[Music] hi good morning and thanks for thanks for inviting me Sam this is a great pleasure to be here I'm just gonna dive right in but before I start I just wanted to say that Sam has actually been very important in my kind of evolution because a few years ago about three four years ago as I was starting to think about these ideas of weight loss and obesity and so on I read on the Internet this young guy who has decided to do his this this experiment on himself where he would you know eat the 5,000 calories I'm like this guy's like crazy right this guy's really dope so it's like okay and so he had two really different diets of 5,000 calories and so he every day he would measure himself and was really fascinating was that it really crystallized for me the the the failure of this sort of oh it's all about calories calories in calories that model that has really been the kind of failing of all of us and that's why we have this obesity epidemic and that's really what we're still fighting against and thank you Sam for that as well so I'm dr. Jason Fong I'm a nephrologist and just I did give one talk for AstraZeneca at a request of a friend but otherwise I don't take any consulting fees or anything from pharmaceuticals further disclosure I have two books one is about obesity and one is about fasting and that's what I'm going to talk to you about today which is a sort of a new idea it's not a new idea but it's one that has fallen out of vogue and how we can use it really to help ourselves and help ourselves stay well so some of you may know this show The Biggest Loser it's a very popular show all across the world really and what it does is it pits contestants against each other and they're obese and they try to lose the most weight whoever loses the most weight at the end of the show is the winner and what's very interesting is that they do very well but Suzanne Minh donk on season 2 said no NBC never does a reunion why because we're all fat again and that's the truth of it and anybody who's been on it knows this so what's interesting is that you can look at what the sort of diet and exercise regimen they use and what they advise is for you to reduce the amount of calories that you take in so they were eating somewhere around a 1200 1400 kilocalorie diets and they exercise a lot so that's what you see on the TV show they spent 8 hours 10 hours exercising so this is really the classic sort of advice that we as doctors had given people so reduce your portions eat a little bit less move a little bit more except this was kind of on steroids for TV and this is the reason why it gets ranked very well so even so the US News for example they will rank diets and they gave this kind of the number 3 overall weight lost I had 11 them a number 11 overall so behind only a few diets out of like 30-something diets so it's really supported by the establishment but where's the evidence that this really works and that's what's really lacking so it's not like we don't have evidence for the calorie reduce diet we do so if you look at the today's study for example you see on the Green Line it's metformin so everybody got metformin this was a study in diabetics and they either got rosy glitters own metformin alone which is the middle line and metformin plus lifestyle so this is a sort of eat less move more so here's a randomized controlled trial of a lifestyle intervention they eat less move more approach compared to say metformin long so at the beginning of the if you look at the Green Line for example so if you look at the Green Line you start off at time 0 with a body mass index of 34 and so after all this time you see 60 months so 5 years your body mass index is 34 so that was worth it right five years of exercise and weight loss and your body mass index is identical and the really tragic sort of part is that it's only identical because you had this real push at the end to drop it otherwise you would have been kind of heavier than you were and that's that's that's what the randomized control trials tell us right we profess that we live in an era of evidence-based medicine and here's the evidence so this is the diabetes prevention trial so again this is the lifestyle intervention so yet at the beginning of time you start with zero kilograms initially you do lose weight and again if you're ever dieted which is probably like 95% of us this is what happens in the first six months you do very well so six seven kilos off but then at the end of it there's no difference at the end of five years whether you did anything or you did nothing so again we say that this sort of intervention works we profess that it does work but the randomized control trial says it doesn't work and really the biggest trial of nutrition that's ever been done was the Women's Health Initiative which was published in 2006 so this is not new data this is data that's more than ten years old and we all know what happens here if you start at baseline seventeen hundred and eighty eight calories that they reduce three hundred and sixty calories per day that's pretty good and they increase their exercise so if you look at metabolic equivalents per week they went from ten to eleven point four so you increase your exercise by roughly 10% 11% something like that so terrific so you decrease your calories by 360 per day and you increase your exercise so the calorie counters they expect it somewhere around 30 pounds of weight loss per year because they're saying oh