about the underlying science to how the human body responds to being in the fasted state. 

 

Probably the most important work I read about were the studies by Dr. George Cahill's into the physiological changes that occur in starvation. I linked it below, and it is an excellent primer on the physiological stages that the human body goes through when deprived of exogenous nutrition.

 

His research which was summed up in the paper, "FUEL METABOLISM IN STARVATION" was a landmark study that fundamentally changed metabolic science and laid the groundwork for safe and effective modern-day fasting protocols.

 

It is essential reading if you are to really understanding what truly happens to the human body while in the fasted state, and some of those changes are complete unique to human beings, as opposed to animals in general.

 

The problem I have with most modern-day proponents of fasting is that many of them don't have a clue of the actual biochemical and physiological changes that occur when the human body is deprived of exogenous macronutrients...and that includes many practicing MD's!

 

As for clinical studies concerning the relationship of exercise to fasting, I have read many.  You can as well by googling.  I purposely don't like citing specific studies since you can't just look at one particular study to form YOUR OWN opinion. 

 

Usually when you want to effectively research a topic, you need to learn from many different sources (including the ones that you might feel a bias against)  and only then begin to form YOUR OWN opinion

 

Personally, I do not downplay any well-vetted sources.  I have watched many interviews and speeches, ands read articles from Goldhammer, Dr. Jason Fung, Dr. Stephen Phinney, and a host of other noted authorities that study prolonged fasting.  I even regularly watch YouTube videos by Berg and Ekberg, since all such sources often have some element of truth.  But, in the final analysis, it's up to you the individual to decide for yourself what is right and what is wrong.

 

Too many just a quick and simple answer to a very complex topic such as this and will usually only look to one source for that.

 

A good place to start for me was with Peter Attia's blog simply because he is both an MD and a triathlete, and he has done extensive study of both fasting and exercise physiology, and practices prolonged fasting protocols on a quarterly basis every year, and considers exercise while in the fasted state to be an integral part of the protocol. 

 

I know he has vested financial interests with a few companies that make products for fasting, but still I find him to be honest, and most of his information led me to other sources and I was able to develop my own valid and actionable course of action.

 

BUT...The real acid test for me is what actually works FOR ME.  All I can say is that ever since I incorporate exercise into my prolonged fasting sessions (7 day fasts, 4 times per year), they have all gone very smoothly with minimal lean body mass loss, good blood tests after the fast, no need for an exotic refeed plan, and high levels of energy during and after the fast.

 

Just a quick point:  In addition to exercise, the other big mistake I made on my initial fast was not considering the importance of electrolyte supplementation, specifically sodium, potassium, and magnesium.  Not only to it stave off headaches and the usual "keto flue" but it helps you sleep better and tolerate exercise better while in a fast.

 

I hope some of what I said you an find useful ????

 

 

I enjoyed reading your response and yes you remembered correctly the clinic in Germany. I may be wrong but I don't think they practice true water fasts. They are closer to what Dr Walter Longo suggests with his fasting mimicking diet - not exactly but similar it seems.

So let's focus on True North for the moment - they are at least partially a non profit organization maybe entirely I am not sure, but certainly not a big business  and they don't promote supplements etc. as many others due.

Link to the non profit foundation for their research:

https://www.truenorthhealthfoundation.org/about

The reason they are good to discuss is that they do have real research in this area as in published studies. High blood pressure and fasting is something they have done well with. Some sraticles on other areas such as limited success with cancer. They do not state that water fasting cures everything just the opposite.

I would say that Dr Goldhammer has a very good understanding of the subject and very important is the fact that he has extensive experience with tens of thousands of fasts which most other researchers do not have. Do you know of any current researchers with similar levels of experience with extended fasting as at True North?

As for Cahill he is very famous and wrote about a number of topics including what happens when the body is fasting but seeing as he died about ten years ago I wouldn't say his research is the latest... Also I did not read his articles and papers I read a summary as I am not an MD or scientist and I don't have a high level understanding of biochemistry or statistics - which I would say is essential.

Dr Jason Fung has education and experience on his side but I don't agree with all his conclusions - but he is very interesting and as you say there are elements of truth... As for Berg he seems to be way off target at times... Ekberg is better and seems more honest but still he is not always correct.

I have watched a number of Dr Attia's videos and he doesn't seem to have experience with long water fasts - but I may easily have missed this please let me know if you heard him say he does long water fasts. Note seven days is not a long fast... And I have limited trust with anyone who promotes products... He may a good man but money subtly changes what we think...

