Episode 339: Vitamin D, Cortisol Circadian Rhythms, Lipoprotein(a), Body Scans, Metabolic Syndrome, Visceral Fat, Carnivore Diet, And More!

Intermittent Fasting


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Oct 15

Welcome to Episode 339 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Vanessa Spina, author of Keto Essentials: 150 Ketogenic Recipes to Revitalize, Heal, and Shed Weight.

Today's episode of The Intermittent Fasting Podcast is brought to you by:

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LMNT: We Have Some Exciting News To Share… Grapefruit Salt Is Officially A Permanent Flavor And Is Now Available Year Round. For A Limited Time Go To drinklmnt.com/ifpodcast To Get A FREE Sample Pack With Any Purchase! Learn All About Electrolytes In Episode 237 - Our Interview With Robb Wolf!

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Listener Q&A: Patty - What are your thoughts on high cortisol and extended fasts?

The Melanie Avalon Biohacking Podcast Episode #218 - Dr. Joel Kahn

I'm Biohacking My Health, the Results Are Incredible

Outlive: The Science and Art of Longevity

Systematic review and meta-analysis reveals acutely elevated plasma cortisol following fasting but not less severe calorie restriction

Time Restricted Feeding Reduces Inflammation and Cortisol Response to a Firegrounds Test in Professional Firefighters

The Window Matters: A Systematic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion

Intermittent fasting’s impact on autophagy, insulin sensitivity and cortisol in a clinical setting

A Preliminary Study of Circadian Serum Cortisol Concentrations in Response to a 72-hour Fast in Rheumatoid Arthritis Patients not Previously Treated with Corticosteroids

Effects of a 48-h fast on heart rate variability and cortisol levels in healthy female subjects

Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans

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Melanie Avalon: Welcome to Episode 339 of The Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat not what you eat, with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker, author of What When Wine, and creator of the supplement line AvalonX. I'm here with my cohost, Vanessa Spina, sports nutrition specialist, author of Keto Essentials and creator of the Tone breath ketone Analyzer and ToneLUX red light therapy panels. For more on us, check out ifpodcast.com, melanieavalon.com, and ketogenicgirl.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment. To be featured on the show, email us your questions to questions@ifpodcast.com. We would love to hear from you. So, pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time, and get ready for The Intermittent Fasting Podcast.

Hi everybody, and welcome. This is episode number 339 of The Intermittent Fasting Podcast. I'm Melanie Avalon and I'm here with Vanessa Spina.

Vanessa Spina: Hi, everyone.

Melanie Avalon: How are you today, Vanessa?

Vanessa Spina: Doing great, how are you? 

Melanie Avalon: Good. I'm trying to see. Okay, now for listeners, we're at the point where we're recording pretty far in advance, so I'm trying to look at future us at this time. I have two timely related things related to this time. Actually, I will save one of them. Really quick announcement, I think, when this comes out, unless things have changed. Do you take a vitamin D supplement, Vanessa?

Vanessa Spina: I'm supposed to be right now. I do take one right now, but it's not a pure one. I take a prenatal by Thorne. It's called Basic Nutrients Prenatal and it has vitamin D in it, so that's what I'm doing. But I also like to get most of my nutrients through food sources. So, I like to add cod liver oil, like just drops of cod liver oil. I think that's what a lot of the drops on the market are actually made of.

Melanie Avalon: Well, that's a perfect segue. So, they probably are if they don't say that they're vegan or if they're not synthetic. I guess that would be the alternative for the vitamin D supplements, right?

Vanessa Spina: Right.

Melanie Avalon: Yeah. Do you regularly test your vitamin D levels? I'm just curious. 

Vanessa Spina: I probably should, [laughs] but I do when I do a full panel. But I don't go out of my way to test just vitamin D more than that, more than annually.

Melanie Avalon: I track mine a lot with InsideTracker, actually. It was funny. I remember one time I was low, so I was like, “I'm going to hit this hard.” So, I started doing the supplements. I started doing-- I know this is controversial, but it was during the winter, so I think I started doing two minutes in a UVB bed every other week or so, and my D levels shot through the roof, it was too high after that. But in any case, hopefully when this comes out, so I actually would love to make a vitamin D supplement because I do take one every single day and have for years. The literature on vitamin D levels is just pretty overwhelmingly positive for the effects on particularly the immune system and so many people are deficient. So, it's on my list of things to make.

It's probably going to be a while aways though, because there are so many other things that I want to be making. Hopefully, when this comes out, hopefully we'll be approaching the launch of my Spirulina supplement, which is very exciting. But in any case, I'm excited. I personally take a liquid form right now, so that's the form I want to make. But MD Logic is making a capsule form that, again, I think should have just launched. But I'm really excited about that because A, I know a lot of people do prefer capsules, so that's a great avenue for that and then it really is. If you take capsules, it's going to be the best form on the market. And speaking to you, what you just said about the source, it's vitamin D3 from lichen. So, it's “Real.” It's not synthetic, but it's vegan, which is super cool.

It comes with K2 and K4, which are really necessary cofactors or important cofactors for vitamin D. They have their own array of benefits. So, I'm excited because I just feel like this is going to be the best vitamin D capsule supplement on the market. Comes in a glass bottle, of course, tested for purity and potency. No problematic fillers. I think they're using an olive oil or a vitamin E as the carrier. I'll have to double check that. But regardless, they should be having a launch special. I think hopefully friends are on my email list and following my updates and my text updates for that, it's avalonx.us/emaillist, text updates, you text AvalonX to 877-861-8318. So, hopefully this hasn't changed. I think the code SUNSHINE15 will get you 15% off one bottle or the subscriptions are going to be 25% off. And that's just during the launch period.