yeah you should lose a pound per one or two weeks what actually happened of course is this at the end of nine years so first year one you did very well but be eat less move more at the by the end of the trial by eight seven eight years there's not even a single pound of difference between the two right and this is a randomized control trial so here's three randomized control trials if they eat less move more approach and it really hasn't worked at all so this is the this is the translation so we've proved again and again and again through trial data evidence that it doesn't work and our clinical experience relief says the same if you look at the UK general practice database so over ten years 2004 to 2014 this is what your results are so if you're obese your probability of achieving a normal weight is 0.6% if you're morbidly obese is 0.1% so in other words you have about a ninety nine point four percent failure rate okay this 80% with 10% weight loss will regain within one year so therefore what what we see is that it's almost guaranteed to fail but at the same time that we know that it's guaranteed to fail what we tell people is eat less move more right none of these approaches has any proven merit this is from one of the sort of Bibles of diabetes Jocelyn's weight loss the handbook of obesity and the all of them say the same thing dietary therapy is the cornerstone reduction of energy intake is the basis of successful weight loss reduction but we know that the results are known to be poor and not long-lasting so how can that be the basis of your advice if you know it doesn't work like are you not just setting people up to fail so that's that's the problem experts say that it's guaranteed to fail so our best advice is to do that okay I mean holy like this is the best the the geniuses at the NHS can come up with so there's two problems with this sort of eat less move more approach and they're fairly well known but one is a slowing metabolism okay so if you eat less calories your meta metabolism slows down again not really new data this comes from nineteen seventeen so this is one hundred years ago that they knew this they took people and they were eating about 2,500 to 3,000 calories they cut it by about thirty percent so they put them on these semi-starvation diets around 1,400 to 2,000 calories so not that low compared to what a lot of people recommend these days and what they found was that the people found themselves almost impossible to keep warm what the reason is is that their metabolic rate so this is the energy that you expend to keep your body sort of running so this is to keep your heart pumping to keep your lungs moving to keep your liver working to keep your brain going it decreased by about 30% so if you reduce your calories and by about 30% your body responds with a decrease in caloric expenditure by about 30% so that's why you feel so cold because you're not generating the body heat because it takes energy to generate body heat and then afterwards you you immediately eat and then regain that weight so that was a hundred years ago that they showed this in the Ancel keys is biology of human starvation they showed the exact same thing so despite the title it was not actually a starvation study in fact what it was was a calorie reduced diet which is about 1,500 calories which again a little bit shocking these days to realize that this is the level that most people recommend so if you talk to people who were you know advised weight loss you should be cut your calories to about 1500 and again it was about a 40 percent reduction in caloric intake and it was almost immediately matched by a 40 percent reduction in metabolic rate and here they measured very detailed measurements of physiology where they found was the heart volume shrank by 20% the heart rate slowed the body temperature drop so again the heart needs energy so you get less energy so therefore you reduce your heart rate you do to reduce your stroke volume body temperature drops and so on and again if you move into the modern era we have the exact same data showing that there's a very close matching of caloric intake and caloric expenditure so this is a very nice study by Rudy Leibel in 1995 so again not new data 20 years old and what he did was he took volunteers and he manipulated their way he used the sort of a shake thing so he can control their very precisely and he made them gain weight 10% and then he moved him to a normal weight and then he made them lose weight and then he measured their energy expenditure at each of those points so an initial weight as they gain weight what happens to their calorie expenditure well it actually goes up so you're burning almost 500 calories per day more than you did before so your body doesn't simply keep storing it it actually is trying to burn off all of those calories that you put on as you move back to your initial way you see it goes back to normal and as you lose weight your caloric expenditure drops it drops by about 300 calories 400 calories per day so again all the studies show the same thing so as you overfeed people their calorie expenditure goes up as you under feed people the caloric expenditure goes down so what happened in the Biggest Loser well here's the data so what was interesting is in one of those seasons they actually got permission to study their metabolism and this is what happens to them so over the the time period of the show you can see that they lost a lot