30 Day Fasting with Dr. Alan Goldhamer: Rational Wellness Podcast 116
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Dr. Alan Goldhamer discusses the benefits of long term fasting with Dr. Ben Weitz.
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Podcast Highlights
4:14 Some of the benefits of doing a water only fast are to reverse the consequences of dietary excess, including obesity, high blood pressure, diabetes, autoimmune diseases, and conditions like lymphoma. Fasting is a way to reboot the body and allow it to heal. Dr. Goldhamer explained that they did a study with Cornell University in which they took 174 patients with high blood pressure and all 174 achieved pressure low enough to eliminate all medication with fasting and a whole food plant based diet (Medically Supervised Water-only Fasting in the Treatment of Hypertension). A high percentage of type II diabetics were able to achieve normal blood sugar without medication with fasting and this result was maintained using diet and exercise.
7:24 The fasting patients drink a minimum of 40 ounces of water per day, but not so much water that they flush out their electrolytes. Their blood and urine is being monitored to make sure their electrolytes are being maintained and that they are safe. The patients drink fractionally steam-distilled water while fasting, which Dr. Goldhamer says is safe and they have published a fasting safety study showing that this protocol can be done safely. (Is fasting safe? A chart review of adverse
events during medically supervised, water-only fasting.) Dr. Goldhamer said that they do not believe in giving the patients electrolytes or other supplements during the fast, which could imbalance their system.
9:52 There are a number of patients that are not eligible for this long term fasting protocol, including pregnant or lactating women, patients who have recently had a stroke, heart attack, dysrhythmia, who are on anti-coagulant therapy, who are on drugs that you cannot stabilize people off of, or who have neuropsychiatric involvement that might prevent them from providing informed consent. Every patient goes through a careful history, exam, lab monitoring, and screening prior to being accepted into the fasting program. Patients who are on anti-hypertensive meds are not a problem, since by placing patients on a whole plant food diet prior to fasting, you can start weaning these patients off their meds. Most patients are being medicated for the diet that’s causing their hypertension and the fasting has a very powerful diuretic effect that lowers blood pressure better than the medications. Many patients enter the program with blood pressures of 220 over 120 and are capped out on medications and they’re 100 over 60 by the time they leave without medications.
12:09 Some patients with cancer can respond well to long term fasting as long as they are not in a cachexic state where weight loss is problematic. Patients with lymphoma may be particularly good candidates, since these patients sometimes go through a prolonged period before they enter conventional treatment, so this is a particularly good time period to do conservative treatment. Dr. Goldhamer explained that they have published a case study in British Medical Journal of a patient with a Stage 3 Follicular Lymphoma who underwent 21 days of fasting and his tumors completely resolved. (Water-only fasting and an exclusively plant foods diet in the management of stage IIIa, low-grade follicular lymphoma.) They also published a three year follow-up study that she continues to be cancer free. (Follow-up of water-only fasting and an exclusively plant food diet in the management of stage IIIa, lowgrade follicular lymphoma.) Dr. Valter Longo published a study in 2015 in the Journal of Metabolism showing that when you fast rats prior to and during chemotherapy they get much better results and they demonstrate much improvement in many biomarkers. But this involves short term, intermittent fasting, which is different than the long term fasting that Dr. Goldhamer is recommending.
17:07 The length of the fast that patients undergo is often dependent upon their response. In the case of patients with high blood pressure, Dr. Goldhamer said that he wants patients to fast until their blood pressure is normal. Occasionally patients may need to faster longer than they have the reserves for, so he will have them terminate a fast, rebuild their reserves, then start over with a fast, until the condition is resolved.
17:59 Patients do not do any vigorous exercise while fasting, since once the glycogen stores are depleted, the only source for extra muscle or brain use would be breaking down proteins or gluconeogenesis. The goal is to minimize protein utilization and maximize fat loss and detoxification, so fasting should be done in a resting state.
18:28 There is a patient who has a testimonial on Dr. Goldhamer’s website who had bulimia and went through the fasting program. Dr. Goldhamer explained that bulimia and anorexia are completely different conditions and patients with bulimia can benefit from fasting, while patients with anorexia would not. In a patient with bulimia, a short period of fasting can reboot the mechanism, increase leptin levels, normalize blood sugar levels, and get rid of some of the biological triggers that stimulate bulimia.
20:40 Dr. Goldhamer admitted to having had some challenges running a fasting program, esp. as a chiropractor over the years. As a chiropractor in 1984, when he went into practice, they hadn’t had the Wilk decision in which the American Medical Association was found guilty of having organized a Committee on Quackery in order to contain and eliminate the chiropractic profession by claiming that chiropractic was unscientific and by concealing evidence of the effectiveness of chiropractic. So just being a chiropractor was considered outside the box and recommending fasting was seen as even more extreme. Dr. Goldhamer says that he was the first person in his family who needed the services of a criminal defense attorney. Fortunately now that Dr. Valter Longo and others are doing really good research on fasting, fasting is gaining some interest and notoriety and he has gone from being a criminal quack to a cutting edge researcher. He’s half way through a study with Mayo Clinic looking at the prevention of stroke with fasting and diet. They’ve completed a study with Washington University looking at biomarker changes in fasting. They are looking at the number of mutations in B lymphocytes, at autophagy, and at the gut microbiome. They completed a study looking at the perception of the taste of food before and after fasting. They are working on a project with Kaiser Permanente to add a model of intense education and nutritional management to help manage patients with high blood pressure. And they have published a number of papers including the safety of fasting, on follicular lymphoma, and on the chriopractic management of subacute appendicitis using fasting and dietary changes rather than surgery. All of these papers can be found at the True North Health Center website.
24:18 Dr. Valter Longo from USC has been researching the benefits of doing a low calorie regimen by eating packaged food that he calls Prolon and Dr. Longo claims that you get similar benefits to what you get with fasting. Dr. Goldhamer says that you cannot get all of the changes that you can get with water only fasting, but it does prove that not eating the greasy, fatty, slimy processed crap that constitutes the Standard American Diet for five days a month is enough to start inducing positive biological changes in people.
25:50 Besides fasting, Dr. Goldhamer recommends a whole plant food, SOS diet. SOS stands for no added sugar, oil or salt. I described Dr. Goldhamer’s approach as a high carb, low fat approach, but he states that since it includes 15-18% of calories from fat that it is an intermediate fat diet. He says that a low fat diet would be less than 10% fat. I mentioned that a high fat, ketogenic diet has been found to be very beneficial in helping to manage diabetes by lowering glucose and insulin levels, inhibiting mTOR, and stimulating AMPK and autophagy. Dr. Goldhamer said that a ketogenic diet will result in a lowered glycemic response, but it’s not a healthful, sustainable, long term diet, in his opinion. Dr. Goldhamer recommends eating modest amounts of nuts and seeds and avocado for those who can tolerate them, but to keep fat intake to around 15-18% of calories. He feels that eating more than that amount of fat is unhealthy for maintaining their weight and for cardiovascular health. Dr. Goldhamer argues that his recommended whole plant food diet will allow you to sustain your blood sugar improvements and he considers it a sustainable long-term, health-promoting diet consistent with our biology.
28:40 Dr. Goldhamer says that his recommended plant food diet should include carbohydrates like squash, potatoes, sweet potatoes, and non-glutinous grains like rice, quinoa, and millet. And for patients who can tolerate it, there’s lentils, peas and beans. He does recommend to avoid eating gluten.