I will make a link for that to go directly to it because it's on MD Logic site. So, for that it will be melanieavalon.com/vitamind. So yes, I just wanted to announce that I'm very excited about that. I have two other quick things, but anything from you? How are things with you? 

Vanessa Spina: Good, Good. I was just going to say that I like to get a lot of vitamin D from the sun. Right now, we're having an extended summer, which I was hoping for.

Melanie Avalon: This is how we're different. You were hoping for, I'm like dying. 

Vanessa Spina: Yeah, because we had about two to three weeks at the end of July, first week of August that were fall here. It was rainy, cold, and it's just not fun when you have a two-year-old and you want to go do stuff outside. So, I just was like, “We were robbed.” [laughs] We were robbed of summer. So, I was really hoping and we often do get in Prague an extended summer into September. Right now, it's like every single day is sunny and beautiful for the next two weeks and then we're going back to our favorite place in Greece. So, I'm going to be getting a ton of vitamin D. [chuckles] Continuing to get a ton of vitamin D. But I do use an app that's really great for--

Melanie Avalon: D Minder?

Vanessa Spina: Yeah, I've been using D Minder for years and I use a new one, which is a circadian one that’s great for also knowing the different windows of light for morning light, like UVA light is earlier versus the later light, when you're actually getting vitamin D. But we happen to live in a place in Prague that does not get vitamin D for most of the winter. So, I try to really get as much as possible spring, summer, and into the late summer because we just don't get access to it at all. The angle of the sun is too low in the winter, so soaking it all in right now. I can't wait to get back to the beach. I'm so excited to be back at our favorite resort and just be on the beach with Luca, enjoying our last little holiday just as a family of three, because there's only a few months before we're going to be a family of four, so it's really crazy.

Melanie Avalon: Wow. I'm so excited for you. I'm also thinking about the experience of being pregnant on the beach, and I really can't think of anything [laughs] I'd rather not be doing. Oh, my goodness. It makes me so happy, though.

Vanessa Spina: Why?

Melanie Avalon:  Well, the beach already not so much a fan.

Vanessa Spina: Not a big beach girl. 

Melanie Avalon: Not a big. Yeah.

Vanessa Spina: It's my favorite place in the world. 

Melanie Avalon: It's hot, there's a lot of wind. You're in the elements.

Vanessa Spina: Yeah. You're in nature and you're like grounding. Okay, this may be an area where we're very different. You're grounding on the beach, you're barefoot on the earth, you're getting all those negative ions, you're getting rid of excess positive charge, and it's multiplied because you have the salt water, which you can walk into, and you can swim in the sea, and you got the sun. It's just such a healthy combination. [chuckles] Yeah, it's nature. Nature is the best, right. [laughs]

Melanie Avalon: The beach does have going for it that there's no grass. That's really nice. 

Vanessa Spina: Yeah.

Melanie Avalon: It's just sand. I guess if it wasn't so hot. 

Vanessa Spina: I've always loved the beach. I mean, you can stay in the shade, have a beach umbrella, which we always have, and stay shady, or you can go in the water to cool off, but it's got to be one of my favorite things. I've been trying to formulate a plan for years to move us full time to a beach location. We're obsessed with the thought of doing that. We're trying to find a way to make it manifest at some point. But it's my favorite place, I can’t wait. So, when you have a kid too, it's even better because the beach is just a giant playground. So, all day you can just do sandcastles and do all this fun stuff in the sand. It's so much fun. It's the best. So, yeah, I'm really excited.

Melanie Avalon: I did use to love it.

Vanessa Spina: Okay.

Melanie Avalon: Growing up. I mean, I used to go to the pool and lay out there like slather myself in coconut oil.

Vanessa Spina: Are you more of an indoor person now? Or--

Melanie Avalon: Mm-hmm. It's a good time. 

Vanessa Spina: At least you have red light therapy panels.

Melanie Avalon: I know, I know.

Vanessa Spina: Cryo and all that stuff to duplicate nature.

Melanie Avalon: Yes, that's honestly the point. Did you know finding this out has to do with my third podcast coming out that I'm very excited about teaser. Oh, I wonder if that'll be out by the time this comes out. Regardless, did you know there's a lake that is pink?

Vanessa Spina: I didn't. I know. I went to a place in the Bahamas that is known for having pink sand, which was an absolute dream. There are wild horses running on the pink sand. It's absolutely amazing, called Harbor Island in the Bahamas. I hadn't heard of the pink lake.

Melanie Avalon: Oh, wow. That is beautiful. 

Vanessa Spina: Yeah.

Melanie Avalon: Just Google pink lake. It'll come up. It's called the one I was looking at was Lake Hillier. H-I-L-L-I-E-R. But the thing that haunts me about it is they said they don't know why it's pink.

Vanessa Spina: I was going to say it sounds like sketchy [laughs] like what is in it.

Melanie Avalon: Yes. And then the crazier thing is they said the water, if you put it in a bottle, is still pink.

Vanessa Spina: Okay, that does not look natural. [laughs] I'm looking at it right now. Middle island in the Goldfields-Esperance region in Western Australia. That looks like a tailings pond or something from a mine. That does not look good or natural at all. [laughs] It could be from-- because Western Australia has a lot of mines, lot of them, and a lot of them have tailings ponds where they deal with the waste. So, it could be from the chemicals of that or something I wonder. It's really close to the ocean though.