of weight so if you look at their weight loss it's almost 60 kilos at the--at week 30 so really really impressive and it's not all muscle loss you see that the majority of it is fat loss oh wow that's terrific they dropped from an average of 329 to 202 pounds and body fat percentage went from 49% to 28% so really really fantastic results well what happened to their metabolism well here's what happened their metabolic rate goes down in every single case so you see for example this poor guy who starts off burning 35 3,600 calories a day at the end of it he is burning about 17 1,600 calories a day he dropped 2,000 calories per day of energy expenditure that's a huge hurdle if you're going to try and maintain that weight loss it's almost impossible because is he eating less oh hell yeah he's eating that but it doesn't matter because if you even if you're eating 2,000 calories so assuming that he's at 35 3,600 he's eating 3,600 and staying stable even if he eats 2,000 calories this poor guy is gonna gain a heck of a lot of body fat and that's because of his slowing metabolism so people assume that you can make up for it with exercise right that's what the show says you can make up for with exercise you can't so even at the end of week 30 which is the end of the show where they're doing amazing you can see that their basal metabolic rate which is divided between kind of this is the basal metabolic rate this is the exercise sort of portion so this is the kind of resting metabolic rate this is the non resting so the kind of exercise portion so as they're losing weight it's already going down but they're making up for it with like eight hours a day of exercise and you can't stop it they haven't been able to stop it that exercise is not increasing your metabolic rate why would it like just because you exercise doesn't mean you're gonna give more you're not you're not gonna put more blood into your liver you're not gonna increase your body temperature so this is the problem the decreasing metabolic rate and we all hope that this may this metabolic rate goes back up towards normal but it never does over a year if you lose weight you can see that the total energy expenditure goes down and it stays down even over a year and this is what happened to the Biggest Loser so this was the article in The New York Times where they looked at people as their weight goes down that's great it comes down very nicely but they all regain the weight and it's because the metabolism goes way down and then it just keeps going down so at the end of it they're burning 800 calories per day fewer except for this guy Rudy Paul's who had gained a lot of weight then he got bariatric surgery and then he lost it what was interesting to me is that nobody really remarked him the fact that look at his metabolic rate it goes back up that's really really interesting because this is the guy that you want to know what he did which is the bariatric surgery so the problem is this this problem is the metabolic rate and this is the reason that the calories out calories calories in calories out model is completely incorrect because it all assumes that there's a single compartment for energy so that's not the way the body works it's not like all your calories which is really just sort of food energy goes into a single compartment and everything comes out of that compartment the issue is that there's actually two ways if you have energy in so imagine yourself as a power plant right your body's like a power plant that's producing energy and you're putting in energy you can either store it as fat or you can put energy in say it's coal and you can burn it off well there's really two ways that this energy in goes so it's not simply energy out right so everything the calories in calories out model kind of just assumes everything goes this way but really it can either go as energy out or as fat stores so what we hope happens is that as you reduce your energy end you'll reduce your fat stores but again that is only true if your calories out or energy out stays constant okay so the calories in calories out model assumes that your basal metabolic rate stays constant so that's what we've known for the last hundred years does not happen and that's why it doesn't work because what really happens is that as you reduce your energy in your energy out goes down and your fat stores are completely unaffected so as you make that adaptation to lower energy intake your fat stores stay the same the key problem is not the fist the energy end the key problem is this where the energy goes it's an energy distribution problem because if you eat a lot you could simply burn it all off and you won't gain fat so the problem is not the amount you eat in the amount is this what controls this so everybody kind of assumes that hey if you put in less energy what will happen is that you'll get less energy and you'll get some of this from this and goes into that and again that's really what doesn't happen and it's like why can't you do that right so if you eat 2,000 calories and you're burning 2,000 why can't you cut it down and you'll get a little bit from fat and so on and it's the reason is this it's the switch here because your body really runs according to what energy is coming in and there's kind of two tracks you can burn food or you can burn fat we just stored food energy but the key is that you have to switch between them and you can't do both at the same time and the main switch