Nutrition

Finding a Balance Between Building and Repair: Part 2 Intermittent Fasting

July 16, 2015 By Dr. Chris Hardy 1 Comment

Finding a Balance between Building and Repair part 2

Prolonged calorie restriction seen in many fad diets is not a sustainable practice. Weight will be lost for sure, but a significant amount of the disappearing pounds will be from valuable muscle mass. Loss of muscle mass with prolonged caloric restriction has a huge health cost in the long term, especially for those with metabolic diseases such as diabetes and the aging population. Adequate muscle mass is vital to maintain metabolic health and prevent frailty as we age. It is also impossible to work out at high enough intensities to achieve the beneficial adaptive responses to exercise while undergoing long term calorie restricted diets. Our engines need adequate fuel to perform optimally.

Prolonged caloric restriction has been shown to extend the life span of rodents, worms, and fruit flies, but longer life spans have not been seen from fasting in higher primates and humans. What is clear is that periodic fasting has been shown to improve the health span in humans and can be highly effective in reversing chronic diseases if done properly.

The issues with prolonged calorically restricted diets for weight loss and the proven benefits with periodic fasting have led many of us to experiment with intermittent fasting (IF). Intermittent fasting is the practice of scheduling short term periods of calorie restriction, followed by normal caloric intake. Recent science has shown that many of the metabolic benefits of fasting can be achieved with IF without the loss of our prized muscle mass. For this reason, IF has gained popularity in recent years. For some IF works fantastically to achieve a lean physique and metabolic health, while others have not been so successful with their experiments with short scheduled fasting. What gives? Why do some people see great results with IF and others crash and burn? Much of the variability with results likely is from the “environmental” context IF is used. Let’s go back to first principles to establish a framework for successfully using intermittent fasting.

Intermittent fasting is an environmental stress (remember that our environment includes all aspects of our lifestyle) on the body and brain. The short-term stress of IF activates the repair and recycling system of autophagy we covered in Part I. Intermittent fasting will temporarily shut off the mTOR building pathway in favor of repair. The autophagy system improves the health and metabolic efficiency of our cells which translates into beneficial effects for our entire body. “Dosed” correctly, IF can be the missing link in your quest for optimum health, body composition, and prevention of chronic disease. The important point to remember is that although potentially beneficial, intermittent fasting like all caloric restriction contributes to your daily “stress cup” (aka allostatic load discussed in Strong Medicine).

Calorie restriction with IF contributes to your daily Stress Cup

The proper dose of IF is a moving target, as the other contributors to your daily stress cup determines how much caloric restrictions you can handle (if any) on any given day. If you have had a night of bad sleep and significant work or social stress, there will be very little room for the added stress of intermittent fasting. If you don’t take into account a nearly full stress cup and press ahead anyway with a significant fasting period that day, your stress cup will overflow (allostatic overload). This will create a substantial response from the HPA axis (stress system) and increase your cortisol levels. Your brain is protecting itself utilizing increased HPA axis activation and resulting high cortisol levels during allostatic overload situations. This response ensures the brain has adequate glucose, even if it has to get it from your precious muscle mass (from amino acids using gluconeogenesis- see Strong Medicine for more).

We can frame the “dosing” of IF using the concept of hormesis. From Strong Medicine, we know that hormesis is the phenomenon of something that is potentially bad for us can be beneficial at the proper dose. Calorie restriction certainly follows the concept of hormesis- small amounts produce a beneficial response while large amounts lead to a starvation state. A crucial concept to understand is that the same dose of fasting can be beneficial one day detrimental the next day depending on the state of your stress cup. This is how hormesis and allostasis are intertwined.

Area “B” represents the optimal dose of calorie restriction this day. The level of your stress cup is relatively low allowing a longer period of fasting resulting in a beneficial autophagy (repair and recycling) response.

This is a day when your stress cup is filled with other sources of stress such as poor sleep, social stress, or high levels of exercise. The length of your fasting this day has to be reduced (to the area of the green”B”). If you did the same length of fasting you did in the first example (yellow “B”) you would “overdose” fasting and overfill your stress cup. On especially high stress cup days, fasting periods should not be attempted.