Melanie Avalon: I know. Maybe it's just the aliens. 

Vanessa Spina: Yeah. Okay. So, it says it's because of the presence of salt-tolerant algae that produces carotenoids.

Melanie Avalon: Oh, so it could be like a vitamin drink. [laughs]

Vanessa Spina: Yeah, exactly. [laughs]

Melanie Avalon: Oh, my goodness. We could start a brand here, [laughs] like pink water. That would be a thing. That would be a thing. 

Vanessa Spina: Xanthan is getting more and more attention to. Apparently, it's got a lot of health benefits, but yeah, that's really interesting. 

Melanie Avalon: Wow. So, yes, pink lakes. One other last thing before we jump in for listeners. We are going to be bringing Valter Longo onto the show, which I'm very excited about. I've had him on the Melanie Avalon Biohacking Podcast, and he was on this show years ago. Gin and I actually had him on. So, he's the founder of ProLon and he's the scientist behind the fasting-mimicking diet. He's a researcher at USC. I think, he's the head of their longevity school. He's a renowned scientist in the fasting and antiaging longevity sphere. So, I am very excited to have him on this show. So, if listeners have questions for him, anything about fasting, fasting-mimicking diet, longevity, definitely submit those questions. Yeah, I'm excited because they reached out because ProLon wanted to sponsor, and I was like, “I don't know that's the best fit,” because I don't personally do, ProLon, Vanessa doesn't, I don't think any of the hosts on this show have.

However, I do think I tried it and it was too hard for me. I do think it has a lot of benefits though, but so when they said that, I was like, “Well, Valter can come on and talk about it.” So, I'm very, very much excited about that. All righty, anything from you, or shall we jump into things? 

Vanessa Spina: I can't wait to get into some of these questions.

Melanie Avalon: Perfect. Would you like to read the first question? 

Vanessa Spina: Yes. So, Patty from Facebook asked, “What are your thoughts on high cortisol and extended fasts? I was told that high cortisol people should only fast 12 to 13 hours from a reliable source.”

Melanie Avalon: All right, Patty, so thank you so much for your question. Okay, so I took a two-pronged approach to this because you ask about extended fast, but then you mentioned people fasting for 12 to 13 hours. So, I wanted to include intermittent fasting as well because it sounds like you're also curious about people who are fasting 14, 15, 16 hours. So, I wanted to address it from both points, is the point. So, I did a deep dive into the literature, wasn't quite sure what I was going to find, and the results are all over the place. It's a hot mess if ever there was. Oh, I got so excited. Sorry, sorry not to go on a Peter Attia tangent, but I am now 25% of the way through his book. Vanessa, I swear, I know I said this last time, but this book, it takes a long time to read, a very long time to read. He used the phrase hot mess to refer to-- he was talking about Lp(a) which I recently went on a tangent. Are you familiar with Lp(a)?

Vanessa Spina: Yes, I studied it in bio-chem a bit.

Melanie Avalon: Just as a quick disclaimer or just as a quick PSA for people. I am so sorry for the tangent. I recently interviewed Dr. Joel Kahn, who is a very renowned cardiologist, very big in the vegan sphere, and his newest book is about Lp(a) and it is blowing my mind. I don't know why we're not testing more for this. It's basically, if you are genetically disposed to having a variant that makes you produce high Lp(a), there's just so much terminology behind this. It's essentially a marker related to LDL that independent of LDL levels, independent of your cholesterol panel, independent of everything else, is a very high predictor of heart disease. If you have a genetic tendency towards it, basically you're very inclined to probably get heart disease. And dietary and exercise interventions don't really affect Lp(a), so it's like a whole thing, but you can test for it, and you only have to test for it once because it is genetic. So, when your test comes back, basically it's probably either going to be nonexistent or very, very low, or it's probably going to be high. So that's something that you can test for. But Peter was talking about it. He said, “This hot mess of a lipoprotein,” and it made me so happy. [laughs]

Vanessa Spina: I'm noticing that more and more in books that people are using or interspersing highly technical terminology with highly casual terminology like that. I don't know-

Melanie Avalon: How do you feel?

Vanessa Spina: Yeah, I think it's fun. It's fine. It's like you want to hear the book in the author's voice, and I think you should interject personality if you have one. [laughs] It should be in there. It's probably something I struggle with when I write because I'm like, “I have to be so serious.” But, yeah, I think it's great if you get to a point where you can be lighthearted. And one of my favorite writers, actually, is Jason Fung when it comes to health writing, like scientific writing, because he breaks things down really well, but he's super snarky and it just makes it really fun to read. He's snarky about the things that we all should be snarky about. Yeah, I think he's cheeky and it makes it way more fun to read.

Melanie Avalon: I feel like I write that way. Like, I put in little quips for sure. Other sidenote, I did want to mention that I don't think it had published since last. I think last time, I reported it had not come out yet, which was the Newsweek piece actually published. And that was my first--

Vanessa Spina: Oh, congrats. 

Melanie Avalon: Thank you. That was my first written piece-

Vanessa Spina: Oh, cool. 