is insulin so in the fed state where you have a lot of insulin what happens is that you really switch to this trap so if you have 2,000 calories of food you burn it but you don't get any from your stored food right in technical terms what we say is that if you have a lot of insulin you're going to turn off the storage you're gonna turn on storage of food energy but you're gonna turn off like pollicis you're gonna turn off gluconeogenesis that kind of thing so when you're burning food you're not gonna you're not gonna take any from here why would you right when you eat insulin goes up tells you you need to store food energy you're not gonna take food you're not gonna burn food energy at the same time the body's just not that stupid in the fasted state when insulin fall so it's saying assuming you go to sleep then your insulin falls well there's no food coming in so you detach that and you switch over to this and now you're burning the stored food energy so that's the glycogen so a low insulin turns on gluconeogenesis like Oh general lysis and and and lipolysis and that's been known for a long time but what happens is that you don't you can't take it from both and that's what you assume that you do when you simply reduce your calories you assume you can take a bit from here and a bit from here but you can't you have to be in one or the other state you're either burning food you're burning fat or you're storing it but you're not doing both at the same time and that's why you have this problem with the decrease metabolism because as you if you keep your insulin levels high if you have insulin resistance for example or if you're eating all the time like six meals a day the what happens is that as you reduce your calories your insulin still high so that switch still stays up here therefore if you only have 1500 coming in you only have 1500 coming out so you feel cold you feel tired and you feel hungry and that's exactly what happens to all of us the second major problem with this kind of caloric reduction is primary sort of strategy is hunger and again we know for sure this happens what this study shows from the New England Journal of Medicine is that this is published in 2011 and what they did was they took people and they made them lose weight and they made a maintain it over a year and so you see that as you lose weight they measured something called ghrelin which is the hunger hormone and peptide YY which is a satiety hormone so if you look at Karelin what you see is that after a year of weight loss maintaining it off joerger Ellyn levels are this is baseline this is weight loss right week 62 week 10 your weight your duraline is much higher basically you're a lot hungrier peptide YY shows the same thing it's much lower so therefore you're not as full because this is the tidy index so what you see is over this time which you hope always you always hope it goes away but it never does that hunger never really goes away when you when you lose weight this way at the end of 52 weeks so even after a year you're hungrier than you were before and that's almost an impossible hurdle to overcome because again it's one of our most basic sort of human instincts right it's sort of the one of the big three apps which is the the you know our our basic needs right food fluids and procreation so this is the whole problem is that our body actually sets a certain weight and it wants to maintain that weight and if you try to lose weight this is what we know happens you reduce your energy expenditure and you increase your hunger the bottom line is you're going to gain that weight back and we know this because 99.9 if people fell and yet when we fail we blame them we say oh you just have no willpower but it's not some hocus-pocus they are hungrier than you were they are hungrier than they were before they can't control that you can't you can decide not to eat but you can't decide to be less hungry you can't decide to burn more energy and yet we pretend that it's all up to them it's not it's all physiology here so that's the problem that's why people can't lose weight and it's the most unfair thing we ever do to people is that we know going in that they're all gonna fail and when they do fail we blame them for it because the vicious cycle of under eating is that as you lose weight with this sort of caloric reduction you have decreased energy expenditure increase hunger so you regain that way so then you kind of redouble your efforts and even B eat even less calories but the problem is then you get do you lose a bit more weight you get a bit more hungry you decrease your metabolic rate some more and it just keeps going round and round and round it's impossible to win so exercise has always been kind of sort of an equal right diet and exercise and it's not like we're not doing exercise if you look at the leisure time activity you can see that as we've become more obese we've exercised more there's actually a very tight correlation between exercise and obesity so it goes on right and it's not that exercise causes obesity I think people who as they get obese start to exercise more but what it means is that we're clearly not having the effect that we wanted to and again we all assume that it's going to be effective but if you look at the randomized control trials it really doesn't show that at all if you look at this cohort study from the Women's Health Study so again they divided people at the beginning of the the study