The benefits of IF-induced autophagy will not be realized if you overdose your fasting period. This point deserves repeating- intermittent fasting is a stress on your body and has to be balanced with the other stresses in your life to do it successfully.

Exercise and Intermittent Fasting

Finding the right mix of high intensity exercise and fasting can be a very tough to consistently pull off. High intensity resistance training and interval training stimulates the mTOR building pathway, increasing/maintaining our muscle mass and promoting fat loss through the actions of growth hormone. High intensity exercise is also a significant stress (which is why it works) on the body and needs to be figured into your daily stress cup evaluation. This type of training directly after a period of fasting can be especially stressful and should be approached with caution and careful assessment of your stress cup.

General guidelines

For the lucky few that live idyllic lives (my Strong Medicine co-author, Marty Gallagher, comes to mind) and have relatively empty stress cups, you can get away reckless forays into fasting experimentation and be just fine. Most of us are not that lucky and need a few guidelines to keep us out of trouble:

Assess your stress cup daily. Fasting is never a good idea with an already-full stress cup.
Start with brief fasting periods when beginning IF. The most popular is fasting from dinner the night before until lunch time the following day.
Avoid fasting when planning high intensity exercise sessions that day (“feed your activity” concept from Strong Medicine). Fueling your post-workout time periods will help maximize mTOR and muscle building. If you are getting good results starting your work out in a fasted state, make sure you feed yourself adequately post-workout.
Avoid fasting after a night of poor sleep. Poor sleep is one of the biggest contributors to the stress cup.
Plan fasting on your non-exercise recovery days. This can help maximize effectiveness of the repair/recycling autophagy system.
If you can’t handle complete fasting try a reduced protein day. Recall that amino acids from protein are potent triggers of the mTOR building system and reduced protein intake will trigger autophagy without abstaining completely from food. Meals consisting of high fiber vegetables with additional fats from olive oil/coconut oil or avocados will work well for this reduced protein strategy.
For those of us pushing middle age it is important that we give potent stimulation of the mTOR pathway to slow the muscle wasting of aging (sarcopenia). It is harder for the aging trainee to stimulate mTOR compared to the younger person. If this applies to you, consider a weekly schedule with less overall fasting and more attention to resistance training with increased protein intake to find your optimal balance between building and repair.

Conclusion

Intermittent fasting practice that is informed by daily monitoring of your stress cup can be hugely beneficial. The key is to be flexible and not overly rigid with planning your fasting. If you are having a high stress cup day, don’t be afraid to ditch your fasting plans. Failing to take allostatic load (stress cup) into account will just hurt you in the long run and slow progress to attaining your fitness and health goals. Start slowly with short fasting periods and increase with small increments. Using the conceptual framework we have created with intermittent fasting and the stress cup you can find your optimal individual balance between building and repair.

****

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Finding a Balance Between Building and Repair: Part 1

July 2, 2015 By Dr. Chris Hardy 3 Comments

Strong Medicine Maximizing Health-Span: Introduction

For the second MHS (Maximizing the Health-Span) post, I set out to write an article focused on intermittent fasting (IF). But, I quickly realized we needed a “first principles” foundation for context first. We need to understand the underlying physiological systems that are affected by intermittent fasting instead of taking a reductionist approach. A very simplistic way of thinking about the two major body systems most affected by intermittent fasting (and also training and other lifestyle choices) is categorizing them as systems of building and repair respectively.

The body has to achieve a balance between building and repair at a cellular level. This balance will necessarily change depending on environmental demands such as physical activity and nutrition as well the aging process. Finding the right balance between building and repair at the right time is key to maximizing the health span.

Building and Repair Diagram

At the center of the building and repair systems is a protein complex known as mTOR. The technical name for mTOR is the mechanistic target of rapamycin (formerly known as the mammalian target of rapamycin). mTOR functions as a molecular switch between building and repair.

Turning mTOR on promotes building. Turning mTOR off promotes repair.

