Fasting and Very Low Calorie Diets

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Dr Wright

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How long do you think you could survive without eating at all? You can fast about a month for every 20 pounds of stored body fat. An average, normal weight adult can fast for about 60 days before they have used up all their fat stores and they starve to death. In the 1970s, under the care of his doctor, a man that initially weighed 455 pounds fasted for 382 days and lost 277 pounds.

During prolonged fasting and starvation, your brain is able to gradually change from eating only glucose and begin using another energy source called ketone bodies. Your liver makes ketone bodies out of fatty acids. This change in your brain from using glucose to using ketone bodies for energy is gradual over many days. By the time you have fasted for a week, your brain can get about 7 out of 10 calories that it needs from ketone bodies, but still needs about 3 out of 10 calories from glucose. After 2 to 4 weeks, your brain has fully adapted to starvation and gets about 9 out of 10 of its calories from ketone bodies. But because your brain still requires about 1 out of 10 of its calories from glucose, your body will still break down and eat some of your muscles to feed your brain.

An extreme form of dieting is called the protein-sparing very low calorie diet. It is sometimes also called a protein-sparing modified fast. People on this diet eat only about 500 calories of food per day. If you are fasting, your body will break down your own muscles to make glucose for your brain. If you are trying to lose weight, it is important to preserve your muscles, because muscles efficiently burn fat and if you have more muscle mass you will have a higher resting metabolic rate. To preserve your muscles, you need about 500 calories per day of carbohydrate or protein to supply your brain with the glucose it needs and prevent the breakdown of your own muscle tissue.

People on this diet also take vitamin and mineral supplements – including extra salt and potassium - every day. They are also told to drink about 2 liters per day of water. It is important if you decide to undertake an extreme diet like this that you have medical supervision.

People who strictly follow this diet, eating only 500 calories of protein per day, lose about 5 to 10 pounds (2-5 kg) in the first week, partly due to loss of water when they use up stored glycogen. Then they lose about 2 to 4 pounds per week (1-2 kg) for women and 3 to 6 pounds (1.5-2.5 kg) per week for men. Heavier people lose weight faster because of their higher resting metabolic rate. The usual amount of weight lost is about 15 to 20 pounds (7-10 kg) in one month, 45 pounds (20 kg) in 3 months, and 70 to 90 pounds (31-41 kg) after 6 months.

This is some very impressive weight loss. It takes a very motivated person to undertake an extreme diet like this. But as you can see, if you eat very few calories, you will definitely lose weight. So why do we not recommend a diet like this more often? The answer is that it doesn’t work well in the long term. When the diet ends, people return to their old habits and eating patterns. When we go back to our prior way of eating, we go back to our previous body weight.

Within about six months of completing a very low calorie diet, more than half of the patients have regained more than half of the weight they had lost. Within a year, people are still usually at a lower weight than they would have been if they had never dieted, but they are not at a lower weight than people who followed a more normal, less extreme diet plan.

A better goal for a low calorie diet is to eat between about 800 and 1500 calories per day. On average Americans eat about 2,700 calories per day. According to the Dietary Guidelines for Americans, most moderately active women who are not trying to lose weight need about 2000 calories per day, and men need about 2600 calories per day. On a low calorie diet, women aim for a goal of eating 1000 to 1200 calories per day. For men the goal is 1200 to 1500 calories per day. This is about the same number of calories per day as the average person living in poor areas of central Africa eats. If you are able to eat this few calories every day, you will lose weight.
 
this is absolutely the WORST advice you can ever give to people. To come up with a generic calorie range to try to fit the members here who probably need more. As a doctor, shouldn't you be offering the Harris Benedict formula for calculating how many calories one needs?
 
This post is about “Fasting and Very Low Calorie Diets”, attempting to explain why fasting or extremely low calorie diets are not likely to be successful for long term weight loss. Most dieters will have better long-term success if they chose a more moderate calorie restriction goal, in the range explained in the post above.

A previous post of mine titled “Making Sense of the Resting Metabolic Rate” explains in more detail daily caloric goals if a dieter wants to be more precise, and includes the Harris Benedict equation. That post can be found here: https://weight-loss.fitness.com/threads/making-sense-of-the-resting-metabolic-rate.81799/
 
"To preserve your muscles, you need about 500 calories per day of carbohydrate or protein to supply your brain with the glucose it needs and prevent the breakdown of your own muscle tissue."

What? If you produce ketones it'll be by transforming fat first by ketogenesis. eating 500 calories of carbs would negate ketosis.
 
Ketosis is a desirable outcome for many, protein levels must be kept at adequate levels and good muscle and strength can be built while maintaining a ketogenic diet.

Dietary Ketosis with adequate protein and moderate calorie deficit = fat loss and minimal muscle loss
Dietary Ketosis with adequate protein and moderate calorie surplus = Muscle gain with minimal fat gain

This way of eating can be maintained for years with significant health benefits, I have maintained this style of eating for many year and know of many others who have done this for 10+ years.
 
"To preserve your muscles, you need about 500 calories per day of carbohydrate or protein to supply your brain with the glucose it needs and prevent the breakdown of your own muscle tissue."

What? If you produce ketones it'll be by transforming fat first by ketogenesis. eating 500 calories of carbs would negate ketosis.


You are confusing very-low calorie diets with low carbohydrate diets. Ketones are made by the liver to feed the brain when there is not enough glucose available. When your brain is using ketones for energy you will feel less hungry, so it is helpful to be in a state of ketosis in a low carbohydrate diet. But in addition to fats, a low carbohydrate diet provides adequate amounts of protein so your body does not need to metabolize its own proteins.

In a very low calorie diet the goal is not to maintain ketosis, but instead to provide the brain with enough glucose for energy so that your body does not break down its own proteins in order to make glucose. The rest of your body, besides the brain, can directly use stored fats for energy and does not need the liver to first turn fats into ketones.
 
I'm not a professional, but I personally follow an AMAZING plan which entails intermittent fasting, for 1-2 days a week. I have significant results for a while now. Easy, sustainable and I still have good muscle mass. I'm a fan.
 
Fasting or skipping supper as a method to lose weight is good in my opinion, but shall consult first with a nutritionist.
 
I think the best stuff is to cut down on bad calories such as sugar, take the bicycle to work and combine this with any proven method for losing weight. So did I and lost 6 pounds in just 2 weeks.
 
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