Is Fasting The Cure For Bloated Healthcare Costs?
More than two centuries ago Thomas Malthus predicted that food production growth would fail to keep up with population growth and that the world would suffer from mass starvation. He couldn’t have been more wrong. In his native Britain, and in her former colony across the Atlantic, our major drivers of mortality are not starvation related but rather obesity related. Malthus and his allies were an almost perfect contrarian indicator, issuing their dire warnings at the very beginning of the great hockey stick curve take-off, about a danger which was the exact opposite of the health crisis that actually occurred. The developed world, with a few exceptions, is not underfed: it is overfed, and we are now looking at an epidemic of the diseases which come from excess body weight especially among the poor.
Before you cue the calls for a new round of spending for another government program to deal with our health care crisis consider this: what if the most powerful solution doesn’t cost anything at all? What if implementing this solution not only involves no new spending but even involves anti-spending, the elimination of a cost center? What if the solution was not a newfangled invention, but the oldest dietary intervention known? What if the solution was not secret, but the most obvious answer?
Dr. Jason Fung is a Canadian nephrologist. who was seeing an ever-growing number of patients suffering from a combination of diabetes and obesity (which have become so closely associated that members of his profession have invented the moniker ‘diabesity’). They came to him when they advanced to the stage of severity which leads to kidney failure. So, Dr. Fung gave them the usual meds and hooked them up to dialysis and held their hand through the long, ‘progressive’ disease of diabetes with its kidney failures, heart attacks, blindness, and amputations – all the bitter fruit of metabolic syndrome. But he began to call into question the general consensus of the food pyramid, the inevitability of decline and the focus away from life style towards medication.
The result of that research comes in the form of his first book, The Obesity Code, which just was published in paperback, and his new book, The Complete Guide to Fasting. Dr. Fung argues quite persuasively that we are thinking of public health in the wrong way, that we have a 19th century mindset which we are bringing to a late 20th and early 21st century problem. In the 1800s people (those who lived to adulthood) tended to die of infections. The antibiotic revolution came to the rescue and enabled us to give patients pills to heal their diseases. If one problem can be solved with a pill than perhaps they can all be solved with pills. A business model emerged in which large corporations developed new compounds, filed for patents in order to create temporary monopolies in that particular intellectual property, monetized the IP, and waited for the patent to lapse as they sought out the next pill.
But the current plague of metabolic disorder, which Dr. Fung says accounts for something like half of our health treatment industry, is not an infection; and so far, getting people to swallow pills has had little success. Perhaps the solution is instead of telling people to put one more thing into their mouths, we should be telling them (us) to stop putting things into our mouths. Perhaps the solution is fasting.
Fasting does possess a certain prima facie plausibility: eat less often… lose weight. But it’s more than just a surface plausibility; there has been a wave of research findings lately about what is called ‘intermittent fasting’, and so far, the findings are promising (Dr. Fung’s books serve up generous portions of footnotes for people like me that want to read the studies). The most common form of intermittent fasting (IF) seems to be overnight fasting: stop eating at, say, 5 pm and don’t eat again until 11 am the next day. That’s an 18 hour fast. Another slightly less popular version is to eat one day and fast the next day. Some go longer, the staff of the Silicon Valley Nootropic (supplements for cognitive enhancement) start-up company Nootrobox fast together each week. They’re by and large young and trim, and not focused on fear of weight loss. They do it for the cognitive benefits (more on that in a future column). Some fasters go longer, one or even two weeks at a time. Dr. Fung’s co-author Jimmy Moore did a 21-day fast leading up to the release of the book.
It sounds hard, doesn’t it? I’ve been doing it since February of 2016 (what better time to start than in the Lenten season?), and I won’t say that it’s easy, but it’s easier than I thought it would be. My wife and I started out with 36 hour fasts centered on Fridays (eat dinner on Thursday evening, don’t eat again until Saturday morning), which was probably pushing things a bit too much too early. We stuck with that until we threw in the towel a week before Easter. Then we switched over to overnight 17 hour fasts and occasional 24 hour ones. Gradually we worked our way back to 36, then 48, then 60, and the week before last we did 72 hours together.
In fact, I’m fasting right now as I write this (it’s been almost exactly 24 hours since I’ve last eaten). It’s just part of our regular Saturday routine. (Be sure and let me know if you think that ‘starvation mode’ has compromised the quality of my writing.)
We’re data people, so we monitor our blood sugar, blood pressure, and our weight (and keep our doctors in the loop on what we’re doing). Blood sugar levels have dropped substantially for both of us. Neither of us were diabetic or even pre-diabetic, but levels were a little on the high side, so we were pleased to find that they dropped about ten percent for both of us. Weight has improved a lot, too (but for me there’s still a long way to go). Blood pressure is largely unchanged but we both had good numbers already so there was no need for change on that metric.
Fung’s book recommends a ketogenic diet as being more comfortable for someone with a fasting lifestyle and I agree: this would be much tougher if we were eating high carb. Before you give me the lecture about eating a lot of fats, we are getting most of our fats from coconut oil, olive oil, avocados and nuts, and my lipid profile has improved markedly.
The more I study the public policy confusion which has tied our health care system into knots, the more I want to stay away from it. No, we can’t avoid the whole system entirely, and there are parts of health care which work pretty well, but I just find myself wanting to do everything which can be done to avoid that Byzantine-verging-on-Kafka-esque system until it is absolutely needed. I don’t like the costs (perhaps that’s what comes of having adopted a health savings account a decade ago), and I don’t like the incentives. Good people in the system do their best to do their best for their patients, but that gets harder and harder with each new bright idea to fix the system from the top down.