BUILDING

Building (growth) is an anabolic process that happens when mTOR is turned on. Stimuli such as resistance training and eating protein (especially the branched-chain amino acid leucine) turn the mTOR switch on. The hormone insulin also turns on the mTOR building pathway. This effect of insulin should come as no surprise to readers of Strong Medicine (SM pages 107-108) as we discussed insulin as a hormone of growth and storage.

As Dan Cenidoza covered in his Strength after Sixty post, the anabolic pathways of building are crucial to grow and maintain muscle mass especially as we age. Not enough of “turning on” the mTOR switch can lead to sarcopenia and frailty in old age.

At the extreme end of the mTOR building pathway is cancer. By the simplest definition, cancer is uncontrolled cell growth. Recent science has shown that many cancer cells have abnormally high mTOR signaling, putting them is a perpetual state of growth. People with insulin resistance (SM p. 180) have higher levels of insulin in their bloodstream at all times which keeps the mTOR switch activated. Thus, it is no surprise that those with insulin resistance/diabetes are known to have increase risk of cancer.

We also now know that high levels of sustained mTOR activation can lead to accelerating aging in many species, including humans. With this information in mind, it becomes evident that getting the proper “dose” of mTOR activation is key.

We need enough “turning on” the mTOR building (growth) switch to prevent the loss of muscle mass so crucial for healthy aging, but no so much that we accelerate the aging process and become at increased risk for diseases such as cancer.

mTOR Activation

REPAIR (AND RECYCLING)

The opposite side of the mTOR coin is the repair and recycling system. This system is activated with the mTOR switch is turned off. The main process that carries out repair and recycling in our cells is called autophagy.

Autophagy literally means “self-eating.” Autophagy is the mechanism our cells use to recycle damaged proteins and cell machinery (including mitochondria) and use their parts to make new machinery and new sources of energy. Recycling old cellular machinery helps protect a cell from premature aging. This is similar to replacing a roof or hot water heater in your house to keep it functional as a dwelling longer. We can replace some of the parts for quite a while before having to buy a new house. Autophagy does the same thing for cells.

Autophagy is a cell-survival mechanism during times of stress. Fasting is one of the most common sources of cell stress that activates autophagy. Low protein intake and low insulin levels create a perfect environment for the mTOR switch to be turned off and autophagy to take over. Autophagy allows your cells to recycle used material for use as energy during stresses such as fasting, instead of breaking down valuable things such as muscle. Preventing catabolism (breaking down) of muscle is always a good thing!

By allowing recycling and repair within the cell, autophagy effectively extends the life span of the cell. This is one of the reasons why we seen increased lifespan with fasting and calorie restriction in animal such as mice and worms (it has not worked as well in humans as we will discuss in subsequent posts).

FINDING THE BALANCE

We know that turning on the mTOR building pathway in the right doses is crucial to maintaining muscle mass through the lifespan, a key to healthy aging. We also know that autophagy is a valuable process to extend the life and health of your cells. Finding the right balance between these two processes is where it can get tricky. This balance is also a moving target throughout our lifespan. We are going to use the concept of balancing mTOR activation (building) and mTOR deactivation (repair/recycle) to discuss training, eating, fasting, and lifestyle modification in upcoming posts. We will couple this with the concepts of hormesis and allostatic load (the Stress Cup) from Strong Medicine to create a framework to form a foundation from which to decide if practices like intermittent fasting have potential to maximize the health span.

****

Kaizen and Strong Medicine

May 14, 2015 By Michael Krivka 8 Comments

Kaizen Strong Medicine Lead Photo

Strong Medicine has over six hundred pages of text and illustrations that will dramatically change how you perceive nutrition, training, and how you can effectively manage the stressors in your lifestyle. The concepts and how they can be applied are laid out in such a manner that, with the some simple planning, discipline and implementation, you will have no choice but to be successful. This blog post is going to provide you with some tools and strategies that you can use in order to implement the concepts presented in Strong Medicine in such a way that you will not only succeed, but will be able to do so with the least amount of stress possible.