Melanie Avalon: -in a very credible publication source. So, I actually thought of you though. Well, I think of you all the time. But I also thought of you specifically, because when they were asking for the before and after photos and I was thinking about how when I read your book and you had your before and after photos and I remember you talking in your book about how even when you weighed more, it wasn't quite as noticeable because of your tall frame and the way you carried it. I was wondering if because the experience I went through because they were asking for before and after photos. The experience I went through was what photos to pick and bracing myself for feedback or backlash about. I thought people would be, “I'm either not overweight enough in the before picture or not thin enough or too thin.” Or I'm just really intrigued by people's response to judging people, especially when it comes to something like before and after photos.

Did you have any of that experience when you were picking yours out? I was wondering if people would either be like you look like the same person, or if they'd be like, you don't look the same at all.

Vanessa Spina: Yeah, I mean, I know the one that I used in my book, I don't really feel like I looked that heavy before. And people are used to seeing more dramatic transformations. But I do really try to explain that I happen to be one of those people who I'm very concerned about who don't show as much on the outside, like skinny fat or thin on the outside, fat on the inside. Because I was 38% body fat, which is quite obese. It was definitely considered at least obese. I think the cut off for morbidly obese, it's definitely higher than that. I wouldn't say I was morbidly obese, but there's a lot of people walking around like me who just don't feel good in their body and they're told that they look fine, which [chuckles] is what kept happening to me. And that's why I always rail against using the scale because the BMI index is so outdated.

When I finally had my body composition scan done, which shouldn't have been something I had to go out and seek on my own, it should be something that is just annual or every other year thing that we do as a part of our medical routines, because we get our bone density assessed in same machine. So just like scan your body composition while you're there, see how your muscle mass is trending. But when I saw that I was that high, everything made sense. So, I do try to talk about that specifically for people who just don't feel good in their body. They don't know why, but they carry their weight okay because they have height or whatnot. Then getting a scan done I think can really help because those people are at risk like I was of just continuously getting worse metabolically and yet maybe not questioning it so much or thinking that they're fine because on the outside they don't look that heavy.

But what astonishes me about body composition is you could see a person that is big, physically large. They could be way more metabolically healthy than someone who looks small because they are mostly muscle. Like say their body fat percentage is 20% because they work out a lot. So, their BMI would show that they were unhealthy or their BMI would definitely show that they were overweight, which would be totally false because they're actually metabolically very healthy. Then someone who just looks has a smaller frame, but is really under muscled, which I was, and over fat. So, yeah, [laughs] I understand. People ask me all the time for before and after photos, but there's so much as well that you can't tell just from the way you look on how you feel on the inside.

Melanie Avalon: I am so glad you drew attention to that. It hadn't actually occurred to me to really point it out from that perspective. Actually, interestingly also, I'll read a quote from Peter's book, by the way it's called Outlive, and he says it's what you just said. He says, “Well, individual fat storage capacity seems to be influenced by genetic factors. This is a generalization, but people of Asian descent, for example, tend to have a much lower capacity to store fat on average than Caucasians. There are other factors at play as well, but that explains in part why some people can be obese but metabolically healthy, while others can appear skinny while still walking around with three or more markers of metabolic syndrome. It's these people who are most at risk.” Then he says, “All things being equal, someone who carries a bit of body fat may also have greater fat storage capacity and thus more metabolic leeway than someone who appears to be more lean.”

He goes on to more detail, but then he says, “This is why I insist my patients undergo a DEXA scan annually, and I am far more interested in their visceral fat than their total body fat.” What's interesting is one of the comments, actually-- so most people were overwhelmingly supportive with the before and after photos, and most people actually said that they thought, I don't even look like the same person. A lot of people were, “Is that you?” I was like, “Yes, that is me.” One person, though, did say-- in the same comment, they said something about like they were sure I felt better now, but I looked healthier before. I was like, okay, I don't really know what to do with that.

I actually don't think I look healthier before, but just goes to show that people will have their own opinions of everything. But I agree so much. I just think there's a problem with putting everything in a box as to what health would look like. Like, we think it would manifest as this certain thing when really metabolic syndrome, so much of it is invisible. Out of the five metabolic syndrome factors, only one of them presents outwardly, which is obesity, right? Is that correct? Because yeah, blood pressure. Yeah. The other ones you're not going to see on the outside. 

Vanessa Spina: Yeah, I also think we live in a world, especially today, where certain things are being normalized more and more like pathogen, just disease is being normalized. Obesity is being normalized. I'm sure people have seen those photos of the store mannequins, the male store mannequins that are quite large and overweight looking. It's like we live in this society where these things are being normalized, I think in an attempt to protect people's feelings. But it's definitely not advantageous when you understand how much obesity is connected to cardiometabolic risk, to cancer risk, to Alzheimer's risk, to so many different diseases and conditions. I don't know why we're normalizing that, but we don't see as many people who are maybe on the other side of it where you're a biohacker and you're like this is what that looks like, if that makes sense. 

Melanie Avalon: I had this exact conversation the other day while at cryotherapy with somebody and actually it was with somebody who is overweight and struggling with their weight. It was a really nice conversation because I didn't bring it up, she did. She felt very strongly about it. She felt very strongly about what you were just saying, like how it's being normalized. She was struggling with her weight, but she was also expressing the issues with how it's being normalized and how there's pressure to, in a way, not want to change your weight. Because then it's like you're subscribing to the narrative that you need to be thin, which I don't know, it makes me all really uncomfortable.