I have read a number of books (intended for normal non scientists) and watched many videos over the last few years and had discussions with scientists which I accidentally met. So my opinion is not professional at all but reasonable for a non professional as I do have some experience with medium length water only fasts - 16 and 17 days. 5 to 7 day fasts are not that long and not so difficult and do not produce much results - at least not for me. I have heard that around 21 days is when you really start to get results. I may go for 21 days as an experiment next time.

Carefully refeeding after long fasts is very, very important.

Electrolyte supplementation is an interesting concept and some find it very useful. I don't get headaches etc while doing long fasts so I don't use them. I am only tired.

So in summary I have not seen any serious research at all stating that exercise while doing a long water fast is a good idea. If you would be so kind as to let me know if you have seen any that would be great. One documentary that I saw on YouTube (not a serious work) did hint that in Russia they do exercise on a water fast...

Again thank you very much for your post!

I can't get insurance do to pre existing conditions but if I could find a high deductible plan taht accepted me and gave me their wholesale rates for my deductible taht would be good.

As an example in America I had a plan with around a $5,000 decidable or something like that.

My wife had our daughter (in America) and above the deductable everything was paid for in a very nice hospital. For the first $5,000 we ended up paying a reduced rate which was the same rate that our insurer paid in effect a wholesale rate...

Around 15 years ago I spoke with an insurance broker in Bangkok who told me taht insurance plans where customers paid a wholesale rate were not available in Thailand. Maybe they are now?

On 8/20/2022 at 1:33 PM, WaveHunter said:

There has been a lot of studies in the last few years (serious studies) that are proving that moderate exercise while in the fasted state is not only possible, but essential for protecting lean body mass. 

 

The consensus up until just a few years ago was that you should NOT exercise while fasting.  It has pretty much proven to be completely wrong, and many who followed that advice (including me) lost significant lean body mass (LBM).

 

Without going into the biochemistry of it all, exercise stimulates the body  to release IGF-1 by dramatically increasing Growth hormone production, and indirectly reduces gluconeogenesis.  In a sedentary state this will not happen, and that's why a sedentary faster can often lose a lot of lean body mass during a prolonged fast.

 

If "moderate" resistance training and cardio training are conducted during a prolonged fast (greater than 5 days), LBM loss will be minimal; nothing you could not restore within a week of being in a gym.  Read about Dr. Peter Attia as a starting point to learn more about this.

 

I'm not going to reference these studies or defend them since that will always lead to a bunch of back and forth arguments and nonsense on a forum like this, but anyone that takes the time to do their own due diligence and become familiar with these studies, and also take the time to understand the ACTUAL metabolic changes that occur in the fasted state, will see that these studies make sense.

 

These studies were carried out by very well established researchers from major universities, not silly YouTube Gurus spewing unsubstantiated pseudo-science.

Thank you for suggesting a very interesting point of view suggesting that exercise during extended fasting is good for preserving lean body mass if I understand you correctly?

I am familiar with Dr Attia but other doctors don't agree with everything he says. And it has certainly not been proven that exercise during long fasts are a good idea. Actually not much of anything has been proven about long water fasts lots more research is needed. Does Dr Logo feel that exercise is a good idea?

Dr Goldhammer and his team at True North (includes MDs) have done recent research and have fasted in a clinical setting literally thousands of people over many years with minimal problems and zero deaths. They say clearly that rest is very important for healing and exercise is while doing extended water fasts is a bad idea - again they have lots of documented experience.

In Germany another established clinic has done research but they don't seem to do actual water fasts...Not sure what other medical clinic has done research with large numbers of patients?

I have water fasted for up to 16 days and for me (N of 1...) normal exercise is simply not possible - for me normal exercise is an hour a day of hill walking and lots of light weights. So I don't know maybe it would be good for me to exercise I have an open mind and would love to read more...

I would love to see studies that back up your point. Please send me a message if you don't want to post on the forum.

3 hours ago, BritTim said:

If really busy, delegating the process to someone else makes sense. However, there are benefits to doing it yourself, and gaining knowledge of what is involved. Usually, labour offices are more helpful than almost any other sector of Thai officialdom, and are foreigner friendly. They will make time to help and explain everything you do not understand.

Agreed that the labor departments are reasonably friendly.

I had a labor department staff person years ago tell me that the process was easy and encouraged me to try myself.

On 7/22/2022 at 6:30 AM, robblok said:

The point is you have no proof, the pages i visited say there is really limited study done and nowhere does it say that the enhanced version is so much better. There are maybe a handful of studies that is not the proof that you think it is. Most of these studies were on animals not humans.

