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The Peter Attia Drive

Jun 24, 2019

In this episode, Jason Fung, nephrologist and best-selling author, shares his experiences utilizing an individualized approach to fasting to successfully treat thousands of overweight, metabolically ill, and diabetic patients, and why being a doctor who specializes in kidney disease gives him a unique insight into early indications of metabolic disease. We also have a great discussion on insulin resistance where Jason makes the case that we should actually think of hyperinsulinemia as the underlying problem. We also discuss the difference between time-restricted feeding, intermittent fasting, and dietary restriction (e.g., low-carb) and how they can be used to attack the root cause of T2D, metabolic syndrome, and obesity. We also have a fascinating discussion about the limitations of evidence-based medicine which leads to a conversation where we compare and contrast the scientific disciplines of medicine and biology to theoretical physics. 
We discuss:
  • Comparing scientific disciplines: Medicine and biology versus physics [7:25];
  • The limitations of evidence-based medicine [12:30];
  • Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50]
  • Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30];
  • Why the common treatments for type 2 diabetes seem to make things worse [42:30];
  • How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15];
  • Insulin and weight gain, and using fasting to empty the cells of glucose [59:30];
  • The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15];
  • NAFLD and hyperinsulinemia: A vicious cycle [1:08:30];
  • Are the features and symptoms of diabetes actually protective? [1:12:15];
  • Is obesity causing insulin resistance or is it the other way around? [1:17:30];
  • What role does inflammation play in obesity? [1:21:45];
  • CVD and cancer: Diseases of too much growth? [1:27:30];
  • How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45];
  • Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15];
  • Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00];
  • Why people think that fasting is bad for you [1:55:15];
  • Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30];
  • A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00];
  • Keys to a successful fast [2:12:45];
  • Muscle loss during fasting, and why Jason isn’t worried  [2:24:45];
  • Will fasting help a healthy person live longer? [2:31:30];
  • Does fasting cause gallstones? [2:38:45]; and
  • More.

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