and the end of the study and what you can see is that those people who exercise more weighed less at baseline so if you didn't exercise at all versus kind of an hour a day six days a week but again over ten almost 10 years what you see is that their weights stayed roughly the same so even if these people doing zero exercise ten years later these people have exercised an hour a day for ten years but the difference in weight is identical so it's just not that effective it doesn't work the way we think it does and there's lots of trials to show this there's this one on aerobics and they didn't really lose a lot there's this one where they made people do a marathon and it didn't really work at all the men lost five pounds but the women laws Eero and you thought might think well but they're healthier but they actually showed no change in body composition so they went from zero exercise to running a marathon and they didn't lose any weight and they didn't lose any body fat so that really wasn't worth it either so this is what all the studies show and this is a well-known phenomenon in exercise physiology it's something called compensation so as you eat as you do more exercise you might increase your caloric intake and the other thing is that you decrease your exercise outside of that prescribed exercise and that's the reason why the average weight loss is only thirty percent of what you predict what that means is that if you are exercising all day so if you're a physical labor so you're a construction worker you're lifting concrete all day when you get home you're not gonna say hey you know I should go for that 10k run it just doesn't seem that appealing but if you sit in front of a computer all day you get home and go whoa that run really sounds like a lot of fun so you go out and you do your running but so that's what happens is that what you do outside of that prescribed exercise is gonna depend a lot what you did during that prescribed period of time and you see this in kids as well and this was a study a few years ago 2009 what they did was they took children and they measured how many steps they made they took kind of thing and they had one group which had no phys ed physical education during school and another one which got a little bit more than an hour a day 9.2 hours per week of prescribed exercise in class at the end of the week what they showed was that whether you go out the exercising class or not the total number of Stapp's was the same again it's the same the kids who had all that physical activity in school they got home and they watched TV the kids who sat in class all day they got home and they went outside and played it kind of makes sense and we know that this happens and so that's what this is compensation right so yeah I'll go to the gym but I'll take this the the escalator to get there and it happens to all of us it's just human nature and even the amount of calories if you think about calories the energy expenditure during exercise is little so now I'm not assuming you're doing ten hours a day sort of like because lose our sort of stuff but if you do what most of the older kind of diabetic people that I treat it's like you might walk for forty five minutes that's really great but if you think about it your calories intake is 2,000 to 2,500 and that 45-minute walk might give you a hundred and two calories which is like barely four percent of your daily caloric intake so if you've ever done a treadmill where they where they you know go and look at that sort of calorie expenditure it's very low you see that that thing goes up very slowly so it's really only four percent so again if you have diet which is responsible for ninety six percent of your total energy expenditure and exercise which is only four percent then you really should be concentrating on the diet so that's how you get results like this they eat less move more where you get no results at the end of it but the ultimate proof is really all of us because we've all done it we've all tried that calorie restriction and do a little bit more exercise and basically we've all failed so all of this kind of comes together all the proof all the ruin randomized trial all the physiology but also all the clinical experience says the same thing this sort of thing doesn't work so in order for you to lose weight successfully there's two things one is the metabolic rate and two is the hunger signaling in order to lose weight in the long term you have to be able to control those two and one of the ways that you can do it is something called intermittent fasting or fasting where you don't eat for a prescribed period of time so again if you think about the two compartment what you have is that you have energy in you have energy out and you have fat stores the critical issue is this signaling this partition which is all about insulin where does the energy go and if you take out the energy and really there's only one way for it to go basically you need to get it all from your fat stores and that's the point this is what happens during a period of time where you don't eat so this is Kevin Hall actually he fasted people for 30 days and what you see is that this is where the energy comes from so the carbohydrates initially come up but then you're go down very quickly so all those carbohydrate stores only last for like a day a day and a bit the fact what you do is you get energy from your fat stores and protein which initially is up a little