 

Plus there has never been proof that your enhanced state is better. That is what you and lot of people like you make of it. You act like we know a lot about this process, yet your own nobel price winner says this

Autophagy research is still at an early stage, and our understanding of the physiological role of autophagy in particular is only in its infancy.  (got this from the site on Yoshinori Ohsumi)

 

How can  you make such bold statements as the enhanced version is better while we are still in its infancy. The thing is you make claims the Nobel prize winner would never have made. Could please link where a study between normal occuring autophagy and enhanced version is compared ? I would be willing to read that.

 

I keep saying the same thing your in an echo chamber and are suffering from confirmation bias. I did not start typing about this without before reading several sources. All claiming that there has been minimal study on humans (certainly not a long term study on people who fast and those who don't when autphagy is concerned). So how can you claim all those things when the studies and your prime example say its in its INFANCY.
 

So how can you when even science sites and your famous Dr Ohsumi all say its in its infancy and that studies are lacking make such huge claims. 

 

Sorry but I have no more interest in discussing this until you stop making things up that are not proven. 

 

Yoshinori Ohsumi (its in its infancy)

Government clinical trials (human studies are lacking)

Waverunner.. this is the new miracle and everyone should do it 

 

See the difference between those scientists and you ?

You are not wrong when you say more study is needed. But step by step evidence is coming out in support of the benefits hits of fasting.

Dr Walter Longo has not won the Noble prize but people say he is in the running... howeever he is is a very serious scientist and he has done studies in animals and in humans supporting the benefits of short fasts and fasting mimicking diets. https://www.valterlongo.com/fasting-mimicking-program-and-longevity/

Dr Alan Goldhammer is not as focused about research perhaps but at his True North Center in California they have been doing long water fasts for many years without problems and lost of success. They are working on studies showing fasting lowers blood pressure better than medicine and other studies. Note he is not an MD but works with Ads and those with Phds https://www.healthpromoting.com/water-fasting/fasting-research

So is there lots of proof about the benefits of water fasting our there? Not yet - but recently more and more research is being done.

Meanwhile I have heard it said that the effects of water fasting are often possible with lots of exercise and a very healthy lifestyle but fasting is deeper and faster...

Again the benefits of extended water fasting are not proven but seems likely...

On 7/20/2022 at 11:23 AM, WaveHunter said:

So you are a cyclist?  Me too!  I used to live in Chiang Mai and miss my daily climbs on Doi Suthep so much!  I envy you if you are still living there!

 

Look, I am not criticizing you or your lifestyle.  Bottom line is whatever works for you is the best way to do things...if they genuinely do, in fact, really work for you.

 

Many people however, delude themselves into believing something works simply because a highly persuasive Guru told them it works. 

 

My problem with gurus like Berg and Ekberg is that they say a lot of things that are simply not the whole truth, from a scientific perspective, and they lead many people astray, particularly the ones that do not follow up with diligent vetting of what they have heard.

 

You may feel comfortable discounting scientific research.  I discount much of it as well, but what I do NOT discount is the "Scientific Method" since that has proven over time to be the ONLY way at arriving at the truth.

 

So many people think of gurus like Berg as being the voice of gospel truth, when in fact, they are not really presenting the full picture.  If you look at Berg's YouTube contents, so much of it touts completely unproven concepts like the virtues of apple cider vinegar, a myriad of different health supplements (many of which he sells), and a whole host of other notions that are highly questionable.

 

His concepts regarding metabolic health are particularly troublesome to me because they are littered with half-truths, and out-of-context cherry picked facts that support his agenda, and rarely provides science-based sources to support his claims, or only sources with a vested interest.

 

The main problem I have with berg and others "Gurus" like him  is that most people who watch his videos are basically lazy people who will accept whatever he says, without doing their own research to see if what he says is actually true.

 

I'm not saying his videos are worthless.  he addresses a wide range of legitimate health concerns.  My issue with him and others like him is he is not unbiased, and present only what support his biased narrative. 

 

However, his videos are good starting off points to explore a new topic you know nothing about, and then to go on and do your own research on Google, and for that purpose I subscribe to his channel and watch many of his videos.

 

I'm just saying his videos should absolutely NOT be considered the final word on any topic.

Completely agree with your comments about Berg and Ekberg.

I use Accucheck Guide and it is close to the readings when my doctor takes blood sample but not perfect....

If you check ratings by Consumer Reports they will tell which meters are the best - again not perfect.