Vanessa Spina: It makes me uncomfortable too. But I think there're a few things that people really don't talk about enough. I don't talk about it very often either, but you and I were talking about it recently in a podcast and it got me thinking is the fact that I don't ever have pain in my body. [chuckles] I wake up every day, and if there's a pain, it's like, what is going on? What's happening? Okay, [laughs] I have to go back through my food journal, the day before, figure out, did I pull something? It's just so rare for me to have pain in my body. We don't even have pain relievers in our home because we just don't ever use them. If I have any pain, I'll tend to use-- If it's like a muscle issue or something, I'll use red light therapy. But I don't have pain in my body. Every day, I feel pain free. I feel amazing in my body every day. I feel energetic in my body every day. I haven't been sick. I could count one hand the number of times I've been sick in the last eight years.

I know people who are chronically sick with colds and flus basically for half the year. I'm like, I couldn't imagine living like that. But I can remember what my life was like before when I was at 38% body fat. I remember having this thought where I was like, every day when I wake up, something else hurts. Like, I either have a headache today or I have this or I have that. Every day, there was some pain. When you get into this phase of practicing super healthy lifestyle like we do and so many of the biohacking things that we do for circadian health and alignment, all these things, and you're like, “I feel amazing in my body,” and this is the way I think a lot of us are supposed to feel. 

And you don't know the difference until you've experienced not feeling pain and not getting sick, and then you're like, “Oh, my gosh, I can't believe how I was living before.” In terms of quality of life, we talk so much about appearance, but what about just the quality of your existence? How do you feel every day in your body? Because it's really hard to go out and conquer the world and follow all your dreams. When you don't feel good, you have no energy, you're sick all the time, or you have chronic pain, right?

Melanie Avalon: Yeah. Since having an Oura Ring, the only time I was sick was with COVID. Otherwise there's not been any fever because that was the first time, I had a fever. And I was like, “Oh, this is what it looks like on the Oura Ring.” I've had the Oura Ring for over three years. So, that means at least in that amount of time, I was only sick with COVID The headache’s one for me. I used to get headaches all the time growing up and I just thought it was normal. I thought that's just normal like you get headaches. 

Vanessa Spina: I thought that was life. 

Melanie Avalon: Yeah. 

Vanessa Spina: And that's something you can't take a before and after photo of.

Melanie Avalon: Exactly. So, I share my journey, my health journey in the article, and it's called I'm Biohacking My Health. The results are incredible, and it's on Newsweek, hah [laughs]. 

Vanessa Spina: I just found the article and it looks amazing.

Melanie Avalon: Thank you. 

Vanessa Spina: Congratulations.

Melanie Avalon: Thank you. The only thing I would change is-- so it is all my words, but the way it was written was they sent me questions, and I answered all of it, and then they put it together. So, if I feel like if I had written it from start to finish, I would have written it a little bit differently. But it's still all my words. It's very surreal. The best comment I got, though this was the best comment somebody DM'd me, and she said she used to work for Newsweek, and so she said she just wanted to let me know how basically big of a deal this was. Congratulations. And I was like, “Oh, my goodness.” It makes me so happy. I'm really honored about that.

Vanessa Spina: Yeah, I can't wait to read it. I feel like we totally went off the rails with the question.

Melanie Avalon: Oh, I know. I know. Oh, my goodness. Okay, bringing it back. 

Vanessa Spina: Sorry, Patty. 

Melanie Avalon: [laughs] I know. Sorry. We're back. Cortisol, fasting, here we go. So, first of all, what does cortisol do? So, cortisol is a hormone. It's actually the end product of the HPA axis, which is involved in our stress response. And cortisol's role is really helping us respond to challenges and stressors in our lives. So, it does things like enhance our cardiovascular output, our breathing, it helps us mobilize energy. It helps deliver energy to our brain and our muscles. So, it's a good thing we want it. Of course, people get really nervous about it because there's always this idea that we're overproducing cortisol or that we have too much of it, or that it's spiking or at the wrong times. So, speaking of times, the normal rhythm of cortisol, it should be in a 24-hour rhythm and it actually tends to rise later during sleep and it peaks in the early morning.

So, people might have heard of the dawn effect, which is like this spike in cortisol that happens in the early morning and then it should decline throughout the day, and then it should be lowest right before you fall asleep and then rinse and repeat. So, eating, interestingly enough can have different effects on cortisol. I did not know this. I was wrong. So, eating actually tends to increase cortisol just a little bit. I thought it did the opposite. During the daytime, when you eat food, it actually creates a small acute increase in cortisol toward the beginning of the meal that peaks around an hour after starting and then it starts going down. You can also get anticipatory cortisol peak. So, if you are about to eat, they've seen in rodents that rodents will have a pre-prandial, which means a pre-eating peak in cortisol.

So, one of the problems, because there are a lot of studies looking at cortisol and fasting, they're mostly the ones I could find are in Ramadan studies. So that's a religious type of fasting where people are not eating during daylight. The main issue and it's almost like this issue is so blinding that I almost don't even feel comfortable. I mean, I can share the results, but I don't even know what we can really draw from this actually, speaking of. [laughs] I highly recommend, Peter Attia has an episode out right now, although by the time this comes out it will be a while ago. But it's all about how to interpret studies and what all the different studies mean and how they're created, and it's really, really helpful. So, I highly recommend listening to that. So, back to the problem with cortisol. Cortisol, when we look at, how we talk on this show about how wearing a CGM can be so beneficial because you get to see your blood sugar levels all the time and not just in one given moment. A snapshot like that you would with a blood finger prick.