31:53 Dr. Goldhamer recommends a low salt diet because he feels that it helps to normalize blood pressure and his data shows that it works. He understands that sodium is an essential nutrient that is needed but that is no justification for adding a chemical in the form of sodium chloride to our food. A whole foods diet contains about a gram of sodium per day. Adding salt to your food tends to make you overeat as it overrides your normal sense of satiety. He also does not think it is necessary to eat salt to get iodine, since most vegetables contain iodine and especially sea vegetables. Dr. Goldhamer also does not advocate taking a multivitamin that includes iodine. He believes that the best source of most nutrients is food and you should only supplement nutrients that are necessary, like B12 with patients not eating animal products. Dr. Goldhamer criticized some of the studies that show lowering sodium intake don’t help with lowering blood pressure is because they lower the sodium intake from 3,000 to 2,400 mg per day, which is not enough of a reduction to see an effect.
39:57 To get enough omega 3 fats, Dr. Goldhamer recommends eating plant foods that are rich in linoleic acid and that is sufficient to achieve acceptable levels of DHA. If not, you can get lichen or algae-based, vegan DHA supplements. Dr. Goldhamer said that a lot of Functional Medicine practitioners are using DHA pharmacologically to suppress inflammation associated with autoimmune disease but he feels that he is going a step further by getting rid of the root cause of autoimmune disease and once this cures the problem and there is no more inflammation, then you don’t need to take pharmacological doses of DHA, which is a less toxic substance than traditional anti-inflammatory medications. Dr. Goldhamer said that we need to get down to the basics, which are diet, sleep, and exercise, which are the things we have the most control over. When you do that you’ll see that the pills, potions, powders and treatments are the feathers on the rattle and are not really necessary. Dr. Goldhamer feels that many practitioners in the medical and even in the Functional Medicine world are too focused on the pills, potions, powders, and treatments and if they took the time to fully implement the first order interventions–diet, sleep, and exercise–like they do at True North Health Center–these other interventions would not be necessary. On the other hand, Dr. Goldhamer admits that his approach involves patients living at his center and this approach may not be practical in an outpatient setting like most doctors or nutritionist’s offices.
50:32 While there are quite a number of studies documenting the benefits of the Mediterranean diet and the paleo diet and the ketogenic diet, Dr. Goldhamer says that “anything you compare to the standard American diet is likely to demonstrate some improvement. Something being less bad doesn’t necessarily make it good.” He said that when you place patients on a high protein, high fat diet, they do well for a while but long term there are devastating consequences with their gallbladder, their digestive system, and with increased risk of cardiovascular disease. Dr. Goldhamer advocates for a whole plant food, SOS diet and he is publishing data to back up the health promoting benefits of this approach.
Dr. Alan Goldhamer is a Doctor of Chiropractic who founded and runs the TrueNorth Health Center, a state-of-the-art facility where you can stay to be monitored while doing a water only fast for up to 40 days. 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. Dr. Goldhamer has supervised the fasts of over 20,000 patients and he can be reached through his website, HealthPromoting.com.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Podcast Transcript
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting-edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health. Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to our Rational Wellness Podcast, please go to Apple Podcasts and give us ratings and review. That way, more people will find out about the Rational Wellness Podcast. Also, there’s a video version on YouTube if you look up right chiro or Rational Wellness and if you go to my website, you can find show notes and a complete transcript.
So our interview today is with Dr. Alan Goldhamer and we’ll be talking about fasting. There’s been a lot of discussion in health and nutrition world recently about the benefits of a complete fast of intermittent fasting and other variations such as the fasting mimicking diet and even the ketogenic diet. In recent weeks, I have interviewed Dr. Josh Axe and Dr. Christopher Shade about the benefits of the ketogenic diet and we discussed its antiaging benefits as well as its potential benefits as a therapeutic diet that may be a benefit for diabetes, hormonal imbalances for brain health such as Alzheimer’s as well as for weight loss and even cancer. Now, we will be speaking to Dr. Alan Goldhamer about fasting for as long as 40 days with supervision followed by a plant-based diet, and they have many of the same benefits including for hypertension, diabetes and autoimmune diseases.
Dr. Alan Goldhamer is a doctor of chiropractic who founded and runs the TrueNorth Health Center, a state-of-the-art facility where you can stay to be monitored while doing a water-only fast for up to 40 days. He’s the author of The Health-Promoting Cookbook and coauthor of The Pleasure Trap: Mastering the Hidden Force that Undermines Health and Happiness. Dr. Goldhamer has supervised the fast of over 10,000 patients. Under his guidance, the center has become one of the premier training facilities for doctors wishing to gain certification in the supervision of therapeutic fasting. Dr. Goldhamer was the principal investigator in at least two published studies, medically supervised water-only fasting in the treatment of hypertension and medically supervised water-only fasting in the treatment of borderline hypertension. Okay. And he has several other studies currently being conducted. Dr. Goldhamer, thank you for joining me today.
Dr. Goldhamer: My pleasure.
Dr. Weitz: Can you tell us about your background and how you became involved in treating patients with nutritional invention … interventions especially using water-only fasting?
Dr. Goldhamer: Well, I went to Western States Chiropractic College and after that, I attended the Pacific College of Osteopathic Medicine in Australia where the gentleman I trained with had an osteopathic hospital that specialized in medically supervised fasting so I got to see a lot of patients that were sick get well by essentially using fasting followed by a whole plant food SOS-free diet. So that was my initial exposure. When I came back to the United States in 1984, my wife, Dr. Marano, and I opened up the TrueNorth Health Center, and we’ve been doing this ever since. We’ve had over 20,000 people now go through medically supervised fasting in the last 35 years and we’ve had a chance to see just how good a job the body does at healing itself if you get out of the way.
Dr. Weitz: Interesting. So what are some of the benefits that you’ve seen of doing this water-only fast?
Dr. Goldhamer: Well, it turns out that a lot of people are sick today as a consequence of dietary excess. So they have obesity and high blood pressure, Type 2 diabetes, autoimmune disease and conditions including things like lymphoma. And when you do fasting, it gives the body a chance to mobilize and eliminate those consequences of dietary excess. So we treat a lot of patients with high blood pressure. In fact, we did a study with Cornell University. It took 174 consecutive patients with high blood pressure, 174 people achieved pressure low enough to eliminate all medication. It’s the largest effect sizes that have ever been shown in treating high blood pressure in humans using fasting and a whole plant food diet.
Dr. Weitz: Interesting. What are some of the other conditions?
Dr. Goldhamer: Well, we treat a lot of Type 2 diabetics where insulin resistance allows blood sugar levels to rise and insulin resistance is reversed with fasting and maintained with diet and exercise. So it’s not surprising that a high percentage of Type 2 diabetics were able to achieve normal blood sugar without medication. We also treat a whole host of autoimmune disease where it’s actually the immune system attacking their own tissue. So, for example, in arthritis, or rheumatoid arthritis, it’s actually the body’s immune system that’s creating the inflammatory process associated with the pain and deformity. And in part, that may be triggered by processes including gut leakage where proteins were absorbed to the system simulating genetically vulnerable people’s immune system to attack itself. With fasting, it’s like rebooting the hard drive in a computer that’s become corrupted. A lot of stuff clears away. You don’t always know exactly the mechanisms, but it works very similar in autoimmune disease. Gut leakage tends to be reduced and then followed by a low antigenic diet, you can actually manage these conditions without the devastating effects of long-term anti-immunological drugs, including steroids, methotrexate and the rest of it.
Dr. Weitz: When you say gut leakage, you mean what we often call leaky gut or hyperpermeability?