Change… Sucks!

Making drastic changes in your life does not lead to dramatic results–it usually leads to dismal failure and a lot of brow beating! Anyone who has made a New Year’s resolution only to have it crumble within a matter of weeks (or in some cases, a matter of hours) knows that making changes (big or small) in your life is hard to do. Everyone starts out with good intentions and a wealth of willpower only to see the good intentions crumble and the willpower dissolve like a puff of smoke at the first impasse. With all of these bad past experiences surrounding change, I’m sure you’re convinced that you can’t make any changes in your life and might as well just quit now. Wrong! Just because you failed in the past doesn’t mean you’ll fail this time–especially if you are honest with yourself about the plans and tools you need to succeed. So… how do you begin making changes? The same way you’d eat an elephant–one bite at a time!

Kaizen = Continual Improvement Kaizen Diagram

Kaizen is a Japanese term that has been borrowed by the business world. Roughly translated, it means “change for the better” or “continual improvement”. As a business major in college (many, many, many years ago) I learned about the concept of “Kaizen” and how it was successfully implemented in the Japanese automotive industry. Kaizen gave everyone–from the guy sweeping the floor to the VP in charge of making million dollar decisions–the power to change how things were done on a daily basis. In other words, the power was placed in the hands of those who could make the most difference. Since then, the concept of Kaizen has been applied to banking, healthcare, government and other areas where complicated processes need to be considered and improved to increase efficiency and consistent outcomes.

How does this apply to you and how will it impact the implementation of what you’ve learned from Strong Medicine? You need to develop a simple but effective plan for implementing the nutritional and training guidelines presented in Strong Medicine. Your plan should be created and executed in a way so that changes can be small, easily managed, and built upon. Remember that the best plans are the simplest effective ones that also have the latitude for change and modification on the fly.

NOTE: Understand that these plans are best implemented one at a time. Trying to make too many changes too soon and with too much accompanying stress will make this process a lot harder than necessary. With this in mind, I feel that the concepts behind Kaizen are the best common-sense approaches to implementing any nutrition, training or lifestyle modifications.

“Eat like an Adult”

Strong Medicine goes into great detail about what and how you should eat–and how those choices are will effect you over the short and long term. There are many scientific theories and big words involved–which can be daunting to some people–but you will need to absorb it to understand what Dr. Chris and Marty are trying to do. They successfully make many complex ideas and concepts simple to grasp, and that’s vitally important for the subjects of nutrition and training. I admire people who can take complex problems and explain solutions in simple terms everyone can understand. For example, when Dan John said, “Eat like an Adult” during a lecture a couple years ago, it really stuck with me. His comment was simple, direct and to the point. Those four words make choosing, preparing, and eating the right foods a lot easier! I know those four words help me get in the right mindset when I’m preparing, ordering, and even shopping for food.

Start with the Beginning Small Daily Improvements

“Eating like an Adult” will help you succeed with the Strong Medicine guidelines. But first you need to know where you stand. The easiest (and the most eye-opening) method I know is to keep a food log for ten days. (Before you start grumbling and groaning, hear me out–the food log will give you some great intel into what’s going on and how to fix it!) Keeping a food log is as simple as folding a piece of paper into sections, then writing down everything that goes in your mouth. Breakfast, lunch, dinner, snacks, drinks, etc.–it all goes in the food log. Once you have all this information you’ll be able to create a baseline for what kind of food you are eating, how much you are eating, and what is missing from your diet. Remember, keep this as simple as possible and don’t stress out about what you are writing down. It’s just information you’ll use to create a plan!

Once you have ten days of information, what do you do with it? First, find the gaps in your nutrition. For example you might notice that during those 10 days the only time you ate any vegetables (not counting the lettuce and tomato on your hamburger) was with dinner. Over ten dinners you had a handful of salads, a couple baked potatoes (not to mention French fries), and several servings of broccoli. If that was the case, then introducing more vegetables into your evening meals AND including them as part of breakfast and lunch would be in order.