goes down then it kind of stays down so you're not ramping up your protein burning in order to get energy you're getting it from fat that's like exactly what we want to do so physiologically it makes a lot of sense what happens to energy expenditure well everybody says if you don't eat your metabolism will go down but that's not what actually happens if you look at over four days of fasting the metabolic rate doesn't go down so this is the weight so your weight goes down steadily over four days of fasting but if you look at the resting energy expenditure it starts at thirty nine point seven and ends after four days of nothing to eat at forty four your energy expenditure went up by 10% and vo2 which is how much energy you're doing how much oxygen you're using does the same thing basal metabolic rate didn't go down and went up even as your insulin and glucose go down what happens is that you're making up for it with ketones and fatty acids so the what you're doing is burning and norepinephrine which is a counter regulatory hormone so remember you have these hormones that run counter to insulin they tend to bring glucose up norepinephrine or noradrenaline goes up and that's one of the key reasons why you're maintaining your metabolic rate at a higher level stable level even after 22 days so this is alternate daily fasting one day you eat one day you don't eat again if you look at the resting metabolic rate you see that it starts out at 66 75 it's ends at 63 29 but there's actually no statistical difference between the two you increase your fat oxidation and you decrease your carbohydrate oxidation so that's very good this is a study that's just published last year on people again alternate daily fasting at the end of thirty two weeks so half a year of alternate daily fasting here's what happens you compare calorie restriction versus alternate daily fasting so calorie restriction reduces your calorie expenditure by 76 a PF 0.045 which means that is statistically significant whereas the alternate daily fasting reduces it by 29 words with a point you have p value of 0.4 again no statistical difference in your metabolic rate at the beginning and the end so that's the huge difference between the two and this is the the difference between the Biggest Loser where you're doing caloric restriction and that guy who did bariatric surgery which is that your basal metabolic rate in fact it goes down so this is Biggest Loser contestants it goes down stays down a rule on why bypass is the bariatric surgery initially goes down a bit but then it goes back up and that's the difference between success and failure you're able to maintain your basal metabolic rate the other thing is the hunger signaling you know you don't want to be hungry and we can measure those things called ghrelin which is the hunger hormone and we all assume that if you don't eat for a period of time that you'll just continue to get more and more hungry than your gonna stuff your face with donuts that's not actually what happens if you measure ghrelin over a 24-hour period of fasting what you do what you see is that at breakfast lunch and dinner you do get a spike so obviously there is a bit of learning involved so we've learned to be hungry at these times but what happens for example if you don't eat lunch well your gorillas and just goes back to baseline same with dinner if you don't eat dinner well it just goes back to baseline and that's what you have to understand about hunger is that it doesn't continue to build because if you don't eat lunch and we've all had that experience you're so busy you kind of work right through lunch by three o'clock you forgot that you even skipped your lunch why because your body was able to provide you that food energy from its stores from its stored body fat so if you look at multiple days of fasting again what you find is fascinating because everybody assumes if you do three four days of fasting you're gonna get more and more hungry but this is go Ellen so it does go up but over time what you can see is that it's slowly going down so as you fast longer and longer your hunger actually goes down if you look at men and women because some people say oh women should never fast what's fascinating is that this is men men have this effect where you see that go down but women have this huge effect where the hunger just goes down and down over time so is it effective for women one yes and two it may actually be more effective in women than men so if you're able to if you compare the weight loss strategies between between fasting and caloric restriction they're actually noting the same this one increases hunger and decreases metabolism so then you look like this person which is like don't talk to me right but then if you're doing fasting your hunger decreases and your metabolic rate stays stable then you're like yeah love it the problem with fasting is that there's all these myths that surround it one of them is that you're gonna burn muscle right and for that you can look at the studies again so this is a study of alternate daily fasting so once again you can compare the fat fat mass which goes down nicely after 70 days of alternate daily fasting and here's the fat free mass 51.4 kilos at the beginning 51.9 kilos at the end so no loss in fat free mass with alternate daily fasting that study I told you about last year where they compared calorie restriction to fasting so here's the trunk fat mass which is the really