Dr. Goldhamer: Yeah. The idea that there’s a membrane in the intestinal tract that prevents larger molecules from being absorbed into the body, unless that membrane becomes damaged. One of the common thoughts, damaging the-
Dr. Weitz: Which is the gastrointestinal mucosa?
Dr. Goldhamer: Absolutely. So it works very much like a screen works to keep flies out. As long as the holes are small enough, only the stuff that’s supposed to get through does, but if through for example exposure to free radicals or other sources of irritation, inflammation, that membrane becomes damaged, you may see particles being absorbed in the immune system that shouldn’t normally be there. And initially, that’s not a big problem, the body’s immune system reacts, but for reasons still to be determined in genetically vulnerable people, that immune system can become overwhelmed or confused and begin to react to its own tissues. And maybe this mechanism is … can be the reason we see such improvement in fasting because you get a chance to reduce that inflammatory response. We know that’s happening because acute phase reactive proteins consistently go down during fast.
Dr. Weitz: Yeah. We usually think it’s because of cross-reactivity, so proteins like gluten cross-react to proteins in the body that look similar. So do the patients drink unlimited water or is there a danger drinking too much water?
Dr. Goldhamer: Well, too much water … Well I guess ultimately, too much water would be called drowning, wouldn’t it? So no. We do monitor patient’s fluid intake. We want a minimum of 40 ounces a day but not so much that they flush out their electrolytes. We’re monitoring blood and urine testing in order to maintain … make sure that people are maintaining a reasonable balance. But most of the detoxification that occurs, occurs because the blood is being processed by the kidneys and is going to show up in the urine. So you need enough of a solute in order to be able to have a place for the intermediary products of metabolism, exogenous toxins that are being mobilized that can be processed and eliminated. Too little is not good. You get dehydrated too much, can be a problem if you flush the system out excessively.
Dr. Weitz: What kind of water do you give them? Is it-
Dr. Goldhamer: We use pure water which is fractionally steam-distilled water, although you could use probably any type of purified water.
Dr. Weitz: So if you do that, that water is depleted in minerals, right?
Dr. Goldhamer: It is depleted in minerals. It’s just pure water which is what rain water would be if you didn’t have a polluted atmosphere. But the gut is not a two-way gradient in a clinically significant way. So you’re not sucking the minerals out of the body through the intestinal mucosa, you’re able to maintain balance including on 40-day water fast on distilled water only.
Dr. Weitz: Really? So even without any food, aren’t some of these people getting electrolyte-depleted?
Dr. Goldhamer: Well, we monitor electrolyte balance on every patient and ensure that potassium, sodium and the other electrolytes are maintaining normal course. And of course, in appropriately selected patients, they’re able to maintain electrolyte balance through the … up to 40 days.
Dr. Weitz: Do you ever give them electrolyte or other supplements?
Dr. Goldhamer: Well, we do not supplement during fasting. In fact, you want to use … We use potassium and other nutrients as rate limiting nutrients. If you supplement just those isolated nutrients, the 20 other downstream less sensitive reactants that you wouldn’t be monitoring for could become a limiting factor. That would be very dangerous. So by not supplementing, you actually eliminate the risk of overall imbalance in the system. And that’s how we’ve been able to do this 20,000 times. In fact, we published a fasting safety study that’s really scientifically analyzed, the safety and efficacy of fasting, and we’ve shown that using this protocol, it can be done safely.
Dr. Weitz: Which patients do you find are not eligible for such an approach?
Dr. Goldhamer: Well, there’s a wide variety of people that fasting would be contraindicated, not at least of which would be pregnant and lactating women, people that have had recent problems with stroke, heart attack, dysrhythmia, people that are on any coagulant therapy, drugs that you can’t stabilize people off of, people that have neuropsychiatric involvement that might prevent them from providing informed consent. There’s a whole host of people that you wouldn’t be a good candidate for fasting that’s why every patient we see goes through a careful history exam, lab monitoring and screening.
Dr. Weitz: Well, what about patients who are on hypertensive meds? You mentioned hypertension-
Dr. Goldhamer: Well, there’s really no problem with hypertension meds because what we do is we get people on a whole plant food diet. In the days prior to fasting, you are able to wean those medications and then as soon as you go on the fast, there’s a precipitous drop in blood pressure so we’re able to safely wean people off blood pressure medications with limited challenge. The diuretic effects of fasting are so powerful. They’re much more powerful than the medications people use so within short order, people’s blood pressures begin to normalize. In fact, most people are not even medicated for their hypertension, they’re medicated for the diet that’s causing the hypertension. And literally, the day you change the diet, blood pressures begin to respond. Many of our patients come in 220 over 120 capped out on medications and yet, by the time we’re done, they’re 100 over 60 and maintaining that level essentially as long as they’re willing to do the diet and lifestyle change. It’s much like obesity. If you eat well and you live right, you maintain the result.
Dr. Weitz: So during the fast, you have an MD on staff who’s monitoring who’s … lowers or takes them off their blood pressure meds?
Dr. Goldhamer: Every patient in our facility has an attending … We have six medical attendings that are full-time employees of the TrueNorth Health Center.
Dr. Weitz: Right.
Dr. Goldhamer: So every patient has an intake and exit. Example an attending which is responsible for monitoring their care and managing their medications. Our daily rounds are typically done by Doctors of Chiropractic or Doctors of Naturopathy. Each patient is seen twice a day by one of our staff doctors. All that information is reported to the attending that’s responsible for ongoing medical management of their care.
Dr. Weitz: What about patients with cancer? Are they good candidates for this?
Dr. Goldhamer: Well, it depends on the patient. But we just published a paper recently which is a follow-up to a paper we published four years ago in the British Medical Journal on the treatment of follicular lymphoma with cancer. And this was a … This case report was a patient with a Stage 3 follicular lymphoma, that has been confirmed by excisional biopsy, monitored for two years of progression. Underwent 21 days of fasting, completely resolved for tumors. Ten days of refeeding back to the medical school for follow-up. Now only did she eliminate her lymphoma cancer, but now on three-year follow-up, we were able to demonstrate she remains cancer-free and we published a follow-up in British Medical Journal to that case report. And those papers … In fact, all of the studies I’ll be citing are available on our website, healthpromoting.com. People can download any of the papers and look for themselves and see what kind of results we’re using with fasting and dietary intervention.
Dr. Weitz: When you’re dealing with cancer patients, sometimes weight loss is a problem. How do you avoid them losing too much weight while being on a fast?
Dr. Goldhamer: Yeah. Well of course, weight loss is a problem in patients that are in cachexic stages of cancer. They may not at that point, necessarily be a candidate for water-only fasting. Most of the patients that we’re seeing as particularly with lymphoma, these are patients that weight management isn’t generally the limiting factor. Usually, what you’ll see … You’ll see a lot of patients that … particularly that when they’ve gone through medical treatment, end up with cachexia and have problems because of devastation not only from the cancer but from the treatment. Generally, these are pre-treated patients. With lymphoma, the medical management has some great limitations and a lot of side effects. It’s generally deferred which makes it a very convenient case for us to treat conservatively because they’re really not doing anything for a while. So it’s not considered unethical to intervene from a chiropractic perspective and actually get the person well.
Dr. Weitz: Yeah. And I do know that some oncology centers will have patients fast around the treatment, maybe a day or two prior to their getting a chemo infusion, the day of, and maybe a day or two afterwards.