Getting Started

Does this sound like a big step and a major hassle? Not really! It just takes a little forethought and preparation and you’ll have it nailed. Prepare by having the food you need on hand, and by creating and using shopping lists. Your shopping list will guide you through the grocery store. For the most part you’ll stay in the periphery, where the vegetables, meat and dairy products are found. (Stay away from the middle of the store where the Mountain Dew and Fritos are located!) Grab your list and shop either once a week or several times a week, whichever is more comfortable or convenient for you. Remember, you’re only shopping for the things on your list! NOTE: if you don’t have a shopping list, you can Google “shopping list” for plenty to choose from and modify as needed.

Now that you have all this food in the kitchen, what do you do with it? Well, you will need to start making your own meals based on the nutrition gaps in your food log. It will be easy for the most part–in the above example, we simply need to increase the amount of veggies throughout the day. We need to make this change as simple as possible. Think about this: it only takes a minute or two to cut up some peppers or cucumbers and throw them into a plastic bag or Tupperware for later in the day. Grab some veggies and prep them for the day while you’re standing around waiting for your coffee to brew in the morning!

I can hear the whining and moaning already! “Veggies for breakfast and lunch? How am I going to do that?” Easily! Just add vegetables you like to meals you are already eating. Still confused? Here’s some ideas to help you jump start the process!

How to add vegetables to breakfast:

Add avocado and salsa to your scrambled eggs
While frying your eggs, sauté some spinach in bacon grease and serve it on the side or as a bed for the eggs
Warm up some sauerkraut for a tangy side (or kimchi for something spicy) with your eggs
Brown onions, tomatoes and mushrooms and make an omelet
Slice up some hard boiled eggs with ripe tomatoes
Slice red or yellow peppers, clean out any seeds and whatnot. Put the slices in a frying pan and add an egg inside the gap for peppers and eggs over easy
Grab a container full of sliced veggies (that you prepared the night before) and a container of yogurt for a quick and easy breakfast on the go
Chop bacon into bite-size pieces and toss them in a frying pan. Add onions and peppers then simmer everything together. Drain the excess oil, then toss the bacon and vegetables on top of scrambled or poached eggs

Small Steps Lead to Big Results

I guarantee that if you take a little time and mental energy and apply it to filling in the gaps of your nutrition, it will pay huge benefits in the short and long term. I’m not proposing massive changes. On the contrary, I think the best and most effective way to ensure your success is by making small changes that you can easily adjust to before moving onto the next step. Remember what you learned in Strong Medicine about how stress (in all its forms) adversely affects the body. Adding stress by making big changes in your nutrition will be counter-productive. Keep the concepts of Kaizen in the forefront of your mind–small changes leading to big results–and you will not stress out at all!

NOTE: The training for life guidelines will be in part two of this blog post. In the meantime, I want you to start improving your nutrition. Small increases in nutrients will have a major impact on how you feel and move. By getting your nutrition plan in place now, you will establish the foundation for a successful training program.

***

Michael Krivka is a Senior RKC with Dragon Door and has been training with, teaching, and sharing the gospel of the kettlebell for over a decade. As a life-long martial artist, he is a Full Instructor under Guro Dan Inosanto in Jeet Kune Do (JKD); the Filipino Martial Arts of Kali, Escrima and Arnis; and Maphilindo Silat. He lives in Gaithersburg, Maryland with his wife and two sons. He owns CrossFit Koncepts where he runs strength and conditioning classes with an emphasis on kettlebell training, mobility and longevity. Follow him on Facebook.com/CrossFitKoncepts or Instagram.com/Michael_Krivka

Editor’s Note:

Where the Strong Medicine book is the template for lifestyle change and taking charge of your health, Mike has the beginnings of a Strong Medicine Operational Manual with this first post. The philosophy of Kaizen melds so well with our philosophy of lifestyle change that I am kicking myself for not including it the book, but this is why I try to surround myself with talented people like Mike Krivka.

In keeping with the mission of the blog for a two-way exchange of information, please share your perspective on lifestyle change in keeping with the Kaizen philosophy. Fantastic job, Mike!