important fat that's carries around the waist which is important for metabolic you know for diabetes and so on so calorie restriction only gives you point three percent off and alternate daily fasting gives you one point eight percent off of your trunk fat mass in other words like six times better for that but here's the lean mass calorie restriction goes up by 0.5 percent remember there's a percentage so as you lose more fat your body your lean mass percentage goes up the alternate daily fasting goes up by two point two percent so if you're talking about preservation of lean mass fasting is like something like four times better I'm just gonna skip this in the in the interest of time but this is the other thing is that everybody says well females shouldn't do it it doesn't work for females or postmenopausal well this is the studies of fasting that came from many years ago from the 60s because they haven't done many lately and what you can see is that both men and women show really the same rate of weight losses averages half a pound of fat mass per day of fasting so for both for men and for women and you see that there's and they're doing like 30 days of fasting here you see that there's no slowdown it just keeps going which kind of makes sense because your body still needs energy so therefore it must burn fat so there's a huge number advantages that you find in fasting that you don't him the other ones the one is that it's a very simple thing to do people understand it it's free so this is the thing about hairs right so if you're trying to do something like bariatric surgery and there's studies that show that it does very well but it's not it's it's impossible to do that on a population wide scale because the costs are prohibitive they're very expensive surgeries whereas if you simply translate that knowledge to people that yes you can fast yes you can do this yes here's a effective weight-loss strategy that's completely free it's not just free you're gonna save money because you're not eating but the government will save money because you're gonna be a lot healthier it's a way to stay healthy rather than a way of treating illness and that's the really important thing it's convenient because you're going to be able to save time you don't have to shop you don't have to you know cook you don't have to eat so if you're really busy then you just skip lunch and just keep working and then you get an hour back from your day every single day and that all about all accumulates it's flexible and that you can do it sometimes and not do it sometime if you go on vacation you can decide I am NOT fasting I am not doing any of that I'm gonna enjoy myself that's okay because you can do it more later so you can bring it on or take it off as you need and that's the way people have always done people have always done feasting when it's prescribed for it I'm fasting so there's the holy month of Ramadan there's Lent there's all these prescribed periods of fasting that people have always really used and you can use it to any diet so whether you don't eat meat or wheat or nuts or you don't have time or you don't have money or you're traveling it doesn't matter because you can still fast it just doesn't matter so the one thing that appeals to most the doctors is that it really has unlimited power that if you look back at those studies of 30 days of fasting I'm not suggesting that anybody do that but you can keep losing weight and that's what doctors love so if you give a drug like metformin for example there's a maximum dosage the reason doctors love insulin is because you can just keep prescribing insulin until you get the effect it has unlimited power and fasting has that same unlimited power you can just keep fasting until you get to your appropriate weight it's okay it doesn't really matter and that's really what we're talking about there's a way for people to get healthy and kind of break free of those chains of illness because we're not talking these days about illness from tuberculosis or bubonic plague or whatever well the modern-day plague is really this it's really obesity it's all about metabolic syndrome and the thing is that we have this huge crisis ahead of us we all know about the obesity epidemic about the type 2 diabetes epidemic and of course type 2 diabetes where you have amputations and heart attacks and strokes and cancer dialysis all that sort of thing and that's all treatable that's all curable that's all preventable by these simple dietary manipulations to reduce insulin and it's not something that's you know some pie in the sky you can do it tomorrow you can start back on the on the road to getting healthy tomorrow anybody can do it it's really just a matter of disseminating information I'm not talking about building huge infrastructure to do bariatric surgery or whatever it's all there it's all free it's all part of our human heritage and that's it all we have to do is let it be known and that's what we're trying to do with the pH C because we have to let it be known that the dietary advice that we've been given doesn't work and we have to do better because that's what they owe us they owe us something that is effective not something that's 99 percent failure rate that's ridiculous and so we have to be heard and that's what organizations like the pH C are so important because we have to lift our our hands and our voices that's really what we're here for thank you [Applause] [Music] [Applause]