Dr. Goldhamer: So Valter Longo was the first person who published 2015 an article in Journal of Metabolism resulting some animal studies that he had done, 30 rats with cancer given enough chemotherapy to kill all the cancer cells, kills all the rats. Picks the same rats, same cancer, but now fasting rats, before and during chemotherapy, all 30 rats survived, dramatic increase of survival. So he was the first person that I saw talking about the idea that fasting actually helps protect healthy cells from the ravages of chemotherapy and makes cancer cells more vulnerable to treatment, alternative or conventional. It’s interesting to note that many of the biomarkers associated with cancer also turn off whether you do chemotherapy or not just in response to fasting.
Dr. Weitz: Wait, which biomarkers are those?
Dr. Goldhamer: There’s a whole host of … Ranging from acute phase reactive proteins on down. So there’s a whole host of markers, he talks about in his article in Journal of Metabolism 2015. And his conclusion was that the use of fasting in conjunction with chemotherapy dramatically enhanced cancer-free survival and so now, people are beginning to apply these principles in humans as well. And that would be more short-term intermittent fasting. A little different than the long-term medically supervised fasting that we’re … we’ve been discussing up to this point.
Dr. Weitz: I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode, the Rational Wellness Podcast is sponsored by Integrative Therapeutics which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top tier manufacturing of clinician-designed cutting-edge nutritional products with therapeutic dosages and scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally.
Integrative Therapeutics is also the founding sponsor of TAP Integrative. This is a great resource for education for practitioners. I’m a subscriber to TAP Integrative. There’s videos, there’s lots of great information constantly being updated and improved upon by Dr. Lise Alschuler who runs it. One of the things I really enjoy about TAP Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, WEITZ, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year.
Dr. Weitz: And now, back to our discussion. How do you decide what length of fast is appropriate for a patient who comes to see you?
Dr. Goldhamer: Well, a lot of times, you don’t know when you start to fast what’s going to be ideal until you see how the person responds to fasting. Fasting is therapeutic as well as diagnostic. In the case of blood pressure though, we want to fast people until their blood pressures are entirely normal after medication. So it can range anywhere from five to 40 days. Occasionally, people need to fast longer than they have the reserves for and so we’ll have to terminate a fast, rebuild them and then start over again and do it again and you continue that process until the condition is resolved.
Dr. Weitz: How do you determine that they’ve depleted their reserves?
Dr. Goldhamer: Well, we’re monitoring their electrolytes, we’re monitoring their clinical picture, they’re being examined twice a day. So between blood, urine and physical examination, there’s a number of parameters that we use to determine status and fitness and appropriateness for fasting.
Dr. Weitz: Are these patients allowed to exercise while they’re fasting?
Dr. Goldhamer: We restrict activity during fasting. We do have some stretching classes and chair yoga and different things that we encourage them to do, but we do have to limit aerobic activity because once you’ve depleted glycogen stores, the only source of energy for extra muscle or brain use would be breaking down proteins or gluconeogenesis. We want to minimize protein utilization and maximize fat loss and detoxification. So that requires that fasting be done in a resting state.
Dr. Weitz: I saw a testimonial on your website from a woman who had bulimia who went through your fasting program. I thought that was unusual. I wouldn’t … Putting somebody on a fasting program who has bulimia tend to encourage anorexia or more bulimia?
Dr. Goldhamer: Well to be clear, anorexia nervosa and bulimia are completely different conditions. We don’t use fasting for anorexia nervosa which is a neurological condition where people have dysmorphia. It’s a whole different category of illness. Many bulimics or bulimic has a maladaptive response to their dietary issues. They don’t want to be fat, but they are addicted to the pleasure trap, the artificial stimulation of dopamine in the brain that cause … chemicals added to their food like oil, salt and sugar. So a short period of fasting can reboot that mechanism, increase leptin levels, normalize blood sugar levels, get rid of a lot of the biological triggers that stimulate bulimia and so it is possible to use fasting in appropriate selected patients as a means of helping mitigate this aberrant behavior pattern. But typically, the focus in eating disordered patients is teaching to eat healthfully. So generally, fasting wouldn’t necessarily have to be used to be effective in managing their condition.
We do have behavioral cognitive clinical psychologists that do the job of helping people address psychological aspects of it and diet and lifestyle and exercise often help address the physical aspects with fasting does sometimes have a role in helping … Just like for example, in cigarette smoking. If you fast a cigarette smoker by the second or third day, there’s really no cravings for cigarettes anymore. So it’s a way of facilitating that transition off in nicotine. Now, some people say, “Yeah, well they’re so miserable fasting. They don’t even think about cigarettes”, but that’s not really the case. The fact is, the adaptive processes that occur in normalizing function often happen much quicker in fasting. It’s a faster way to get to the end result.
Dr. Weitz: Interesting. So you really see bulimia as completely different than anorexia?
Dr. Goldhamer: It is completely different.
Dr. Weitz: I think most people tend to put in the same bucket of-
Dr. Goldhamer: Most people are mistaken though if you look at the actual condition. There’s a completely different condition.
Dr. Weitz: Okay. So have you had any challenges running a fasting program as a chiropractor?
Dr. Goldhamer: Well, I think running a fasting program as any type of doctor is going to present problems particularly in the past. As a chiropractor in 1984 when I went into practice, they hadn’t had the Wilk decision at this point so the Committee on Quackery or the committee to eliminate chiropractic was still in full force. So doing anything as a chiropractor, that was considered outside the box. Up until even relatively recently, the California Board of Medical Quality Assurance had suggested that fasting or recommending fasting to a patient might constitute such a gross violation to the standard of practice that rose to level of criminal negligence. At one point, I was represented by a criminal defense attorney. So I remember being the first person in my family ever that needed the services of a criminal defense attorney, and my father was very proud. But I did get a lot of advice from other chiropractors though that had served time in prison for practicing chiropractic around in the ’50s. And they said, “Well, just treat the guards and they’ll take care of you”. Fortunately, it never came to that because they cited actually on review at that time, even Medicare had a provision to reimburse fasting but it was … only if it was necessary for rapid weight loss for urgent surgery. So if the patient fasted and got well, it wouldn’t be considered a covered benefit. As far as any hospital in this country to this day will be fasting for certain conditions like if you come in with acute pancreatitis, they’ll put you on IV fluids and no food and use fasting in order to manage the condition.
So once we really got into the weeds on it, I realized that recommending fasting really wasn’t criminal behavior. Now, what’s interesting is recently in large part, because of people like Valter Longo and a gentleman we’ve done some research with, Luigi Fontana at Washington University, we’ve gone from being criminal quacks to cutting-edge researchers because fasting has gained some notoriety and some interest. So we’re doing the exact same things we’ve always done but now, it’s viewed differently and so we’re currently working on a study. We’re about halfway through with the Mayo Clinic. We’re looking at the primary preventing of stroke through the use of fasting and dietary change. We’ve completed a study with Washington University looking at biomarker changes in fasting. They’re counting the number of mutations in B lymphocytes and looking at autophagy. And the gut microbiome, the 1,000 strains of bacteria that live in the gut and how they’re influenced by fasting.
We have completed a study which is called taste neuroadaptation study that looks at the changes in the perception to food before and after fasting. And we’re working right now on a project that we hope to do with Kaiser Permanente where we look at adding to standard Kaiser care this type of a model of intense education and nutritional support at the management of high blood pressure and compare what happens when you educate patients to get them eating well compared to standard medical management. So lots of interesting things going on. We published a number of papers. In addition to our papers in hypertension, we published the fasting safety study. The patient reports in the British Medical Journal on the follicular lymphoma. We have one paper we published on the chiropractic management of subacute appendicitis using fasting and dietary change rather than surgery. We’ve got additional papers on a number of subjects all of which can be found on our website. In fact, our foundation, the TrueNorth Health Foundation is a 501(c)(3) nonprofit research foundation. It has a website, fasting.org, and everything about fasting that people might want to know, they can find just by going to fasting.org.