Cortisol is the same thing. So, looking at a snapshot of cortisol, it doesn't tell you what cortisol was doing the rest of the time. It doesn't tell you if that was just a transitory peak for whatever reason. It just doesn't tell you a lot. And then on top of that, half of the studies out there or a lot of the studies out there, don't even say when they tested the cortisol. So, it's like we don't even know what to do with that data. And then on top of that, if they're only testing once or a few times, it's not necessarily a very clear picture. So, point is, it's hard to know how to even read all these studies. But I did find a nice systemic review that looked at a lot of Ramadan studies and it looked at how it affected cortisol. 

Just to show you how it's all over the place, so this study was called-- it was December 2020 and it was called The Window Matters: A Systemic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion. It included 14 studies. And in the review, they found that two out of three of the Ramadan papers noted an abolishing of the circadian rhythm of cortisol. So, that doesn't sound good. But going back to what I was just saying about cortisol being a typical 24-hour rhythm, so basically that rhythm was just off. It was just different on Ramadan. One of the studies found-- this is interesting, found increased cortisol levels in the not fasting group. So that's contrary to what you might think. One of the studies found that if you skipped dinner, it reduced evening cortisol and non-significantly raised morning cortisol.

And on the contrary, those who skipped breakfast, so fasting in the morning had reduced morning cortisol. So, that's actually the opposite of the normal axis. They concluded that that was a blunting and indicated a dysfunctional HPA axis. The crazy thing is-- so I'm going to leave that study for a second. I had gone on a tangent, it was when Cynthia was co-hosting the show, I believe. Dr. Sarah Ballantyne had done an overview of some studies and she had referenced a 2019 study called Early Time-Restricted Feeding Improves 24 Hours Glucose Levels and Affects Markers at the Circadian Clock, Aging, and Autophagy in Humans. What was interesting is she talked about how they found that it affected cortisol and she was saying that might be a problem for people with cortisol issues. But then what was ironic was if you looked at the study, they actually found that it did, in my opinion, what you would want to happen.

So, it actually found that early time restricted feeding increased cortisol in the morning and reduced cortisol at night. So that is in line with the normal circadian cortisol rhythm. So, I don't see that as a problem for most people. And then comparing it to what I just read from that other review, it's similar into how they also said that dinner skipping, which would be early time restricted feeding, also resulted in significantly reduced evening cortisol and non-significantly raised morning cortisol. So, basically when you're fasting-- so you can't just apply everything to intermittent fasting without looking at the early versus later versions of it because it might manifest differently. So, also in that study that looked at the 14 studies, they found, for example, that one study cortisol maintained its normal rhythm, but that it had a biphasic pattern, so it was shifted or different.

One of the other studies in the group found that the fasting decreased morning cortisol at the end of Ramadan. Then another one of the studies actually found that it rose cortisol in the fasting group of pregnant women. But the problem with these studies was that neither of them reported the time of the sample collection. So that goes to what I was saying and that it's really hard to draw conclusions when they don't say when they collected it. There's also another study that's been quoted a lot and maybe it's just because I've seen it a lot, but it actually looked at intermittent fasting and professional firefighters and it was an eight-week intervention with time restricted eating and they actually found that it reduced their levels of cortisol. The conclusion from that study, they thought that the contradictory effects of intermittent fasting diets on different markers might have to do with the short duration of the studies and that we just need longer studies to see what is actually happening. 

So, again, that one was a two-month study, eight weeks. So, basically it would be nice to have longer studies. Then I did go down the rabbit hole of longer fasts because I know Patty was asking about longer fasts and I really thought I'd be able to find more. I thought this was going to be easy. I thought I was going to type it in and it would be like here's like 50 studies--

Vanessa Spina: That’s what I looked into a little bit more, it was the extended--

Melanie Avalon: The ones I found were like very-- they weren't actually looking at cortisol specifically, it was just included in the study or some of them sort of were, but it was like different-- I'll just tell you what I found. So, I found one that was looking at the circadian cortisol concentrations and a 72-hour fast in patients with rheumatoid arthritis not previously treated with corticosteroids. And that study found, so it was a three-day fast and they found that overall, the 24-hour free and total cortisol concentrations rose by-- so the cortisol rose by 50%. And then another study called effects of a 48-hour fast on heart rate variability and cortisol levels in healthy female subjects. So that was looking at, again, a two-day fast in women. It found that the cortisol profile shifted towards lower values from baseline to the end of the experiment and they concluded that a total fast induced parasympathetic withdrawal with simultaneous sympathetic activation, in other words it increased their stress response.

Then, I found another study, and this was from 1996, so take that with a grain of salt. But the title literally answers it and the title, It says Fasting as a Metabolic Stress Paradigm Selectively Amplifies Cortisol Secretory Burst Mass and Delays the Time of Maximal Nyctohemeral Cortisol Concentrations in Healthy Men. So, they found basically that in fasted men-- this went up to a five-day water fast and they found that the 24-hour cortisol production increased in bursts by 1.6 fold. So, that is interesting. So, all of that to say, the takeaway that I had from all of this was A, it's hard to draw conclusions because there's not a lot of good data to go on, but B, in shorter fasts, so intermittent fasting during the day, it seems to be all over the place in people's responses. It seems to probably depend on when you're doing your window.

But it might have no effect, it might increase cortisol, it might decrease cortisol. It's just all over the place. It seems like if you had to pick a window most in line with the normal cortisol pattern, it's probably early time restricted feeding. With the longer fasts, it seems to definitely increase cortisol. At least everything I saw on longer fasts, it did increase. That was all over the place. I don't even know how helpful that was. But Vanessa, what did you find? 