Interesting article:

https://diatribe.org/are-blood-glucose-meters-accurate-new-data-18-meters

1 hour ago, scorecard said:

Application form for Work Permit is available in both Thai and English language.

Being in English is helpful but still lots of forms and waiting in line - I wouldn't do it unless you have lots of extra time and don't mind this sort of paperwork...

14 minutes ago, scorecard said:

Go see the local Labor Department to get advice, as they issue Work Permits not the Company. They will be able to tell you precisely what documentation is required from the Company, from Financial status to no of employees.

Expand  

If it's easy to get to the miinistry office at Din Daeng, there's a 'complaints' office on the ground floor. Can't miss it, big signage.

 

From above "...what documentation is required from the Company,  "

 

The 'documents' required are the basic every day start up and ongoing documents. Don't let anybody tell you that the documents are very complex and you need a lawyer to do this. Totally not true.

You don't need a lawyer agreed.

But the amount of paperwork takes time and you want all to go smoothly - have local CPA do it for you (not expensive at all)  has worked well for me especially during COVID times . They came to my office and did everything they then filed everything and saved me a trip to the labor department and waiting incline very much worth their fee,

If you don't mind trips to the local labor department and enjoy doing paperwork and are on a tight budget then do it yourself - as I recall the forms were in Thai...

16 minutes ago, Rotweiler said:

From reading the one responder's posts, I must assume that he has not been at the RAM for awhile.  There is now a huge parking lot in the back (part of what was once the shopping centre's "extra land".   I have not had to climb the tower for ages (those who have been at the RAM "parkade" will understand that.

 

I must strongly echo the positive comments about Dr. Vipawan, my endocrinologist for 5 years. It is rare to see a doctor (at any hospital) who cares as much for the patient and actually listens to them, as she does.  I have had considerably poorer results elsewhere, and I don't go to hospitals for orchids, to lurk in toilets, or any other reason except to get the best care I can to meet my health needs..

 

 

You are correct - I have not been to CM Ram in a long time... and have no plans to return - my experience there was not a very good one. With the worst part being the long waits even with an appointment. It is a given that good doctors and nurses are important. The doctors and nurses were OK at that time; I saw an older man who I believe was a medical school teacher.

Good to hear that Dr Vipawan is caring! All the doctors at Bangkok hospital have been good listeners. But I have not yet found a single endocrinologist in Chiang Mai who has a focus on diet/nutrition and exercise for treating type 2 diabetes. 

If you told me that Dr Vipawan was a diabetes specialist with a focus on diet and exercise and drugs only as a last resort type of doctor I would be very interested in seeing her even if CM Ram still had long waits in the Endocrinology department. My experience with diabetes over many years has been taht diet and exercise are very important but many doctors seem to know very little about nutrition...

By the way has CM Ram updated their file system to be computerized? It used to be folders that were retrieved before an appointment... If they have improved their system then probably the wait times would drop quite a bit.

PS Do you have a Rottweiler? They are beautiful dogs and a friend told me that they are great with kids. I have two German Shepards and which are great with my kids and protect my farm - outside Chiang Mai so guard dogs are great to have...

Local labor departments can be different - don't fool around by cheating - not worth it. You can actually hire two staff and pay them their salaries.

I have done this with a bit of help - the paperwork is not hard but best left to the pros until you have gone through it at least once.

Depending on your location you can normally get a two year permit and yes they may come out to visit you. although not always.

So have your office with company name put up.

Only two employees needed since you have a Thai wife.

38 minutes ago, elektrified said:

Are you serious? Who cares about decorations and orchids everywhere and a piano? Thais are impressed by those type of things and will pay more for them. I can't believe you would gladly pay more for something as meaningless as that. What's important is the doctor.

I don't have many Phalaenopsis (Butterfly) orchids ar home and they have many at the hospital - I enjoy looking at them.

Pianos don't mean that much to me but for others they probably do mean something.

Doctors are important and sometimes nurses are even more important. Also good cashiers and pharmacists are important.

I also like it when I have to go to a number of different clinics they have customer service staff to make sure everything goes smoothly.

Clean bathrooms at a clinic and hospital are also important.

As is the newest equipment and convenient parking and so on...

I am happy to pay a bit extra for all the above. I understand that not everyone feels the same. Some people probably want a good doctor and don't care about the environment... I respect that but not me. Sometimes I feel quite stressed at the hospital and the nice environment calms me down.

As point of reference I am also willing to pay extra for nice restaurants and hotels although theses days I don't travel at all and very rarely eat outside. I prefer home cooking!