Dr. Weitz: So you mentioned Dr. Longo. And he’s recommending a super low-calorie program that you do for five days on a monthly basis or something like that. And he claims to get the same benefits that you do with fasting-
Dr. Goldhamer: Well, he doesn’t claim that you get the same benefits that you do with fasting. What he claims is that even just doing prolonged, five days a month which is a 600-calorie, higher fat, low carbohydrate substance, even that is enough to induce some of these changes that are associated with fast. And this is something that patients can do on their own. They purchase this product, they take the product and he’s got some evidence to suggest that that might be helpful. So even not eating greasy, fatty, slimy processed crap five days a month is enough to start inducing biological changes in people. But I don’t think anybody is going to compare a five-day intermittent fasting mimicking diet with long-term water-only fasting. Now, what’s interesting is the Longo group has approached us and we are going to be trying to do some collaborative comparative research looking at long-term fasting which really needs to be on a medically supervised setting, like the TrueNorth Health Center. And the intermittent fasting with products like ProLon and we’ll compare and contrast and see how they can be used independently or possibly together. One of the suggestions they made is we may want to use a product like ProLon as an ongoing source of … to improve long-term compliance, et cetera.
Dr. Weitz: I understand that you believe in a high starch, low fat, low sodium, plant-based dietary approach.
Dr. Goldhamer: Well, a whole plant food diet is about 10% to 12% in calories from protein, about 15% to 18% in calories from fat, with the balance coming from whole plant carbohydrates.
Dr. Weitz: So that’s a high carb diet, a low fat, high carb diet essentially?
Dr. Goldhamer: Well, I think many low-fat diets are advocating less than 10% of calories and fat. So this wouldn’t technically be considered a low-fat diet because there’s still nuts, avocado, other plant-rich sources of whole fat in the diet. So it’s 15% to 18% of calories from fat is more of an intermediate fat diet compared to the lower fat, no sources of plant fats in the diet-diet.
Dr. Weitz: Well, one of the benefits of fasting is to lower blood sugar levels which is why you mentioned that it’s beneficial for Type 2 diabetes. And many advocates of a high fat, super low carb ketogenic diet claim very similar benefits to fasting including improving insulin resistance, inhibiting mTOR, stimulating AMPK, stimulating autophagy as part of an antiaging approach.
Dr. Goldhamer: Okay. So there’s no question that high fat, high protein … and/or high protein diet alone, carbohydrate short term will result obviously in lowered glycemic response, but it’s not a healthful, sustainable long-term diet in my opinion. So when you put people on a high fat, high protein diet particularly, over the long run, there’s all kinds of clinical problems that occur. And even many of the people that advocate these diets advocate them more short term as a fast mimicking kind of effect because they don’t have the ability to say … actually, put a person on an actual fast. Water-fasting isn’t something people are going to be doing on their own at home.
So they’ll implement these diets and over the short run, they’ll demonstrate some good results just getting all the refined carbohydrate diet, just tremendous benefit for everybody. But you need to differentiate an 80% calorie of refined carbohydrates from sugars and processed foods from a whole plant starch-based diet which is the way human beings … what they’re designed to eat. And you can sustain this whole food plant-based diet indefinitely. And we published a data to show what happens when you treat for example, high blood pressure with this approach. You normalize blood pressure and you sustain it indefinitely. We’ve demonstrated the effects of not only normalizing blood sugar levels but the fact that you can sustain those levels as long as you are willing to comply with the health-promoting diet. And I’ve never seen anybody produce the results that we produced in treating autoimmune disease long term. So I think we have to be careful about therapeutic interventive diets that are high in fat and protein versus a sustainable long-term, health-promoting diet consistent with our biology.
Dr. Weitz: So what types of starches do you recommend as part of your program?
Dr. Goldhamer: Whole plant foods. So things like-
Dr. Weitz: What?
Dr. Goldhamer: You have a host of tubers vegetables like Hubbard squash, butternut squash, kabocha, sweet potatoes, potatoes. There are for patients that are not lectin-sensitive. They may be able to eat non-glutinous grains like rice, quinoa, millet, et cetera. And there are also … Again, for people that are able to tolerate beans, there’s lentils, peas and beans. Some patients don’t do well with those products and so we’ll use starchy vegetable materials instead, mostly, your tubers, squash and sweet potatoes.
Dr. Weitz: Sweet potatoes and squashes. And which patients are sensitive to lectins, or how do you determine that?
Dr. Goldhamer: Yeah. Some of the patients that you see having autoimmune-related symptomology, particularly people with gastrointestinal inflammation, ulcerative colitis, colitis, Crohn’s, these conditions, some of the patients that have other manifestations of autoimmune response find they’ll do better at least initially getting rid of some of the more complex products like particularly glutinous grains, but even some standard grains and beans. Again, frankly, for most of our patients, once we get them fasted, get rid of the gut leakage and rotate food back in, some patients can have food once a week but they may not want to eat them every single day because they have some sensitivity issues. But they can get on that whole plant food rotational diet, maintain good clinical outcomes and not have to be as restrictive as maybe other people that have not had the benefit of fasting. If you’re going to do this change without fasting, it can take weeks or months to get the changes that you see in days or weeks of the fast.
Dr. Weitz: Do you recommend whole wheat bread?
Dr. Goldhamer: We don’t use any glutinous grains with any of our products. All of our cookbooks are whole plant foods, SOS-free, so salt, oil and sugar-free and also gluten-free. So we don’t use wheat, rye or barley as grains for any of our patients. And particularly for the third … the patients that are particularly sensitive to that.
Dr. Weitz: All right. Do you advocate eating nuts and seeds and other source of fat like avocado, olives, coconut?
Dr. Goldhamer: For patients that are able to tolerate those, and most people are, we’ll use up to a half an avocado or up to an ounce of dry nuts or seeds today. But we do limit them in the sense that we want to keep the fat around 15% to 18% in calories and fat. If you use unlimited amount of nuts and seeds and avocado, they’re very rich. Percentage of calories and fat goes higher than we think is probably long term ideal and sustainable.
Dr. Weitz: What’s wrong with having a lot of fat?
Dr. Goldhamer: Well, we believe that the patients that maintain the best both weight balance as well as cardiovascular and autoimmune health have fat in the 15% to 18% of calories from that range. You may be able to demonstrate a higher percentage of that intake for some individuals and maintain good clinical results but our general observation has been that when we get the percentage of calories and fat higher, it’s harder to maintain optimum weight control. It’s harder to maintain optimum immunological function. But obviously, there’s a range in people and a range in sensitivity and these are the basic dietary standards that we’ve implemented at the clinic and they seem to work very well.
Dr. Weitz: So why do you recommend a low salt diet? Dr. Nicolantonio’s book, The Salt Fix, where he lays out some pretty compelling evidence that a low salt diet is actually harmful, that a low salt diet increases LDL cholesterol, activates our renin-angiotensin system which actually makes high blood pressure worse.
Dr. Goldhamer: Yeah. Of course, that’s not at all what our experience has been. And again, I think I’ll point to our data. We not only achieved the highest effect sizes ever shown in normalizing blood pressure, we’re able to show you can sustain it. And we do that on a diet that’s between a half a milligram and a milligram of sodium per calorie which is consistent with what any all-natural food diet would be without adding a chemical in the form of sodium chloride to the food. You don’t need to add salt to your food any more than you need to add sugar to your food or you need to add oil to your food. The fact is a whole food diet has a gram … around a gram of sodium naturally inherent in the food which is going to mean everybody except your rare person with hyperparathyroidism or some problem producing glucocorticoids or absorbing sodium. So the idea of salt though, you want to be real clear about it, salt is a essential nutrient without which you die.