Vanessa Spina: I'm glad that you covered all of that, especially on the shorter-term fasts. A couple things that I would add is, well, first of all, I would want to ask if you've had your cortisol assessed with a functional medicine practitioner or someone who specializes in hormonal health. They probably could guide you better on this in terms of actually advising you on what would be recommended but just looking at the research out there. So, I thought I would also find immediate answers. I did find, though, one systematic review and meta-analysis where they were looking at the plasma cortisol levels following fasting and also caloric restriction. There're a few things that stood out for me. The first one that was really interesting is that they noted that cortisol levels went up quite a bit at the beginning, especially with fasting, not so much with caloric restriction, so it's more so with fasting.

So, I mean, you could probably consider a very low-calorie diet or low-calorie diet, just intraday fasting or time restricted eating. But they found that cortisol really went up with the extended fasting and that's more like the prolonged fasting that you were asking about, Patty but a couple interesting things about that. The first is that it tapers off, it spikes at the beginning and it seems to level off. The second observation is that some of it is related to perceived stress. So, I would say if doing prolonged fasting, if you perceive that to be something very stressful, you're probably going to have higher cortisol levels as a result of that because you're perceiving it as a stressor. I would think that that's probably something that happens with people who are more beginners at it whereas people who've been doing extended fasting, like for example, just using myself as an example, I do extended fasts a few times a year seasonally and I don't find it stressful.

I've been doing it for so many years and I actually look forward to it. It's just such a nice break and reset for me. So, I would consider myself an advanced faster though. So, it depends on where you're at. And some people don't find fasting that easy. I think that there's definitely ways to get some of those benefits of autophagy without having to do like a full out fast. Like you could do more of a keto fast with MCT oil, coffee and that kind of thing, bone broth, those kind of like “fasting aids.” Another really interesting thing that they found is that it looks like the cortisol levels go up when salt gets really low. I think that that's probably why it's very much recommended during extended fasting to supplement with electrolytes. Our favorite LMNT electrolytes. I always supplement with them on a daily basis because I eat very low carb and so my body does not retain as much of the electrolytes when those electrolytes are being filtered by the kidneys. So, I take them every day.

But if I'm doing extended fast, I take a lot of sodium on those days, there’s lot of LMNT and I also supplement just with sodium. So, I think that that makes a lot of sense because of how-- what's happening during the stress or prolonged fasting is that HPA axis, as you mentioned, is being activated as a perceived stressor. Last two things, I wanted to say [chuckles] about it is that cortisol going up is not always a bad thing. Like, for example, our mutual friend, Dr. Gabrielle Lyon. She talks about how her patients, when she gets them on a higher protein diet, all of their markers improve. For some reason, they tend to have slightly higher cortisol, but she doesn't consider it to be a negative. They tend to also have slightly higher blood glucose on average. But that's because of a lot of different mechanisms, because you're now relying more on gluconeogenesis as opposed to stored glycogen.

So, having cortisol a little bit higher isn't always necessarily something to fear. It also is going up because on extended fasting, you are then activating all your act-- well, first you're flipping that metabolic switch. You're going from primarily burning glucose to primarily burning fat. And you need cortisol to help be in that catabolic mode to be breaking down fat stores. So, I think that depending on your goals at the fast where you're at, if you do have high cortisol levels already that you've had tested and you're working with someone and they've said to avoid stress or avoid anything that raises your cortisol, then prolonged fasting is probably not necessarily a great idea. This meta-analysis did find that it does go up quite a bit with fasting, although it does tend to level off after the initial spike, which I thought was really interesting. 

They also seemed to have a mixed conclusion on it, but we understand the mechanisms. But they did say that with very low-calorie diets or less intense low-calorie diets, it's not so much an issue. The higher cortisol is not as much of an issue. So, it brought up some interesting points. We'll definitely link this in this meta-analysis as well as all the research that you brought up. But the very last thing that I wanted to mention that they talk about in the conclusions is, so they acknowledge that they haven't studied the consequences of this, what they refer to as transient hypercortisolemia, because they're saying it's transient, it has a spike, but then it levels off. But they actually suggest that this elevated cortisol might mediate some of the adverse effects of caloric restriction in the short term. So, they talked about a few different ways that it could help with some of the adverse effects of caloric restriction and also improve fat loss.

So, again, that cortisol is being mobilized because your body needs to be in that catabolic mode and break down fat. And that's definitely what you are being mostly fueled off during a prolonged fast after you get past the first one to three days, there's a little bit of protein breakdown there, but once you get past that, you're just purely burning off of fat-- So, running off of fat. [laughs] So, it doesn't seem to be super clear, but on an individual basis, I would definitely recommend consulting with a hormone specialist or your doctor to look at different strategies. But it does seem like from everything that we've been talking about that those sort of, like you mentioned 12 to 13 hours fast or the intraday fasting during the day, some time restricted feeding doesn't seem to have as much of an effect on the cortisol levels. 

Melanie Avalon: Thank you for finding that study. That's awesome. It's like I'm haunted by it. I remember that exact sentence in Dr. Gabriel Lyon's book about the blood sugar levels. I didn't remember that she talked about the cortisol as well, so I'm glad you mentioned that. 

Vanessa Spina: No, she just told me that on an interview that we did together. I don't know where it would be in the book, but I was just asking her specifically about that because people get concerned whenever blood glucose goes up, but she doesn't consider it to be a bad thing. It's just something that seems to happen when you're in a different metabolism there, like you're running a little bit more off of that gluconeogenesis than off of the glycogen.