While smart policy advocates work on fixing the system and the rest of us wait for them to succeed, we’ve decided to focus on fixing ourselves. It costs nothing except saying ‘no’ to our desires from time to time, and at least so far, it’s working.
I sat down across a Skype line with Dr. Fung recently to talk about his new book, The Complete Guide to Fasting, and his more academic work, The Obesity Code. You can hear the entire interview here, and you can read a partial transcript (edited for clarity) below:
Jerry Bowyer: The United States transformed its healthcare system. Now it’s un-transforming it back more in the direction of the way it was before, but with a lot of uncertainty about where we’re going to end up. And Americans are obviously very dependent on healthcare. It’s a system in which we tend to run to the doctor for a lot of things. It’s a very expensive system.
And it occurs to me in talking to you, Dr. Jason Fung, about your book, “The Complete Guide to Fasting”, which is just out now, and the paperback edition of “The Obesity Code”, that the idea of entering into intermittent fasting could be actually financially a very good decision because treatment is very expensive, especially for a metabolic syndrome. So do you have any thoughts on that?
Dr. Fung: Yeah, I think the implications for the healthcare system in general, not just for the United States, but really for the entire world, are enormous, because the treatment, fasting, is free. And if you compare it to how we normally treat these patients with medications and surgeries, the costs are huge.
And it’s not just one medication; it’s often multiple medications. And if you look at the spectrum of disease that we’re talking about, it runs virtually through everything. So the thing about fasting, for example, is that it’s really targeted towards the healthcare problems of today, because we’re stuck in a mindset of nineteenth century medicine.
So if you look back at the diseases of the nineteenth century, people were dying of tuberculosis, pneumonia, and infections. So the treatment there is antibiotics. So when antibiotics came out then those treatments were very, very effective. But we got into this mindset where we have a disease and we take a pill to treat it.
So now we fast-forward into the twenty-first century, and we still have that mindset. You have ‘diabesity’, let’s look for a drug to give you so that you can take care of this problem. But that’s not the problem. It’s the same thing with Type 2 diabetes, which is very closely related to the obesity epidemic. We look for a pill or some drug that we can give you.
But at their core, they’re actually metabolic diseases, they’re actually dietary diseases. So giving a drug to cure a dietary disease does not make any sense. And that’s exactly what we see.
So for Type 2 diabetes and obese patients, we give them the medications, but they don’t get better, because what happens is that they take more and more pills year after year. So what happens of course, is that the cost to the system keeps going up every year that these patients are there.
But instead, if you could make them lose weight — and we all know this — those patients wouldn’t have these problems. They wouldn’t have the Type 2 diabetes. They wouldn’t have the high blood pressure. They wouldn’t have the cholesterol issues.
But the downstream problems of Type 2 diabetes cost a lot of money. So keep in mind that Type 2 diabetes is the leading cause of blindness; the leading cause of kidney failure and dialysis, which is very expensive; one of the leading causes of strokes; cancers; heart attacks.
So practically a half of medicine — modern medicine — is related to metabolic syndrome. So therefore, the implication is that you could actually prevent all these diseases along with the human cost, but also the financial cost, simply by spreading the knowledge that people can take care of these problems, really, for free.
Jerry Bowyer: A very interesting point you make. We’re still stuck in a — in an antibiotic pill mindset. You take a pill for things. But in many cases, the answer for metabolic syndrome might be not putting anything between your — between your lips, but instead not swallowing anything for a while, except for water and maybe a little bone broth or some tea.
Dr. Fung: Exactly. And the thing is that if you don’t eat, then your blood sugars will come down and you don’t need to take that pill. If you don’t eat, you’ll lose weight; and if you lose weight, you’ll have less knee problems, you’ll have less hip problems, you’ll have less back problems, for example. So all those knee replacements, hip replacements, all those problems actually go down.
And the thing is that it’s a different mindset entirely, because again, you got to keep in mind that nineteenth century medicine is how to cure illness. So you get sick, you take a pill; whereas really what we need is a treatment to keep people well. Right? It’s a wellness cure.
We want people to stay well rather than develop an illness and get better. But we treat diabetes and obesity as illnesses rather than kind of this failure to stay well. And that’s what fasting is about. It’s kind of like a preventative sort of treatment to prevent all these issues from becoming a problem down the line.
It can be used in a higher dose, to reverse these conditions; but really it’d a way of staying healthy rather than a way of treating illness.
Jerry Bowyer: Sometimes it seems to me as if there’s really one great modern mono-illness, and that is this whole octopus of too much sugar, too much insulin resistance, too much obesity, and then downstream from that, the diabetes, the heart disease, maybe even the cancer.
Dr. Fung: Yeah.
Jerry Bowyer: There’s, you know, increasingly evidence of a metabolic input to cancer.
If we solved this one, we could shut down, I don’t know, fifty percent of the hospital capacity in this country because of all this downstream stuff. But I hadn’t thought about the skeletal problems: hip replacement, knee replacement. That’s also, in some sense, a metabolic disease, because of all that stress on the joints from the extra weight.
Dr. Fung: Yeah. If you’re carrying 50 pounds of extra weight or 100 pounds or 200 pounds, sometimes, every day, for ten years, that’s going to put a lot of wear and tear on your knees, right? The knees take it all, the hips take it all, the back takes it all, and those are big issues that have to be taken care of, absolutely.
Originally published on Forbes.