But you don’t need to add any added fraction of salt, you get the sodium in your food. That’s one of the reasons you are very sensitive to sodium intake is you … if you pick that up, it’s one of the essential nutrients you need. The problem is that salt, if you think about it was used as a preservative. So in those times, before refrigeration was a viable commodity, salting the food allowed to be antibacterial. When you add a high salt diet, think about the five pounds of bacteria that live in your intestinal tract. It may not be the very best thing to be doing is putting a concentrated preservative agent into the intestinal tract and you’re trying to maintain normal balance of 1,000 strains of bacteria. Salt also has a powerful stimulation of passive overeating. So one of the reasons why excess salt makes people fat is because of the stimulatory effect it has to the apathetic mechanisms. For example, if you’ve given an animal or a human, let it eat its satiety … to satiety of a certain thing, say, you’re eating rice or something, whatever. You’ll eat a certain amount and you … eventually, you feel satiated or full. If you take that same animal or that same person, everything else being equal the next day, give it the same exposure but salt it up, they’ll eat significantly more before they reach satiety. And some people say, “Well, that’s because it tastes better”. Yeah. Well, that’s what tasting better means, is stimulating dopamine production in the brain. And it can lead to stimulating the cram circuits and overeating. When you do that consistently, it helps make people fat. Salt causes people to retain fluids particularly the third of the population that’s highly salt-sensitive. And if you look at hypertensive patients, it’s the majority of them. So what happens is until you reduce that sodium intake, it’s very difficult to achieve and maintain normal blood pressure. So the idea that adding … not adding chemicalized salt into the diet is some kind of limiting factor I find inaccurate and inconsistent with our experience.
Dr. Weitz: Now, isn’t salt a way that we supplement our population with iodine to prevent goiter?
Dr. Goldhamer: Yeah, it is. We’ve decided to add one chemical to another chemical and so that’s common with getting … And for people that live for example in the Midwest where the soils aren’t naturally high in iodine because they’ve never been covered by the oceans, that could be a serious problem if you didn’t supplement iodine, or if you didn’t use foods that are naturally high in iodine like for example sea vegetable materials. If you include a little bit of kelp or a little bit of dulce things, you’re going to get some additional iodine that way. If you get vegetables growing on soil, it is iodized, and vegetables do contribute significant quantities of iodine. But it is a theoretical limiting nutrient because plants don’t have to have iodine in order to survive so like Vitamin B12 which needs to be supplemented on a whole plant food diet, iodine and Vitamin D or other nutrients have to be evaluated to make sure that you’re getting enough sun exposure to form your D. You’re getting plants that have iodine or take an iodine supplement or sea vegetables in order to ensure that iodine is adequate in the diet, you don’t need to add salt though, is the only source of getting iodine, and I think it’s a poor choice.
Dr. Weitz: So do you advocate everybody take a multivitamin that contains iodine-
Dr. Goldhamer: I do not recommend a multivitamin because there’s many nutrients in multiples that are frankly harmful. And not the least of which would be iron, some limitation at males for example, Vitamin A is-
Dr. Weitz: Well, most of us are not putting men on multivitamins with iron in it.
Dr. Goldhamer: Yeah. So the point is we wouldn’t recommend taking any nutrient other than the nutrients that you think you have clinical justification for recommending for that given individual patient. So the only nutrient we recommend routinely in the inpatients is Vitamin B12. And then beyond that, it would depend on patients, their diets. I think the best source of most nutrients is diet and for people that get all of their calories from whole natural foods, concentration of most common nutrients can be good. If it’s not, then you can supplement nutrients that are necessary but the host cell just to be sure I think has as many potential problems as it has benefits.
Dr. Weitz: Now, don’t we see in some of the healthiest populations, dietary patterns that are much higher in sodium like the Japanese diet, the Korean diet, and the Mediterranean diet, these all contain moderate to higher amounts of salt than you’re advocating?
Dr. Goldhamer: Yeah. You do see differences in population and different disease patterns. What I’m really talking about here is what we found as the most effective way of both achieving and then maintaining health long term. And a lower sodium intake offered to thousands of patients that we’re monitoring now appears to be a very helpful way. And when you really think about it, right now, salt is more popular to think as a critical … they’re adding to the food.
You could make the same kind of argument for sugar, you could make the same kind of arguments for oil. People like to hear good news about their bad habits and it’s difficult to adapt to a low-sodium … It takes people about a month to adapt to a low-sodium diet without fasting. It happens a little bit quicker with fasting. Once people make the adaptation though, then they like their food without adding this artificial stimulatory chemical to the product and they function and do quite well.
Dr. Weitz: I think one more thing on the sodium is I think there’s been quite a number of studies showing that lowering sodium intake had no appreciable benefit for hypertension.
Dr. Goldhamer: Yeah. Lowering sodium intake from very high to only moderately high doesn’t seem to have much of a threshold. They’ll say the same thing with eggs. If you’re already on a high fat diet and you add a couple more eggs, it doesn’t make much difference. You have to look at those studies with a little bit … kind of a greener kelp because what they’ve never done is actually look at what happens when people actually go on a health-promoting diet? They’re talking about, “We’ll drop the sodium from 3,000 to 2,400 milligrams. We don’t see appreciable changes”. Look at our outcome data. A hundred seventy four out of 174 people with hypertension achieved normal blood pressure and the people that sustained the diet sustained the results. If you can give me better data, then I’ll look at modifying the program but right now, that’s the large effect size that I’ve seen and it’s certainly consistent with the results we’re seeing at the TrueNorth Health Center.
Dr. Weitz: So you think eggs contribute to heart disease?
Dr. Goldhamer: Well, I don’t know. We don’t use any kind of animal products. Meat, fish, eggs or dairy products in any of our food so I’m not an expert on what does or doesn’t happen with these … not something that we use in the diet at all.
Dr. Weitz: And why don’t you use any animal products?
Dr. Goldhamer: Because I believe that the negative effects, the biological concentration concerns with animal products, the excess fat and protein and the effect that that has on heart disease and cancer, not to mention the moral, ethical, spiritual, environmental impact to the animal-based diet. Make it better to adopt the whole plant food, SOS-free diet than it does to dabble in the biologically concentrated that became flesh, coagulated cow pus and chicken [inaudible 00:39:57].
Dr. Weitz: How do you get enough omega-3 fats?
Dr. Goldhamer: Well, there are some foods that are very rich … some plant foods, very rich in linoleic acid. For example-
Dr. Weitz: Yeah, but very small percentage of that gets converted into EPA, DHA.
Dr. Goldhamer: Well actually, I’m not … I don’t think I completely agree because there is a difference in some people. Some people do have conversion issues at the … where their percentage are going to be small than others. But in our experience, most patients during … getting a 15% to 18% of calories from whole plant food diet are able to maintain acceptable levels of DHA. If you were concerned about it, you can use a vegan DHA supplement from our tech. They have lichen-based DHA supplements or DHA, EPA supplements. So if you’re concerned about it, that would certainly be a way of increasing DHA without necessarily having to use higher fat intake foods. But in most of our patients, they’re able to maintain normal essential fatty acids without having to resort to supplementation but certainly an option if a person has conversion issue.