Melanie Avalon: That makes sense why [laughs] I didn't remember it. She does mention the blood sugar part in her book and I was going to ask her about that because I actually don't know how I feel about that because I did experience that when I was essentially zero carb, my fasting blood sugar was higher. Then when I switched to bringing back carbs, it was lower.

Vanessa Spina: So, what's interesting about that, especially the morning blood glucose, is when you are high carb or higher carb, your blood glucose tends to be lower because you're running off of the stored glycogen throughout the night. But when you are doing higher protein, lower carb, then because you're running more off the gluconeogenesis, you usually deplete the glycogen throughout the night and so you start making some glucose in your liver and that's why the morning glucose readings tend to be higher.

Melanie Avalon: What's weird though, either way it's your liver regulating everything. It's the liver basically using the glycogen stores or creating its own. So, do you think that just when it's creating its own, it tends to favor a higher resting blood sugar rate?

Vanessa Spina: I think that it's just the mechanism because instead of having it all stored, you're slowly breaking it down. So, if you're eating lots of carbs, you get the glycogen. So, you can just run off of that in your various muscle cells and your various tissues and you have some obviously stored in your liver, which you can also kick out. But if you are running out of glycogen and you're having to make it, then it's just going to be a little bit higher. But I can tell you I run off a lot of protein mostly. I really don't eat a lot of carbs. My glucose is 70s every day. So, when I was doing carnivore, it tended to be more in the 80s but I think I was just eating more then, so especially like when people first go on carnivore, they're just like, “Oh my gosh, all the ribeyes, give me all the ribeyes, give me all the meat.”

I think also I was overcompensating for a while for all the years that I didn't eat protein. A lot of people have that effect where they'll eat a lot at the beginning and then they go down to about half that after they adjust. So, I definitely eat like way less than I used to when I first did carnivore so that could be part of it. But also, as I talked about before, I closed my eating window pretty early. And that I think makes a big difference.

Melanie Avalon: That would make sense, especially with what I read in all those studies. One last point as well about the cortisol and fat burning. I'd read this a lot before and then I again, just read it as well in Peter's book. He says, “Cortisol is especially potent with a double-edged effect of depleting subcutaneous fat, which is generally beneficial, and replacing it with more harmful visceral fat.” I've also heard though and I've read this somewhere else, so basically what he's saying there is that cortisol helps you burn fat, the fat that you can pinch and see, which tends to be relatively metabolically benign, and it can encourage visceral fat storage, like as the hormone itself can do that. But I've also read elsewhere that basically it can go down different pathways. Basically, the state that you're in can have different effects as to whether or not it's encouraging fat storage or not compared to breaking it down more.

I'm trying to remember the technicalities of it. I think it's like does it have to do with-- I don't want to say the wrong hormone. There was like a lot that went into it. Basically. It's complicated. [chuckles] Here's the point, really glad that you made that very practical for her with working with a doctor and trying to see what's actually going on. People can do a DUTCH test, which is a 24-hour urine sampling test for cortisol levels and then they can work with a practitioner to help interpret it.

Vanessa Spina: Yeah, and we should mention the link for LMNT as well if anyone is wanting to take electrolytes when they're fasting.

Melanie Avalon: Yes, thank you. Because they can get it for free. So, you can get free electrolytes to try if you go to drinklmnt.com/ifpodcast and that will get you a free sample pack with any order. We love LMNT electrolytes around here. I'll also mention that if people are unaware, a CGM, a continuous glucose monitor. We love NutriSense, so you can go to nutrisense.io/ifpodcast and the coupon code IFPODCAST will get you 30% off. So, yeah, okay. It was great answering Patty's question. [laughs] Anything from you, Vanessa, before we wrap this up? 

Vanessa Spina: I know I enjoyed the episode and the discussion and all the things and so happy for you with your Newsweek article. It's really huge and huge moment and you should feel so proud of yourself and yeah, just congrats on that and I can't wait for the next episode.

Melanie Avalon: Thank you so much. That means so much coming from you. I really, really appreciate it. So, for listeners, you can submit your own questions, you can directly email questions@iapodcast.com or you can go to ifpodcast.com and you can submit questions there. Please feel free to submit questions for Valter Longo, who I will be interviewing. I'll also be interviewing Dave Asprey and I think the other interviews will have happened by now. So, questions for Dave or Valter, send them our way and you can follow us on Instagram. We are @ifpodcast, I am @melanieavalon, and Vanessa is @ketogenicgirl. The show notes for today's episode, which will have a transcript and links to everything that we talked about those will be @ifpodcast.com/episode339. Okie Dokie. I think that is all the things. Anything from you Vanessa, before we go?

Vanessa Spina: I can't wait for the next one with you. 

Melanie Avalon: Likewise. I will talk to you soon. 

Vanessa Spina: It sounds good. Talk to you soon. 

Melanie Avalon: Bye. 

Vanessa Spina: Byeee

Melanie Avalon: Thank you so much for listening to The Intermittent Fasting Podcast. Please remember everything we discussed on this show does not constitute medical advice and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing a review on iTunes. We couldn't do this without our amazing team, administration by Sharon Merriman, editing by Podcast Doctors, show notes and artwork by Brianna Joyner, transcripts by SpeechDocs, and original theme composed by Leland Cox and re-composed by Steve Saunders. See you next week.

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