Dr. Weitz: Well I mean my understanding is, even at best, you’re looking at 12% to 15% in somebody who’s really efficient so that means depending upon what you think is optimal level for-
Dr. Goldhamer: Well, that’s the debate, isn’t it? There is no real clear-cut scientific literature of what’s optimum levels of circulating DHA. So even when you’re doing testing, it’s not absolutely clear yet. What’s optimum? What’s suboptimal? There’s legitimate debate amongst people. But my point is the answer would be … could be supplementing with a pre-formed DHA from algae. That’s where fish and other animals make their DHA. You can go to the source and use the supplementation of DHA, EPA that’s perfectly acceptable at any those that you decide clinically that’s necessary.
Dr. Weitz: Sure.
Dr. Goldhamer: A lot of people are using these pharmacologically. They’re trying to increase DHA in order to suppress inflammation associated with autoimmune disease. We’re actually going a step further which is getting rid of the source of the autoimmune disease and once the pain is gone and people are less concerned about pharmacologically managing it with a less toxic substance.
Dr. Weitz: Well, many of us are trying to get to the root cause of autoimmune disease. Some people see inflammation as one of the causes, other people … in some people, it’s probably a series of different triggers including food sensitives and then … So-
Dr. Goldhamer: When we really get down to the basics, the things that we have the most control of are diet, sleep and exercise. And the point I’m making is if we control diet, sleep and exercise, oftentimes, we get significant improvement clinically so the need to for example, get rid of the pain because we’re taking high dose of DHA trying to suppress … that goes away. So their CRP is normalized, their acute phase reactive protein is normalized whether we’re dosing it or not. If they don’t, I got no problem. Do whatever you have to do clinically to get clinical control. But a lot of times, people have never gone the extra step to get people on a whole plant food, SOS-free diet, get them sleeping adequately, get them exercising appropriately and until … And that’s one of the advantages of an inpatient facility is we have highly motivated people that will do all these things. And when you do that, you start seeing all the pills, potions, powders and treatments are really the feathers on a rattle. They’re not the core. The core is diet, sleep and exercise. And when you fully implement diet and sleep and exercise, you get the results that we see at the TrueNorth Health Center. I’m not saying it’s practical. If you enter an outpatient practice working with people that are … you’re having trouble getting … even quit smoking, our approach is going to be necessarily useful. But for the people that are really serious about getting healthy and they’re willing to do anything, even eat well or exercise, go to bed on time-
Dr. Weitz: Wow.
Dr. Goldhamer: See a chiropractor. Do a fast. Really radical things. These are the results that are possible. So again, I don’t pretend that you could extrapolate this to the whole population. That’s not what I’m suggesting. But in the appropriate people, this is a really cool approach and it doesn’t prevent you from saying, “Okay. We’ve done all that and now, we’re still having some stuff. Let’s look at our options whether they’re medical options, whether they’re nutritional medicine, Functional Medicine”, that’s no problem. I have no difficulty doing whatever you have to do clinically to move a person the right direction. But let’s not pretend that the answer is of the pill, potions, powders, that that’s the fundamental problem. It may be the necessary clinical application, but it’s not the fundamental deficit. That’s going to come back down to first level therapeutic order interventions in the naturopathic world.
Dr. Weitz: I think most of us, at least most of the people in the Functional Medicine world, integrative medical world and I know and speak to all agree that the fundamentals are sleep, exercise, nutrition, stress reduction, et cetera. And using things like nutritional supplements are only to be used once those pillars are in place.
Dr. Goldhamer: Absolutely.
Dr. Weitz: The question is what is the best dietary approach? What is the best exercise approach?
Dr. Goldhamer: Right. Right, and I think those are all perfectly legitimate debates. But I also think that it’s up to those of us that are advocating radical interventions and what we do is considered radical to prove it. That’s why we have federally chartered IRB and we’ve got a nonprofit research organization. We’re trying to publish the results of what we’re seeing. If it can be done better, that’s great. We’d love to know how to do it better. We’re open to that but at this point, for example, when we treat something like high blood pressure, I haven’t seen anybody that’s getting better consistent results than we’re demonstrating using this model. Until we do, it’s hard to rationalize doing a lot of intervention and unfortunately, there’s a big bias including in Functional Medicine where practitioners are making their living off of selling the treatments and the pills and the potions. Whether they realize it or not, sometimes there’s a bias there that involves what those recommendations are making.
There’s also a problem of practicality. Because people don’t want to quit smoking and drinking, they don’t want to give up their meat, fish, fowl, dairy products and sugar and processed foods, they’re trying to do the next best thing. Dr. Longo, for example, tells people look, you eat whatever diet you’re going to eat but just five days a month do ProLon. Why? Well, because he knows that it’s very difficult to tell people what to eat, do ProLon and then in between let’s adopt this health promoting diet, regardless of what your individual beliefs might be. Our program trains doctors. We have, for example, Texas A&M has a functional medicine training program for physicians. They have their family medicine functional medicine focus and their students can rotate for a month, spend some part of their training at the treatment health center. One of the most common things that these doctors say when they come through is they say, “Wow. It’s the first time I’ve ever seen patients with these conditions actually getting well.” We’re essentially doing nothing. We’re getting out of the way. We use fasting to normalize the system. We feed them a whole plant food diet. We get them to exercise appropriately, use their body properly, try to get them sleeping properly. There’s no magic pill, potion, powder stuff and yet we’re seeing consistent results in the conditions that we’re selecting for. The conditions that respond best to this are conditions caused by dietary excess. That’s why high blood pressure and diabetes respond so well. There are other conditions, neurological conditions. Conditions that are primary mechanical in nature. You wouldn’t just … That’s why we have chiropractors and naturopaths and acupuncturists, people that do different kinds of intervention when that’s necessary.
Dr. Weitz: I think what you’re doing is extremely admirable, commendable, the fact that you’re doing the research to actually prove that the interventions you’re doing are effective. I think that’s great. We need a lot more research in that regard. But I would like to stand up for some of the other Functional Medicine practitioners who are not using your fasting approach. We all have our tendencies in the things that we have found to be useful and a lot of us have found that when you take somebody who’s on a typical standard American diet and they’re suffering from all these different chronic diseases, which we know are all related to problems with the way they’re eating and lack of exercise, et cetera, et cetera, and exposure to toxins and exposure to mold and all these other things and most of us have found that, at least in a big chunk of patients, 50% or more, we use some of these interventions and people feel better for the first time in years and decades. Just like you are prejudiced towards fasting and have found great results, a lot of us have found great results using different sorts of nutritional interventions including the prudent use of nutritional supplements.
Dr. Goldhamer: Sure.
Dr. Weitz: We’re not necessarily only using nutritional supplements because that’s how we make our money or because we’re prejudiced towards those. We’re using those because we found that they’ve been really efficacious for our patients.
Dr. Goldhamer: Right, so the thing I would challenge doctors though to think about is that–I teach at a lot of the naturopathic colleges, and they talk about first level therapeutic order intervention. You don’t really get paid to do first level therapeutic intervention. You get paid to do procedures and provide product and so what happens, a lot of times, is there’s a skipping over the time-consuming, difficult educational part of really teaching people how to live healthfully or the advice that we’re giving them.
Dr. Weitz: That’s only if you’re in the insurance model, right?
Dr. Goldhamer: Yeah, whatever. The naturopaths are not an insurance model because they’re not covered by insurance. They’re in a cash-based model and yet, they’re still skipping over that time consuming, in my experience, and jumping into the pill, potion, powder stuff. I think the power of naturopathic medicine is really in that first level therapeutic order of intervention which is what we try to do at TrueNorth Health where we have the luxury of having patients living with us for anywhere from a week to a year. You can really see what happens when you fully control that environment. It’s very empowering. I’m not sure what the best strategy is on an outpatient basis. That’s 35 years of inpatient work, but I do see that the results that I’m seeing and that we can demonstrate and document are very consistent. I don’t see a lot of stuff coming out of the outpatient practice that’s documented to the level where it makes us want to try to implement those recommendations. You hear a lot of stories but I’d like to see those documented. I’d like to see the outcome data and I think that’s weak.
Dr. Weitz: There’s quite a number of … I guarantee there’s a lot more studies on the Mediterranean diet than there is on fasting. There is now quite a number of studies on the Paleo diet or the ketogenic diet or different dietary interventions.
Dr. Goldhamer: Yeah, I’ve looked at those studies and the good news is, anything you compare to the standard American diet is likely to demonstrate some improvement. Something being less bad doesn’t necessarily make it good. I think, again, in terms of critical evaluation about long-term sustainability, you’ll see a lot of the stuff. When people put people on high protein, high fat diets is they do well for a while because they get the fasting blunting effect of ketosis, whether they’re getting into ketosis, that they’re not as hungry, they lose some weight for a while, but then long-term, you see the devastating consequences. Their gallbladder, their digestive system, increased risk of cardiovascular disease, iatrogenesis, I’m not so sure depending on how you implement it.
Dr. Weitz: That’s not necessarily the case. If you monitor patient’s lipids, they don’t necessarily have devastating effects on lipids.
Dr. Goldhamer: I’m talking about more long-term effects and particularly for the patients right now that we’re seeing coming in that have made it a good faith effort with high protein and high fat animal-based diets. We definitely see consistent and predictable results they’re having long term.
Dr. Weitz: Since most cholesterol in the body is produced by the liver, then what’s the problem with having a high animal fat diet?
Dr. Goldhamer: Well, I think that the problem is a question of super saturation. Yeah, most of your cholesterol’s made by your biotin, a necessary and essential nutrient, but when you super saturate the system then you begin to develop the problems. It is pretty well demonstrated that an association between higher or both refined carbohydrates and higher fat, high protein diets. We see it in patients when they’re trying to regulate these conditions particularly the autoimmune conditions and we can turn it on and off depending on what you’re putting in their mouth.
Dr. Weitz: I’m with you on the high refined carbohydrates and sugar, but I don’t think we’ve really settled the question of whether higher animal fat diet is associated with more heart disease or not. The American Heart Association is still relying on some of the same studies from the 1960s to advocate for a low fat, higher carbohydrate diet and consider the fact that the liver is producing cholesterol from glucose, not from saturated fat.
Dr. Goldhamer: Well, we’re not arguing with you on that point. I agree, refined carbohydrates are one of the things we eliminate. We also eliminate animal products and oil, salt, and sugar. What we’re down to is just whole plant foods, fruits, vegetables, grains, legumes, nuts and seeds. I think that although grains and legumes are not necessarily going to work well for all patients, some people do have sensitivity issues. The idea of eating those whole plant foods, you can debate whether you want to include animal foods in there or you don’t want to include animal foods in there but this idea of a whole plant food diet I think is finding at least some general consensus amongst most people. Certainly, people that experiment with diet will find, I think, the simpler they get their diets and the more they get it back to whole foods, not highly processed, fractionated foods. I get into trouble with the National Vegan Conferences that I lecture at saying that as bad as animal foods might be, with various issues, a lot of these highly processed vegan food may be actually even worse. When you tell people they’d be better off eating meat than some of these processed, you get into a lot of trouble. Basically, I don’t like any of it other than whole foods. I would argue on the idea that animal foods themselves, not dairy products so much but meat and stuff is a whole food. If you’re going to eat meat just like you eat anything, we recommend, obviously, you get animals that haven’t been fed garbage and et cetera, et cetera. I do think like nuts and avocado and other rich foods, you can overdo it. When you do overdo it, we see consequences physiologically. Now then the only question is, what’s over doing it? Maybe there’s some variation amongst individuals too about what their tolerance to these factors.
Dr. Weitz: I think there clearly is.
Dr. Goldhamer: Yeah, that may very well be the case. We have a model with the conditions that we treat that we use universally and that is a whole plant food, SOS-free diet. We know what those constitutes are and we’re able to monitor the outcome data and the outcome data is consistent. It doesn’t mean it’s the only way to do it. It doesn’t mean it’s the best way to do it but we’re at least making an effort to publish the demonstrable results. We lay out the protocol and then people can decide for themselves whether that’s going to be appropriate for them or for their patients.
Dr. Weitz: Great and the more data we get, the better.
Dr. Goldhamer: Absolutely, but I think that we certainly don’t have enough data arguing our case but I think that people have this impression that there’s this vast amount of clinical outcome data on these nutritional issues and there really isn’t. Some of the data that’s there isn’t as strong as it should be so we’re trying to do our part of improving that and particularly looking at long-term outcome data.
Dr. Weitz: It’s very difficult to get good nutritional data, especially when so many of these studies are using these food frequency questionnaires which are like a joke. I just saw something about … I think the headline was red meat causes something bad and they followed people for five years. The way they monitored this was they gave them a four-day food frequency questionnaire at the beginning of the study and after five years that’s supposed to account for the way they were eating. I mean that’s not accurate.
Dr. Goldhamer: Yeah, of course, it’s not rocket science. The conclusions that are driven are often times weak as well. We are in the process right now of validating a food questionnaire for this type of a diet. We are doing this with our colleagues from Cornell. It’s very difficult. It’s challenging to come up with reliable and then validating the data takes a lot of effort and work and you can’t do studies that, like you said, where you have a single intervention and then try to do long-term conclusions. You have to be able to do ongoing monitoring. We’re fortunate though we’re in a position where we have a long-term relationship with these patients that are involved in these studies because we have to, for example, in our lymphoma patients, 10% of the patients go through spontaneous remission with lymphoma but they typically don’t sustain it. Unless you have good long-term outcome data, nobody is really that impressed. We are in a position to be able to do long-term tracking and monitoring of these patients. We’ll find out if we’re right and everybody else is wrong or if we need to improve or modify our stand. I would say that if the data is strong, we’re happy to evaluate, modify and we’re happy to study whatever it is that makes some kind of logical sense. We believe that what we do makes sense. We’ve written a book called The Pleasure Trap. We’ve laid it out. We’ve referenced it and we’re open to whatever suggestions or criticism people want to give us.
Dr. Weitz: Awesome. How can our listeners find out about your TrueNorth Health Center and what do they need to do if they want to come there?
Dr. Goldhamer: We have a nice service for your listeners. If they’re interested in knowing whether we think fasting and this approach might have some use to them, they can go to our website at healthpromoting.com.
Dr. Weitz: Say it again. What is it?
Dr. Goldhamer: healthpromoting.com
Dr. Weitz: healthpromoting.com. Okay.
Dr. Goldhamer: If they go in and they fill out the registration forms, it gets me their medical history, we offer a no cost phone conversation where I’m happy to review their history with them and talk to them about whether or not there’s anything we do that might be relevant. If they don’t live near us, we have a number of doctors that we’ve trained around the country we can refer them to their medical facilities that do medically supervised fasting if that seems to be appropriate. All of our studies, all of our papers, are freely available on our website. There’s also something called TrueNorth TV on there. It has all the video links. There’s a lot of information that people can get. We have three cookbooks out there. There are vegan, SOS-free cookbooks so you can show people how to make food simple, even simple enough I can make it. That’s kind of cool.
Dr. Weitz: Awesome. Thank you Dr. Goldhamer.
Dr. Goldhamer: It’s my pleasure. It’s nice talking to you.
